UPSC-CMS 2013 - Obstetrics and Gynecology Practice Questions

Q: The following conditions are associated with molar pregnancy except:

Gestational diabetes. **Gestational diabetes** - Gestational diabetes is not directly associated with a **molar pregnancy**. Its pathogenesis is related to **insulin resistance** and pancreatic beta-cell dysfunction during pregnancy. - While both conditions can occur during pregnancy, there is no increased risk of gestational diabetes in the presence of a molar pregnancy. *Thyrotoxicosis* - **Molar pregnancies** produce very high levels of **human chorionic gonadotropin (hCG)**, which has a structural similarity to thyroid-stimulating hormone (TSH). - This high hCG can stimulate the thyroid gland, leading to **hyperthyroidism** or thyrotoxicosis in some patients. *Hyperemesis gravidarum* - The extremely high levels of **hCG** produced in a **molar pregnancy** are strongly linked to the severity of nausea and vomiting experienced during pregnancy. - This often manifests as **hyperemesis gravidarum**, which is more common and severe in molar pregnancies due to the exaggerated hormonal response. *Pregnancy induced hypertension* - Patients with **molar pregnancies** are at an increased risk of developing **pregnancy-induced hypertension (PIH)**, often presenting earlier in gestation than typical pre-eclampsia. - The precise mechanism is thought to involve the abnormal placental development and exaggerated maternal inflammatory response associated with molar tissue.

Q: What is the commonest cause of retention of urine at 12-14 weeks of pregnancy ?

Retroverted gravid uterus. ***Retroverted gravid uterus*** - A **retroverted uterus** can become "trapped" in the pelvis as it enlarges during pregnancy, causing the **cervix to push against the urethra, leading to outflow obstruction**. - This typically occurs between **12-14 weeks of gestation** before the uterus ascents out of the pelvis. *Diminished bladder tone* - While bladder tone can be affected in pregnancy, it's not the primary or most common cause of **acute urinary retention** at this specific gestational age. - **Decreased bladder sensation** and volume capacity changes are more gradual and less likely to cause acute retention until later stages. *Prolapse of uterus* - **Uterine prolapse** is more common in **multiparous women** and tends to cause symptoms like pressure, discomfort, and potentially urinary incontinence, rather than acute retention, particularly in early pregnancy. - A prolapsed uterus is usually located **lower in the pelvic cavity**, which would not typically obstruct the urethra in the manner of a retroverted uterus. *Impacted pelvic tumour* - An **impacted pelvic tumour** could cause urinary retention, but it is a **less common cause** than a retroverted gravid uterus in the context of a healthy 12-14 week pregnancy. - This would be a more serious and typically pre-existing condition, often with other associated symptoms, and not a physiological consequence of pregnancy.

Q: Which of the following is a uterine compression suture during management of atonic postpartum haemorrhage?

B-Lynch suture. **B-Lynch suture** - The **B-Lynch suture** is a specific type of surgical technique involving the placement of sutures across the uterine fundus and lower uterine segment to compress the uterus. - This compression helps to reduce blood loss by mechanically occluding the endometrial vessels, making it highly effective in managing **atonic postpartum hemorrhage**. *Sturmdorf suture* - The Sturmdorf suture is primarily used in **cervical cone biopsy** or **trachelectomy** to close the cervical stump. - It involves everting and suturing the cervical mucosa to provide hemostasis and promote healing of the cervix, not for uterine compression. *Fothergill's suture* - Fothergill's operation (Manchester operation) is used for **pelvic organ prolapse**, particularly uterine prolapse. - It typically involves shortening the cardinal ligaments and repairing the perineum, but does not involve uterine compression for hemorrhage. *Moscowitz suture* - The Moscowitz suture is used for **obliteration of the cul-de-sac (pouch of Douglas)** to prevent **enterocele** formation during pelvic floor repair. - This technique involves plicating the peritoneum over the pouch of Douglas, and is not a uterine compression suture for atonic hemorrhage.

Q: Misoprostol can be used in obstetric practice by the following routes except:

Intravenous. ***Intravenous*** - Misoprostol is **not used intravenously** in obstetric practice due to safety concerns - IV administration could lead to **rapid, uncontrolled systemic effects** including severe adverse events like **cardiovascular collapse** and anaphylactoid reactions - The drug formulation is not intended for IV use, and its rapid absorption via this route would pose significant maternal risk - All approved obstetric uses employ **oral, sublingual, vaginal, or buccal routes** *Vaginal* - Vaginal administration is commonly used in obstetrics for **cervical ripening** and **labor induction** - Also used for **management of miscarriage** and **postpartum hemorrhage** - Allows for **gradual absorption** with local effect on the cervix and uterus *Sub-lingual* - Sublingual misoprostol is effectively absorbed through the **oral mucosa** - Used for **labor induction** and **management of postpartum hemorrhage** - Offers **rapid onset of action** and bypasses first-pass metabolism *Oral* - Oral administration is used for **medical abortion**, **miscarriage management**, and **labor induction** - Also approved for prevention of **NSAID-induced gastric ulcers** (non-obstetric indication) - Absorption is slower with lower peak concentrations compared to sublingual or vaginal routes

Q: During the first 6 months of lactation, which amongst the following contraceptives is not advisable?

Combined oral contraceptive pills. ***Combined oral contraceptive pills*** - **Combined oral contraceptive pills (COCs)** contain both **estrogen** and **progestin**, and the synthetic estrogen component can potentially reduce breast milk supply, which is critical during the initial 6 months of breastfeeding. - Estrogen may also alter the composition of breast milk, and there's a theoretical concern about **estrogen excretion into breast milk** affecting the newborn during this vulnerable period. *Norplant* - **Norplant** (levonorgestrel implants) contains only **progestin**, which is generally considered safe for use during breastfeeding from 6 weeks postpartum. - Progestin-only contraceptives do not significantly affect milk supply or infant health. *DMPA* - **DMPA (depot medroxyprogesterone acetate)** is an injectable contraceptive containing only **progestin**. It is considered safe and effective during breastfeeding, typically from 6 weeks postpartum. - It does not negatively impact milk production or infant growth and development. *Progestin only pills* - **Progestin-only pills (POPs)** are safe for use during breastfeeding, usually initiated immediately postpartum or from 6 weeks. - They do not contain estrogen, thereby avoiding the concerns associated with combined oral contraceptives regarding milk supply and infant exposure.

Q: Oral contraceptives may provide protection against the following malignancies except :

Cervical cancer. ***Cervical cancer*** - Oral contraceptives (OCPs) are associated with an **increased risk of cervical cancer**, particularly with prolonged use, due to their potential influence on the immune response to **HPV infection**. - OCPs do not provide protection against cervical cancer; instead, they are considered a **risk factor** in its development. *Endometrial cancer* - OCPs, especially with their progestin component, offer significant **protection against endometrial cancer** by counteracting unopposed estrogen effects on the endometrium. - This protective effect is evident after just a few years of use and can persist for decades after discontinuation. *Ovarian cancer* - Oral contraceptive use is well-established to **reduce the risk of ovarian cancer**, with the protective effect increasing with longer duration of use. - This protection is thought to be mediated by the **suppression of ovulation**, thereby reducing the continuous trauma to the ovarian surface epithelium. *None of the options* - This option is incorrect because OCPs do provide protection against several malignancies, specifically endometrial and ovarian cancers, but actually increase the risk of cervical cancer.

Q: The following drugs are effective in the management of menorrhagia except :

Prostaglandins. ***Prostaglandins*** - Prostaglandins, particularly **PGE2** and **PGF2α**, are generally associated with **increased uterine contractions** and **vasodilation**, which can worsen menstrual bleeding rather than reduce it. - While cyclooxygenase inhibitors (NSAIDs) work by inhibiting prostaglandin synthesis, exogenous prostaglandins themselves are not used to treat menorrhagia and can exacerbate it. *Progestational agents* - Progestins help to **stabilize the endometrium**, reducing excessive bleeding by inducing decidualization and limiting endometrial growth. - They can be administered orally, via injection, or through an **intrauterine device (IUD)** like the levonorgestrel-releasing IUD (Mirena), which is highly effective. *Non-steroidal anti-inflammatory drugs* - NSAIDs reduce menorrhagia by **inhibiting prostaglandin synthesis** in the endometrium, which leads to reduced vasodilation and uterine contractions. - They also help alleviate associated **dysmenorrhea** (menstrual pain). *Anti-fibrinolytic drugs* - These drugs, such as **tranexamic acid**, work by **inhibiting plasminogen activation**, thereby preventing the breakdown of fibrin clots within the uterus. - This promotes clot stability and reduces menstrual blood loss significantly.

Q: What is the commonest cause of Vulvo-Vaginal Fistula in developing countries ?

Obstructed labour. ***Obstructed labour*** - **Prolonged obstructed labor** causes **ischemic necrosis** of the tissues between the vagina and the bladder or rectum due to continuous pressure from the fetal head, leading to a fistula. - This is the **most common cause** of vulvo-vaginal fistulas in developing countries, often due to limited access to emergency obstetric care like C-sections. *Carcinoma of bladder* - While bladder carcinoma can cause fistulas, they are more typically **vesicovaginal fistulas** and are less common than those resulting from obstructed labor in developing countries. - Fistulas due to malignancy often involve **tissue destruction** and may be associated with prior radiation therapy. *Injury during hysterectomy* - Iatrogenic injury during a **hysterectomy** can lead to a fistula, but this is more common in developed healthcare settings with higher rates of surgical interventions. - This cause is less prevalent globally compared to the widespread issue of obstructed labor in resource-limited regions. *Radiotherapy for treatment of carcinoma cervix* - **Radiotherapy** for cervical carcinoma can cause **radiation-induced necrosis** and lead to fistulas, particularly **rectovaginal** or **vesicovaginal** types. - While a significant cause in cancer patients, it is not the commonest overall cause in developing countries compared to the sheer volume of cases resulting from obstructed labor.

Question 1

The following conditions are associated with molar pregnancy except:

Accepted Answer

Gestational diabetes

Answer

Thyrotoxicosis

Answer

Hyperemesis gravidarum

Answer

Pregnancy induced hypertension

Question 2

What is the commonest cause of retention of urine at 12-14 weeks of pregnancy ?

Accepted Answer

Retroverted gravid uterus

Answer

Diminished bladder tone

Answer

Prolapse of uterus

Answer

Impacted pelvic tumour

Question 3

Which of the following is a uterine compression suture during management of atonic postpartum haemorrhage?

Accepted Answer

B-Lynch suture

Answer

Sturmdorf suture

Answer

Fothergill's suture

Answer

Moscowitz suture

Question 4

Misoprostol can be used in obstetric practice by the following routes except:

Accepted Answer

Intravenous

Answer

Vaginal

Answer

Sub-lingual

Answer

Oral

Question 5

Following are the contraindications for laparoscopic female sterilization except :

Accepted Answer

Hiatus hernia

Answer

Respiratory dysfunction

Answer

Heart disease

Answer

Obesity

Question 6

A man underwent vasectomy, but 6 months later his wife was 16 week pregnant. What is the most likely cause ?

Accepted Answer

Failure to use additional contraception in postoperative period

Answer

Recanalisation of vas

Answer

Pregnancy antedating vasectomy

Answer

Failure of operative procedure

Question 7

During the first 6 months of lactation, which amongst the following contraceptives is not advisable?

Accepted Answer

Combined oral contraceptive pills

Answer

Norplant

Answer

DMPA

Answer

Progestin only pills

Question 8

Oral contraceptives may provide protection against the following malignancies except :

Accepted Answer

Cervical cancer

Answer

Endometrial cancer

Answer

Ovarian cancer

Answer

None of the options

Question 9

The following drugs are effective in the management of menorrhagia except :

Accepted Answer

Prostaglandins

Answer

Progestational agents

Answer

Non-steroidal anti-inflammatory drugs

Answer

Anti-fibrinolytic drugs

Question 10

What is the commonest cause of Vulvo-Vaginal Fistula in developing countries ?

Accepted Answer

Obstructed labour

Answer

Carcinoma of bladder

Answer

Injury during hysterectomy

Answer

Radiotherapy for treatment of carcinoma cervix

UPSC-CMS 2013 — Obstetrics and Gynecology