UPSC-CMS 2018 - Obstetrics and Gynecology Practice Questions

Q: Consider following statements regarding Beta Thalassemia in pregnancy: 1. There is low MCH and MCV 2. Total Iron binding capacity may be elevated or normal 3. HbA2 more than 3.5% is seen in Haemoglobin Electrophoresis Which of the statements given above is/are correct?

1, 2 and 3. ***1, 2 and 3*** - Statement 1 is correct: Patients with **beta thalassemia** typically exhibit **microcytic (low MCV)** and **hypochromic (low MCH)** anemia due to reduced beta-globin chain synthesis. - Statement 2 is correct: **Total iron binding capacity (TIBC)** in beta thalassemia trait is typically **normal or slightly elevated**. Unlike iron deficiency anemia where TIBC is markedly elevated, in thalassemia trait the TIBC remains in the normal range or may be mildly elevated. Importantly, serum ferritin is normal or elevated (unlike iron deficiency where it's low). - Statement 3 is correct: **Hemoglobin electrophoresis** in beta thalassemia trait characteristically shows **HbA2 > 3.5%** (usually 4-6%), which is the key diagnostic criterion that differentiates it from iron deficiency anemia. *2 and 3 only* - This option is incorrect because statement 1 (low MCH and MCV) is a fundamental hematological characteristic of beta thalassemia and is therefore correct. *1 and 2 only* - This option is incorrect because statement 3 (HbA2 > 3.5%) is the definitive diagnostic criterion for beta thalassemia trait and is essential for diagnosis. *1 only* - This option is incorrect because statements 2 and 3 are also accurate. Low MCV and MCH alone cannot distinguish beta thalassemia from iron deficiency anemia; elevated HbA2 and normal/elevated ferritin with normal/slightly elevated TIBC are key differentiating features.

Q: A 25 year old, G2P1L1 came with amenorrhoea of two and half months followed by bleeding PV and pain abdomen. On examination cervical OS is open with slight bleeding. The uterus is 10 weeks size with no tenderness in the fornices. The probable clinical diagnosis is:

Inevitable abortion. ***Inevitable abortion*** - The presence of **amenorrhea** followed by **vaginal bleeding** and **abdominal pain**, with an **open cervical os**, indicates that the abortion process cannot be halted. - Critically, there is **no history of passage of products of conception**, which means the abortion is inevitable but has not yet occurred. - The uterus size being consistent with **10 weeks of gestation** confirms an intrauterine pregnancy in the process of being expelled. *Incomplete abortion* - This diagnosis also involves vaginal bleeding and an open cervical os, but it is characterized by the **partial expulsion of products of conception**. - The key differentiator is that incomplete abortion requires **history or evidence of tissue passage**, which is not mentioned in this clinical scenario. - In inevitable abortion, the os is open and bleeding is present, but expulsion has not yet begun. *Missed abortion* - A missed abortion involves fetal demise without symptoms like bleeding or pain, and a **closed cervical os**. - This patient presents with active bleeding and pain, and an open cervical os, which contradicts the features of a missed abortion. - The uterus may be smaller than expected for dates in missed abortion. *Ectopic pregnancy* - Although an ectopic pregnancy can cause amenorrhea, vaginal bleeding, and abdominal pain, the uterus in an ectopic pregnancy is typically **smaller than expected for gestational age** or normal in size, and there is often **significant adnexal tenderness or mass**. - The finding of a **10-week sized uterus** strongly suggests an intrauterine pregnancy rather than ectopic, and the absence of adnexal tenderness makes ectopic pregnancy unlikely.

Q: Which one of the following statements regarding intrauterine growth restriction is NOT correct?

Defined according to biparietal diameter. ***Defined according to biparietal diameter*** - **Intrauterine growth restriction (IUGR)** is primarily defined by estimated fetal weight falling below the **10th percentile** for gestational age, not solely by biparietal diameter (BPD). - While BPD is one of several biometric measurements used to estimate fetal weight, it alone is insufficient to diagnose or define IUGR. Other factors like umbilical artery **Doppler studies** and maternal-fetal risk factors are also considered. *There is danger of fetal asphyxia during delivery* - Fetuses with IUGR are at increased risk of **fetal compromise** due to altered placental function and reduced reserve, making them more susceptible to **asphyxia** during the stress of labor. - This increased risk often necessitates careful monitoring during labor and sometimes leads to earlier intervention such as **cesarean section**. *Generally not seen in women with gestational diabetes* - This statement is correct. While gestational diabetes can lead to various complications, the primary fetal concern is **macrosomia** (large-for-gestational-age infants), rather than IUGR. - IUGR is more commonly associated with conditions causing **placental insufficiency**, while maternal hyperglycemia in gestational diabetes tends to cause excessive fetal growth. *Doppler studies are indicated* - **Doppler velocimetry** of the umbilical artery and other fetal vessels is crucial for monitoring fetuses with IUGR. - These studies assess **placental function** and fetal hemodynamics, helping to determine the severity of IUGR and guide the timing of delivery.

Q: Which of the following is an absolute contraindication for use of oral contraceptive pills?

Focal Migraine. ***Focal Migraine*** - A **focal migraine**, especially with aura, significantly increases the risk of **ischemic stroke** in women using combined oral contraceptives. - Due to the heightened risk of **thrombosis** associated with oral contraceptives, a history of focal migraine is considered an **absolute contraindication** (WHO MEC Category 4). *Epilepsy* - Epilepsy is generally not an absolute contraindication for oral contraceptive pills, though some **antiepileptic drugs** can reduce contraceptive efficacy due to **enzyme induction**. - Adjustments in contraceptive methods may be needed, but the condition itself does not make OCPs absolutely unsafe. *Bronchial Asthma* - Bronchial asthma is **not a contraindication** to the use of oral contraceptive pills. - There is no known interaction or increased risk of adverse events between OCPs and asthma. *Smoking* - **Smoking** in women **aged ≥35 years who smoke ≥15 cigarettes/day** is an **absolute contraindication** (WHO MEC Category 4) due to significantly increased risk of **cardiovascular events** including myocardial infarction and stroke. - In younger women or lighter smokers, it represents a **relative contraindication** (WHO MEC Category 2-3). - In the context of this question, **focal migraine** is the correct answer as it is an absolute contraindication regardless of age or severity, whereas smoking becomes absolute only in specific circumstances.

Q: Which one of the following clinical situations is NOT ideal to perform female sterilization procedure?

During active pelvic inflammatory disease. ***During active pelvic inflammatory disease*** - **Active infection** increases surgical risks, complications, and may worsen the existing **pelvic inflammatory disease**. - Standard medical practice requires **treating the infection first** before performing elective procedures like sterilization. *Postmenstrual period* - This is an **ideal time** for sterilization as the uterus is **atrophic** and there is high certainty that the woman is not pregnant. - The **risk of pregnancy** is minimal, and the procedure can be performed with greater safety and efficacy. *Concurrent with MTP* - Performing sterilization concurrently with **medical termination of pregnancy (MTP)** is **standard practice** and often advisable. - This approach ensures the woman is not pregnant and provides convenient **permanent contraception** without requiring an additional surgical procedure. *7 days postpartum* - The **immediate postpartum period** is an excellent time for female sterilization due to the enlarged uterus being easily palpated and **fallopian tubes** being readily accessible. - The woman is usually secure in her decision, and this timing allows for **one hospital stay** for both delivery and sterilization.

Q: Pregnancy can be terminated at any gestation if the fetus is diagnosed to have:

Anencephaly. ***Anencephaly*** - Anencephaly is a **lethal congenital anomaly** where the brain and skull do not develop properly. - Due to the **incompatible-with-life prognosis**, termination of pregnancy at any gestation is medically justified and often offered. *Duodenal atresia* - **Duodenal atresia** is a treatable condition where the duodenum is blocked. - It is **surgically correctable** after birth and does not warrant termination of pregnancy at any stage. *Bilateral talipes* - **Bilateral talipes** (clubfoot) is a common musculoskeletal birth defect that can be corrected with conservative management (e.g., Ponseti method) or surgery. - It is **not life-threatening** and does not justify termination of pregnancy. *Hydrocephalus* - While hydrocephalus can be severe, its prognosis is variable and often depends on the underlying cause and severity. - Many cases of **hydrocephalus are manageable** with shunting procedures, and it is not universally considered a condition that warrants termination at any gestation.

Q: Which one of the following is NOT a cause of recurrent spontaneous abortion?

Rubella infection. ***Rubella infection*** - While rubella infection during pregnancy can lead to serious **congenital anomalies** (congenital rubella syndrome) and fetal death, it is **NOT a typical cause of recurrent spontaneous abortions** - Rubella primarily causes **single pregnancy loss** or teratogenic effects in ongoing pregnancies, rather than the pattern of repeated losses seen in recurrent abortion - The infection does not create the persistent maternal factors (immunological, thrombophilic, or anatomical) that characterize causes of recurrent pregnancy loss *Antiphospholipid syndrome* - This autoimmune disorder is a **well-established cause of recurrent pregnancy loss** (accounts for 10-15% of cases) - Antiphospholipid antibodies cause **thrombosis in placental vasculature**, leading to placental insufficiency and infarction - Results in repeated pregnancy losses, typically in the second trimester *Inherited thrombophilia* - Conditions like **Factor V Leiden mutation** and **prothrombin gene mutation** increase thrombotic risk - Cause **placental microthrombi** that compromise fetal blood supply - Recognized as a cause of recurrent spontaneous abortion, though the association is stronger for late pregnancy loss *Chromosomal abnormality* - **Parental balanced translocations** are an important cause of recurrent spontaneous abortion (3-5% of couples) - While random fetal aneuploidy is the most common cause of sporadic abortion, parental chromosomal rearrangements lead to **recurrent unbalanced offspring** and repeated losses - Karyotyping of both partners is recommended after recurrent pregnancy loss

Q: For vaginal breech delivery, ideal selection criteria would include: 1. Fetus not compromised 2. Adequate pelvis 3. Flexed breech presentation 4. Estimated fetal weight < 3.5 kg Select the correct answer using the code given below:

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All listed criteria (fetus not compromised, adequate pelvis, **flexed breech presentation**, and estimated fetal weight < 3.5 kg) are considered **ideal selection criteria** for a safe vaginal breech delivery. - **Flexed (frank) breech** with hips flexed and knees extended is the **most favorable type** for vaginal delivery, as it presents the smallest diameter and has the lowest risk of cord prolapse. - While many institutions now favor elective cesarean section for breech presentations, these criteria represent conditions under which a **vaginal delivery can be safely attempted** with minimal risk. *2 and 4 only* - This option is incomplete as it correctly identifies adequate pelvis and estimated fetal weight < 3.5 kg but omits other crucial factors like **fetal well-being** and the **type of breech presentation**. - A successful vaginal breech delivery also requires the fetus to be **uncompromised** and ideally in a **flexed (frank) breech** presentation. *1, 3 and 4 only* - This option overlooks the critical importance of an **adequate maternal pelvis**, which is fundamental for allowing the passage of the fetus during vaginal delivery regardless of fetal presentation. - While fetal status, presentation, and weight are important, a **contracted or inadequate pelvis** would contraindicate vaginal delivery. *1, 2 and 3 only* - This option excludes the **estimated fetal weight** being less than 3.5 kg, which is a significant factor in assessing the feasibility of vaginal breech delivery. - Larger fetuses (typically >3.5-4 kg) have a **higher risk of birth trauma** and **head entrapment** during vaginal breech delivery, even with an adequate pelvis and favorable presentation.

Question 1

Consider following statements regarding Beta Thalassemia in pregnancy:

1. There is low MCH and MCV
2. Total Iron binding capacity may be elevated or normal
3. HbA2 more than 3.5% is seen in Haemoglobin Electrophoresis
Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 only

Question 2

A 20 year old Primigravida, comes at 35 weeks of gestation with complaints of swelling of feet. On examination her blood pressure is 170/110 mm Hg on 2 occasions; urine examination shows proteinuria. Which one of the following statements regarding her management is NOT true?

Accepted Answer

Injection Dexamethasone is to be given for fetal lung maturity

Answer

Can be labelled as Preeclampsia

Answer

Both maternal and fetal monitoring are required

Answer

Requires urgent admission

Question 3

A 25 year old, G2P1L1 came with amenorrhoea of two and half months followed by bleeding PV and pain abdomen. On examination cervical OS is open with slight bleeding. The uterus is 10 weeks size with no tenderness in the fornices. The probable clinical diagnosis is:

Accepted Answer

Inevitable abortion

Answer

Incomplete abortion

Answer

Missed abortion

Answer

Ectopic pregnancy

Question 4

Which one of the following statements regarding intrauterine growth restriction is NOT correct?

Accepted Answer

Defined according to biparietal diameter

Answer

There is danger of fetal asphyxia during delivery

Answer

Generally not seen in women with gestational diabetes

Answer

Doppler studies are indicated

Question 5

Which of the following is an absolute contraindication for use of oral contraceptive pills?

Accepted Answer

Focal Migraine

Answer

Epilepsy

Answer

Bronchial Asthma

Answer

Smoking

Question 6

Which one of the following clinical situations is NOT ideal to perform female sterilization procedure?

Accepted Answer

During active pelvic inflammatory disease

Answer

Postmenstrual period

Answer

Concurrent with MTP

Answer

7 days postpartum

Question 7

Cardiac diseases in pregnancy which have major risk of maternal mortality are:

1. Pulmonary hypertension
2. Aortic coarctation with valvular involvement
3. Atrial septal defect
4. Mitral stenosis

Select the correct answer using the code given below:

Accepted Answer

1 and 2

Answer

1 and 4

Answer

2 and 3

Answer

3 and 4

Question 8

Pregnancy can be terminated at any gestation if the fetus is diagnosed to have:

Accepted Answer

Anencephaly

Answer

Duodenal atresia

Answer

Bilateral talipes

Answer

Hydrocephalus

Question 9

Which one of the following is NOT a cause of recurrent spontaneous abortion?

Accepted Answer

Rubella infection

Answer

Antiphospholipid syndrome

Answer

Inherited thrombophilia

Answer

Chromosomal abnormality

Question 10

For vaginal breech delivery, ideal selection criteria would include:

1. Fetus not compromised
2. Adequate pelvis
3. Flexed breech presentation
4. Estimated fetal weight < 3.5 kg

Select the correct answer using the code given below:

Accepted Answer

1, 2, 3 and 4

Answer

2 and 4 only

Answer

1, 3 and 4 only

Answer

1, 2 and 3 only

UPSC-CMS 2018 — Obstetrics and Gynecology