UPSC-CMS 2021 - Obstetrics and Gynecology Practice Questions

Q: The normal rate of dilatation of the cervix in a primigravida in the active phase of labor is

1 cm/hour. ***1 cm/hour*** - The **active phase** of labor in a **primigravida** (first-time mother) is characterized by a cervical dilatation rate of at least 1 cm per hour. - This rate signifies good progress and is often used as a benchmark on a **partogram** to monitor labor. *0.25 cm/hour* - This rate is significantly **slower** than normal for the active phase of labor in a primigravida and would indicate **abnormal labor progression**, possibly requiring intervention. - Such a slow rate might be seen in the **latent phase** or in cases of **protracted labor**. *0.75 cm/hour* - While closer, this rate is still **below the expected minimum** for a primigravida in the active phase, suggesting slightly slower than optimal progress. - It could still indicate a **protracted active phase**, particularly if it persists. *0.5 cm/hour* - This rate is **substantially slower** than the typical progress in the active phase of labor for a primigravida. - It would be a strong indicator of **failure to progress** and would likely warrant a thorough evaluation for potential causes such as **cephalopelvic disproportion** or ineffective uterine contractions.

Q: In the mechanism of normal labour the engaging transverse diameter is

Biparietal diameter (9.5 cm). ***Biparietal diameter (9.5 cm)*** - In normal labor, with the fetus in a **flexed attitude**, the **biparietal diameter** is the widest transverse diameter of the fetal head that engages in the maternal pelvis. - This diameter measures approximately **9.5 cm** and indicates the distance between the two parietal eminences. *Bimastoid diameter (7.5 cm)* - The **bimastoid diameter** measures the widest transverse diameter at the base of the skull, going from one mastoid process to the other. - At **7.5 cm**, it is too small to be the primary engaging transverse diameter of the fetal head in normal labor, which involves the broader cranial vault. *Suboccipitofrontal diameter (10 cm)* - The **suboccipitofrontal diameter** is typically the engaging diameter when the fetal head is in a **deflexed attitude** (e.g., military presentation). - This diameter measures approximately **10 cm**, indicating moderate extension, which is not characteristic of normal labor where good flexion is expected. *Suboccipitobregmatic diameter (9.5 cm)* - The **suboccipitobregmatic diameter** is the smallest and most favorable anteroposterior diameter for engagement when the fetal head is **well-flexed**. - While it also measures **9.5 cm**, it is an **anteroposterior diameter**, not a transverse diameter, and hence not the answer to the question regarding transverse engaging diameter.

Q: In non-lactating mothers, after delivery, ovulation

may occur as early as 2 weeks. ***may occur as early as 2 weeks*** - In non-lactating mothers, the **hypothalamic-pituitary-ovarian axis** recovers relatively quickly after delivery because it is not suppressed by prolactin. - The earliest documented return of ovulation can be as soon as **2 weeks postpartum**, although 4-6 weeks is more common. *may occur as early as 4 weeks* - While 4 weeks is a common timeframe for ovulation to resume in non-lactating mothers, it is not the **earliest possible occurrence**. - This option misses the possibility of an even earlier return of **fertility**. *is unusual before 6 weeks* - This statement is incorrect as ovulation can, and frequently does, occur **before 6 weeks postpartum** in non-lactating women. - Delaying ovulation until 6 weeks is more typical in breast-feeding women due to **prolactin's inhibitory effect** on gonadotropin-releasing hormone. *may occur as early as 6 weeks* - Similar to the 4-week option, while ovulation can occur at 6 weeks, it is not the **earliest possible time point** for a non-lactating mother. - Assuming 6 weeks as the earliest timeframe could lead to an underestimation of the **risk of conception**.

Q: Which of the following are the pre-requisites of outlet forceps delivery? 1. Bladder should be empty 2. Membranes should be intact 3. Cervix should be fully dilated 4. Fetal skull has reached level of pelvic floor

1, 3 and 4. ***1, 3 and 4*** - For an **outlet forceps delivery**, the **bladder must be empty** to prevent trauma during instrumentation and to create more space in the pelvis. - A **fully dilated cervix** (10 cm) is an absolute prerequisite, ensuring that the fetal head can pass without causing cervical lacerations. The **fetal skull must have reached the pelvic floor**, indicating the head is at or beyond +2 station, and the sagittal suture is in the anteroposterior diameter. *1, 2 and 4* - While an **empty bladder** and the **fetal skull at the pelvic floor** are prerequisites, the **membranes should not be intact** for forceps delivery. - Intact membranes would require artificial rupture (amniotomy) before applying forceps to avoid membrane stripping or fetal injury. *1, 2 and 3* - An **empty bladder** and **fully dilated cervix** are essential, but **intact membranes** are not a prerequisite, as they must be ruptured for a safe forceps application. - The fetal head must also be at the **level of the pelvic floor**, which is missing from this option. *2, 3 and 4* - While a **fully dilated cervix** and the **fetal skull at the pelvic floor** are necessary, **intact membranes** are not desirable for forceps delivery, and an **empty bladder** is a crucial missing prerequisite. - Omitting the requirement for an **empty bladder** significantly increases the risk of maternal injury.

Q: The vaginal pH in childbearing age normally ranges between

4 - 5.5. ***4 - 5.5*** - A vaginal pH within the range of **4.0 to 5.5** is considered normal for women of childbearing age, indicating a healthy acidic environment. - This acidic pH is maintained primarily by **Lactobacillus species** bacteria, which produce lactic acid, protecting against pathogenic bacteria. *1 - 2* - A pH range of 1-2 is **extremely acidic** and would be highly corrosive, far outside the physiological range for the vagina. - This level of acidity is typically found in the **stomach**, not the vagina. *7 - 8* - A pH range of 7-8 is considered **alkaline** and suggests an imbalance in the vaginal flora, potentially leading to infections such as **bacterial vaginosis**. - A neutral to alkaline pH is harmful to the normal vaginal microbiota and can promote the growth of opportunistic pathogens. *2.5 - 3.5* - While acidic, a pH of 2.5-3.5 is generally **too low** for a healthy vagina in most women of childbearing age, as the normal range typically starts closer to 4.0. - Although the vagina is acidic, this range is at the **extreme lower end** and might indicate an altered microenvironment.

Q: Primary Dysmenorrhoea can be treated by which of the following? 1. Antiprostaglandin 2. Cyclic combined estrogen and progesterone preparations 3. Pre-sacral neurectomy 4. Uterine curettage

1, 2 and 3. ***1, 2 and 3*** - **Antiprostaglandins (NSAIDs)** are the first-line treatment for primary dysmenorrhea as they inhibit prostaglandin synthesis, reducing uterine contractions and pain. - **Cyclic combined estrogen and progesterone preparations (oral contraceptives)** are second-line therapy that suppress ovulation, leading to a thinner endometrium and reduced prostaglandin production, thereby alleviating dysmenorrhea. - **Pre-sacral neurectomy** is a surgical procedure that may be considered for severe, refractory primary dysmenorrhea that has failed medical management, though it is more commonly used for secondary dysmenorrhea and chronic pelvic pain. *1, 2, 3 and 4* - This option incorrectly includes **uterine curettage**, which is not a treatment for primary dysmenorrhea. - Uterine curettage is a diagnostic or therapeutic procedure for conditions like abnormal uterine bleeding or retained products of conception, not for menstrual pain management. *1, 2 and 4* - This option incorrectly includes **uterine curettage** while excluding pre-sacral neurectomy. - Curettage has no role in primary dysmenorrhea treatment, whereas the other interventions target the underlying pathophysiology. *2, 3 and 4* - This option incorrectly excludes **antiprostaglandins (NSAIDs)**, which are the cornerstone first-line therapy for primary dysmenorrhea. - It also incorrectly includes uterine curettage, which has no role in dysmenorrhea management.

Q: Which one of the following is an abnormal parameter in accordance with WHO Semen Analysis Criteria (Normal reference value)?

Volume 14%* - WHO criteria state that **≥ 4% of sperms should have normal morphology** (strict criteria) - A morphology of >14% is **well within the normal range** (more than 3 times the threshold) - This represents a normal finding, not an abnormality *Progressive forward motility of sperms > 50%* - WHO guidelines indicate that **progressive motility (PR) should be ≥ 32%** - Progressive forward motility of >50% is **significantly above the threshold** - This indicates excellent sperm motility and is a normal finding *Sperm concentration < 10 million/ml* - Normal reference value for sperm concentration is **≥ 15 million/ml** - While <10 million/ml would be considered abnormal (**oligozoospermia**), the question asks for "an abnormal parameter" - **Volume < 1.0 ml is the best answer** as it represents a more significant deviation from normal values (1.0 vs 1.5 ml threshold) compared to other parameters

Q: Which one of the following is the most important haematological condition to be ruled out while investigating a case of puberty menorrhagia ?

Coagulation disorder. ***Coagulation disorder*** - Puberty menorrhagia (excessive menstrual bleeding at puberty) is frequently linked to underlying **hemostatic dysfunction**, with **Von Willebrand Disease** being the most common cause. - A coagulation disorder can lead to **uncontrolled bleeding** during menstruation, necessitating thorough investigation to prevent severe blood loss and complications. *Leukemia* - While leukemia can cause **easy bruising** and **bleeding tendencies** due to thrombocytopenia or impaired platelet function, it is less common as the primary cause of isolated menorrhagia in puberty. - Leukemia would typically present with a broader range of symptoms, including systemic signs like **fatigue**, **fever**, and **lymphadenopathy**. *G-6PD deficiency* - G-6PD deficiency is primarily a cause of **hemolytic anemia**, triggered by certain drugs or foods, leading to red blood cell breakdown. - It does not directly cause prolonged or heavy menstrual bleeding (menorrhagia) as a primary symptom. *Anaemia* - Anaemia is often a **consequence** of heavy menstrual bleeding (menorrhagia) rather than its direct cause. - While iron deficiency anemia is common in young women with menorrhagia, addressing the underlying cause of the bleeding is crucial, which might be a coagulation disorder.

Q: Which of the following are risk factors for developing pelvic inflammatory disease in females? 1. Use of oral contraception pills 2. Multiple sexual partners 3. Lower socioeconomic status 4. Genetic predisposition

1, 2 and 3. ***1, 2 and 3*** - **Multiple sexual partners** is a well-established major risk factor for PID as it significantly increases exposure to sexually transmitted infections (STIs), particularly *Chlamydia trachomatis* and *Neisseria gonorrhoeae*, which are the primary causative organisms of PID. - **Lower socioeconomic status** is associated with increased PID risk due to reduced access to healthcare services, delayed diagnosis and treatment of STIs, and barriers to preventive care. - **Use of oral contraception pills** has a controversial relationship with PID. While OCPs do not prevent STIs and may be associated with behavioral factors (reduced condom use), the direct relationship remains debated. Some evidence suggests OCPs may actually provide modest protection against ascending infection by thickening cervical mucus. However, this option represents the best available answer among the choices given. *1, 2 and 4* - This incorrectly includes **genetic predisposition**, which is not an established risk factor for PID. PID is primarily an infectious disease driven by behavioral and socioeconomic factors, not genetic susceptibility. *2, 3 and 4* - This incorrectly includes **genetic predisposition** as a risk factor for PID, which lacks evidence-based support. - It also excludes oral contraception pills, making this option incomplete even considering the controversial role of OCPs. *1, 3 and 4* - This incorrectly includes **genetic predisposition** and critically excludes **multiple sexual partners**, which is the most significant and well-established behavioral risk factor for PID. - Missing this key risk factor makes this option clearly incorrect.

Question 1

The normal rate of dilatation of the cervix in a primigravida in the active phase of labor is

Accepted Answer

1 cm/hour

Answer

0.25 cm/hour

Answer

0.75 cm/hour

Answer

0.5 cm/hour

Question 2

In the mechanism of normal labour the engaging transverse diameter is

Accepted Answer

Biparietal diameter (9.5 cm)

Answer

Bimastoid diameter (7.5 cm)

Answer

Suboccipitofrontal diameter (10 cm)

Answer

Suboccipitobregmatic diameter (9.5 cm)

Question 3

In non-lactating mothers, after delivery, ovulation

Accepted Answer

may occur as early as 2 weeks

Answer

may occur as early as 4 weeks

Answer

is unusual before 6 weeks

Answer

may occur as early as 6 weeks

Question 4

Which of the following are the pre-requisites of outlet forceps delivery?

1. Bladder should be empty
2. Membranes should be intact
3. Cervix should be fully dilated
4. Fetal skull has reached level of pelvic floor

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 5

The vaginal pH in childbearing age normally ranges between

Accepted Answer

4 - 5.5

Answer

1 - 2

Answer

7 - 8

Answer

2.5 - 3.5

Question 6

Primary Dysmenorrhoea can be treated by which of the following?

1. Antiprostaglandin
2. Cyclic combined estrogen and progesterone preparations
3. Pre-sacral neurectomy
4. Uterine curettage

Accepted Answer

1, 2 and 3

Answer

1, 2, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 7

Which of the following is correct regarding obesity and infertility?

Accepted Answer

It is associated with hypogonadotropic hypogonadism

Answer

It is always associated with endometrial atrophy

Answer

It is associated with hypergonadotropic hypogonadism

Answer

There is no change in HPO axis

Question 8

Which one of the following is an abnormal parameter in accordance with WHO Semen Analysis Criteria (Normal reference value)?

Accepted Answer

Volume < 1.0 ml

Answer

Normal morphology of sperms > 14%

Answer

Progressive forward motility of sperms > 50%

Answer

Sperm concentration < 10 million/ml

Question 9

Which one of the following is the most important haematological condition to be ruled out while investigating a case of puberty menorrhagia ?

Accepted Answer

Coagulation disorder

Answer

Leukemia

Answer

G-6PD deficiency

Answer

Anaemia

Question 10

Which of the following are risk factors for developing pelvic inflammatory disease in females?

1. Use of oral contraception pills
2. Multiple sexual partners
3. Lower socioeconomic status
4. Genetic predisposition

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

UPSC-CMS 2021 — Obstetrics and Gynecology