UPSC-CMS 2024 - Obstetrics and Gynecology Practice Questions

Q: Which of the following is a common pathology that increases the risk of uterine injury during abdominal hysterectomy?

Pelvic endometriosis. ***Pelvic endometriosis*** - Pelvic endometriosis causes **dense adhesions, anatomical distortion, and obliteration of normal tissue planes**, making surgical dissection technically challenging during hysterectomy. - The **fibrotic adhesions** bind pelvic organs together, obscure surgical landmarks, and increase the risk of inadvertent injury to the uterus, bladder, ureters, and bowel. - Studies show that **endometriosis is a significant risk factor** for intraoperative complications, including uterine perforation and vascular injury. - The **distorted pelvic anatomy** requires careful dissection and may necessitate modifications in surgical technique. *Hydrosalpinx* - Hydrosalpinx is a **fluid-filled, dilated fallopian tube** resulting from distal tubal obstruction, typically from prior pelvic inflammatory disease. - While it may be encountered during hysterectomy, it does **not distort the uterine anatomy or create adhesions** that would increase the risk of uterine injury. - Hydrosalpinx is generally easily separated from surrounding structures. *Ovarian teratoma* - Ovarian teratoma (dermoid cyst) is a **benign germ cell tumor of the ovary** containing mature tissues from all three germ layers. - It is typically **well-encapsulated and does not cause significant pelvic adhesions** unless there has been rupture or torsion. - It does not increase the risk of uterine injury during hysterectomy. *Adenomyosis* - Adenomyosis is **endometrial tissue within the myometrium**, causing an enlarged, boggy, tender uterus. - While adenomyosis is often an **indication for hysterectomy**, it is an intrinsic uterine condition that does **not cause pelvic adhesions or anatomical distortion**. - The uterus may be more vascular and bulky, but this does not specifically increase the risk of uterine injury during standard hysterectomy technique.

Q: Which of the following is confirmatory for the diagnosis of bicornuate uterus?

Hysteroscopy and laparoscopy. ***Hysteroscopy and laparoscopy*** - **Hysteroscopy** allows visualization of the uterine cavity, revealing two distinct hemi-cavities separated by a septum or deep indentation. - **Laparoscopy** provides external visualization of the uterus, confirming the presence of two separate uterine horns and distinguishing a bicornuate uterus from a septate uterus by identifying the deep indentation on the fundus and the angle between the horns greater than 75 degrees. *Hysteroscopy* - While hysteroscopy can visualize the **internal uterine cavity** and may suggest dual cavities, it alone cannot definitively distinguish between a deeply septate uterus and a bicornuate uterus. - It does not offer a view of the **external uterine contour**, which is crucial for diagnosis. *Hysterectomy* - A hysterectomy is the **surgical removal of the uterus**, which is a definitive treatment but not a diagnostic procedure for uterine anomalies. - This procedure would only reveal the uterine anatomy after its removal, which is not the purpose of a **confirmatory diagnostic evaluation**. *Dilatation and curettage* - This procedure involves **dilating the cervix** and **scraping the lining of the uterus**, primarily used for diagnostic sampling or therapeutic abortion. - It does not provide any information about the **uterine morphology** or congenital anomalies like a bicornuate uterus.

Q: A 25-year-old female comes to the gynaecology OPD for evaluation of secondary amenorrhoea. She gives history of previous dilatation and curettage, and her FSH levels are 8 IU/L. The probable cause of amenorrhoea is

Asherman syndrome. ***Asherman syndrome*** - This syndrome is characterized by the formation of **intrauterine adhesions** or scarring, often following uterine procedures such as **dilatation and curettage (D&C)**. - The **normal FSH level** (8 IU/L) indicates intact ovarian function, ruling out primary ovarian issues and pointing towards a structural uterine problem as the cause of secondary amenorrhea. *incomplete abortion* - An incomplete abortion would typically present with **vaginal bleeding and abdominal pain**, not secondary amenorrhea, unless it occurred significantly in the past and led to complications. - While D&C can be performed for incomplete abortion, the primary cause of amenorrhea in this context would be the subsequent formation of uterine adhesions, not the incomplete abortion itself. *premature ovarian failure* - This condition involves the cessation of ovarian function before age 40, which would result in **elevated FSH levels** due to lack of negative feedback from estrogen. - The patient's **normal FSH level** (8 IU/L) makes premature ovarian failure an unlikely diagnosis in this case. *Sheehan syndrome* - Sheehan syndrome is caused by **ischemic necrosis of the pituitary gland** typically following severe postpartum hemorrhage, leading to panhypopituitarism. - It would present with symptoms of **multiple hormone deficiencies**, including low FSH and LH (due to pituitary failure), along with other anterior pituitary hormone deficiencies, which contradicts the normal FSH and lack of mention of postpartum hemorrhage.

Q: Which of the following criteria are required to be fulfilled for hospitalization in a case of pelvic inflammatory disease? 1. Coexisting pregnancy 2. Mild fever and pain responding well to antibiotics 3. Suspected tubo-ovarian abscess 4. Coexistent HIV infection Select the correct answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - **Coexisting pregnancy** is a critical indication for hospitalization in PID due to the increased risk of adverse pregnancy outcomes, including **septic abortion**, preterm birth, and disseminated infection. - **Suspected tubo-ovarian abscess (TOA)** requires inpatient management because it can lead to **sepsis**, rupture, and peritonitis, necessitating aggressive intravenous antibiotics and potentially surgical intervention. - **Coexistent HIV infection** is an important hospitalization criterion as immunocompromised patients may experience more severe PID, atypical presentations, and a higher risk of systemic complications or treatment failure. *1, 2 and 4* - This option incorrectly includes "Mild fever and pain responding well to antibiotics," which signifies a less severe course typically managed **outpatient**. - The other conditions (pregnancy, HIV) are valid reasons for hospitalization, but the presence of mild, responsive symptoms argues against inpatient care. *1, 2 and 3* - This option also incorrectly includes "Mild fever and pain responding well to antibiotics," which would typically allow for **outpatient management**. - While pregnancy and suspected TOA are strong indications for hospitalization, mild symptoms that resolve quickly with antibiotics do not warrant inpatient admission. *2, 3 and 4* - This option mistakenly includes "Mild fever and pain responding well to antibiotics," which is a criterion for **outpatient management**, not hospitalization. - It excludes "Coexisting pregnancy," which is a significant reason for inpatient care due to potential maternal and fetal risks.

Q: Which of the following are risk factors for Pelvic Inflammatory Disease (PID)? 1. Multiple sexual partners 2. IUD use 3. Genetic predisposition 4. Sexually active teenagers Select the correct answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** - **Multiple sexual partners** is a well-established risk factor for PID as it increases exposure to sexually transmitted infections (STIs), particularly *Chlamydia trachomatis* and *Neisseria gonorrhoeae*, which are the primary causative organisms of PID. - **IUD use** increases the risk of PID, particularly during the first 3 weeks after insertion when the insertion procedure can introduce vaginal flora into the upper genital tract. The risk returns to baseline after this initial period. - **Sexually active teenagers** are at higher risk due to biological factors (cervical ectopy with larger area of columnar epithelium susceptible to infection) and behavioral factors (multiple partners, inconsistent condom use, higher rates of STIs). *1, 2 and 3* - This option incorrectly includes **genetic predisposition** as a primary risk factor for PID. - PID is predominantly an **infectious disease** caused by ascending infection from the lower genital tract, not directly linked to genetic predisposition. *1, 3 and 4* - This option incorrectly includes **genetic predisposition** while correctly identifying multiple sexual partners and sexually active teenagers. - Genetic factors are not established risk factors for PID compared to behavioral and infectious causes. *2, 3 and 4* - This option incorrectly includes **genetic predisposition** and omits multiple sexual partners, which is one of the most important behavioral risk factors for PID. - The primary risk factors are related to sexual behavior and STI exposure, not genetics.

Q: Which one of the following is correct regarding choriocarcinoma?

Vaginal bleeding is the commonest presenting symptom. ***Vaginal bleeding is the commonest presenting symptom*** - **Vaginal bleeding** (often irregular or persistent) is the most frequent symptom of choriocarcinoma, especially when it arises after a hydatidiform mole or pregnancy. - This bleeding can be accompanied by symptoms related to distant metastases, highlighting the aggressive nature of the disease. *About 20-30% of patients with molar pregnancies develop choriocarcinoma* - The risk of developing choriocarcinoma after a **hydatidiform mole** is much lower than 20-30%; it's estimated to be around 2-3% after a complete mole and less than 0.5% after a partial mole. - The majority of molar pregnancies resolve spontaneously without progressing to choriocarcinoma. *Highly resistant tumour to chemotherapy* - Choriocarcinoma is notably one of the most **chemosensitive solid tumors** and generally responds very well to chemotherapy, even in advanced stages. - This high sensitivity to chemotherapy is a key characteristic that distinguishes it from many other cancers. *Primary site of involvement is fallopian tube* - The primary site of choriocarcinoma is usually the **uterus**, developing from gestational trophoblastic tissue. - While it can metastasize widely, the fallopian tube is not its primary site of involvement.

Q: Which of the following are favourable factors in prognosis of ovarian malignancy? 1. Older age group 2. Well-differentiated tumour 3. Smaller tumour volume 4. Younger age group Select the correct answer using the code given below.

2, 3 and 4. ***2, 3 and 4*** - **Well-differentiated tumours** indicate less aggressive cell growth and a better prognosis due to their similarity to normal tissue and slower metastatic potential. - **Smaller tumour volume** implies less disease burden, making the cancer more amenable to treatment and reducing the likelihood of widespread metastasis. - **Younger age group** is often associated with better overall health, greater tolerance to aggressive treatments, and a more robust immune response, contributing to a better prognosis in ovarian cancer. *1, 3 and 4* - **Younger age group**, **well-differentiated tumour**, and **smaller tumour volume** are indeed favorable prognostic factors. - However, **older age group** is generally associated with a poorer prognosis in ovarian malignancy due to increased comorbidities and decreased tolerance to aggressive therapies. *1, 2 and 4* - While **well-differentiated tumours** and **younger age group** are favorable, **older age group** is typically a poor prognostic indicator. - This option incorrectly includes older age as a favorable factor and omits **smaller tumour volume**, which is a significant positive prognosticator. *1, 2 and 3* - This option incorrectly lists **older age group** as a favorable factor, which usually indicates a poorer prognosis. - It also includes **well-differentiated tumour** and **smaller tumour volume**, which are indeed favorable, but is flawed by the inclusion of older age.

Q: Which one of the following drugs is most effective in the treatment of gestational trophoblastic neoplasia?

Methotrexate. ***Methotrexate*** - **Methotrexate** is the most commonly used first-line chemotherapy for **low-risk gestational trophoblastic neoplasia (GTN)**, with cure rates exceeding 90% as a single agent. - It works by inhibiting **dihydrofolate reductase**, thereby blocking DNA synthesis and cell proliferation in rapidly dividing trophoblastic cells. - Administered as a single agent in various regimens (weekly IM, 5-day course, or 8-day alternating with folinic acid). *Actinomycin D* - **Actinomycin D** is an equally effective alternative first-line agent for low-risk GTN with similar cure rates to methotrexate. - However, the question asks for the "most effective," and both drugs have comparable efficacy; methotrexate is often preferred initially due to its favorable side effect profile and ease of administration. - Actinomycin D is frequently used when methotrexate resistance develops or as part of combination therapy for high-risk disease. *Cisplatin* - **Cisplatin** is a platinum-based chemotherapy drug reserved for **high-risk or resistant GTN**, typically as part of multi-drug regimens like EMA-CO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, Vincristine). - While effective in combination therapy, it is not used as first-line monotherapy for GTN. *Gemcitabine* - **Gemcitabine** is an antimetabolite used in various cancers but is **not a standard drug** for GTN treatment. - It may be considered for **refractory or resistant cases** as part of salvage therapy, but is not part of standard first-line or second-line protocols for GTN.

Question 1

Which of the following is a common pathology that increases the risk of uterine injury during abdominal hysterectomy?

Accepted Answer

Pelvic endometriosis

Answer

Hydrosalpinx

Answer

Ovarian teratoma

Answer

Adenomyosis

Question 2

Which of the following are correct regarding pathology of stress urinary incontinence?

1. Hypermobility of urethra
2. Descent of bladder neck and proximal urethra below pelvic diaphragm
3. Lowered urethral pressure
4. Increased detrusor activity

Accepted Answer

1, 2 and 3

Answer

2 and 4

Answer

3 and 4

Answer

1, 2 and 4

Answer

1 and 2

Question 3

Which of the following is confirmatory for the diagnosis of bicornuate uterus?

Accepted Answer

Hysteroscopy and laparoscopy

Answer

Hysteroscopy

Answer

Hysterectomy

Answer

Dilatation and curettage

Question 4

Which of the following are useful investigations for diagnosis of unresponsive endometrium as a cause of primary amenorrhoea?

1. Karyotype
2. Progesterone challenge test
3. Hormonal studies
4. Hysterosalpingography

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 5

A 25-year-old female comes to the gynaecology OPD for evaluation of secondary amenorrhoea. She gives history of previous dilatation and curettage, and her FSH levels are 8 IU/L. The probable cause of amenorrhoea is

Accepted Answer

Asherman syndrome

Answer

incomplete abortion

Answer

premature ovarian failure

Answer

Sheehan syndrome

Question 6

Which of the following criteria are required to be fulfilled for hospitalization in a case of pelvic inflammatory disease?

1. Coexisting pregnancy
2. Mild fever and pain responding well to antibiotics
3. Suspected tubo-ovarian abscess
4. Coexistent HIV infection

Select the correct answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 7

Which of the following are risk factors for Pelvic Inflammatory Disease (PID)?

1. Multiple sexual partners
2. IUD use
3. Genetic predisposition
4. Sexually active teenagers

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 8

Which one of the following is correct regarding choriocarcinoma?

Accepted Answer

Vaginal bleeding is the commonest presenting symptom

Answer

About 20-30% of patients with molar pregnancies develop choriocarcinoma

Answer

Highly resistant tumour to chemotherapy

Answer

Primary site of involvement is fallopian tube

Question 9

Which of the following are favourable factors in prognosis of ovarian malignancy?

1. Older age group
2. Well-differentiated tumour
3. Smaller tumour volume
4. Younger age group
Select the correct answer using the code given below.

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 10

Which one of the following drugs is most effective in the treatment of gestational trophoblastic neoplasia?

Accepted Answer

Methotrexate

Answer

Actinomycin D

Answer

Cisplatin

Answer

Gemcitabine

UPSC-CMS 2024 — Obstetrics and Gynecology