UPSC-CMS 2009 - Obstetrics and Gynecology Practice Questions

Q: Uterine rupture is most commonly encountered after which one of the following surgeries?

Classical cesarean. ***Classical cesarean*** - A **classical cesarean section** involves a vertical incision in the **upper uterine segment**, which contains fewer muscle fibers and heals less strongly than the lower segment. - This weaker scar is more prone to rupture in subsequent pregnancies or during labor, leading to a significantly higher risk compared to other uterine surgeries. *Hysterotomy* - **Hysterotomy** is a surgical incision into the uterus, often performed for fetal surgery, but **uterine rupture** risk is heavily dependent on the type and location of the incision. - While it creates a uterine scar, the risk of rupture varies with the depth and extent of the incision, and it is generally associated with a lower rupture risk than a single, full-thickness classical incision. *Metroplasty* - **Metroplasty** is a reconstructive surgery of the uterus, typically performed to correct uterine anomalies like a **septate uterus**, improving reproductive outcomes. - While it involves cutting and suturing uterine tissue, the goal is to create a more functional and robust uterus, and if performed meticulously, the risk of subsequent rupture is relatively low. *Myomectomy* - **Myomectomy** involves the surgical removal of **fibroids** (leiomyomas) from the uterus while preserving the uterus. - The risk of **uterine rupture** after myomectomy is proportional to the number, size, and depth of the fibroids removed, especially if the uterine cavity is entered; deep intramural fibroids pose a higher risk, but generally less than a classical cesarean.

Q: The "fern pattern" of cervical mucus seen in the first half of menstrual cycle is because of

Low mucoprotein level. ***Low mucoprotein level*** - The **fern pattern** is formed by the crystallization of **sodium chloride** in the presence of **estrogen** and a relatively **low mucoprotein content** in cervical mucus. - During the proliferative phase, high estrogen levels increase the fluid and electrolyte content relative to mucoproteins, facilitating this distinct crystallization. - **Key concept**: While both high NaCl and low mucoprotein are present, it is the **low mucoprotein** that is the distinguishing factor allowing crystallization to occur. *Low sodium chloride level* - A low sodium chloride level would lead to **less crystallization**, not the characteristic fern pattern. - The presence of sodium chloride is crucial for forming the crystalline structure. *High sodium chloride level* - While sodium chloride is indeed **elevated during the follicular phase** and necessary for ferning, this alone is not the defining reason for the fern pattern. - Sodium chloride is present throughout the menstrual cycle; the key factor is the **reduced mucoprotein** that allows unimpeded crystallization. - Both high NaCl AND low mucoprotein work together, but the **low mucoprotein is the distinguishing feature** that permits the crystallization to manifest as ferning. *High mucoprotein level* - A high mucoprotein level would **interfere with the crystallization** of sodium chloride, preventing the formation of a clear fern pattern. - This occurs during the luteal phase when progesterone increases mucoproteins, inhibiting ferning.

Q: Polycystic ovarian syndrome is associated with the following except

Ovarian carcinoma. ***Ovarian carcinoma*** - While polycystic ovarian syndrome (PCOS) increases the risk of **endometrial hyperplasia** and subsequently **endometrial carcinoma** due to unopposed estrogen, it is **not directly associated with an increased risk of ovarian carcinoma**. - Ovarian carcinoma is a distinct entity with different risk factors, and PCOS does not typically predispose to it. *Obesity* - **Obesity**, particularly central obesity, is highly prevalent in women with PCOS, affecting many metabolic and hormonal aspects of the syndrome. - It contributes to **insulin resistance**, which is a key feature of PCOS and exacerbates its symptoms. *Infertility* - **Anovulation** or oligo-ovulation, a hallmark of PCOS, directly leads to **infertility** in many affected women. - The hormonal imbalances in PCOS interfere with normal follicular development and ovulation. *Endometrial hyperplasia* - The **unopposed estrogen stimulation** resulting from chronic anovulation in PCOS leads to continuous endometrial proliferation without regular shedding. - This persistent stimulation increases the risk of developing **endometrial hyperplasia**, which can be a precursor to endometrial carcinoma.

Q: The most appropriate management of a 32 weeks pregnant lady with carcinoma cervix stage IIb is.

Cesarean delivery followed by chemoradiation. ***Cesarean delivery followed by chemoradiation*** - For **stage IIb carcinoma cervix** at 32 weeks gestation, **cesarean delivery** is the safest option to deliver the baby while avoiding trauma to the tumor and potential dissemination. - Subsequently, **chemoradiation** is the standard treatment for stage IIb cervical cancer, ensuring optimal maternal oncologic outcome. *Observation and follow-up* - This approach is **inappropriate** for stage IIb cervical cancer in pregnancy, as it delays definitive treatment and allows for disease progression. - Such an aggressive cancer requires **prompt intervention** for the best maternal prognosis. *Chemo-radiation followed by labour induction and vaginal delivery* - **Chemoradiation during pregnancy** is harmful to the fetus, especially beyond the first trimester. - A **vaginal delivery** in the presence of cervical cancer carries a high risk of hemorrhage and tumor dissemination, making it contraindicated. *Labour induction, vaginal delivery followed by radio-therapy* - **Labour induction and vaginal delivery** are contraindicated due to risks of hemorrhage, tumor spread, and potential obstruction from the tumor. - While radiotherapy would follow, the mode of delivery poses significant risks to the mother.

Q: Safe period is calculated by

Length of menstrual cycle. ***Length of menstrual cycle*** - The **"safe period"** or **rhythm method** of contraception relies on estimating the fertile window by tracking the length of the menstrual cycle. - Ovulation typically occurs around day 14 of a 28-day cycle, and the fertile window includes the days leading up to and immediately after ovulation, which is determined by the overall cycle length. *Length of luteal phase* - The **luteal phase** is relatively constant in most women, lasting about **14 days**, irrespective of the overall cycle length. - While it's part of the menstrual cycle, its length alone does not provide enough information to calculate the fertile window for overall "safe period" estimation. *Date of ovulation* - The **date of ovulation** is a crucial component in determining the fertile window but is a specific point within the cycle, not the overall calculation method for the "safe period." - Methods to predict ovulation (e.g., basal body temperature, ovulation predictor kits) help identify the fertile window but are not how the cyclic "safe period" is initially calculated for planning purposes. *Duration of menstrual flow* - The **duration of menstrual flow** (usually 3-7 days) is highly variable among individuals and has no direct correlation with the timing of ovulation or the fertile window. - It marks the beginning of a new cycle but does not help in identifying the fertile days for natural family planning.

Q: Which of the following is not related to the use of Levonorgestrel releasing intra-uterine contraceptive device ?

Inhibition of ovulation. ***Inhibition of ovulation*** - Levonorgestrel-releasing IUDs primarily act by thickening cervical mucus, thinning the **endometrium**, and creating a local inflammatory reaction that impairs sperm viability and fertilization. - While some systemic absorption of levonorgestrel occurs, it is generally **insufficient to consistently inhibit ovulation**, unlike higher-dose hormonal contraceptives. *Reduction of pain and dysmenorrhoea in endometriosis and adenomyosis* - The **local release of levonorgestrel** directly in the uterus helps to thin the endometrial lining, reducing prostaglandin production and mitigating pain associated with conditions like endometriosis and adenomyosis. - This local hormonal effect suppresses the growth of ectopic endometrial tissue and decreases uterine contractions, leading to a significant reduction in pain. *Amenorrhoea in 50% of cases* - The **endometrial thinning** caused by continuous levonorgestrel release often leads to a significant decrease in menstrual bleeding, and in about 50% of users, this results in complete amenorrhoea over time. - This effect is beneficial for women with heavy menstrual bleeding or dysmenorrhoea. *Reduction of blood loss* - Levonorgestrel-releasing IUDs are well-known for their efficacy in treating **heavy menstrual bleeding (menorrhagia)**. - The progestin causes significant atrophy and thinning of the endometrium, reducing the amount of tissue shed during menstruation and thus **decreasing blood loss**.

Q: Combined oral pills protect the woman against all except

Venous thromboembolism. ***Venous thromboembolism*** - Combined oral contraceptives (COCs) contain estrogen, which increases the synthesis of **coagulation factors**, elevating the risk of **venous thromboembolism (VTE)**. - While the absolute risk is low, it is a known serious side effect and COCs do not protect against it; rather, they can increase its likelihood. *Pelvic inflammatory disease* - **Combined oral pills** can reduce the risk of **pelvic inflammatory disease (PID)** by thickening cervical mucus, which acts as a barrier to ascending infections. - They also decrease menstrual flow and endometrial proliferation, making the uterus less hospitable to infection. *Benign breast disease* - Combined oral contraceptives have been shown to **reduce the incidence of benign breast diseases**, such as fibrocystic changes and fibroadenomas. - This protective effect is thought to be related to the hormonal regulation provided by the pills. *Menorrhagia* - COCs are commonly used to treat **menorrhagia (heavy menstrual bleeding)** as they regulate the menstrual cycle and reduce the amount and duration of bleeding. - The progestin component thins the endometrial lining, leading to lighter periods.

Q: Following statements are correct about levonorgestrel containing intra-uterine contraceptive device (Mirena) except

It increases the risk of ectopic pregnancy. ***It increases the risk of ectopic pregnancy*** - This statement is **INCORRECT**. The **levonorgestrel-releasing IUD (Mirena)** does NOT increase the absolute risk of ectopic pregnancy compared to women not using contraception. - In fact, it **significantly reduces** the risk of ectopic pregnancy by preventing pregnancy altogether. The absolute risk of ectopic pregnancy is much lower in IUD users than in non-contraceptive users. *It reduces the risk of pelvic inflammatory disease* - The **levonorgestrel-releasing IUD (Mirena)** actually reduces the risk of PID. This is because **progestin thickens cervical mucus**, creating a barrier that can prevent ascending infection. - Unlike older copper IUDs, newer IUDs (both copper and hormonal) are generally not associated with an increased risk of PID after the first month following insertion. *It releases 20 µg/day of levonorgestrel* - The **Mirena IUD** is designed to release approximately **20 micrograms of levonorgestrel per day** initially, which then gradually decreases over its lifespan. - This consistent low-dose release is crucial for its contraceptive and therapeutic effects. *It increases the risk of ovarian cyst formation* - **Levonorgestrel-releasing IUDs** can increase the incidence of **functional ovarian cysts**. This is because the hormonal action can interfere with the normal follicular development and ovulation cycle. - These cysts are usually benign, asymptomatic, and resolve spontaneously.

Question 1

Uterine rupture is most commonly encountered after which one of the following surgeries?

Accepted Answer

Classical cesarean

Answer

Hysterotomy

Answer

Metroplasty

Answer

Myomectomy

Question 2

The "fern pattern" of cervical mucus seen in the first half of menstrual cycle is because of

Accepted Answer

Low mucoprotein level

Answer

Low sodium chloride level

Answer

High sodium chloride level

Answer

High mucoprotein level

Question 3

Polycystic ovarian syndrome is associated with the following except

Accepted Answer

Ovarian carcinoma

Answer

Obesity

Answer

Infertility

Answer

Endometrial hyperplasia

Question 4

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→4  B→3  C→2  D→1

Answer

A→1  B→2  C→3  D→4

Answer

A→3  B→4  C→1  D→2

Answer

A→4  B→1  C→2  D→3

Question 5

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→3  B→4  C→1  D→2

Answer

A→1  B→2  C→3  D→4

Answer

A→2  B→1  C→4  D→3

Answer

A→4  B→3  C→2  D→1

Question 6

The most appropriate management of a 32 weeks pregnant lady with carcinoma cervix stage IIb is.

Accepted Answer

Cesarean delivery followed by chemoradiation

Answer

Observation and follow-up

Answer

Chemo-radiation followed by labour induction and vaginal delivery

Answer

Labour induction, vaginal delivery followed by radio-therapy

Question 7

Safe period is calculated by

Accepted Answer

Length of menstrual cycle

Answer

Length of luteal phase

Answer

Date of ovulation

Answer

Duration of menstrual flow

Question 8

Which of the following is not related to the use of Levonorgestrel releasing intra-uterine contraceptive device ?

Accepted Answer

Inhibition of ovulation

Answer

Reduction of pain and dysmenorrhoea in endometriosis and adenomyosis

Answer

Amenorrhoea in 50% of cases

Answer

Reduction of blood loss

Question 9

Combined oral pills protect the woman against all except

Accepted Answer

Venous thromboembolism

Answer

Pelvic inflammatory disease

Answer

Benign breast disease

Answer

Menorrhagia

Question 10

Following statements are correct about levonorgestrel containing intra-uterine contraceptive device (Mirena) except

Accepted Answer

It increases the risk of ectopic pregnancy

Answer

It reduces the risk of pelvic inflammatory disease

Answer

It releases 20 µg/day of levonorgestrel

Answer

It increases the risk of ovarian cyst formation

UPSC-CMS 2009 — Obstetrics and Gynecology