Gynaecology, family welfare and reproductive health

35 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Gynaecology, family welfare and reproductive health, part of Obstetric and Gynaecological Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Hard

   At 26 weeks, a scan shows anencephaly in a woman's fetus. She requests termination. Under the MTP (Amendment) Act 2021, which procedure applies?

   1. ATermination on the decision of the state Medical Board
   2. BNo termination is allowed at any time after 24 weeks
   3. CTermination on the opinion of two registered doctors
   4. DTermination on the opinion of one registered doctor

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   Answer: A · Termination on the decision of the state Medical Board

   The 2021 amendment allows termination up to 20 weeks on one registered medical practitioner's opinion and from 20 to 24 weeks on two opinions, for specified categories of women. Beyond 24 weeks the gestational limit does not apply when there are substantial fetal abnormalities, but the diagnosis must be confirmed by a Medical Board set up by the state. Anencephaly is incompatible with life and qualifies. The woman's consent and confidentiality rules still apply.

   • B: The Act does allow termination after 24 weeks for substantial fetal abnormalities.
   • C: Two opinions cover 20-24 weeks for special categories, not 26 weeks.
   • D: One opinion is enough only up to 20 weeks.

2. Question 2 · Hard

   Six days after an hCG trigger for IVF, a woman has abdominal distension, nausea and breathlessness. Weight is up 4 kg in 3 days, ascites is present, urine output is 300 mL in 24 hours and haematocrit is 49% (it was 38%). What best explains her low urine output and rising haematocrit?

   1. AAscending infection causing acute pyelonephritis
   2. BAcute bleeding from a ruptured ectopic pregnancy
   3. CFluid leaking from vessels into the third space
   4. DWater retention caused by high progesterone levels

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   Answer: C · Fluid leaking from vessels into the third space

   This is severe ovarian hyperstimulation syndrome. hCG drives the enlarged ovaries to release vasoactive factors such as VEGF, which increase capillary permeability, so fluid moves into the peritoneal and pleural spaces. The intravascular volume falls, the blood is concentrated (haematocrit above 45%) and the kidneys are underperfused, causing oliguria. Care includes strict intake-output, daily weight and girth, thromboprophylaxis because of haemoconcentration, and drainage of tense ascites.

   • A: Pyelonephritis causes fever and loin pain without ascites or haemoconcentration.
   • B: Bleeding would lower the haematocrit, not raise it.
   • D: Progesterone-related water retention would not concentrate the blood or cause ascites.

3. Question 3 · Medium

   A pregnant woman is found to have undergone a sex-determination test. Under the PCPNDT Act, how does the court view her role unless the contrary is proved?

   1. AShe is presumed to be the main offender
   2. BShe is presumed compelled by her husband or relatives
   3. CShe is held equally liable with the doctor who did it
   4. DShe is liable only if she paid for the test

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   Answer: B · She is presumed compelled by her husband or relatives

   The Act directs the court to presume, unless the contrary is proved, that the pregnant woman was compelled by her husband or other relatives to undergo the test. She is then not punished, while the relatives who compelled her and the doctor or centre that performed the test are liable. This reflects the social pressure behind son preference.

   • A: The Act treats her as a likely victim of pressure, not the main offender.
   • C: The doctor and those who compel her are liable; she is presumed coerced.
   • D: Payment for the test does not change the presumption in her favour.

4. Question 4 · Medium

   A woman at 7 weeks of gestation chooses medical abortion and takes mifepristone 200 mg orally in the clinic. What should the nurse teach about the next step?

   1. ATake misoprostol only if no bleeding starts within 7 days
   2. BTake another mifepristone tablet every day for the next 3 days
   3. CReturn the next morning for a suction evacuation
   4. DTake misoprostol 24-48 hours later and expect bleeding with cramps

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   Answer: D · Take misoprostol 24-48 hours later and expect bleeding with cramps

   The standard regimen is mifepristone 200 mg by mouth followed 24-48 hours later by misoprostol 800 micrograms, usually buccal, sublingual or vaginal. Bleeding heavier than a period and cramping pain usually start within hours of misoprostol, and the pregnancy is passed. She should know the danger signs, such as soaking more than two pads an hour for two hours, fever, or no bleeding, and should return for follow-up about 2 weeks later to confirm completion.

   • A: Misoprostol is given routinely, not only if bleeding fails to start.
   • B: A single dose of mifepristone is enough; repeated daily doses are not part of the regimen.
   • C: Suction evacuation is needed only if medical abortion fails or is incomplete.

5. Question 5 · Easy

   In the Billings (cervical mucus) method of natural family planning, the fertile days are recognised by mucus that is:

   1. AScanty, dry and crumbly
   2. BClear, slippery and stretchy
   3. CThick, sticky and opaque
   4. DYellow, frothy and foul-smelling

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   Answer: B · Clear, slippery and stretchy

   As oestrogen rises before ovulation, cervical mucus becomes abundant, clear and slippery like raw egg white and can be stretched between the fingers (spinnbarkeit). This mucus helps sperm pass, so the woman avoids intercourse from the first day she notices wetness until the fourth day after the peak mucus day. After ovulation progesterone makes the mucus thick and sticky again.

   • A: Dry days with little mucus are usually infertile days.
   • C: Thick, sticky mucus is the progesterone-dominated, infertile pattern after ovulation.
   • D: Yellow, frothy, offensive discharge suggests infection such as trichomoniasis.

6. Question 6 · Easy

   In the FIGO PALM-COEIN classification of abnormal uterine bleeding, the letter C stands for:

   1. AChronic endometritis
   2. BContraceptive use
   3. CCervical carcinoma
   4. DCoagulopathy

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7. Question 7 · Hard

   At a PHC screening camp, a 38-year-old woman has a well-defined acetowhite area on VIA within a fully visible transformation zone, covering less than three-quarters of the cervix, with no growth or signs of invasive cancer. She is not pregnant. Under the screen-and-treat approach, what is the best next step?

   1. AReassure her and repeat VIA after 5 years
   2. BGive antibiotics and repeat VIA after 6 months
   3. COffer ablation (thermal ablation or cryotherapy) at the same visit
   4. DRefer her at once for radical hysterectomy

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8. Question 8 · Easy

   Which cancer of the female genital tract is the most common among women in India?

   1. ACarcinoma of the endometrium
   2. BCarcinoma of the vulva
   3. CCarcinoma of the cervix
   4. DCarcinoma of the ovary

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9. Question 9 · Easy

   The net replacement level of fertility that demographic goals in India aim for corresponds to a total fertility rate of about:

   1. A4 children per woman
   2. B2.1 children per woman
   3. C3 children per woman
   4. D1.0 child per woman

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10. Question 10 · Hard

    On day 8 after a radical (Wertheim) hysterectomy, a woman's urinary catheter is removed. Over 6 hours she voids 90 mL with a weak stream and feels no urge, and a bladder scan shows 380 mL residual urine. What is the most appropriate action?

    1. ATeach Kegel exercises and plan discharge with no catheter
    2. BRestart bladder drainage with intermittent or indwelling catheterisation
    3. CStart oral antibiotics, as the retention means a urinary infection
    4. DEncourage 3 litres of fluid and recheck the residual tomorrow

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11. Question 11 · Medium

    Clomiphene citrate induces ovulation because it:

    1. AInhibits aromatase, lowering oestrogen made by the ovary
    2. BBlocks hypothalamic oestrogen receptors, raising FSH and LH output
    3. CActs directly on the ovarian follicles as a follicle-stimulating hormone
    4. DSuppresses prolactin release from the anterior pituitary

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12. Question 12 · Hard

    A 34-year-old woman's Pap smear is reported as a high-grade squamous intraepithelial lesion (HSIL). She has a visible cervix with no growth. What is the most appropriate next step in management?

    1. ATotal hysterectomy without further tests
    2. BRepeat Pap smear after 12 months
    3. CColposcopy with directed biopsy
    4. DHPV DNA test and repeat Pap in 3 years

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13. Question 13 · Medium

    The main way in which a copper-bearing IUCD prevents pregnancy is by:

    1. AMechanically blocking the uterine opening of each fallopian tube
    2. BSuppressing the mid-cycle LH surge so ovulation fails
    3. CThinning the endometrium through steady progestogen release
    4. DCopper ions that are toxic to sperm and prevent fertilisation

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14. Question 14 · Hard

    A woman is receiving intracavitary low-dose-rate brachytherapy for cervical cancer. On a check, the nurse sees a radioactive source lying on the bed sheet. What should the nurse do first?

    1. APick it up quickly in a gloved hand and replace it in the applicator
    2. BLeave the room and lock it until the next morning
    3. CPick it up with long-handled forceps into the lead container
    4. DWrap it in the sheet and send it to the laundry

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15. Question 15 · Medium

    In the classic definition of menorrhagia used in Indian gynaecology texts, menstrual blood loss is excessive when it exceeds:

    1. A35 mL per cycle
    2. B20 mL per day
    3. C150 mL per cycle
    4. D80 mL per cycle

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16. Question 16 · Hard

    A 29-year-old woman with pulmonary tuberculosis starts a rifampicin-containing regimen under NTEP. She has used the combined pill (Mala-N) reliably for 2 years and wants no pregnancy during treatment. What is the best advice?

    1. AContinue Mala-N as before, as the pill and anti-TB drugs do not interact
    2. BChange to a copper IUCD or DMPA for the treatment period and 4 weeks after
    3. CChange to the progestogen-only pill taken at the same time each day
    4. DKeep the pill and add a levonorgestrel emergency pill after each act

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17. Question 17 · Easy

    Scanty periods or secondary amenorrhoea caused by intrauterine adhesions after a vigorous curettage is known as:

    1. AAsherman syndrome
    2. BSheehan syndrome
    3. CStein-Leventhal syndrome
    4. DKallmann syndrome

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18. Question 18 · Medium

    A 37-year-old woman with regular cycles has tried to conceive for 7 months with regular unprotected intercourse. She asks if it is too early for tests. What is the most appropriate reply?

    1. AShe should wait 2 years as for any couple
    2. BEvaluation can begin now because she is over 35
    3. CShe should wait until 12 months have passed
    4. DTests are needed only if her cycles become irregular

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19. Question 19 · Medium

    A 52-year-old woman with an intact uterus starts menopausal hormone therapy for severe hot flushes. Why must a progestogen be added to her oestrogen?

    1. ATo make the oestrogen relieve her hot flushes much faster
    2. BTo prevent loss of bone mineral density
    3. CTo protect the endometrium from hyperplasia and cancer
    4. DTo prevent deep vein thrombosis in the legs

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20. Question 20 · Hard

    A 26-year-old woman develops continuous dribbling of urine through the vagina 9 days after a prolonged obstructed labour at home. She passes no urine normally. Methylene blue instilled into the bladder stains a swab placed high in the vagina. What is the most likely diagnosis?

    1. AOverflow incontinence from urinary retention
    2. BVesicovaginal fistula from pressure necrosis
    3. CUreterovaginal fistula from a surgical injury
    4. DStress urinary incontinence from pelvic floor weakness

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21. Question 21 · Medium

    Under NACO's colour-coded syndromic STI/RTI kits, a woman with lower abdominal pain suggesting pelvic inflammatory disease is given:

    1. AKit 7 (black), bubo kit
    2. BKit 2 (green)
    3. CKit 6 (yellow)
    4. DKit 1 (grey)

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22. Question 22 · Medium

    A 17-year-old has used DMPA injections every 3 months for 2 years and wants to continue. Which effect of long-term use is most important to discuss with her?

    1. AReduced bone mineral density
    2. BPermanent infertility after stopping
    3. CRaised risk of ectopic pregnancy
    4. DRapid weight loss

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23. Question 23 · Medium

    How did the MTP (Amendment) Act 2021 change termination on the ground of contraceptive failure?

    1. AIt made it require the husband's written consent
    2. BIt removed contraceptive failure as a ground
    3. CIt extended the ground to any woman or her partner
    4. DIt limited the ground to women with two or more living children

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24. Question 24 · Medium

    A husband is asked to give a semen sample for analysis. Which instruction is correct?

    1. AAbstain at least 10 days to get the highest count
    2. BAbstain 2-7 days and deliver it within 1 hour, kept warm
    3. CKeep it in the refrigerator if it cannot be delivered at once
    4. DCollect it in an ordinary condom during intercourse

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25. Question 25 · Medium

    Why is life-table analysis considered a better measure of contraceptive failure than the Pearl index?

    1. AIt excludes women who stop the method early
    2. BIt counts only pregnancies that occur in the first year
    3. CIt gives a failure rate for each month of use
    4. DIt needs no record of how long each woman used it

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