UPSC-CMS 2020 - Obstetrics and Gynecology Practice Questions

Q: The placenta synthesizes all EXCEPT:

Dehydroepiandrosterone. ***Dehydroepiandrosterone*** - **Dehydroepiandrosterone (DHEA)** is primarily synthesized in the **adrenal cortex** of both the fetus and the mother. - The placenta primarily converts DHEA into other steroids, such as **estrogens**, rather than synthesizing DHEA itself. *Oestriol* - The placenta plays a crucial role in synthesizing **oestriol**, particularly by utilizing **androgen precursors** from the fetal adrenal gland. - This synthesis is a key indicator of **feto-placental unit** well-being. *Corticotrophin releasing hormone* - The placenta extensively synthesizes **Corticotropin-releasing hormone (CRH)**, which gradually increases throughout pregnancy. - Placental CRH is thought to be involved in the **timing of parturition** and the regulation of fetal adrenal development. *PAPP-A (Pregnancy Associated Plasma Protein A)* - **PAPP-A** is a glycoprotein synthesized by the **syncytiotrophoblast** cells of the placenta. - It serves as an important biochemical marker in **combined first-trimester screening** for chromosomal abnormalities like Down syndrome.

Q: Withdrawal bleeding following administration of progesterone in a case of secondary amenorrhea indicates all EXCEPT:

Defect in pituitary gland. ***Defect in pituitary gland*** - While withdrawal bleeding after progesterone suggests the problem lies at the **hypothalamic-pituitary level** (anovulation with adequate estrogen), it does **not definitively rule out all pituitary defects**. - The pituitary may still produce sufficient **FSH to stimulate ovarian estrogen production** but have defective **LH surge mechanism** (WHO Group II anovulation). - Examples include **hyperprolactinemia** or **functional hypothalamic amenorrhea** where estrogen production is preserved despite pituitary-hypothalamic dysfunction. - This is the **EXCEPT answer** because the other options are more definitively confirmed by withdrawal bleeding. *Absence of pregnancy* - Withdrawal bleeding after progesterone administration **definitively confirms absence of pregnancy**. - Pregnancy would prevent withdrawal bleeding due to sustained progesterone production by the corpus luteum and placenta. - This is a key diagnostic exclusion in the evaluation of **secondary amenorrhea**. *Endometrium is responsive to estrogen* - The occurrence of withdrawal bleeding **definitively demonstrates** that the endometrium has been exposed to adequate estrogen and has proliferated. - This proliferative endometrium then sheds when progesterone is withdrawn, confirming **normal endometrial responsiveness to hormonal stimulation**. - This rules out **Asherman syndrome** and other uterine factors. *Production of endogenous estrogen* - Withdrawal bleeding **definitively confirms** that there has been sufficient **endogenous estrogen production** to prime the endometrium. - The estrogen causes endometrial thickening, which then sheds when progesterone is withdrawn. - This indicates **adequate ovarian function** in terms of estrogen synthesis and rules out **hypergonadotropic hypogonadism** (ovarian failure).

Q: Monilial vaginitis is commonly associated with all EXCEPT:

Treatment of malaria with chloroquine. ***Treatment of malaria with chloroquine*** - **Chloroquine** is an antimalarial drug and has no direct known association with an increased risk of **monilial vaginitis (candidiasis)**. - Unlike antibiotics, corticosteroids, or immunosuppressants, chloroquine does not significantly alter the vaginal flora or immune response in a way that predisposes to Candida overgrowth. *Prolonged antibiotic therapy* - **Antibiotics** can disrupt the normal vaginal flora by killing off beneficial bacteria (like *Lactobacillus*), leading to an overgrowth of **Candida albicans**. - This altered microbial balance is a common cause of **vulvovaginal candidiasis (VVC)**. *Pregnancy* - Hormonal changes during **pregnancy**, particularly elevated estrogen levels, can increase **glycogen deposition** in vaginal epithelial cells. - This provides a rich food source for **Candida**, making pregnant women more susceptible to **monilial vaginitis**. *Diabetes Mellitus* - **Poorly controlled diabetes mellitus** leads to hyperglycemia, which can result in **elevated glucose levels** in vaginal secretions. - This increased glucose serves as a nutrient for **Candida albicans**, fostering its growth and making diabetic women more prone to recurrent **vaginal yeast infections**.

Q: Which one of the following is NOT a risk factor for the development of placenta previa?

Maternal anaemia. ***Maternal anaemia*** - **Maternal anaemia** is generally considered a *consequence* of conditions like antenatal hemorrhage from placenta previa, rather than a direct risk factor for its development. - While anaemia is common in pregnancy and can exacerbate outcomes, it does not independently increase the likelihood of the placenta implanting abnormally close to or over the cervical os. *Maternal age* - **Advanced maternal age** (typically over 35 years) is a well-established risk factor for placenta previa. - This is thought to be due to an increased incidence of pre-existing uterine abnormalities and degenerative changes in the endometrium. *Previous caesarean section* - A **previous caesarean section** significantly increases the risk of placenta previa due to the presence of a uterine scar. - The placenta may preferentially implant over the scar tissue, which can be less vascular, leading to a lower implantation and potentially previa. *Smoking* - **Smoking** during pregnancy is a recognized risk factor for placenta previa, potentially due to hypoxic-ischemic effects on the endometrium. - It may contribute to abnormal placentation by inducing compensatory placental hypertrophy and extending the placental surface area, increasing the chance of covering the cervical os.

Q: Common clinical presentations of moderate to severe abruption are all EXCEPT:

Prolonged labour. ***Prolonged labour*** - While **placental abruption** can sometimes lead to **uterine dysfunction** and difficulties in labor progression, **prolonged labor** is *not* a characteristic or common clinical presentation of an abruption itself. - The primary concerns with abruption are **hemorrhage**, **fetal compromise**, and rapid progression to delivery due to **uterine irritability**. *Uterine tenderness* - **Uterine tenderness** is a classic and common sign of **placental abruption**, resulting from the extravasation of blood into the myometrium. - This tenderness is often localized over the site of the abruption and can range from mild to severe depending on the extent of the blood collection. *Unexplained preterm labour* - **Placental abruption** is a known cause of **preterm labor**, often presenting as uterine contractions and pain. - The irritation of the uterus by blood and the presence of **prostaglandins** released during the abruption process can trigger premature contractions. *Fetal distress* - **Fetal distress**, indicated by **non-reassuring fetal heart rate patterns** like decelerations or bradycardia, is a common and serious consequence of **placental abruption**. - This occurs due to the reduction in **placental perfusion** and oxygen exchange between the mother and fetus.

Q: The initial prevention strategy for antiphospholipid syndrome will be: 1. Steroids 2. Heparin 3. Low dose aspirin 4. Progesterone support Which of the above is/are correct?

2 and 3. ***2 and 3*** - For pregnant women with antiphospholipid syndrome (APS), a combination of **low-dose aspirin** and **low molecular weight heparin (LMWH)** or **unfractionated heparin (UFH)** is the most widely accepted and effective initial prevention strategy to prevent pregnancy complications. - **Low-dose aspirin** helps reduce platelet aggregation, while **heparin** inhibits coagulation, addressing both thrombotic tendencies associated with APS. *1 and 4* - **Steroids** are typically reserved for severe manifestations of APS, such as catastrophic APS or refractory cases, and are not part of the initial standard preventative regimen. - **Progesterone support** is indicated for threatened miscarriage or luteal phase defect but does not address the underlying thrombotic risk in APS for pregnancy prevention. *3 only* - While **low-dose aspirin** is an important component, it is insufficient on its own for preventing pregnancy complications in women with antiphospholipid syndrome due to the high thrombotic risk. - **Heparin**, either LMWH or UFH, is crucial to provide adequate anticoagulation and is always used in conjunction with aspirin for initial prevention. *3 and 4* - **Low-dose aspirin** is appropriate, but **progesterone support** (4) is not a primary measure for preventing thrombotic events or pregnancy complications specifically linked to antiphospholipid syndrome. - The critical missing component in this option is **heparin**, which is essential for anticoagulation in APS pregnancies.

Q: Diagnostic criteria for PCOS are: 1. Oligo/amenorrhea 2. Hyperandrogenism 3. Polycystic ovaries on ultrasound Which of the above are correct?

1, 2 and 3. ***1, 2 and 3*** - All three listed features are the **Rotterdam criteria** for diagnosing PCOS, which is the most widely used diagnostic system. - The Rotterdam criteria require **at least 2 out of 3** of the following: **(1) oligo-ovulation/anovulation** (clinically presenting as oligo/amenorrhea), **(2) clinical or biochemical hyperandrogenism**, and **(3) polycystic ovaries on ultrasound**. - Since all three listed features are valid diagnostic criteria, the correct answer includes all of them (1, 2, and 3). - Note: Diagnosis requires meeting 2 out of 3 criteria, but all 3 are recognized valid criteria. *2 and 3 only* - This option incorrectly excludes **oligo/amenorrhea** (oligo-ovulation/anovulation). - Oligo/amenorrhea is a core criterion in the Rotterdam criteria and represents the ovulatory dysfunction that is central to PCOS. - Excluding this criterion makes the option incomplete. *1 and 3 only* - This option incorrectly excludes **hyperandrogenism**. - Hyperandrogenism (clinical signs like hirsutism, acne, or biochemical elevation of androgens) is a fundamental criterion in the Rotterdam criteria. - It reflects the hormonal dysregulation that characterizes PCOS and cannot be excluded as a valid diagnostic criterion. *1 and 2 only* - This option incorrectly excludes **polycystic ovaries on ultrasound**. - The ultrasound finding of polycystic ovarian morphology (≥12 follicles measuring 2-9 mm or ovarian volume >10 mL) is an essential criterion in the Rotterdam criteria. - Excluding this morphological feature makes the option incomplete.

Q: Which of the following symptoms can be associated with pelvic organ prolapse? 1. Difficulty in passing urine 2. Incomplete evacuation of urine 3. Urgency and frequency Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - Pelvic organ prolapse can cause **urinary symptoms** due to anatomical distortion affecting the bladder and urethra. - Patients may experience **difficulty in initiating micturition**, the sensation of **incomplete emptying**, **increased urgency**, and **frequency** as common manifestations. *1 and 3 only* - This option is incomplete as it excludes **incomplete evacuation of urine**, which is a frequent symptom of pelvic organ prolapse. - The sensation of incomplete emptying is often due to the physical obstruction or kink in the urethra caused by the prolapsed organ. *2 and 3 only* - This option is incorrect because it dismisses **difficulty in passing urine**, also known as **voiding dysfunction**, which can be a direct result of urethral compression or angulation. - **Voiding dysfunction** is a key symptom that impacts quality of life for women with prolapse. *1 and 2 only* - This choice omits **urgency and frequency**, common irritative symptoms of the bladder often associated with pelvic organ prolapse. - Even without infection, bladder irritation can stem from changes in bladder support and position caused by the prolapse.

Q: A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true regarding the above case? 1. Bartholin's abscess may be the likely diagnosis 2. It is to be managed by marsupialisation 3. Gonococcus is the most common pathogenic organism Select the correct answer using the code given below:

1 and 2 only. ***1 and 2 only*** - The presentation of **painful, unilateral vulvar swelling for 3 days** is highly suggestive of a **Bartholin's abscess**, making statement 1 correct. - **Marsupialization** is a valid surgical management option for Bartholin's abscess. While **incision and drainage with Word catheter placement** is preferred for acute cases, marsupialization can be performed and is especially indicated for recurrent cases. Statement 2 is considered true as marsupialization is an accepted treatment modality. - **Statement 3 is false**: Gonococcus is NOT the most common organism. **Polymicrobial infections** (E. coli, Staphylococcus, Streptococcus, anaerobes) are most common in current practice. Gonococcus accounts for <10% of cases. *3 only* - This option is incorrect because statement 3 alone is false (Gonococcus is not the most common organism), while statements 1 and 2 are true. - Selecting only statement 3 contradicts the clinical presentation and current microbiology data. *1, 2 and 3* - This option is incorrect because **statement 3 is false**. Gonococcus is no longer the most common pathogenic organism causing Bartholin's abscesses. - **Polymicrobial infections** predominate in modern practice, making this combination incorrect. *1 and 3 only* - This option is incorrect because it excludes statement 2 (marsupialization is a valid management option) while including statement 3 (which is false regarding Gonococcus being the most common organism). - This combination is medically inaccurate on both counts.

Q: Which one of the following is NOT a sign of separation of placenta?

The fundal height reduces further. ***The fundal height reduces further*** - A **reduction in fundal height** is not a sign of placental separation; rather, the fundus often rises slightly as the separated placenta descends into the lower uterine segment. - After separation, the uterus typically becomes **globular** and the fundus may rise to a level above the umbilicus. *Apparent lengthening of the cord with slight gush of vaginal bleeding* - **Lengthening of the umbilical cord** outside the vagina is a classic sign of placental separation, indicating the placenta has descended. - A **gush of blood** often occurs as the placenta detaches from the uterine wall, releasing pooled blood from the retroplacental space. *Uterus becomes globular, firm and ballotable* - After separation, the uterus contracts strongly, becoming more **globular** and **firm** as it expels the placenta. - The uterus may feel **ballotable** if the placenta is still within the uterine cavity but detached. *Slight bulging in the suprapubic region* - A **slight bulging in the suprapubic region** (above the symphysis pubis) indicates that the separated placenta has descended into the lower uterine segment or vagina, creating a palpable mass. - This sign is often referred to as a "boggy" or "fullness" sensation in the lower abdomen due to the descended placenta.

Question 1

The placenta synthesizes all EXCEPT:

Accepted Answer

Dehydroepiandrosterone

Answer

Oestriol

Answer

Corticotrophin releasing hormone

Answer

PAPP-A (Pregnancy Associated Plasma Protein A)

Question 2

Withdrawal bleeding following administration of progesterone in a case of secondary amenorrhea indicates all EXCEPT:

Accepted Answer

Defect in pituitary gland

Answer

Absence of pregnancy

Answer

Endometrium is responsive to estrogen

Answer

Production of endogenous estrogen

Question 3

Monilial vaginitis is commonly associated with all EXCEPT:

Accepted Answer

Treatment of malaria with chloroquine

Answer

Prolonged antibiotic therapy

Answer

Pregnancy

Answer

Diabetes Mellitus

Question 4

Which one of the following is NOT a risk factor for the development of placenta previa?

Accepted Answer

Maternal anaemia

Answer

Maternal age

Answer

Previous caesarean section

Answer

Smoking

Question 5

Common clinical presentations of moderate to severe abruption are all EXCEPT:

Accepted Answer

Prolonged labour

Answer

Uterine tenderness

Answer

Fetal distress

Answer

Unexplained preterm labour

Question 6

The initial prevention strategy for antiphospholipid syndrome will be:
1. Steroids
2. Heparin
3. Low dose aspirin
4. Progesterone support
Which of the above is/are correct?

Accepted Answer

2 and 3

Answer

1 and 4

Answer

3 only

Answer

3 and 4

Question 7

Diagnostic criteria for PCOS are:

1. Oligo/amenorrhea
2. Hyperandrogenism
3. Polycystic ovaries on ultrasound

Which of the above are correct?

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 3 only

Answer

1 and 2 only

Question 8

Which of the following symptoms can be associated with pelvic organ prolapse?

1. Difficulty in passing urine
2. Incomplete evacuation of urine
3. Urgency and frequency

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Question 9

A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true regarding the above case?

1. Bartholin's abscess may be the likely diagnosis
2. It is to be managed by marsupialisation
3. Gonococcus is the most common pathogenic organism

Select the correct answer using the code given below:

Accepted Answer

1 and 2 only

Answer

3 only

Answer

1, 2 and 3

Answer

1 and 3 only

Question 10

Which one of the following is NOT a sign of separation of placenta?

Accepted Answer

The fundal height reduces further

Answer

Apparent lengthening of the cord with slight gush of vaginal bleeding

Answer

Uterus becomes globular, firm and ballotable

Answer

Slight bulging in the suprapubic region

UPSC-CMS 2020 — Obstetrics and Gynecology