UPSC-CMS 2016 - Obstetrics and Gynecology Practice Questions

Q: An adolescent girl with stage 1a dysgerminoma is managed by:

Unilateral salpingo-oophorectomy alone. ***Unilateral salpingo-oophorectomy alone*** - For **stage 1a dysgerminoma**, which is confined to one ovary, **fertility-sparing surgery** with unilateral salpingo-oophorectomy is the standard treatment, especially in young patients. - This approach aims to preserve reproductive function while effectively treating the localized tumor, given the **high radiosensitivity** and **chemosensitivity** of dysgerminomas. *Chemotherapy* - While dysgerminomas are sensitive to chemotherapy, it is typically reserved for **advanced stages** (stage 1c or higher), **recurrent disease**, or cases with **residual disease** after surgery. - It is not the primary treatment for **stage 1a disease** when complete surgical resection is achievable, especially when fertility preservation is desired. *Bilateral salpingo-oophorectomy alone* - This procedure would remove both ovaries and fallopian tubes, leading to **sterility and premature menopause**. - It is an **over-treatment** for stage 1a dysgerminoma, as the disease is localized to one ovary, and it is not fertility-sparing. *Total abdominal hysterectomy with unilateral salpingo-oophorectomy* - This extensive surgery involves the removal of the uterus and one ovary/fallopian tube, rendering the patient **infertile**. - It is an **overly aggressive** approach for stage 1a dysgerminoma in an adolescent girl, as the uterus is not involved, and fertility preservation is a crucial consideration.

Q: Which of the following conditions is best treated by a posterior colpotomy?

Pelvic abscess. ***Pelvic abscess*** - A **posterior colpotomy** allows for direct access and drainage of a pelvic abscess located in the **cul-de-sac** (pouch of Douglas). - This minimally invasive surgical approach provides effective relief for loculated pelvic infections. - **Most definitive indication** for posterior colpotomy as it allows complete drainage of purulent material. *Pyosalpinx* - Refers to a pus-filled fallopian tube, which is typically located **laterally to the uterus** and not easily accessible via a posterior colpotomy. - Drainage of a pyosalpinx usually requires a **laparoscopic or open abdominal approach**. *Pyometra* - Characterized by **pus accumulation within the uterine cavity**, which is drained via the cervix, not the posterior vaginal fornix. - **Cervical dilation** and drainage are the primary treatment, not colpotomy. *Pelvic haematocele* - Involves a collection of **blood in the pelvic cavity**, often within the cul-de-sac. - While technically accessible via colpotomy, **pelvic haematoceles are usually managed conservatively** or require laparoscopy to identify and control the bleeding source. - Colpotomy drainage alone is insufficient as it doesn't address the underlying cause of bleeding.

Q: Menopause is associated with the following except:

Delusion. ***Delusion*** - Delusions are a feature of **psychotic disorders** and are not directly associated with the physiological changes of menopause. - While menopause can affect mood and cognitive function, it does not typically cause **psychotic symptoms** like delusions. *Loss of libido* - The decline in **estrogen levels** during menopause can lead to vaginal dryness and discomfort during intercourse, which can contribute to a loss of libido. - Hormonal changes also directly impact sexual desire, making it a common menopausal symptom. *Ischemic heart disease* - Estrogen has a **cardioprotective effect**, and its decline after menopause increases women's risk for **ischemic heart disease**. - The absence of estrogen contributes to changes in lipid profiles and endothelial function, predisposing women to cardiovascular events. *Osteoporosis* - Estrogen plays a crucial role in maintaining **bone density**, and its reduction during menopause accelerates bone loss. - This loss of bone mass significantly increases the risk of **osteoporosis** and fractures in postmenopausal women.

Q: Which one of the following conditions simulates the menstrual pattern of pain?

Adenomyosis. ***Adenomyosis*** - Adenomyosis is characterized by the presence of **endometrial tissue within the myometrium**, which responds cyclically to hormonal changes, similar to normal endometrium. - This leads to **dysmenorrhea** (painful periods) and **menorrhagia** (heavy bleeding) due to the cyclic growth and shedding of endometrial tissue within the uterine muscular wall. *Intramural fibroid* - Intramural fibroids are **benign uterine tumors** within the muscular wall that can cause heavy bleeding and pressure symptoms. - While they can cause pain and heavy bleeding, the pain is typically not directly related to a **menstrual pattern of cyclic pain** in the same manner as adenomyosis, as the fibroid tissue itself does not undergo cyclic shedding. *Granulosa cell tumour of ovary* - This is a **sex cord-stromal tumor** of the ovary that often produces **estrogen**, which can lead to irregular uterine bleeding or postmenopausal bleeding. - It does not directly cause pain that simulates a **regular menstrual pattern**, as its hormonal effects are typically sustained or irregular, not cyclic in the way normal menstruation or adenomyosis pain is. *Haematometra* - Haematometra is the accumulation of **menstrual blood within the uterus** due to an obstruction of the outflow tract, such as cervical stenosis. - This condition causes increasing pain and distension as blood accumulates, but the pain is usually **constant or progressively worsening**, not cyclic in a pattern that simulates normal menstruation, and typically leads to **amenorrhea** rather than patterned bleeding.

Q: Which of the undermentioned conditions does not cause postmenopausal vaginal bleeding?

Benign cystic teratoma of ovary. ***Benign cystic teratoma of ovary*** - A **benign cystic teratoma** of the ovary is a germ cell tumor that typically does **not cause hormonal changes** leading to vaginal bleeding. - While it can cause symptoms such as **abdominal pain** or a palpable mass, it is not directly associated with postmenopausal vaginal bleeding. *Carcinoma of cervix* - **Cervical cancer** is a well-known cause of both **intermenstrual** and **postmenopausal vaginal bleeding**, especially following intercourse. - The abnormal growth of cells on the cervix can be fragile and bleed easily, leading to the symptom. *Senile vaginitis* - Also known as **atrophic vaginitis**, this condition occurs due to the **thinning and inflammation** of the vaginal walls due to decreased estrogen levels after menopause. - The fragile, dry tissues can easily tear and bleed, leading to postmenopausal bleeding or spotting. *Prolapse of uterus with decubitus ulcer* - A **decubitus ulcer** can form on the prolapsed cervix or vaginal wall due to **chronic friction and irritation**, particularly in cases of severe uterine prolapse. - The raw, ulcerated surface readily **bleeds**, especially with minor trauma or straining, causing postmenopausal vaginal bleeding.

Q: For a woman who has had unprotected intercourse two days ago, which one of the following emergency contraceptive methods is LEAST preferred as first-line emergency contraception?

Yuzpe regimen. ***Yuzpe regimen*** - The **Yuzpe regimen** uses higher doses of combined oral contraceptive pills, leading to more side effects like nausea and vomiting and generally lower efficacy compared to newer methods. - It involves taking two doses of estrogen and progestin, making it less convenient and less effective, especially after **48 hours**, compared to progestin-only or ulipristal acetate pills. *Levonorgestrel 1.5 mg* - **Levonorgestrel (LNG)** 1.5 mg, taken as a single dose, is a highly effective and widely recommended first-line emergency contraceptive within **72 hours** of unprotected intercourse. - It primarily works by **inhibiting or delaying ovulation**, without causing significant side effects in most women. *LNG IUD* - While an **LNG IUD** can be used as emergency contraception, it is not typically considered a first-line *oral* method; it is placed by a healthcare provider and can provide long-term contraception. - It is effective if inserted within **5 days** of unprotected intercourse, making it a highly effective option that also offers ongoing contraception. *Ulipristal acetate* - **Ulipristal acetate (UPA)** is a highly effective emergency contraceptive, even up to **120 hours (5 days)** after unprotected intercourse. - It works by delaying or inhibiting ovulation and is generally more effective than levonorgestrel, especially when taken more than **72 hours** post-coitally.

Q: Deep transverse arrest of head in labour occurs in:

Android pelvis. ***Android pelvis*** - An **android pelvis** has a heart-shaped inlet with a narrow forepelvis, causing the fetal head to engage in a transverse or occiput posterior position. - The narrow midpelvis and convergent side walls in an android pelvis can lead to deep **transverse arrest**, as the fetal head cannot easily rotate to the anterior position. *Anthropoid pelvis* - The **anthropoid pelvis** is characterized by a long anteroposterior diameter and a relatively narrow transverse diameter. - This pelvic shape typically favors engagement in the **occiput anterior** or **occiput posterior** positions, making deep transverse arrest less common. *Platypelloid pelvis* - A **platypelloid pelvis** has a wide transverse diameter and a very short anteroposterior diameter, leading to a flattened shape. - This shape often results in the fetal head engaging in the **transverse position**, but arrest usually occurs at the inlet rather than deep in the pelvis, or the head fails to engage at all. *Gynaecoid pelvis* - The **gynaecoid pelvis** is considered the ideal female pelvis, with a rounded inlet and adequate diameters in all planes. - This shape allows for easy engagement and rotation of the fetal head, making deep **transverse arrest** very unlikely.

Q: Early deceleration of foetal heart rate in labour is due to:

Foetal head compression. ***Foetal head compression*** - **Early decelerations** are a direct result of **foetal head compression** during uterine contractions, leading to increased intracranial pressure. - This pressure causes a **reflex vagal response**, resulting in **slowing of the foetal heart rate** which mirrors the contraction pattern. *Hyperpyrexia* - **Maternal hyperpyrexia** typically causes **foetal tachycardia**, which is an elevated heart rate, not deceleration. - This is a response to the increased maternal and foetal metabolic rate and can be a sign of infection. *Umbilical cord compression* - **Umbilical cord compression** usually leads to **variable decelerations**, which are sharp, abrupt drops in heart rate not uniformly related to contractions. - This occurs due to transient occlusion of the umbilical vessels, reducing blood flow to the foetus. *Congenital heart block* - **Congenital heart block** is a persistent bradycardia (slow heart rate) that is present throughout labour and is not directly linked to uterine contractions. - It is a structural abnormality of the foetal cardiac conduction system.

Q: McRoberts manoeuvre is used during labour for management of:

Shoulder dystocia. ***Shoulder dystocia*** - **McRoberts manoeuvre** involves sharp flexion of the maternal thighs against the abdomen, which straightens the **sacrum** and rotates the **symphysis pubis** anteriorly. - This maneuver increases the functional size of the pelvic outlet and helps to dislodge the impacted fetal shoulder in cases of **shoulder dystocia**. - It is the **first-line intervention** for managing shoulder dystocia and is successful in resolving the majority of cases. *Delivery of after coming head of breech* - Management of an after-coming head in breech delivery typically involves maneuvers like the **Mauriceau-Smellie-Veit** maneuver or **Prague maneuver**. - **McRoberts manoeuvre** does not directly facilitate the delivery of the fetal head in a breech presentation. *Normal labour to assist extension of head* - In normal labor, the fetal head typically delivers by **extension** as it passes under the symphysis pubis, and no specific maneuver is usually required. - McRoberts manoeuvre is a specific intervention for a complication (**shoulder dystocia**), not a routine aid for head extension during normal delivery. *Extended arms of breech during assisted breech delivery* - Extended arms in a breech presentation are managed by maneuvers designed to free the arms, such as **Løvset's maneuver**. - **McRoberts manoeuvre** primarily addresses shoulder impaction, not arm entrapment in breech delivery.

Q: Which one of the following is not a suitable condition for outlet forceps application?

Head is above ischial spine level. ***Head is above ischial spine level*** - For **outlet forceps** application, the fetal head must be engaged, meaning the **leading point of the skull** is at or below the **level of the ischial spines (+2 station or lower)**. - If the head is above the ischial spines, it indicates a higher station, making **outlet forceps** an inappropriate and potentially dangerous choice, as it could lead to fetal or maternal injury. *Cervix fully dilated* - This is a **prerequisite** for any type of **forceps delivery**, including outlet forceps. - Performing forceps delivery with a partially dilated cervix risks severe **cervical lacerations** and other maternal complications. *Membranes absent* - This condition refers to **ruptured membranes**, which is a **necessary condition** for safe forceps application. - Intact membranes would prevent proper application of the forceps blades to the fetal head and increase the risk of **fetal scalp injury**. *Vertex presentation* - **Outlet forceps** are primarily used for **vertex presentations** (head-first), where the fetal head is oriented optimally for delivery. - Other presentations, such as **breech** or **transverse**, are **contraindications** for outlet forceps and typically require **cesarean section** or other delivery methods.

Question 1

An adolescent girl with stage 1a dysgerminoma is managed by:

Accepted Answer

Unilateral salpingo-oophorectomy alone

Answer

Chemotherapy

Answer

Bilateral salpingo-oophorectomy alone

Answer

Total abdominal hysterectomy with unilateral salpingo-oophorectomy

Question 2

Which of the following conditions is best treated by a posterior colpotomy?

Accepted Answer

Pelvic abscess

Answer

Pyosalpinx

Answer

Pyometra

Answer

Pelvic haematocele

Question 3

Menopause is associated with the following except:

Accepted Answer

Delusion

Answer

Loss of libido

Answer

Ischemic heart disease

Answer

Osteoporosis

Question 4

Which one of the following conditions simulates the menstrual pattern of pain?

Accepted Answer

Adenomyosis

Answer

Intramural fibroid

Answer

Granulosa cell tumour of ovary

Answer

Haematometra

Question 5

Which of the undermentioned conditions does not cause postmenopausal vaginal bleeding?

Accepted Answer

Benign cystic teratoma of ovary

Answer

Carcinoma of cervix

Answer

Senile vaginitis

Answer

Prolapse of uterus with decubitus ulcer

Question 6

For a woman who has had unprotected intercourse two days ago, which one of the following emergency contraceptive methods is LEAST preferred as first-line emergency contraception?

Accepted Answer

Yuzpe regimen

Answer

Levonorgestrel 1.5 mg

Answer

LNG IUD

Answer

Ulipristal acetate

Question 7

Deep transverse arrest of head in labour occurs in:

Accepted Answer

Android pelvis

Answer

Anthropoid pelvis

Answer

Platypelloid pelvis

Answer

Gynaecoid pelvis

Question 8

Early deceleration of foetal heart rate in labour is due to:

Accepted Answer

Foetal head compression

Answer

Hyperpyrexia

Answer

Umbilical cord compression

Answer

Congenital heart block

Question 9

McRoberts manoeuvre is used during labour for management of:

Accepted Answer

Shoulder dystocia

Answer

Delivery of after coming head of breech

Answer

Normal labour to assist extension of head

Answer

Extended arms of breech during assisted breech delivery

Question 10

Which one of the following is not a suitable condition for outlet forceps application?

Accepted Answer

Head is above ischial spine level

Answer

Cervix fully dilated

Answer

Membranes absent

Answer

Vertex presentation

UPSC-CMS 2016 — Obstetrics and Gynecology