UPSC-CMS 2009 - Obstetrics and Gynecology PYQs Practice Questions

Q: Consider the following statements: 1. The placenta is usually located in the upper uterine segment. 2. The placenta is usually located in the lower uterine segment. 3. The placenta is usually located in the fundus. 4. The placenta is usually located in the anterior uterine wall. Which one of the statements given above are correct ?

1 and 3 only. ***1 and 3 only*** - The placenta typically implants in the **upper uterine segment** and often extends to the **fundus**, providing a robust blood supply and optimal conditions for fetal growth. - An implantation in the **upper uterine segment** or **fundus** ensures that as the uterus grows, the placenta moves away from the cervix, reducing the risk of placenta previa. *1, 3 and 4* - While the placenta can be located in the **anterior uterine wall**, this is not a universal characteristic as it can also be posterior, lateral, or even fundal. - The core locations for healthy placental implantation are the **upper uterine segment** and **fundus**, which are accurately captured in statements 1 and 3. *1, 2 and 3* - The statement that the placenta is usually located in the **lower uterine segment** (statement 2) is incorrect; this location is associated with **placenta previa**, a complication [1]. - Healthy placental implantation avoids the **lower uterine segment** to prevent issues during labour and delivery. *2 and 3 only* - This option incorrectly states that the placenta is usually located in the **lower uterine segment** (statement 2), which is generally considered abnormal. - While location in the **fundus** (statement 3) is correct, combining it with an incorrect primary location makes this option invalid. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

During labour. ***During labour*** - The **highest risk** of mother-to-child HIV transmission occurs during labor and delivery due to the infant's exposure to maternal blood and genital secretions. - The process of passing through the **birth canal** can lead to inoculation with HIV-infected cells and viral particles. *Third trimester* - While some transmission can occur in the third trimester, the risk is significantly **lower** than during labor. - The placenta generally provides a barrier, though there's a risk of **transplacental passage** if the placental integrity is compromised. *First trimester* - The **lowest risk** of HIV transmission occurs during the first trimester. - The developing fetus is relatively protected by the placenta, and the viral load in maternal blood might be lower compared to later stages without intervention. *During breast feeding* - **Breastfeeding** is a known route of HIV transmission, but its risk is generally **lower per exposure** compared to labor and delivery, especially if the mother is on antiretroviral therapy. - The risk is **cumulative** over the duration of breastfeeding. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What is the most commonly observed fetal effect in women receiving magnesium sulphate therapy for pre-eclampsia/eclampsia ?

Respiratory depression. ***Respiratory depression*** - Magnesium sulfate readily crosses the placenta, leading to elevated magnesium levels in the fetus, which can cause **central nervous system depression** and **respiratory depression** at birth. - This is the **most commonly observed fetal effect**, manifesting as neonatal hypermagnesemia with respiratory compromise, hypotonia, and decreased reflexes. - The effect is due to magnesium's role as a **neuromuscular blocker**, reducing acetylcholine release at the neuromuscular junction. *Intestinal obstruction* - There is no direct link between maternal magnesium sulfate therapy and an increased risk of **fetal intestinal obstruction**. - Intestinal obstruction in neonates is typically associated with **structural anomalies** or conditions like meconium ileus, not magnesium exposure. *Variability in fetal heart rate pattern* - While magnesium sulfate can cause **decreased fetal heart rate variability** as a monitoring finding, this is not the "most commonly observed fetal effect." - Decreased variability is a **transient monitoring change** during therapy, whereas respiratory depression is a direct clinical effect observed at birth. - The question asks for the most common **fetal effect**, and respiratory depression at delivery is more clinically significant and commonly encountered. *Cerebral palsy* - Magnesium sulfate is actually used as a **neuroprotective agent** in preterm births to **reduce the risk of cerebral palsy**. - It does not cause cerebral palsy; rather, it provides fetal neuroprotection when given for preterm labor <32 weeks gestation. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

Consider the following statements:
1. The placenta is usually located in the upper uterine segment.
2. The placenta is usually located in the lower uterine segment.
3. The placenta is usually located in the fundus.
4. The placenta is usually located in the anterior uterine wall.

Which one of the statements given above are correct ?

Accepted Answer

1 and 3 only

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2 and 3 only

Question 2

The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

Accepted Answer

During labour

Answer

Third trimester

Answer

First trimester

Answer

During breast feeding

Question 3

Which one of the following statements is not correct about obstetric cholestasis ?

Accepted Answer

Associated with markedly high bilirubin and raised liver enzymes

Answer

It results in pruritus without rash

Answer

It is an indication of termination of pregnancy at 37 weeks

Answer

Risk of recurrence is high in future pregnancies

Question 4

What is the most commonly observed fetal effect in women receiving magnesium sulphate therapy for pre-eclampsia/eclampsia ?

Accepted Answer

Respiratory depression

Answer

Intestinal obstruction

Answer

Variability in fetal heart rate pattern

Answer

Cerebral palsy

Question 5

Spiegelberg's criteria for diagnosis of ovarian pregnancy include the following except

Accepted Answer

Gestational sac is connected with infundibulopelvic ligament

Answer

Gestational sac must occupy the position of ovary

Answer

Ovarian tissue should be present in the wall of gestational sac on histopathology

Answer

Tube on the affected side must be intact

Question 6

Consider the following markers:

1. Nuchal translucency
2. PAPP-A
3. GTT
4. Inhibin A

Which of the above markers are included in the first trimester screening of Down's syndrome?

Accepted Answer

1 and 2

Answer

2, 3 and 4

Answer

1 and 4

Answer

2 and 3 only

Question 7

The following changes may be seen in pre-eclampsia except

Accepted Answer

Hemodilution

Answer

Thrombocytopenia

Answer

Decreased antithrombin III

Answer

Elevated uric acid

Question 8

"Variable decelerations" on an electronic fetal heart rate monitor imply

Accepted Answer

Umbilical cord compression

Answer

Fetal head compression

Answer

Utero-placental insufficiency

Answer

Fetal anemia

Question 9

What is the maternal risk of using misoprostol for ripening of cervix during induction of labour?

Accepted Answer

Tachysystole/hyperstimulation of uterus

Answer

Bradycardia

Answer

Hypotension

Answer

Tachycardia

Question 10

A 25 year old patient who has had an abortion four months ago has come with the history of profuse vaginal bleeding. On examination uterus is bulky, both the ovaries are enlarged, pregnancy test is positive. What is the probable clinical diagnosis ?

Accepted Answer

Choriocarcinoma

Answer

Ectopic pregnancy

Answer

Incomplete abortion

Answer

Malignant ovarian tumor

UPSC-CMS 2009 — Obstetrics and Gynecology