A 28-year-old woman has not conceived after 18 months of unprotected intercourse. Which investigation should be performed FIRST?
Answer: C
Male factor infertility accounts for 40% of cases. Semen analysis is non-invasive, cost-effective, and should be the first investigation when evaluating an infertile couple.
Q.82Easy
Which of the following contraceptive methods has the highest failure rate?
Answer: C
Spermicides used alone have a failure rate of 18-28% with typical use. IUDs and implants have failure rates <1% with typical use.
Q.83Medium
A 32-year-old man presents with azoospermia. Semen analysis shows normal seminal fluid parameters but absence of spermatozoa. What is the most likely diagnosis?
Answer: B
Normal seminal fluid with absent sperm indicates obstruction in the reproductive tract rather than failed production. This is obstructive azoospermia, often due to vasectomy, absence of vas deferens, or ejaculatory duct obstruction.
Q.84Easy
Which stage of oogenesis is arrested at the time of ovulation?
Answer: B
The secondary oocyte is arrested in metaphase II at ovulation. It completes meiosis II only if fertilization occurs.
Q.85Medium
A 26-year-old woman with history of pelvic inflammatory disease presents with infertility. Which imaging modality is MOST appropriate to assess tubal patency?
Answer: B
HSG is the gold standard for assessing tubal patency and detecting tubal blockage or damage. It uses radiographic contrast to visualize the fallopian tubes.
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Q.86Easy
Which of the following STIs is most commonly associated with pelvic inflammatory disease (PID)?
Answer: B
Chlamydia trachomatis is the leading cause of PID, accounting for 30-40% of cases. Neisseria gonorrhoeae is the second most common cause.
Q.87Medium
A woman using combined oral contraceptive pills (COCs) presents with breakthrough bleeding. Which action should be taken?
Answer: B
Breakthrough bleeding is common in the first 3 months of COC use and usually resolves spontaneously. Continuation of the same regimen is recommended unless bleeding persists beyond 3 months.
Q.88Medium
Which contraceptive method is absolutely contraindicated in women with current or history of breast cancer?
Answer: B
Combined oral contraceptives containing estrogen are contraindicated in breast cancer patients due to estrogen's proliferative effects. Copper IUD, progestin-only methods, and barrier methods are safe alternatives.
Q.89Medium
A 34-year-old man has oligozoospermia with motility of 20%. Which of the following is the most likely etiology?
Answer: D
Varicocele is the most common correctable cause of male infertility. Fever temporarily affects spermatogenesis for 2-3 months. Smoking reduces sperm count and motility. All are valid etiologies of oligozoospermia.
Q.90Medium
What is the window period during which emergency contraception is most effective?
Answer: C
Levonorgestrel (Plan B) is effective within 120 hours (5 days) if taken within 72 hours for maximum efficacy. Ulipristal acetate (a selective progesterone receptor modulator) can be used up to 120 hours.
Q.91Easy
A 29-year-old woman with regular 28-day cycles wants to use the rhythm method for contraception. Which days are considered the fertile window?
Answer: B
In a 28-day cycle, ovulation typically occurs on day 14. The fertile window includes 5 days before and 1 day after ovulation (approximately days 8-19), accounting for sperm survival and ovum viability.
Q.92Medium
Which of the following best describes the mechanism of action of levonorgestrel IUD in preventing pregnancy?
Answer: B
Levonorgestrel IUD works primarily by altering the endometrium to prevent implantation and secondarily by thickening cervical mucus. Complete ovulation inhibition occurs in only 20-30% of cycles.
Q.93Medium
A 31-year-old woman presents with secondary amenorrhea and infertility. Blood tests show elevated prolactin levels. What is the next appropriate investigation?
Answer: B
Elevated prolactin requires MRI of pituitary to rule out prolactinoma, which is the most common pathological cause of hyperprolactinemia. Thyroid tests should be done to exclude hypothyroidism as a cause.
Q.94Easy
Which of the following is a copper-containing IUD approved for use in India with the longest duration of effectiveness?
Answer: B
Copper T 380A has the longest duration of effectiveness (10-12 years) among copper IUDs approved in India, with the lowest failure rate of 0.6-0.8%.
Q.95Hard
A 27-year-old nulliparous woman with endometriosis and infertility is considering assisted reproductive technology. Which ART technique would be most beneficial for her?
Answer: B
IVF is the gold standard for endometriosis-related infertility as it bypasses tubal and peritoneal factors. IUI has lower success rates in endometriosis. GIFT is rarely used now.
Q.96Hard
A man with cystic fibrosis presents with infertility. Which finding is characteristic in his semen analysis?
Answer: A
Cystic fibrosis typically results in congenital bilateral absence of vas deferens (CBAVD), leading to azoospermia with normal seminal fluid parameters (obstructive azoospermia).
Q.97Easy
Which of the following hormonal changes is MOST characteristic of the luteal phase of the menstrual cycle?
Answer: B
The luteal phase is characterized by high progesterone levels secreted by the corpus luteum. Estrogen levels are moderate but lower than follicular phase peak.
Q.98Hard
A couple with unexplained infertility (normal semen analysis, ovulation confirmed, patent tubes) is offered IVF. What is the rationale for this recommendation?
Answer: B
In unexplained infertility, IVF allows multiple sperm-egg interactions and can overcome subtle defects in gamete interaction that cannot be detected by standard testing.
Q.99Medium
A 35-year-old woman with polycystic ovary syndrome (PCOS) seeks contraception with metabolic benefits. Which method would be most appropriate?
Answer: A
Combined OCPs with anti-androgenic progestins (like cyproterone acetate or spironolactone) provide contraception while treating PCOS-related hyperandrogenism and improving metabolic parameters.
