Optimal pregnancy timing to start medication for diabetes should ideally be started or adjusted before pregnancy to ensure proper blood sugar control. High blood sugar levels in early pregnancy increase the risk of congenital abnormalities in the fetus as organogenesis occurs during the first 8 weeks.

Incorrect Options-

• First trimester- starting medication at this point might help but does not eliminate risks of abnormalities since the development of the fetus has already begun.
• Second/Third trimester- waiting until later in pregnancy delays treatment and causes complications for both mother and baby.

Congenital anamolies- neural tube defects [anencephaly, spina bifida], cardiac defects [VSD, TGA], caudal regression syndrome, renal malformation [agenesis urinary tract defects], gastrointestinal defects [small left colon syndrome]. 

For a pregnant women who prefers non-invasive screening the best choice is ultrasound [USG]. Its completely safe as it uses sound waves,and provides valuable information without any risk to the fetus and mother.

Incorrect Options-

• Amniocetesis is an invasive procedure.
• Transvaginal ultrasound is not as risky but still involves inserting a probe and is considered invasive.
• Urine tests are not invasive but arent comprehensive enough to assess the condition of fetus.

Gestational diabetes [GDM] increases a mothers long term risk of developing type 2 DM. The hormonal change that causes insulin resistance durinng pregnancy may persist, leading to type 2 DM.

Incorrect Options-

• Type 1 DM - its an auto immune condition.
• Impaired fasting glucose- GDM may increase imapaired fasting glucose but the main concern here in progression to type 2 DM.
• No risk is an incorrect option since GDM is a known predictor for future health issues.

Clomiphene citrate is used to induce ovulation. It tricks the body into thinking that the estrogen levels are low, prompting the release of hormones like FSH to stimulate egg maturation and induce ovulation.

In a pregnant woman with  cardiac condition, vaginal delivery is avoided as the strain of labour can put significant stress on the heart incresasing the risk of complications.

Other options-

• Epipidural anesthesia -helps manage pain and reduce stress, making it safer for women with a cardiac condition.
• Diuretics- can control fluid overload, reducing hearts workload.
• Digitalis- helps improve heart function when needed.

Placenta previa occurs when the placenta attaches low in the uterus, near or covering the cervix. The most common symptom of placenta previa is painless vaginal bleeding, often bright red in colour.

The following are features of placenta previa-

• Painless vaginal bleeding- sudden, bright red bleeding in the secind/third trimester.
• Soft uterus- no tenderness or contraction.
• Fetal malpresentation- breech or transverse lie due to placenta in the lower segment.
• High presenting part- fetal head remains unengaged.
• USG- placenta covers or is near the cervix.

Vaginal bleeding, lower abdominal pain, passage of tissue, and a 1 cm dilated cervical os indicates that not all product of conception has been expellled.

Incorrect Options-

• Complete abortion- all products of conception expelled, bleeding subsides, os closed.
• Missed abortion- pregnancy is non viable but with no pain, bleeding, or tissue passage, and the os is closed.
• Molar pregnancy-  excessive uterine enlargement with absent fetal parts.

The patient has signs of preeclampsia. Admission is necessary  to monitor the mother and fetus, control BP, and prevent complication like eclamsia or HELLP syndrome.

Incorrect Options-

• Oral labetalol- used to control BP but is not sufficent enough and requires hospital monitoring.
• Diuretic- not recommended as edema in pregnancy is not due to fluid overload but vascular changes.
• Low sodum diet- dietary changes have minimal impact in  managing acute preeclampsia.

Trichomoniaisis even in asymptomatic patient should be treated with antibiotics [eg., metronidazole or tinidazole] to prevent complications such as pelvic inflammatory disease, infertility, and transmission to sexual partners.

In mild gestational diabetes during earlier gestation, dietary changes and lifestyle modifications are the first-line management to control blood sugar before considering medications or insulin. 

Incorrect Options-

• Repeat glucose trolerance test- unnecessary once GDM is confirmed.
• C- section- not immmediately indicated unless there is poor glycemic control leading to complications like macrosomia.
• Sliding insulin helps manage sugar levels effectively in gestational diabetes that persistes late in pregnancy.

Swine flu [H1N1 influenza] in pregnancy can lead to severe complications, so antiviral treatment with oseltamivir [Tamiflu], should be started immediately without waiting for the test results.

The patient's presentation of painless vaginal bleeding at 19 weeks of gestation, followed by spontaneous delivery, strongly suggests cervical incompetence. This condition involves the premature dilation of the cervix in the absence of contractions and can lead to pregnancy loss in the second trimester. In cases of cervical incompetence, factors such as structural abnormalities or previous cervical trauma may contribute to diminished support for the pregnancy as it advances. Healthcare providers must comprehensively assess the patient's medical history and perform a thorough examination.

Additionally, considering potential interventions, such as cervical cerclage in subsequent pregnancies, may be beneficial in mitigating the risk of recurrence.

The sudden and significant swelling of the left lower extremity in a pregnant woman at 30 weeks of gestation is indeed highly suggestive of deep vein thrombosis (DVT).

Impedance plethysmography is a non-invasive test that assesses changes in blood volume in the legs, which can help in detecting DVT. While compression ultrasonography is the preferred initial diagnostic tool in pregnancy, impedance plethysmography can be considered when ultrasound is unavailable.

Low molecular weight heparin (LMWH) is the preferred blood thinner for treating deep vein thrombosis (DVT) in pregnant women. It is safe and effective in preventing the formation of new blood clots. LMWH has fewer side effects compared to other types of heparin and is easier to manage since it provides a more predictable response.

Bed rest is initially recommended for patients diagnosed with deep vein thrombosis (DVT) to help reduce the risk of embolization. By minimizing movement, bed rest can help prevent dislodging a blood clot, potentially leading to serious complications such as a pulmonary embolism. However, the management of DVT should be closely monitored by healthcare professionals to determine the appropriate course of treatment, which may include anticoagulation therapy alongside bed rest.

Greenish vaginal discharge, the appearance of red spots = Trichomoniasis.

Incorrect options-

• Candidiasis- thick white, odorless discharge, and intense itching.
• Gonorrhea- can cause greenish-yellowish discharge but is not presented as red spots.
• Gardnerella vaginalis- thin grayish-white discharge with a fishy odor.

PCOS is a common hormonal imbalance leading to symptoms like irregular periods, acne, and hirsutism

The absence of other symptoms and normal pelvic examination further support the diagnosis.

Postmenopausal bleeding even when taking estrogen must be evaluated thoroughly to rule out  serious causes like endometrial hyperplasia or carcinoma.

Incorrect option-

• Pap smear- it does not evaluate endometrium.
• Stop estrogen- discontinuing estrogen without determining the cause of bleeding would delay diagnosis and management.
• Continuing estrogen may lead to the masking of serious underlying conditions.

Uterovaginal prolapse is a condition where the uterus or vaginal walls sag into the vaginal canal, leading to a sensation of pelvic pressure or heaviness. This feeling can become more pronounced during prolonged standing or physical activity due to the effects of gravity, which exacerbates the descent of pelvic organs. Women may also experience discomfort, urinary issues, or difficulty with bowel movements.

It's important for those experiencing these symptoms to consult a healthcare provider for an accurate diagnosis and potential treatment options.

Infertility is typically defined as the inability to conceive after 12 months of unprotected intercourse for women under 35 years old. For couples who have been trying for only 6 months, reassurance and encouragement to continue attempting conception are usually advised, unless there are specific risk factors present. These risk factors may include irregular menstrual cycles, known reproductive issues, or relevant medical histories that could affect fertility. 

The above-mentioned features align with endometriosis.

Incorrect option- 

• Fibroids typically present with menorrhagia and may cause infertility but are often associated with an enlarged uterus.
• Adenomyosis usually presents with menorrhagia, an enlarged and tender uterus.
• PID presents with more acute symptoms like fever, purulent vaginal discharge cervical motion tenderness.

OCP primarily work by altering cervical mucus thickness,making it thicker and less penetrable to sperm, thus preventing fertilization.

Dilation refers to the opening of the cervix, which is a direct indicator of the progress of labour. As the labour progresses the cervix dialates from 0- 10 cm

Descent refers to the downward movement of the fetus through the birth canal.

• while fetal heart rate and degree of pain are important for monitoring the well -being of the baby and the mother, they are not reliable indicators of labor progressions.

OCP decreases the risk of ovarian cancer by inhibiting ovulation and limitingthe exposure of ovaries to hormones that could promote cancer development.

Incorrect Options-

• They do not increase the risk of breast cancer.
• OCPs are known to decrease the risk of endomentrial cancer because they reduce the number of menstrual cycles lowering the exposure of endometrium to estrogen. 
• They do not increase the risk of ectopic pregnancy. 

CA- 125 is a protein that is often elevated with ovarian cancer.

Incorrect Options-

• HLA-DQ4 and HLA-B27 are associated with autoimmune disease.
• CA-19-9 is a marker primarily used for pancreatic cancer.

A tupical menstrual cycle ranges from 21-35 days, with 28 daysbeing considered the ''average'' cycle length.

Measles-mumps-rubella (MMR) vaccine and its components should not be administered to women known to be pregnant.

MMR VACCINE contains live attenuated viruses.

Antipartum hemorrhage refers to bleeding that occurs before labor, typically in the second or third trimester, and includes conditions like placental abruption and placenta previa.

Fetal mortality is generally higher than maternal mortality due to the risk of fetal hypoxia, premature delivery, or placental insufficiency.

Nutritional advice- A well-balanced diet with controlled carbohydrate intake is crucial to managing blood glucose levels.

Incorrect Options-

• Insulin is given when blood glucose levels cannot be controlled with diet alone, oral hypoglycemic drugs are generally not recommended in pregnancy due to potential fetal risks, although drugs like metformin may be considered in some cases.
• Repeat OGTT is unecessary once GDM has been diagnosed.

Magnesium sulfate is the correct choice in the given scenario. The pregnant woman is hypertensive, and the baby is experiencing bradycatrdia which may indicate fetal distress. Magnesium sulfate is used in the management of severe hypertension to prevent eclampsia.

Incorrect Options-

• Give a dose of oxytocin- This is not appropriate in this case as the baby is already suffering from  bradycardia and administering oxytocin would increase uterine contractions, which would further contribute in fetal distress.
• Give methotrexate- It is used for conditions like ectopic pregnancy not for labour management or fetal distress.
• Do nothing is not an acceptable approach.

In most cases, the best course of action is to monitor the pregnancy closely and offer counselling about the potential risks of congenital rubella syndrome.

Incorrect options-

• IG is effective when given within 72 hours of exposure. However, in this case, the exposure occured 3 days ago, so it would be ineffective.
• Vaccine- [live attenuated] rubella vaccines are contraindicated during pregnancy due to potential risk of congenital rubella syndrome. 

Uterine atony is the most common cause of postpartum hemorrhage. It occurs when the uterus fails to contract properly after childbirth, leading to excessive bleeding.

Incorrect options- 

• Coagulation disorders can lead to postpartum hemorrhage but compared to uterine atony are less common.
• Retained placenta and rupture of uterus are serious complications of childbirth that can lead to significant bleeding, but are less common than uterine atony.

Pituitary adenoma is a benign tumor of the pituitary gland that can cause amenorrhoe due to disruption of hormone production.

• Pituitary adenoma→ increase prolactin→ decrease GnRH→decreae LH and FSH→decreased estogen→ Amenorrhea.

Incorrect options-

• Eating disorders can cause amennorhea, but the patient's stable BMI for the past 5 years makes this unlikely.
• Endometriosis and PCOS are common causes of amenorrhea, but they are often accompanied by other symptoms like- pelvic pain, hirsuitism, and irregular bleeding.

Screening for GDM at 24-28 weeks is recommended practice for GDM screening during pregnancy. This is because GDM typically develop later in pregnancy due to increasing levels of placental hormones such as human placental lactogen, estrogen, and progesterone.

Incorrect options-

• Diet control is used as an initial treatment but, is always not successful. It might require addintional medications or insulin to manage the optimal levels .
• Screening for GDM at 8 or 12 weeks is not recommended because GDM typically develops later in pregnancy.  

An ultrasound is the most appropriate next step to assess the pelvic organs and rule out any underlying cause.

IUD are safe and effective form of reversible contraception for a female with a history of DVT.

Incorrect option-

• Tubal ligation and vasectomy are permanent methods of contraception and does not align with the patients requirements.
• OCPs can increase the risk of blood clots , especially in women with a history of DVT.

Uretrovaginal fistula is a communication between the ureter and vagina, which can occur as a complication of pelvic surgery, including hystertectomy. This condition allows urine to leak from the ureter into the vagina.

Candida is a yeast infection that can cause a white, cottage cheese-like discharge. Antibiotics can disrupt the normal balance of bacteria in the vagina making it more suseptible to yeast overgrowth.

Epidural analgesia can cause urinary retention due to numbing effect on the nerves that control the bladder.

She can take the vaccine without any further advice regarding breastfeeding, as MMR is a live attenuated vaccine and does not pose any risk to the breastfeeding infants.

Sertoli-Leydig cell tumors are rare tumors that produce androgens, leading to signs of androgen excess like hirsuitism, acne, and deepening of voice. They are often associated with ovarian masses. 

The following symptoms described are suggestive of androgen excess. Androgens are male hormones that can cause masculinizing effects in the females.

Complete hydatidiform mole is a type of gestational trophoblastic disease GTD, where the placenta develops abnormally, forming grape like clusters. This abnormal development results in a snow storm appearance on ultrasound.

Prolactin is a hormone produced by the pituitary gland. It is responsible for milk production in lactating women. Pituitary adenomas can cause production of prolactin in excess levels, leading to galactorrhea.

In the abscence of any complications, it is generally safe to wait for spontaneous labor to start. Close monitoring of the mother and fetus  is essential to ensure a safe delivery.

Insulin is the most common medication used for GDM. It is safe and effective treatment that helps control blood sugar levels during pregnancy.

Incorrect options-

• Metformin can be used but is not as effective as insulin.
• Sulfonylureas are not recommended as they can cause hypoglycemia in the new born.
• SGL-2 inhibitors are not currently recommended and are still under trial.

Greenish frothy discharge is a characterstick feature of trichomoniasis.

Placenta previa is a condition where the placenta partially or completely covers the cervix. This can lead to painless vaginal bleeding, especially in the third trimester.

Incorrect options-

• Placenra abruption is a condition where placenta seprates prematurely from the uterine wall, causing bleeding and severe abdominal pain.
• Placenta accreta and increta are conditions where placenta is abnormally attached to the uterine wall.

Duodenal atresia is a congenital condition in which the first part of the small intestine [duodenum] is blocked. This blockage  prevents the fetus from swallowing and absorbing amniotic fluid. 

Laproscopy is considered the gold standard for diagnosing ectopic pregnancy.

This refers to painful periods that occur without an underlying medical condition. It typically starts during adolscence  and improves with age.

This combination is the most appropriate approach as it provides non- invasive screening for common chromosal abnormalities.

USG can assess fetal anatomy with gestational age, while maternal blood tests can screen for markers of down syndrome and other chromosomal abnormalities. 

Increase estrogen→ decrease prolactin sceretion by inhibiting prolactin release from anterior pituitary→ decrease milk production →supressed lactation.

Diphtheria is a serious bacterial infection, vaccination with diphtheria toxoid is considered safe during pregnancy.

There is a slight increase in the risk of breast cancer associated with combined oral contraceptive pills, particularly for women who have used them for a long time or at a young age. 

The act of breastfeeding itself is the most effective stimulus for milk production. When a baby suckles, it transits signals to mothers brain, which triggers the release of hormones like oxytocin and prolactin. Oxytocin causes the milk to flow from the breasts, while prolactin stimulates milk production.

Ampicillin is generally considered safe for use during pregnancy.

Incorrect options-

• Ciprofloxacin- not recommended during pregnancy due to potential risks to the developing fetus including both bone and cartilage abnormalities.
• Tetracycline- can cause tooth discoloration,and developmental abnormalities in fetus.
• Cephalosporin- some drugs of this class have potential risks.

Late deceleration on CTG indicates fetal distress, which is suggestive of an immediate delivery to prevent further harm to the baby. Suction is a quick and effective method to assist in vaginal delivery in such situations.

Incorrect options-

• C-section- can be considered in some cases but is a more invasive procedure.
• Forceps delivery- is another option for assisted vaginal delivery, but it carries risks.
• Spontaneous delivery- unlikely to be sucessful in this situation.

Laproscopy is considered a gold standard for diagnosing endometriosis. It involves inserting a thin, lighted tube with a camera into abdomen through a small incision. This allows direct visuslization of the pelvic organs and identification of endometrial tissue which is located outside the uterus.

Oligohydramnios at 41 weeks is a concern as it is indicative of placental insufficiency and compromise of fetal well-being.Therefore inducing labor is the correct management to ensure the wellbeing of both mother and baby, which would otherwise be compromised if other options are used for further management.

Bacterial vaginosis has a combination of classic features which includes whitish-grey discharge, a positive KOH test [which release a fishy odor when mixed with vaginal discharge], and a fishy odor itself. This condition is caused by an imbalance of bacterial flora in the vagina.

This is the most appropriate treatment for a post-coital odorless and colorless discharge. Douching after intercourse can help remove any irritants or bacteria that may have been introduced during intercourse.

NSAIDs are effective in relieving pain associated with primary dysmenorrhea. They work by reducing the production of prostaglandins, which are substances that cause uterine contractions and pain.

Obstructed labor is a condition that arises during labor when the baby cannot pass through the birth canal due to various reasons like a small pelvis, large baby, or abnormal fetal position. 

Incorrect options- 

• Common in primi- While primiparous women may have a higher risk of obstructed labor,it can occur regardless of parity.
• Excessive caput and molding- it can sometimes be a sign of prolonged labor, they are not specific to obstructed labor.
• Most common occipto- anterior- this is the most common fetal position. However, this presentation is not necessary for preventing obstructed labor.

The WHO [world health organization] has recommended initiating the breast feeding within the first hour of birth. This is known as the ''golden hour''. Early breastfeeding helps establish a strong bond between the mother and baby, promotes milk production, and provides essential nutrients to the newborn.

Fibroids often shrink or even disappear after pregnancy and childbirth. The changing hormone levels during pregnancy and after delivery can contribute to the regression of its size.

Incorrect options-

• Presented with severe anemia- it can cause heavy mestrual bleeding but this is always not the case.
• Suregery is generally not recommended for fibroids during pregnancy unless they are causing any severe complicayion like heavy bleeding or obstruction.
• Presented with antepartum hemorrhage- they can increase the risk of APH but its not alwasy the case.

The most appropriate next step is to confirm the pregnancy with a quantitative serum hCG test.

PID is an infection of the female reproductive organs, often caused by sexually transmitted bacteria. It typically presents with lower abdominal pain, tenderness on pelvic exam, and abnormal vaginal discharge.

The primary causative organism include-

• Chlamydia trachomatis- the most common bacterial cause of PID.
• Neisseria gonorrhoea
• Anaerobic bacteria- bacteroides species and peptostreptococcus
• Mycoplasma

These medications are commonly used to treat hot flushes, especially when HRT is not suitable.Venlafaxine and paroxetine drugs belon to the class of antiderpressants that can also help in regulating body temprature, while clonidine is a medication used in controlling blood pressure that can also reduce hot flushes.

The hymen is a thin membrane that partially covers the vaginal opening and is located at the 6 o'clock position. In case of a forceful sexual intercourse it is most likely to rupture in this direction.

[Hymen can rupture due to various reasons, including physical activies like sports or accidents].

In this scenario c-section would be the best management. The combination of transverse lie, back down presentation, and an open cervix with bulgingbag of waters indicates that vaginal delivery is unlikely to be sucessful.

Metronidazole is the first-line treatment for trichomoniasis. It effectively kills the parasite and clears the infection.

Incorrect options-

• Clindamycin-it's an alternative treatment but not first-line.
• No need to treat husband- both sexual partners should be treated to prevent reinfection.
• Vaginal swab culture after 2 weeks- not necessary after treatment with metronidazole.

Ovarian torsion is a condition in which the ovary twists over its supporting ligamens, cutting off blood supply.This can lead to sudden severe pain in the lower abdomen, often on one side.  

Incorrect options-

• Endometriosis- causes choronic pelvic pain that worsens during menstruation.
• PID- presents with fever, vaginal discharge,  and cervical motion tenderness.
• PCOS- It can cause irregular periods, acne, hirsuitism, but doesn't typically present with sudden, severe abdominal pain.

Levonorgestrel is a progesterone only pill that is highly effective in preventing pregnancy within 72 hours of unprotected sex. It works by preventing ovulation, thickening cervical mucus, making it difficult for sperm to reach the egg.

Ruptered ectopic pregnancy is the most likely diagnosis in the given scenario. An ectopic pregnancy is defined as implantation of fertilized egg outside the uterine cavity, often in the fallopian tube. As the pregnancy progresses the tube can rupture, causing severe abdominal pain an internal bleeding.

This patient has a previous history of cervical incompetence and is therefore at a high risk of premature labor and delivery. Cerclage is a surgical procedure where a stitch is placed around the cervix to strengthen it and prevent premature opening. The suture is removed typically at 36-37 weeks. This helps to maintain the pregnancy and reduce the risk of premature birth.

Live vaccine like the pox virus vaccine should be avoided during breastfeeding as the vaccine virus can potentially be transmitted to the infant through breast milk. However if the mother already had an episode of pox virus infection,its generally safe to give the vaccine after 2-3 weeks of recovery, as the risk of transmission to the infant is minimal at this point.

Injectable progesterone commonly used for contaception is known to cause irregular bleeding pattern and potential weight gain.

During pregnancy there is an increase in thyroid hormone binding globulin [TBG] production by the liver. This leads to an increase in the T3 and  T4 levels, as more T4 is bound to the TBG. However, the free T4 levels remain normal, as the increase in TBG is proportional to the increase in total T4.

For confirming pre-eclampsia we need to monitor the BP, as it is characterized by high blood pressure and protein in the urine. Measuring the blood pressure is the most straight forward way to assess pre-eclampsia.

• Fetures of pre-eclampsia- 
• HTN > or = to 140/90 mmhg measured on 2 occassions 4 hrs apart.
• Proteinuria- >/= 300mg/24 hr urine collection, protein-to-cretinine ration>/=0.3, urine dipstick>/=1+
• End organ dysfuntion with or without proteinuria
• intrauterine complications- IUGR, oligohydamnios.

Generally a normal pregnancy is expected to continue until 39-40 weeks. However, if there are no complications and if the mother desires, inducing labor at 36 weeks is generally considered safe, and it can reduce the risk of post term pregnancy complications.

Incorrect options-

• At 34/35 weeks- not generally recommended unless some specific medical reason like preeclampsia or fetal growth restriction occurs.
• At 37 weeks- it's  a ressonable option in some cases but generally preferable to wait until 38-40 weeks.

IUCD are a safe and effective long-term reversible contraceptive method. They are particularly suitable for women with a history of thromboembolic disease because they do not contain hormone, which can increase the risk of blood clots.

Late decelaration on CTG indicates fetal distress, likely due to increased oxygen delivery to the fetus. The immediate management is to increase oxygenation to the fetus.

VZIG is a medication containing antibodies against the varicella zoster virus. It typically is used for immunocompromised individuals or pregnant women who have been exposed to chickenpox.

In a patient with severe vaginal bleeding a comprehensive approach is necessary to stabalize the patient and control the bleeding.

• Polymenorrhea- increased frequency of mensturation.
• Metrorrhagia- bleeding between menstrual periods.
• Hypermenorrhea- heavy menstrual bleeding.
• Hypomenorrhea- scanty menstrual bleeding.

The symptoms described are characteristic of a vaginal yeast infection, commonly caused by Candida albicans, miconazole is an antifungal medication that is effective in treating vaginal yeast infection.

Gestational hypertension (formerly known as pregnancy-induced hypertension): Idiopathic hypertension without significant proteinuria (< 300 mg/L) that develops at > 20 weeks’ gestation.

As many as 25% of patients may go on to develop preeclampsia.

Chronic hypertension: Present before conception and at < 20 weeks’ gestation, or may persist for >12 weeks postpartum.

Up to one-third of patients may develop superimposed preeclampsia.

• Preeclampsia: New-onset hypertension (SBP >/= 140 mmHg or DBP >/= 90 mmHg) and proteinuria (> 300 mg of protein in a 24-hour period) occurring at > 20 weeks’ gestation.
• Eclampsia: New-onset grand mal seizures in women with preeclampsia. 

Since the patient is 34 weeks pregnant and has no other symptoms, placenta previa is the most likely diagnosis.

Long term use of estrogen therapy has been linked to an increased risk of developing breast and endometrial cancer.

Amniotic fluid embolism- Typically occurs acutely during labor and delivery or immediately at postpartum.

Classic signs and symptoms are hypoxia, hypotension with shock, altered mental status and disseminated intravascular coagulation. Other signs and symptoms include seizure activity, agitation, and evidence of fetal distress.

• Diagnosis: primarily a clinical diagnosis of exclusion.
• Treatment: Aggressive supportive management is needed, and the patient should be intubated and monitored.

Breech presentation is not associated with increased alpha feto protein levels.

Ovarian faliure is a condition where the ovaries stop functioning properly before the age of 40. The elevated FSH and LH levels in this patient are indicative of ovarian faliure.

Culdocentesis refers to the extraction of fluid from the rectouterine pouch posterior to the vagina through a needle > The Rectouterine Pouch is often reached through the posterior fornix of the vagina. The process of creating the hole is called "colpotomy" a scalpel incision is made to drain the fluid rather than using a needle. Drainage of a tubo-ovarian/pelvic abscess is appropriate if the mass persists after antibiotic treatment; the abscess is > 4–6 cm, or the mass is in the cul-de-sac in the midline and drainable through the vagina. If the abscess is dissecting the rectovaginal septum and is fixed to the vaginal membrane, colpotomy drainage is appropriate. If the patient’s condition deteriorates, perform an exploratory laparotomy.

Outpatient antibiotic regimens : Regimen A: Ofloxacin or levofloxacin × 14 days +/– metronidazole × 14 days. Regimen B: Ceftriaxone IM × 1 dose or cefoxitin plus probenecid plus doxycycline × 14 days +/– metronidazole × 14 days. Inpatient antibiotic regimens: Cefoxitin or cefotetan plus doxycycline × 14 days. Clindamycin plus gentamicin × 14 days.

Pelvic ultrasound is the most accurate initial diagnostic tool.It helps in visualizing the gestational sac, confirm the location of pregnancy, and identify any potential complications.

External cephalic version [ECV] ia a procedure to turn a breech baby into a head down position. It is typically performed between 36-37 weeks.

Uterine fibroids are noncancerous growths in the uterus. They can cause a variety of symptoms, including infertility, heavy menstrual bleeding, pelvic pain, and pressure on bladder and rectum. The diffuse abdominal pain mentioned in the question is a common symptom of uterine fibroid.

PID is an infection of the female reproductive organs, It often presents with the above mentioned fearures.The negative Lerrheic test further supports the diagnosis of PID.

Baby blues is a common condition that can affect many women after childbirth. It is characterized by mood swings, crying spells, anxiety, and fatigue. While it usually resolves on its own within a few weeks, providing support and reassurance can alleviate symptoms.

Fluroquinolones are contraindicated during pregnancy as they have the potential to cause cartilage damage and joint problems in the developing fetus.

Ampicillin is generally considered safe to use during breastfeeding. It has a low level of excretion in breast milk and a low risk of causing side effects in infants.

Semen analysis is the initial evluation for couples with infertility as it assesses the quality and quantity of sperm, which are essential for fertilization.

Incorrect options-

• Temperature chart- It can help keep a track of ovulation, but can't evaluate fertility factors in both partners.
• Refer to reproductive clinic- not the initial step.
• Ovum analysis- more invasive and is therefore not the first step.

Primary hypogonadism is the most common cause of male infertility. In this condition the testicles fail to produce sufficient testosterone or sperm due to problems within the testicles themselves.

Incorrect options-

• Secondary hypogonadism- faliure of pituitary gland to signal testicles to produce sufficent testosterone, it can cause infertility but is less common than primary hypogonadism.
• Ejaculation obstruction- issue in the passageway of sperms which can cause infertility, but is less common compared to primary hypogonadism.
• Premature ejaculation- a sexual dysfunction in which ejaculation occurs rapidly, not considered a primary cause of male infertility.

CMV is a common virus that can cause a range of symptoms including hepatosplenomegaly and jaundice, in newborns. CMV shows vertical transmission during pregnancy, which can lead to serious health issues in the baby.

Newborn complications caused by CMV-

• Hearing loss [most common long term complication]
• Partial or comlete vision loss
• Developmental delays
• Microcephaly
• Seizures
• Low birth weight

Other options can lead to birth defects but do not manifest as hepatosplenomegaly and jaundice of the newborn.

A thin cervical thickness and scanty cervical mucus often indicate low estrogen levels. Oestrogen injection can help make the cervical mucus thick and improve its quality, making it more conducive for sperm passage and fertilization.

fascial dehiscence is defined as sepration of layers of surgical wound. Blood-stained discharge 6 days post C-section strongly suggests this condition. If a fascial dehiscence is observed, the patient should be taken immediately to the operating room where the wound can be opened, debrided, and reclosed in a sterile environment.

Incorrect options-

• Wound infection is suggested when excessive purulent discharge  from the wound is present.
• Bacterial infection does not commonly present with blood stained discharge.
• Lochia is the normal vaginal discharge after childbirth and is unrelated to the abdominal sutures.

USG is the initial investigation of coice in this scenario.

IFG: (6.1-7.0 mmol), IGT: (7.8-11.1 mmol/l, 2h after 75g )

• First step: One-hour 50-g glucose challenge test; venous plasma glucose is measured one hour later (at 24–28 weeks). Values > 140 mg/dL are considered abnormal.
• Next step: Confirm with an oral three-hour (100-g) glucose tolerance test showing any two of the following: fasting > 95 mg/dL; one hour > 180 mg/ dL; two hours > 155 mg/dL; three hours > 140 mg/dL.

At 34 weeks, it's still relatively early. The baby still has a chance of turning to cephalic presentation. Waiting and monitoring is the usual approach in this stage.

Multiple pregnancies increase the risk of PPH due to the following factors-

• Overstretching of uterus to accomodate multiple babies which in turn decreases the contractility.
• Multiple pregnancies have an increased chance of having placental abnormalities like placenta previa, accreta, which can cause excessive bleeding.

Other options given are not a strong risk factor for PPH.

The given scenario is suggestive of ''Abruptio placenta''. It is a condition where the placenta prematurely seprates from the uterine wall and can lead to heavy bleeding, fetal distress and even death of baby and mother.

Immediate C-section is the standard treatment of this condition.

Incorrect options-

• Gice oxytocin- it is used to induce or augment labor, but its contraindicated in placental abruption as it can lead to increased uterine bleeding by further contracting the uterus.
• Rupture of membrane- not an appropriate management.
• Obsereve- not an appropriate step in this scenario.

Fundus is the thinnest and most vulnerable part of the uterus, especially in situations where excessive force is applied during the procedure.

PAP screening should begin within three years of the onset of sexual activity or at the age of 21 in a patient with an uncertain history of sexual activity. HIV+ patients should be screened every six months during their first year of diagnosis and then yearly if the initial tests are negative.

Preeclampsia is a serious pregnancy condition characterized by high blood pressure and other signs of organ damage, such as protrein in the urine, or edema.

Hospitalization and monitoring are crucial for women with preeclampsia so that they do not progress towards more sever condition like eclampsia.

Incorrect options-

• Diuretics- children of mothers with hypertension in pregnancy plus diuretic treatment in the third trimester were at significantly increased risk of developing schizophrenia.
• Low salt diet- may be helpful in lowering the BP, but its not the primary intervention. 
• Labetalol is contraindicated in pregnancy.

Aim for delivery when the pregnancy is at term.

If a couple has been trying for less than a year and has no underlying fertility issues, the advice is usually keep trying.

Even after having tried for one year yet no results, then refer to a specialist.

Complications of hysterectomy-

• Hemorrhage: Average intraoperative blood loss is 400 mL. Excessive bleeding complicates 1 to 3 percent of hysterectomy.
• Infection: Approximately one-third of women undergoing abdominal hysterectomy without antibiotic prophylaxis develop postoperative fever.
• Thromboembolic disease: in 0.2 and 2.4 percent.
• Ureteral injuries

Renal glucosuria is the excretion of glucose in the urine in detectable amounts at normal blood glucose concentrations or in the absence of hyperglycemia. In general, renal glucosuria is a benign condition and does not require any specific therapy. Glycosuria may be associated with tubular disorders such as Fanconi syndrome, cystinosis, Wilson disease, hereditary tyrosinemia, or oculocerebrorenal syndrome (Lowe syndrome).

Loss of deep tendon reflexes [ like knee jerk reflex] is one of the earliest signs of magnesium sulfate toxicity. 

Incorrect options-

• Hypotension- it is a potential side-effect of magnesium sulfate, but is usually not the first sign of toxicity.
• Flaccid paralyisis- it is a more severe sign of magnesium sulfate toxicity and occurs later.
• Respiratory faliure- serious but not initial complication of magnesium sulfate toxicity.

[Preterm delivery refers to the delivery of baby before completing 37 weeks of gestation].

• Amniochorionitis- it is an infection of amniotic fluid surrounding the baby. It can lead to serious complications for the baby and requires prompt delivery.
• Placenta abruption- It is a condition where the placenta prematurely seprates from the wall of the uterus. It can cause severe bleeding and requires immediate delivery.

• The first place this bacterium infects is usually the columnar epithelium of the urethra and endo cervix.
• Non-genital sites in which it thrives are in the rectum, oropharynx, and the conjunctivae.
• The vulva and vagina are usually spared because they are lined by stratified epithelial cells.

Instrumental delivery refers to the use of tools like forceps or vaccum to assist in delivery of the baby.

CPD is a clinical condition in which the baby's head is too large to fit through the mother's pelvis. Therefore before attemting instrumental delivery its crucial to rule out CPD.

Incorrect options-

• Face presentation- though it's an abnormal position but instrumental delivery is not contraindicated, given the baby is health and the mother's pelvis is adequate.
• Breech presentation- instrumental delivery is generally not recommended.
• Cord prolapse- it's a medical emergency and requies immediate delivery by C-section.

HSV in pregnant is treated by: oral acyclovir 400 mg TID for 5-7 days.

[If HSV was present at the time of labor: c-section].

Postpartum depression is a serious condition that affects new mother's. It is characterized by feeling of sadness, anxiety, and fatigue. In many cases treatment with therapy is sufficent but it is important to know that involving family in this process can be benificial.

Neural tube defects arr birth defects that happen when a baby's spinal cord or brain doesn't form properly during the first month of pregnancy. Anencephaly is a severe form of NTD in which a major portion of brain and skull are missing.The recurrence risk is estimated to be around 2%.

Postpartum psychosis is a severe mental health condition that occurs in femalses after child birth.

• Onset- sudden,within days to weeks after delivery.

Features of postpartum psychosis-

• Severe mood change- mania or depression
• Hallucination [auditory/visual]
• Delusions [false beliefs often about baby]
• confusion and disorganized thinking.
• Agitation, insomnia, and catatonia

In a normal labor the baby's head flexes to fit through the birth canal. However, in OP position flexion can hinder rotation to the anterior position.

During pregnancy, the calorie requirement increases by 300-500 kcal/day.

Prolactin levels in excess of 200 ng/mL are not observed except in the case of prolactin-secreting pituitary adenoma (prolactinoma).

In 50 % of those having high prolactin levels there is radiological changes in the sella turcica.

Head engagement - it is defined as when the widest part [ususally the bi-parietal-diameter] has passed through the pelvic inlet into the pelvic cavity.

If 3/5 of the baby's head is still palpable, it indicates that the head has not yet engaged in the pelvis.

Incorrect options-

• Zero station- presenting part at the level of ishial spine, which is a sign of engagement.
• Crowning of the head- widest part of the baby's head is visible at vaginal opening, signifies engagement.
• BPD at ischial spine- hallmark of head engagement.

After the insertion of IUCD there is a slight increase in the chance of suffering from bacterial vaginosis. This is because the insertion procedure can disrupt the normal balance of bacteria in the vagina.

Symptoms-

• Thin, gray, or white discharge.
• Itching or burning sensation.
• Abdominal discomfort or pain.

Edema of lower limbs during pregnancy is quiet common, especially towards the later stages. However, excessive edema may be indicative of preeclampsia.

Loop diuretics have the tendency to cause hypovolemia, electrolyte imbalance which can have adverse effect on both mother and fetus.So, the best management is to stop both diuretics and at the same time evaluate the cause of the edema.

During pregnancy hormanal changes and the increased pressure that is exerted by the growing fetus can lead to worsening of the symptoms of hiatal hernia.

Both history of DVT and breast cancer are absolute contraindication, but in history DVT is more accurate.

Increasing urerine tone in a patient with placenta previa is a significant concern, as it is indicative of onset of labor or placental abruption both of which are serious complications.

One of the concerning risks of postpartum psychosis is the risk of recurrence in subsequent pregnancies.Women who have experienced psychosis once are at a higher risk of experiencing it again in future pregnancies. 

If the Pap smear is unsatisfactory due to inadequate sampling or other obscuring factors like, inflammation, and there are no other risk factors, it's reasonable to repeat the test in a year. This allows for potential issues to be resolved and a more accurate evaluation to be performed 

Laboratory findings include-

• Ketonuria
• Increased urine specific gravity
• Elevated hematocrit and BUN level
• Hyponatremia ,Hypokalemia , Hypochloremia
• Metabolic alkalosis.

In this scenario, the most important measure is to have the IUD removed by an OB/GYN.

• Even if the IUD is partially expelled, it increases the risk of infection, miscarraige, or premature labor. Therefore it's crucial to remove it to minimize these risks.

Home pregnancy tests detect the presence of the hormone hCG in urine. After implantation the, hCG levels start to rise rapidly. Most of the home pregnancy test kits are designed to detect hCG levels around 1 week before your expected period.

Uterine fiboids are benign tumors that grow in the uterus and are a common cause of heavy menstrual bleeding and pelvic pain. The precense of uterine mass further supports the diagnosis.

Incorrect options-

• Adenomyosis- can cause mennorhagia, but do not present with abdominal mass.
• Endometriosis- can cause pelvic pain, irregular bleeding but not associated with abdominal mass.
• PID- can cause pelvic pain, irregular bleeding, but is not associated with abdominal mass.

DUB is the most likely diagnosis in this scenario. It refers to abnormal uterine bleeding that occurs in the abscence of any identifiable underlying medical causes.

Pelvic ultrasound is the preferred initial diagnostic tool for ectopic pregnancy dur to its high specificity and senstivity.

Types of vaginitis:

• Bacterial Vaginosis -->Gardnerella
• Vaginal candidiasis --> Candida
• Trichomoniasis -->Trichomonas vaginitis.

This refers to normal, healthy vaginal discharge produced by the body. It can vary in consistency and amount depending upon the hormonal cycle. 

Pyogenic granuloma is a benign vascular tumor that can grow during pregnancy, it is considered a pregnancy tumor because of its emergence in the mouth area. 

Ectopic pregnancy is the most common cause of pregnancy-related death during the first trimester. In this condition, the fertilized egg implants outside the uterus, typically in the fallopian tube. This can lead to severe internal bleeding and potentially life-threatening complications if not diagnosed and treated promptly.

Monilial vaginal discharge, also known as candida vulvovaginitis, is a yeast infection caused by overgrowth of the fungus Candida albicans. Miconazole is an antifungal medication that comen in various forms, including cream. Using it for 7 days effectively treats the infection by causing cell wall disruption.

According to the given scenario-

• The vaginal pH is 5 [acidic] which is the ideal environment for candida to thrive.
• Itching and discharge are common symptoms of yeast infection.
• Pseudo-hyphae on culture strongly supports the diagnosis of candida albicans.

Pregnancy, breastfeeding, mental stress, sleep, hypothyroidism, and use of prescription drugs are the most common causes of hyperprolactinemia.

In men, the most common symptoms of hyperprolactinemia are - decreased libido, erectile dysfunction, infertility, and gynecomastia.

While ectopic pregnancy can occur in the ovary [about 0.5-1% cases], the statement that it accounts for 20% is incorrect. The most common site of ectopic pregnancy is fallopian tube.

Sites-

• Isthmus [10-12%]
• Fimbrial end [5%]
• Interstitial/ cornual [2-4%]
• Ovary [0.5-1%]
• Abdomen [<1%]
• Cervix [rare <1%]

Paroxetine is a SSRI antidepressant that is effective in treating hot flashes associated with menopause. It works by regulating serotonin levels in the brain, which can reduce the frequency and severity of hot flashes.

Obstructed labor occurs when the passage of baby is hampered through the birth canal due to physical blockage. This can lead to prolonged labor. Caput succedaneum and excessive molding of the baby's head are common signs of obstructed labor. Thses indicate that the baby's head has been pressing against the cervix for an extended period causing pressure and deformation.

The presence of pseudo hyphae in the discharge is strongly suggestive of infection by Candida albicans.

• Miconazole cream is an antifungal medication that is effective against Candida.

Rifampicin is the recommended treatment for prophylaxis of close contacts of individuals with meningococcal meningitis.

[Ciprofloxacin is contraindicated in pregnancy].

Presence of ''strawberry cervix'' is highly suggestive of Trichomonas vaginalis infection.Trichomonas vaginalis is a protozoan that causes STI.

[strawberry cervix- a cervix with small, red petechiae]

Incorrect options-

• STIs like chlamydia and gonorrhea can cause discharge and cervicitis but lack the characterstic feature of strawberry cervix appearance.
• HSV causes genital ulcers and dischrge but not strawberry cervix.

HSV 2 while a sexually transmitted infection, it is primarily associated with genital herpes and is not a typical cause of IUGR.

Other options-

Toxoplasmosis, CMV, and rubella can cross the placenta and cause IUGR in the developing fetus. They can interfere with the proper growth and development of fetus.

Erythromycin, 500 mg four times daily for seven days, is the treatment of choice during pregnancy & lactation.

Oxytocin is the first-line drug for the management of PPH. It stimulates uterine contractions, which help compress the blood vessels and reduce bleeding. It is routinely used in active management of the third stage of labor to prevent PPH.

Misoprostol, a prostaglandin, is an alternative to oxytocin particularly in low-resource settings where oxytocin might not be available, it is considered a second- line option.

Incorrect options-

• Warfarin- is an anticoagulant, it would worsen the bleeding.
• Aspirin - it is also an antiplatelet and anticoagulant agent and will increase the risk of bleeding.

In the given scenarion the placenta is located close to the cervix but not completely covering the cervical opening. In case of mild bleeding and a favourable cervical dilation spontaneous vaginal delivery can be considered.

This decision would depend on several factors, including the severity of bleeding, fetal well-being, and the mother's overall health.

While severe mitral regurgitation is a serious condition, it can often be managed during pregnancy, with careful monitoring and medical treatment.

Stein-Leventhal syndrome is the other name for PCOS, and is characterized by the triad of hirsuitism, obesity, and infertility. The precense of multiple ovarian follicle on ultrasound is a hallmark feature of PCOS.

The most likely cause of the described symptoms is HSV. Genital herpes often presents with clusters of small, painful blisters on the genitals. The characterstick rose-red base is also typical feature of herpes.

Incorrect options-

• Syphills- painless chancre at site of infection
• Chancroid- painful soft sore on the genitals
• HPV- painless, cauliflower like growths

Placenta previa occurs when the placenta partially or completely covers the cervical opening. In this case the per vaginal examination reveals that the placenta is not covering the cervix as the examiner's finger cannot reach the placenta.

Anterolateral placenta means that the placenta is located on the anterior and towards one lateral side. This is the normal position of placenta.

The women in the given scenario is experiencing symptoms of menopause. While HRT with estrogen and progesterone can help alleviate few symptoms, it is not the first-line treatment for all menopausal women.

Fluoxetine is an antidepressant medication that is effective in treating menopausal symptoms by increasing the level of serotonin in the brain, which can also help to improve mood and reduce anxiety.

Ovarian cancer is also called the serial killer as it develops without any noticeable symptoms in its early stages. By the time symptoms appear the cancer may have already spread, making it difficult to treat.

The scenario is a classic presentation of of gonorrhea, a sexually transmitted infection caused by bacterium Neisseria gonorrhoeae.

The prescnce of gram-negative diplococci within cells strongly suggests diagnosis of gonococcal infection.

Toxoplasmosis can be transmitted to the fetus through the placenta. In pregnant women especially during the first trimester, toxoplasmosis can lead to severe complications of the fetus such as abortion, still birth, and severe birth defects.

Incorrect options-

• HIV- can be managed by ART , reducving the risk of transmission and severe complication.
• Rubella-  can lead to congenital rubella syndrome, but is preventable by vaccine.
• Measeles- can increase risk of abortion, premature birth, and low birth but is preventable by vaccination.

Colonoscopy is a procedure in whcih a special magnifying instrument with a light source attached to it is used to examine the cervix and vagina for any abnormalities. It is the next step in evaluating atypical squamous cells detected on PAP smear.

Endometriosis is a condition where endometrial tissue grows in places other than the uterine cavity, such as ovaries, fallopian tubes, or even other organs. This tissue at abnormal sites can lead to a variety of symptoms, including-

Dysmenorrhea, amenorrhea, and infertility.

It is an opioid medication used to treat pain .It causes hyperkalemia as a side effect.Therefore it is the only contraceptive drug listed that can cause hyperkalemia.

In early pregnancy USG is the most accurate test to confirm pregnancy. Along with confirmation it gives infomation regarding various other parameters related to the fetus including- estimated gestational age, EDD, fetal viability ,etc.

Incorrect options-

• CBC - gives info about the overall health of mother
• Urine pregnancy test- It can confirm pregnancy but does not provide information about fetal development
• MRI- not typically done

Premenstrual syndrome: is defined as a symptoms complex of physiological and emotional symptoms severe enough to interfere with everyday life and occur cyclically during the luteal phase of menses.

Premenstrual dysphoric disorder: is a severe form of premenstrual syndrome characterized by severe recurrent depressive and anxiety symptoms with premenstrual (luteal phase) onset that remit a few days after the start of menses.

Melasma is a common skin condition that causes brown patches on the face, often triggered by hormonal changes, sun exposure or certain medications

Cervical assessment is a crucial part of managing a woman who has expreienced a spontaneous abortion. It helps to determine the cause of abortion and assess the risk of future complications.

Incorrect options-

• 30-40% of pregnancies end with of miscarrriage- not accurate
• Most of them happen in the seconfd trimester- most of them acually occur in first trimester.
• Most of them happen in third trimester-  less common in third trimester.

FAS can lead to LBW and small head size.

• Facial abnormalities- smooth philtrum, thin upper lip and small eye opening.
• CNS abnormalities- intellectual disability, poor coordination, and behavioural issues.

Sheehan's syndrome is a condition that occurs due to severe blood loss or low blood pressure during or after childbirth, leading to pituitary gland damage. Since the pituitary glad is the powerhouse of hormone regulation, its damage can result in secondary amenorrhea.

Incorrect options-

• Due to gonadal agenesis- related to primary amenorrhea.
• It's always pathological- It can be due to non- pathological causes like pregnancy, stress, or lactation.
• Causes infertility- it is not directly linked to causing infertility.

Herpes infection during pregnancy can pose risk to newborn, such as neonatal herpes.If the mother has an active infection around the time of delivery, a C-section is recommended to prevent the virus from being transmitted to the baby during delivery.

ASCUS on PAP smear is indicative of abnormal cells in cervix. If any suspicious areas are found during coloscopy, a biopsy can be taken to determine the malignant potential of the cells.

Incorrect options-

• Biopsy- performed after colposcopy.
• VDRL - done for screening of STD's.
• CBC- not done for ASCUS.

Post-coital bleeding and precense of cervical mass are strong indicators of malignant potential.

Direct biopsy is the most appropriate step to obtain tissue sample and perform further evaluation. This will help determine the nature of the mass.

Incorrect options-

• Cone biopsy- it's an extensive procedure and is usually done after diagnosis of cervical cancer that has been confirmed through direct biopsy.
• Pap smear- it's a screening test for cervical cancer.
• Colposcopy-  it can help identify abnormal areas but is not a diagnostic test.

Salpingitis is the inflammation of the fallopian tubes often caused by infections like chlamydia or gonorrhea. Scarring due to inflammation caused by these infective agents leads to the blokage of fallopian tubes, preventing the fertilized egg from reaching the uterine cavity leading to ectopic pregnancy.

The precence of a uterine fibroid in a female during pregnancy is not always indicative of an immediate intervention, especially if the women is asymptomatic. In the above mentioned scenario the main concern for which the female presented to the clinic is abdominal pain. Pain management methods such as over-the-counter pain relievers or stronger medications would be the appropriate first-step in her management.

Magnesium- sulfate is the first- line drug used to treat seizures associated with eclampsia. it stabalizes the neuronal membranes and acts as a CNS depressant.

[ Remember-in eclampsia it ''treats seizure'', in severe preeclampsia it ''prevents seizure''].