UPSC-CMS 2023 - Obstetrics and Gynecology Practice Questions

Q: A 60-year-old woman presents with postmenopausal bleeding per vaginum. Both per vaginum and per speculum examination reveal no abnormality, and the Pap smear is normal. What will be the most appropriate management?

Measure endometrial thickness with ultrasound. ***Measure endometrial thickness with ultrasound*** - **Postmenopausal bleeding (PMB)** is a significant symptom that requires thorough evaluation to rule out **endometrial hyperplasia** or **carcinoma**, even with normal clinical exams and Pap smear. - Measuring **endometrial thickness with transvaginal ultrasound (TVS)** is the **first-line investigation** for PMB to assess for abnormalities. - **Endometrial thickness >4-5mm** warrants further evaluation with **endometrial biopsy** to rule out malignancy. - This is a non-invasive, cost-effective screening tool with high sensitivity for detecting endometrial pathology. *Keep her under observation* - This approach is inappropriate for PMB, as **10-15% of cases** can indicate underlying serious pathology like **endometrial cancer**. - **Prompt investigation** is necessary to ensure timely diagnosis and treatment. - Observation without investigation can lead to dangerous delays in cancer diagnosis. *Administer haemostatics* - Administering haemostatics addresses the symptom (bleeding) but does not identify or treat the underlying cause, which could be malignant. - This would delay crucial diagnostic evaluation and potentially worsen the prognosis if a **malignant condition** is present. - **PMB always requires investigation**, not symptomatic treatment alone. *Hysterectomy* - Hysterectomy is an invasive surgical procedure and is considered a definitive treatment, not a diagnostic step in this initial presentation. - It would only be contemplated after a definitive diagnosis of a serious condition, such as **endometrial cancer**, is made via less invasive means (e.g., endometrial biopsy). - Diagnostic workup should proceed stepwise: **TVS → endometrial biopsy → treatment decision**.

Q: Hormonal contraceptives are contraindicated in women

who have thromboembolic disorders. **who have thromboembolic disorders** - **Estrogen** components of hormonal contraceptives increase the risk of **venous thromboembolism** (VTE), including deep vein thrombosis and pulmonary embolism, especially in women with pre-existing clotting disorders or risk factors. - This increased risk is a major contraindication due to the potential for serious, life-threatening complications. *less than 25 years of age* - Age itself is not a contraindication for hormonal contraceptive use; many young women use them safely and effectively. - The **risk of VTE** from hormonal contraceptives is generally lower in younger women compared to older women, especially those over 35 years old and who smoke. *who are normotensive* - **Normotension** is a normal blood pressure reading, which is not a contraindication for hormonal contraceptive use. - In fact, women with well-controlled hypertension may use some hormonal contraceptives, although close monitoring is often required. *who have anaemia* - **Anemia** is not a contraindication to hormonal contraceptive use and, in some cases, can even be improved by them. - Hormonal contraceptives can reduce menstrual blood loss, thereby potentially improving or preventing **iron-deficiency anemia**.

Q: The contraindications for Progestasert include the following except

Previous history of abortion. ***Previous history of abortion*** - A prior history of abortion is generally **not a contraindication** for the insertion of a progestogen-releasing intrauterine device (Progestaert or similar IUDs). - The risk of complications like infection or perforation is not significantly increased in women with a history of abortion, especially if it was a safe procedure. *Previous history of ectopic pregnancy* - A history of **ectopic pregnancy** is a **relative contraindication** for progestogen-only IUDs, as these devices primarily prevent intrauterine pregnancy but can marginally increase the risk of ectopic pregnancy if conception occurs. - While IUDs are highly effective at preventing pregnancy overall, if a pregnancy does occur with an IUD in place, there is a higher chance it will be ectopic. *Pelvic Inflammatory Disease* - **Active or recent Pelvic Inflammatory Disease (PID)** is a **strong contraindication** for IUD insertion due to the increased risk of ascending infection and exacerbation of the condition. - IUD insertion can potentially introduce bacteria into the uterus, worsening an existing infection or causing a new one if the patient is at high risk. *Uterine fibroids* - **Large or distorting uterine fibroids** can be a **contraindication** for IUD insertion, especially if they alter the uterine cavity significantly. - Fibroids can make IUD insertion difficult, increase the risk of perforation, and compromise the effectiveness of the device by preventing proper placement or causing expulsion.

Q: The daily requirement of iron during second half of pregnancy is :

6 mg per day. ***6 mg per day*** - This represents the **additional absorbed elemental iron** required during the second half of pregnancy (beyond the non-pregnant requirement of ~1-2 mg/day). - The increased demand is due to **fetal growth** (300-400 mg total), **placental development** (50-75 mg), **expansion of maternal red cell mass** (450 mg), and **blood loss at delivery** (150-250 mg). - **Important distinction**: This is the *absorbed* requirement. Since iron absorption from the gut is only 10-20%, the actual **oral supplementation** recommended is much higher: **100-200 mg of elemental iron daily** (as per WHO/ICMR guidelines). - In India, the standard National Iron+ Initiative provides **100 mg elemental iron + 500 mcg folic acid** daily during pregnancy. *2 mg per day* - This represents approximately the **basal iron requirement** for non-pregnant women, which is insufficient for pregnancy. - Would lead to **severe maternal iron-deficiency anemia** and poor fetal outcomes. *20 mg per day* - While higher than baseline, this is still insufficient as absorbed iron requirement. - However, this could represent a fraction of the therapeutic supplementation dose. *10 mg per day* - This exceeds the absorbed requirement but is far below the recommended **oral supplementation dose** of 100-200 mg. - Reflects neither the absorbed requirement nor the standard supplementation protocol. **Clinical Pearl**: When discussing iron in pregnancy, always clarify whether referring to *absorbed* iron (5-6 mg/day additional) or *supplemental* oral iron (100-200 mg/day).

Q: A typical case of Iron Deficiency Anaemia (IDA) in pregnancy will show which of the following? 1. Hb less than 10 g/dL 2. PCV less than 30% 3. MCHC more than 30% 4. Microcytic hypochromic picture on peripheral blood smear (PBS). Select the correct answer using the code given below:

1, 2 and 4. ***1, 2 and 4*** - All three options (Hb < 10 g/dL, PCV < 30%, and microcytic hypochromic picture on PBS) are characteristic features of **iron deficiency anemia (IDA)** in pregnancy [1]. - While exact thresholds can vary, these values generally indicate significant anemia and the classic morphological changes associated with IDA [1]. *1, 2 and 3* - This option incorrectly includes "MCHC more than 30%." IDA is characterized by **hypochromia**, meaning **MCHC (mean corpuscular hemoglobin concentration)** is typically *less than* 30%, not more [1]. - The other two points (Hb < 10 g/dL and PCV < 30%) are consistent with IDA [1]. *2, 3 and 4* - This option incorrectly includes "MCHC more than 30%," which is contrary to the **hypochromic** nature of IDA [1]. - While PCV < 30% and microcytic hypochromic picture on PBS are correct, the inclusion of incorrect MCHC value makes this choice invalid. *1 and 4 only* - This option correctly identifies Hb less than 10 g/dL and a microcytic hypochromic picture on PBS as features of IDA [1]. - However, it omits **PCV less than 30%**, which is also a common finding in IDA, making it an incomplete answer compared to the most comprehensive correct option.

Q: Which of the following are the clinical features of molar pregnancy ? 1. History of amenorrhea and vaginal bleeding 2. Patient has excessive vomiting 3. History of expulsion of grape-like vesicles Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - **All three are clinical features of molar pregnancy (hydatidiform mole)** - **Amenorrhea and vaginal bleeding**: Classic presentation seen in most cases. Vaginal bleeding typically occurs in the first or early second trimester and is the most common presenting symptom - **Excessive vomiting (hyperemesis gravidarum)**: Occurs in approximately 25-30% of cases due to abnormally high levels of **hCG** produced by the proliferating trophoblastic tissue, much higher than in normal pregnancy - **Expulsion of grape-like vesicles**: This is a **pathognomonic (definitive) sign** of molar pregnancy. While it may not be the initial presenting symptom and often occurs during spontaneous expulsion or evacuation, it is a characteristic clinical feature when present - **Other features**: Uterine size larger than dates, absent fetal heart sounds, pre-eclampsia before 20 weeks, and markedly elevated serum hCG levels *1 and 2 only* - This option incorrectly excludes the **expulsion of grape-like vesicles**, which is a definitive clinical feature of molar pregnancy - While vesicle expulsion may occur later in the clinical course, the question asks about clinical features, not just initial presenting symptoms *2 and 3 only* - This option omits **amenorrhea and vaginal bleeding**, which are the most common and important presenting symptoms - Vaginal bleeding occurs in 80-90% of molar pregnancies and is typically the chief complaint *1 and 3 only* - This option incorrectly excludes **excessive vomiting**, which is a well-recognized clinical feature occurring in 25-30% of cases - Hyperemesis gravidarum associated with molar pregnancy can be severe due to extremely elevated hCG levels

Q: Which of the following vaccines can be given to a pregnant woman ? 1. COVID vaccine 2. Measles, Mumps, Rubella vaccine 3. Hepatitis B vaccine 4. Rabies vaccine Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** The vaccines that can be safely given during pregnancy are: - **COVID-19 vaccine** (mRNA or inactivated virus) is recommended for pregnant women to protect against severe illness. It has been shown to be safe and effective, and provides passive immunity to the newborn. - **Hepatitis B vaccine** is safe during pregnancy as it is an inactivated vaccine. Vaccination can provide protection for both the mother and the newborn, preventing vertical transmission. - **Rabies vaccine** (inactivated) is given in situations of exposure to rabies, as the risk of rabies infection (which is almost 100% fatal) far outweighs any theoretical risk from the vaccine during pregnancy. *1, 2 and 3* This option incorrectly includes the **Measles, Mumps, Rubella (MMR) vaccine**, which is a live attenuated vaccine and is **contraindicated in pregnancy** due to the theoretical risk of congenital infection. While COVID-19 and Hepatitis B vaccines are safe, the inclusion of MMR makes this option incorrect. *2, 3 and 4* This option is incorrect because the **Measles, Mumps, Rubella (MMR) vaccine** is a live attenuated vaccine and is contraindicated during pregnancy. Women should be counseled to avoid pregnancy for at least 4 weeks after receiving MMR vaccine. Hepatitis B and Rabies vaccines are safe, but the presence of MMR makes this choice incorrect. *1, 2 and 4* This option incorrectly includes the **Measles, Mumps, Rubella (MMR) vaccine**, which is a live attenuated vaccine and should not be given to pregnant women. COVID-19 and Rabies vaccines are safe in pregnancy, but the contraindication for MMR makes this selection incorrect.

Q: Which of the following are the characteristics of true labour pains ? 1. Intensity and duration of contractions increase progressively 2. Progressive effacement and dilatation of the cervix 3. Formation of the 'bag of forewaters' 4. Pain is confined to lower abdomen and groin Select the correct answer using the code given below :

1, 2 and 3. ***Correct Answer: 1, 2 and 3*** - **Progressive increase in intensity and duration of contractions** (1) is a hallmark of true labor, as uterine activity becomes more coordinated and forceful over time. - **Progressive effacement and dilatation of the cervix** (2) are the definitive signs of true labor, indicating that the uterus is actively working to prepare for birth. - The **formation of the 'bag of forewaters'** (3) occurs as the lower uterine segment stretches and the fetal head descends, causing the membranes to bulge into the cervical os, which is characteristic of advancing labor. *Incorrect: 1, 2 and 4* - While options 1 and 2 are true, the statement that **pain is confined to the lower abdomen and groin** (4) is incorrect; true labor pain typically **starts in the back and radiates anteriorly** to the lower abdomen. - True labor pain is typically felt as a **wave-like contraction** that encompasses the entire uterus, not just localized to the lower abdomen and groin. *Incorrect: 1, 3 and 4* - Options 1 and 3 are correct diagnostic characteristics, but **pain confined to the lower abdomen and groin** (4) is not accurate for true labor pain, which usually involves the back as well. - The absence of **progressive cervical changes** (2) makes this option incomplete as a definition of true labor. *Incorrect: 2, 3 and 4* - While **progressive effacement and dilatation of the cervix** (2) and **formation of the 'bag of forewaters'** (3) are signs of true labor, the characteristic that **pain is confined to the lower abdomen and groin** (4) is incorrect. - This option also omits the crucial feature of **increasing intensity and duration of contractions** (1), which is a primary indicator of true labor.

Q: Which are the parts of active management of third stage of labour? 1. Injection oxytocin 10 units IM within 1 minute of delivery of baby 2. Uterine massage after placental delivery 3. Controlled cord traction 4. Delayed cord clamping as per indications Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - **Active management of the third stage of labor (AMTSL)** consists of three key interventions: **prophylactic uterotonic administration** (oxytocin 10 units IM within 1 minute of delivery), **controlled cord traction**, and **uterine massage after placental delivery**. - These interventions work synergistically to prevent **postpartum hemorrhage** by promoting rapid uterine contraction and complete placental expulsion. - This combination represents the **WHO-recommended standard** for AMTSL. *1, 2 and 4* - **Delayed cord clamping** (4) is an important **neonatal intervention** for improving iron stores and hemoglobin levels in the newborn, but it is **not a component of AMTSL**. - While this option correctly includes **oxytocin administration** (1) and **uterine massage** (2), it omits **controlled cord traction** (3), which is essential for safe placental delivery. - Delayed cord clamping is typically performed **before** AMTSL interventions begin. *2, 3 and 4* - This option omits **immediate prophylactic oxytocin** (1), which is the **most critical component** of AMTSL for preventing postpartum hemorrhage. - Without prompt uterotonic administration, the risk of **uterine atony** and subsequent hemorrhage increases significantly. - Additionally, **delayed cord clamping** (4) is not part of the AMTSL protocol. *1, 3 and 4* - This option omits **uterine massage after placental delivery** (2), which is important for ensuring sustained uterine contraction and detecting early signs of atony. - While **oxytocin** (1) and **controlled cord traction** (3) are correctly included, **delayed cord clamping** (4) is **not a component of AMTSL**. - The absence of uterine massage reduces the completeness of active management.

Q: Which of the following are correct regarding acute mastitis ? 1. It usually occurs in first 2 - 4 weeks postpartum. 2. Microscopic examination of breast milk shows leukocyte count more than 10^6/mL and bacterial count more than 10^3/mL. 3. Common organisms are bacteroids, E. coli and Klebsiella. 4. The source of infection is infant's nose and throat. Select the correct answer using the code given below :

1, 2 and 4. ***1, 2 and 4*** - **Acute mastitis** most frequently occurs within the **first 2-4 weeks postpartum** during lactation establishment (Statement 1 correct) - Diagnosis of infectious mastitis is confirmed by **breast milk culture** showing **leukocyte count > 10^6/mL** and **bacterial count > 10^3/mL** (Statement 2 correct) - **The primary source of infection** is the infant's **nose and throat flora**, which colonizes the mother's nipple and invades through cracks or fissures (Statement 4 correct) - **Staphylococcus aureus** is the most common causative organism, not Bacteroides, E. coli, or Klebsiella (Statement 3 incorrect) *1, 3 and 4* - While statements 1 and 4 are correct, statement 3 incorrectly identifies the common organisms - The primary organism responsible for acute mastitis is **Staphylococcus aureus** from infant's oral flora, not anaerobes or gram-negative organisms *1, 2 and 3* - Statements 1 and 2 are correct, but statement 3 is incorrect - **Staphylococcus aureus** accounts for the vast majority of mastitis cases, not Bacteroides, E. coli, or Klebsiella *2, 3 and 4* - Statements 2 and 4 are correct, but statement 3 incorrectly identifies the causative organisms - The correct organism is **Staphylococcus aureus**, not the organisms listed in statement 3

Question 1

A 60-year-old woman presents with postmenopausal bleeding per vaginum. Both per vaginum and per speculum examination reveal no abnormality, and the Pap smear is normal. What will be the most appropriate management?

Accepted Answer

Measure endometrial thickness with ultrasound

Answer

Keep her under observation

Answer

Administer haemostatics

Answer

Hysterectomy

Question 2

Hormonal contraceptives are contraindicated in women

Accepted Answer

who have thromboembolic disorders

Answer

less than 25 years of age

Answer

who are normotensive

Answer

who have anaemia

Question 3

The contraindications for Progestasert include the following except

Accepted Answer

Previous history of abortion

Answer

Previous history of ectopic pregnancy

Answer

Pelvic Inflammatory Disease

Answer

Uterine fibroids

Question 4

The daily requirement of iron during second half of pregnancy is :

Accepted Answer

6 mg per day

Answer

2 mg per day

Answer

20 mg per day

Answer

10 mg per day

Question 5

A typical case of Iron Deficiency Anaemia (IDA) in pregnancy will show which of the following?

1. Hb less than 10 g/dL
2. PCV less than 30%
3. MCHC more than 30%
4. Microcytic hypochromic picture on peripheral blood smear (PBS).

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1 and 4 only

Question 6

Which of the following are the clinical features of molar pregnancy ?

1. History of amenorrhea and vaginal bleeding
2. Patient has excessive vomiting
3. History of expulsion of grape-like vesicles

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 7

Which of the following vaccines can be given to a pregnant woman ?

1. COVID vaccine
2. Measles, Mumps, Rubella vaccine
3. Hepatitis B vaccine
4. Rabies vaccine

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 8

Which of the following are the characteristics of true labour pains ?

1. Intensity and duration of contractions increase progressively
2. Progressive effacement and dilatation of the cervix
3. Formation of the 'bag of forewaters'
4. Pain is confined to lower abdomen and groin

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 9

Which are the parts of active management of third stage of labour?

1. Injection oxytocin 10 units IM within 1 minute of delivery of baby
2. Uterine massage after placental delivery
3. Controlled cord traction
4. Delayed cord clamping as per indications

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 10

Which of the following are correct regarding acute mastitis ?

1. It usually occurs in first 2 - 4 weeks postpartum.

2. Microscopic examination of breast milk shows leukocyte count more than 10^6/mL and bacterial count more than 10^3/mL.

3. Common organisms are bacteroids, E. coli and Klebsiella.

4. The source of infection is infant's nose and throat.

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

UPSC-CMS 2023 — Obstetrics and Gynecology