UPSC-CMS 2018 - Obstetrics and Gynecology Practice Questions

Q: Consider the following presentations: 1. Brow presentation 2. Left mento anterior position 3. Occipito posterior position 4. Breech presentation In which of the above Vaginal delivery is NOT possible?

1 only. ***1 only*** - A **brow presentation** presents the fetal head at an unfavorable diameter (**mentovertical diameter**), making vaginal delivery impossible due to **mechanical obstruction**. - With the brow presenting, the head cannot adequately mold or engage in the maternal pelvis, necessitating a **cesarean section** for safe delivery. *1, 2 and 3* - While **brow presentation** (1) is not amenable to vaginal delivery, **left mento anterior position** (2) generally allows for successful vaginal delivery. - **Occipito posterior position** (3) can often be delivered vaginally, sometimes requiring rotation, making this option incorrect. *4 only* - **Breech presentation** (4) can sometimes be delivered vaginally, although it carries higher risks and often warrants a **cesarean section**, but it is not universally impossible. - This option incorrectly suggests that only breech presentation is impossible for vaginal delivery, while brow presentation is a definitive contraindication. *1 and 3 only* - **Brow presentation** (1) is indeed a contraindication for vaginal delivery. - However, **occipito posterior position** (3) does not inherently preclude vaginal delivery, as many cases can be delivered vaginally, making this option incorrect.

Q: Consider the following statements regarding changes in pregnancy: 1. Plasma volume increases up to 30–50% 2. Pregnancy is a hypercoagulable state 3. Hematocrit is decreased 4. Total plasma protein concentration increases Which of the statements given above is/are correct?

1, 2 and 3 only. ***1, 2 and 3 only*** - **Statement 1 is correct**: Plasma volume increases significantly by **30-50%** during pregnancy, representing a key physiological adaptation. - **Statement 2 is correct**: Pregnancy is inherently a **hypercoagulable state** due to increased clotting factors (I, VII, VIII, IX, X, fibrinogen), decreased protein S, and reduced fibrinolysis—an adaptive mechanism to prevent excessive bleeding during delivery. - **Statement 3 is correct**: Hematocrit **decreases** due to physiological hemodilution; plasma volume increases proportionally more (40-50%) than red blood cell mass (20-30%), resulting in physiological anemia of pregnancy. - **Statement 4 is incorrect**: Total plasma protein concentration actually **decreases** during pregnancy (not increases) due to the hemodilution effect; albumin typically decreases from ~4.0 to ~3.0 g/dL. *1 and 2 only* - While statements 1 and 2 are correct, this option incorrectly excludes **statement 3 (decreased hematocrit)**, which is a well-established physiological change during pregnancy caused by hemodilution. *1 only* - Statement 1 is correct, but this option excludes both the **hypercoagulable state (statement 2)** and **decreased hematocrit (statement 3)**, which are both fundamental pregnancy-related changes. *1, 2, 3 and 4* - Statements 1, 2, and 3 are all correct. However, **statement 4 is incorrect** because total plasma protein concentration **decreases** (not increases) during pregnancy due to the disproportionate increase in plasma volume compared to protein synthesis. *3 and 4 only* - Statement 3 is correct, but **statement 4 is incorrect** (plasma protein concentration decreases, not increases). Additionally, this option incorrectly excludes statements 1 and 2, which are both correct and represent important physiological adaptations in pregnancy.

Q: A 50 year old postmenopausal woman comes with complaints of bleeding per vaginum. Which one of the following investigations is NOT required?

Diagnostic laparoscopy. ***Diagnostic laparoscopy*** - **Diagnostic laparoscopy** is NOT indicated in the routine workup of **postmenopausal bleeding** as it does not allow direct visualization of the **endometrial cavity**, which is the primary site of pathology in PMB. - It is an invasive surgical procedure used to visualize pelvic and abdominal organs **externally** and is reserved for evaluating conditions like **endometriosis**, **pelvic inflammatory disease**, **adnexal masses**, or **ectopic pregnancy**. - The key investigations for PMB focus on evaluating the **endometrium** and **cervix**, not the peritoneal cavity or external surface of pelvic organs. *Hysteroscopy* - **Hysteroscopy** involves direct visualization of the **uterine cavity** and is crucial for identifying and biopsying focal lesions like **polyps**, **submucosal fibroids**, or **endometrial cancer** that can cause postmenopausal bleeding. - It allows for targeted biopsy of suspicious areas that might be missed by blind endometrial sampling. *Pap smear* - A **Pap smear** is essential for screening for **cervical cancer** and **precancerous lesions** of the cervix, which can present as postmenopausal bleeding. - Although it primarily screens the cervix, abnormal cytology indicates the need for further investigation with colposcopy and biopsy. *Endometrial biopsy* - **Endometrial biopsy** is the **gold standard** for investigating postmenopausal bleeding, as the most common cause is **endometrial cancer** or **hyperplasia**. - It provides histological samples of the endometrium to rule out malignancy and confirm benign causes like **atrophic endometrium**.

Q: Which one of the following is NOT an emergency contraception method?

Norplant. ***Norplant*** - **Norplant** is a brand name for a **subdermal implant** that provides long-term contraception (up to 5 years) and is not used as an emergency method. - Its mechanism involves the continuous release of a progestin, thereby inhibiting ovulation and thickening cervical mucus over an extended period. *Levonorgestrel* - **Levonorgestrel** is a common and effective form of **emergency contraception**, taken as a single dose or two doses within 72-120 hours of unprotected intercourse. - It works primarily by inhibiting or delaying **ovulation** and preventing fertilization, not by inducing abortion. *Intra uterine contraceptive device* - The **copper intrauterine device (IUD)** is the most effective method of emergency contraception, effective up to 5 days after unprotected intercourse. - It primarily prevents implantation by causing a **spermicidal inflammatory reaction** within the uterus. *High dose oral contraceptive pill* - High-dose **combined oral contraceptive pills** ("Yuzpe method") can be used as emergency contraception, taken in two doses 12 hours apart within 72 hours of unprotected sex. - This method utilizes the **estrogen and progestin** in the pills to prevent ovulation and fertilization.

Q: Which of the following is NOT a method of second Trimester abortion?

Intra-amniotic KCl instillation. ***Intra-amniotic KCl instillation*** - Intra-amniotic KCl instillation is **NOT an abortion method** but rather a **feticide procedure** used to induce fetal demise before the actual termination. - It involves injecting potassium chloride directly into the fetal heart or amniotic sac to cause fetal asystole, and **must be followed by another method** (medical induction or D&E) to complete the abortion. - It is used primarily in **late second trimester and beyond** when legally or ethically required to ensure fetal demise prior to expulsion, but is **not a standalone abortion method**. *Hysterotomy* - Hysterotomy is a **surgical method** of abortion that involves making an incision in the uterus (similar to cesarean section) to remove the fetus. - While rarely used today due to **higher maternal morbidity** compared to D&E or medical methods, it **remains a recognized second-trimester abortion method**. - It may be considered in specific situations such as failed medical abortion, cervical pathology preventing D&E, or when other methods are contraindicated. *Mifepristone and PGE1* - This combination is a **standard medical abortion method** for the second trimester. - Mifepristone (antiprogestogen) sensitizes the uterus to prostaglandins, and PGE1 (misoprostol) induces uterine contractions and cervical ripening. - It is **safe, effective, and commonly used** for second-trimester medical termination. *PGE2 analog* - **Prostaglandin E2 analogs** (such as dinoprostone) are established methods for second-trimester abortion. - They induce uterine contractions and cervical ripening, and can be administered vaginally, extra-amniotically, or intravenously. - They are a **standard medical induction method** for second-trimester termination.

Q: In the process of MTP (Medical Termination of Pregnancy) done by suction and evacuation, it was realized that perforation of uterus occurred with cannula. The next step should be:

Laparotomy with exploration of bowel. ***Laparotomy with exploration of bowel*** - **Uterine perforation** during suction and evacuation abortion with a **cannula** (large instrument) carries high risk of bowel or vascular injury and necessitates surgical intervention. - **Laparotomy** (or laparoscopy in stable patients) allows for direct visualization of the injury, assessment of any associated bowel or vascular damage, and repair of the perforation. - Given the mechanism (cannula perforation), the risk of **intra-abdominal organ injury** is significant, warranting exploration. *Manual vacuum aspiration* - This procedure is used for uterine evacuation, not for managing a **uterine perforation**. - Continuing with aspiration after perforation risks aggravating the injury and causing further damage to internal organs. *Complete the evacuation with curette* - Using a **curette** after perforation would worsen the uterine injury and potentially cause damage to intra-abdominal organs. - The immediate concern is the perforation and its sequelae, not completing the abortion via the transcervical route. *Wait and watch* - While **small uterine perforations** from dilators without suspected visceral injury may be managed conservatively with close observation, **cannula perforation** represents a **high-risk mechanism**. - Given the size of the instrument and risk of bowel injury, immediate surgical exploration is required rather than expectant management.

Q: Consider the following statements regarding MTP (Medical Termination of Pregnancy): 1. Suction and evacuation can be done up till 12 weeks. 2. Medical methods can be used up till 10 weeks 3. Manual vacuum aspiration (MVA) syringe can be used up to 6 weeks Which of the statements given above is/are correct?

2 only. **2 only** - **Medical methods** for abortion, primarily using medications like **mifepristone** and **misoprostol**, are generally recommended and most effective for pregnancies up to **10 weeks of gestation**. - Beyond 10 weeks, the success rate decreases, and the risk of complications increases, making surgical methods more appropriate. *1 only* - **Suction and evacuation**, also known as **vacuum aspiration**, is a surgical method typically performed for pregnancies up to **14-16 weeks** of gestation, not limited to 12 weeks. - After 12 weeks, the procedure may be referred to as D&C (dilation and curettage) or D&E (dilation and evacuation), depending on the gestational age and technique used. *2 and 3* - While statement 2 is correct, statement 3 is incorrect because **Manual Vacuum Aspiration (MVA)** using a syringe can be safely and effectively used for pregnancies up to **10-12 weeks** of gestation, not just up to 6 weeks. - MVA is a versatile and often preferred method for early pregnancy termination due to its simplicity and effectiveness. *1 and 3* - Both statements 1 and 3 are incorrect in their specified gestational limits. Suction and evacuation can be performed beyond 12 weeks, and MVA can be used beyond 6 weeks, up to 10-12 weeks.

Question 1

Consider the following presentations:

1. Brow presentation
2. Left mento anterior position
3. Occipito posterior position
4. Breech presentation

In which of the above Vaginal delivery is NOT possible?

Accepted Answer

1 only

Answer

1, 2 and 3

Answer

4 only

Answer

1 and 3 only

Question 2

Which one of the following regarding amniotic fluid is true?

Accepted Answer

It reveals information about fetal lung maturity and wellbeing

Answer

It is decreased in gestational diabetes

Answer

The volume is highest at 28 weeks

Answer

It is decreased in duodenal atresia in baby

Question 3

Consider the following statements regarding changes in pregnancy:

1. Plasma volume increases up to 30–50%
2. Pregnancy is a hypercoagulable state
3. Hematocrit is decreased
4. Total plasma protein concentration increases

Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3 only

Answer

1 and 2 only

Answer

1 only

Answer

1, 2, 3 and 4

Answer

3 and 4 only

Question 4

A 30 year old lady, mother of 3 children presents with mass descending per vaginum. On examination it is found to have stage 3 prolapse, moderate cystocele, no posterior vaginal wall prolapse. The recommended surgery would be:

Accepted Answer

Manchester operation

Answer

Vaginal hysterectomy

Answer

Rectocele repair

Answer

Cystocele repair

Question 5

A 50 year old postmenopausal woman comes with complaints of bleeding per vaginum. Which one of the following investigations is NOT required?

Accepted Answer

Diagnostic laparoscopy

Answer

Hysteroscopy

Answer

Pap smear

Answer

Endometrial biopsy

Question 6

Which one of the following is NOT an emergency contraception method?

Accepted Answer

Norplant

Answer

Levenorgestrel

Answer

Intra uterine contraceptive device

Answer

High dose oral contraceptive pill

Question 7

Which of the statements regarding anemia in pregnancy is NOT true?

Accepted Answer

If mother is severely anemic, the fetus is also severely anemic

Answer

Iron deficiency anemia is most common in Tropics

Answer

Faulty dietary habit is one of the factors responsible for anemia

Answer

Mild anemia is most common

Question 8

Which of the following is NOT a method of second Trimester abortion?

Accepted Answer

Intra-amniotic KCl instillation

Answer

Hysterotomy

Answer

Mifepristone and PGE1

Answer

PGE2 analog

Question 9

In the process of MTP (Medical Termination of Pregnancy) done by suction and evacuation, it was realized that perforation of uterus occurred with cannula. The next step should be:

Accepted Answer

Laparotomy with exploration of bowel

Answer

Manual vacuum aspiration

Answer

Complete the evacuation with curette

Answer

Wait and watch

Question 10

Consider the following statements regarding MTP (Medical Termination of Pregnancy):

1. Suction and evacuation can be done up till 12 weeks.
2. Medical methods can be used up till 10 weeks
3. Manual vacuum aspiration (MVA) syringe can be used up to 6 weeks
Which of the statements given above is/are correct?

Accepted Answer

2 only

Answer

1 only

Answer

2 and 3

Answer

1 and 3

UPSC-CMS 2018 — Obstetrics and Gynecology