UPSC-CMS 2014 Practice Questions

Q: Treatment of choice in 28 year old nullipara with third degree cervical descent is:

Abdominal cervicopexy. ***Abdominal cervicopexy (Sacrohysteropexy)*** - For a **28-year-old nullipara**, **fertility preservation is paramount** as she may desire future pregnancies. - **Abdominal cervicopexy** (or sacrohysteropexy) suspends the uterus to the sacral promontory using mesh, effectively correcting third-degree uterine prolapse while **preserving the uterus and fertility potential**. - This is the **treatment of choice** in young women with significant pelvic organ prolapse who wish to maintain reproductive capability. - Has high success rates (>90%) with good anatomical outcomes and allows for future vaginal delivery in most cases. *Vaginal hysterectomy with PFR* - While this provides definitive surgical correction of prolapse, it **permanently eliminates fertility**. - This would be inappropriate as first-line treatment for a 28-year-old nulliparous patient unless she explicitly declines uterine preservation. - Reserved for patients who have **completed childbearing** or have additional indications for hysterectomy. *Fothergill's repair (Manchester repair)* - Involves cervical amputation, cardinal ligament shortening, and anterior colporrhaphy. - Although it preserves the uterus, it is **less effective for high-grade prolapse** (third degree) and may compromise fertility due to cervical amputation. - Has largely been replaced by modern uterine suspension procedures like sacrohysteropexy. *Anterior and posterior colporrhaphy* - Repairs **cystocele and rectocele** (vaginal wall defects) but **does not address uterine/cervical descent**. - Would be inadequate as sole treatment for third-degree uterine prolapse, though may be performed as adjunctive procedures.

Q: A G 2 P 1 A 0 presents with full term pregnancy with transverse lie in the first stage of labour. On examination, cervix is 5 cm dilated, membranes are intact and foetal heart sounds are regular. The appropriate management would be:

Caesarean section. ***Caesarean section*** - A **transverse lie** at term in the first stage of labor is a contraindication to vaginal delivery due to the high risk of **cord prolapse**, **uterine rupture**, and fetal distress. - **Caesarean section** is the safest mode of delivery for both mother and fetus in this scenario, as it prevents these complications. *External cephalic version* - **External cephalic version** is typically attempted in cases of **breech presentation** in the late third trimester (around 36-37 weeks) to convert it to a cephalic presentation. - It is **contraindicated** in transverse lie during active labor, especially with cervical dilation, as it has a low success rate and can lead to complications such as **placental abruption** or **cord prolapse**. *Internal podalic version* - **Internal podalic version** is a procedure typically reserved for the delivery of the second twin in a **transverse or oblique lie**, or in some cases of breech presentation. - It carries significant risks, including **uterine rupture** and fetal injury, and is generally not performed for a singleton pregnancy with cervical dilation. *Wait for spontaneous evolution and expulsion* - **Spontaneous evolution** (where the fetus rotates to a longitudinal lie) is extremely rare in a transverse lie presentation at term, especially once labor has started. - Waiting for spontaneous rotation would lead to **prolonged labor**, increased risk of **uterine rupture**, and severe fetal compromise due to obstruction.

Q: Absolute contraindication for the use of OCPs is:

Thromboembolism. ***Thromboembolism*** - A **current or past history of thromboembolism** (e.g., DVT, pulmonary embolism) is an **absolute contraindication (WHO MEC Category 4)** for combined oral contraceptive pills (OCPs) due to the significantly increased risk of recurrent thrombotic events. - Exogenous **estrogen** in OCPs increases the synthesis of clotting factors (II, VII, IX, X, fibrinogen) and decreases anticoagulant proteins (protein S, antithrombin), thereby promoting a hypercoagulable state. - Even a remote history of VTE makes OCPs absolutely contraindicated. *Diabetes* - Diabetes **with vascular complications** (retinopathy, nephropathy, neuropathy) or diabetes of >20 years duration is a contraindication (WHO MEC Category 3/4). - However, **uncomplicated diabetes without vascular disease** is not an absolute contraindication for OCPs. - Among the options listed, thromboembolism is the clearest absolute contraindication. *Epilepsy* - Epilepsy itself is **not a contraindication** for OCPs (WHO MEC Category 1). - However, some **enzyme-inducing antiepileptic drugs** (phenytoin, carbamazepine, phenobarbital, topiramate) can reduce OCP efficacy by increasing hepatic metabolism of contraceptive hormones. - In such cases, higher-dose OCPs, alternative methods, or non-enzyme-inducing AEDs should be considered. *Hypertension* - **Severe or uncontrolled hypertension** (≥160/100 mmHg) or hypertension with vascular disease is an absolute contraindication (WHO MEC Category 4). - **Adequately controlled and monitored hypertension** is a relative contraindication (WHO MEC Category 3), not an absolute one. - Among the given options, thromboembolism represents a clearer and more universally accepted absolute contraindication.

Q: Rokitansky-Küster-Hauser syndrome is associated with:

All of the options. ***All of the options*** Rokitansky-Küster-Hauser (MRKH) syndrome is associated with **all three features** listed, making this the correct answer. **Primary amenorrhea with Müllerian agenesis:** - This is the **hallmark feature** of MRKH syndrome - Müllerian agenesis leads to **absent or underdeveloped uterus and upper two-thirds of vagina** - Patients present with **primary amenorrhea** despite normal pubertal development - The external genitalia and lower vagina are normal **Normal hormone profile:** - MRKH syndrome patients have **functioning ovaries** with normal oogenesis - **Normal 46,XX karyotype** - **Normal FSH, LH, estrogen, and progesterone levels** - Normal development of **secondary sexual characteristics** (breast development, pubic hair, normal height) - This distinguishes MRKH from androgen insensitivity syndrome **Renal abnormalities:** - Present in **15-30% of MRKH type 1** cases - Present in **up to 50% of MRKH type 2** (MURCS association - Müllerian, Renal, Cervicothoracic Somite abnormalities) - Common anomalies include **renal agenesis** (unilateral or bilateral), **ectopic kidney**, **horseshoe kidney**, and **hydronephrosis** - Renal ultrasound is recommended as part of initial evaluation **Why "All of the options" is correct:** All three features—primary amenorrhea with Müllerian agenesis, normal hormone profile, and renal abnormalities—are characteristic associations of MRKH syndrome, making this the most complete and accurate answer.

Q: The level of external cervical os in a second degree utero vaginal prolapse is:

Introitus. ***Introitus*** - In a **second-degree uterovaginal prolapse**, the external cervical os descends to the level of the introitus (hymenal ring). - The cervix reaches the vaginal opening but does not extend beyond it, typically becoming visible during straining or examination. - This is the defining characteristic of second-degree prolapse. *Between ischial spines and introitus* - This description refers to a **first-degree uterovaginal prolapse**, where the cervix descends into the lower vagina but remains above the introitus. - The external os has not yet reached the **introitus** and remains within the vaginal canal. *3 cm outside introitus* - This indicates a **third-degree uterovaginal prolapse (procidentia)**, where the cervix and entire uterus descend completely outside the vagina. - The measurement of 3 cm outside the introitus represents significant prolapse beyond the vaginal opening. *At the level of ischial spines* - The **ischial spines** serve as the anatomical zero point in the POP-Q (Pelvic Organ Prolapse Quantification) staging system. - If the external cervical os is at the level of the ischial spines, this represents minimal or no prolapse, as the cervix is in its normal anatomical position high in the vagina.

Q: Which one of the following is not an epithelial tumour of the ovary?

Endodermal sinus tumour. ***Endodermal sinus tumour*** - This is a type of **germ cell tumor** of the ovary, not an epithelial tumor. - It is characterized by the presence of **Schiller-Duval bodies** and elevated **alpha-fetoprotein (AFP)** levels. *Clear cell tumour* - This is a well-recognized sub-type of **epithelial ovarian cancer**, often associated with **endometriosis** [1]. - The histology typically shows cells with clear cytoplasm, sometimes arranged in glandular or tubulocystic patterns [1]. *Serous cystadenoma* - This is a common **benign epithelial tumor** of the ovary, characterized by cysts lined by serous epithelium [2]. - It arises from the **surface epithelium** of the ovary. *Brenner's tumour* - This is a less common but distinct type of **epithelial ovarian tumor**, characterized by nests of **transitional epithelial cells** resembling bladder urothelium [3]. - It is usually **benign** and often discovered incidentally [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1032. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 478-480. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1032-1033.

Q: In which of the following is the term low and high grade squamous intraepithelial neoplasia used?

Bethesda classification. ***Bethesda classification*** - The Bethesda classification system is used for reporting **cervical cytology** results (Pap test) [1]. - It categorizes squamous cell abnormalities into **low-grade squamous intraepithelial lesion (LSIL)** and **high-grade squamous intraepithelial lesion (HSIL)** [1]. *Shaw's classification* - **Shaw's classification** is not a recognized system for reporting cervical cytopathology. - This term does not apply to the categorization of squamous intraepithelial neoplasia. *FIGO staging* - **FIGO (International Federation of Gynecology and Obstetrics) staging** is used for the clinical staging of **gynecologic cancers**, not for initial cytological screening results [1]. - It describes the extent of cancer progression, not intraepithelial lesions. *Papanicolaou method* - The **Papanicolaou (Pap) method** refers to the staining technique and the general cytological test for cervical cancer screening [1]. - While it's the test itself, the **interpretation and reporting** of results, including terms like LSIL and HSIL, fall under the Bethesda classification system [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1006-1010.

Q: Cephalhematomas are most commonly found over:

Parietal bone. ***Parietal bone*** - The **parietal bones** are the most common site for cephalhematomas due to their prominence and susceptibility to trauma during vaginal delivery [1]. - The **force of uterine contractions** and contact with the birth canal can cause blood vessels beneath the periosteum of the parietal bone to rupture [1]. *Occipital bone* - While possible, cephalhematomas are less commonly observed over the **occipital bone** compared to the parietal region. - The **occipital protrusion** is less frequently subjected to the specific shearing forces that cause subperiosteal bleeding. *Temporal bone* - Cephalhematomas over the **temporal bone** are rare, primarily because this area is less frequently directly impacted during birth. - The relatively thinner bone and surrounding muscles also provide some protection against the typical trauma leading to this condition. *Frontal bone* - Cephalhematomas are generally uncommon over the **frontal bone**. - This area is less exposed to direct pressure and friction from the maternal pelvis during delivery.

Q: Neo-natal infection in a Hepatitis 'B' positive pregnant woman can be prevented by administering:

Vaccine and Immunoglobulin. ***Vaccine and Immunoglobulin*** - Administering both the **Hepatitis B vaccine** and **Hepatitis B immune globulin (HBIG)** provides both active and passive immunity to the newborn. - This combination is crucial for preventing perinatal transmission of HBV from an infected mother, significantly reducing the risk of the baby becoming a chronic carrier. *Hepatitis 'B' vaccine* - The vaccine alone provides **active immunity**, which takes time to develop, thus not offering immediate protection against acute exposure at birth. - While essential for long-term protection, it's insufficient as a sole measure for newborns at high risk of immediate infection. *Immunoglobulin* - **Hepatitis B immune globulin (HBIG)** provides **passive immunity**, offering immediate but short-term protection. - It contains pre-formed antibodies that neutralize the virus, but it does not confer lasting immunity. *Corticosteroids* - **Corticosteroids** are used as anti-inflammatory or immunosuppressive agents and have no role in preventing viral infections like Hepatitis B. - Their use in this context would be inappropriate and could even be harmful.

Q: Oxytocin is not responsible for:

Milk production. ***Milk production*** - **Oxytocin** is primarily responsible for the **ejection of milk** from the mammary glands, not its production. - **Prolactin** is the hormone chiefly responsible for **milk synthesis** or production. *Uterine involution* - **Oxytocin** plays a crucial role in **uterine contractions** postpartum, which helps the uterus return to its normal size (involution). - These contractions compress blood vessels, reducing **postpartum hemorrhage**. *After pains* - The contractions stimulated by **oxytocin** after childbirth, essential for uterine involution, are often perceived as **'after pains'**. - These pains are more pronounced in **multiparas** and breastfeeding women due to vigorous oxytocin release. *Milk ejection* - **Oxytocin** causes the contraction of **myoepithelial cells** surrounding the alveoli in the mammary glands. - This contraction leads to the **'let-down reflex,'** forcing milk into the ducts and outward through the nipple.

Question 1

Treatment of choice in 28 year old nullipara with third degree cervical descent is:

Accepted Answer

Abdominal cervicopexy

Answer

Fothergill’s repair

Answer

Anterior and posterior colporrhaphy

Answer

Vaginal hysterectomy with PFR

Question 2

A G 2 P 1 A 0 presents with full term pregnancy with transverse lie in the first stage of labour. On examination, cervix is 5 cm dilated, membranes are intact and foetal heart sounds are regular. The appropriate management would be:

Accepted Answer

Caesarean section

Answer

External cephalic version

Answer

Internal podalic version

Answer

Wait for spontaneous evolution and expulsion

Question 3

Absolute contraindication for the use of OCPs is:

Accepted Answer

Thromboembolism

Answer

Diabetes

Answer

Epilepsy

Answer

Hypertension

Question 4

Rokitansky-Küster-Hauser syndrome is associated with:

Accepted Answer

All of the options

Answer

Normal hormone profile

Answer

Primary amenorrhoea with mullerian agenesis

Answer

Renal abnormalities

Question 5

The level of external cervical os in a second degree utero
vaginal prolapse is:

Accepted Answer

Introitus

Answer

Between ischial spines and introitus

Answer

3 cm outside introitus

Answer

At the level of ischial spines

Question 6

Which one of the following is not an epithelial tumour of the ovary?

Accepted Answer

Endodermal sinus tumour

Answer

Clear cell tumour

Answer

Serous cystadenoma

Answer

Brenner’s tumour

Question 7

In which of the following is the term low and high grade squamous intraepithelial neoplasia used?

Accepted Answer

Bethesda classification

Answer

Shaw's classification

Answer

FIGO staging

Answer

Papanicolaou method

Question 8

Cephalhematomas are most commonly found over:

Accepted Answer

Parietal bone

Answer

Occipital bone

Answer

Temporal bone

Answer

Frontal bone

Question 9

Neo-natal infection in a Hepatitis 'B' positive pregnant woman can be prevented by administering:

Accepted Answer

Vaccine and Immunoglobulin

Answer

Hepatitis 'B' vaccine

Answer

Immunoglobulin

Answer

Corticosteroids

Question 10

Oxytocin is not responsible for:

Accepted Answer

Milk production

Answer

Uterine involution

Answer

After pains

Answer

Milk ejection

UPSC-CMS 2014

Obstetrics and Gynecology

Pathology

Pediatrics

Physiology