UPSC-CMS 2023 - Obstetrics and Gynecology Practice Questions

Q: As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), complete tear of External Anal Sphincter is of degree :

3c. ***3c*** - A **3c tear** involves a **complete tear** of the **external anal sphincter (EAS)**, often along with the internal anal sphincter (IAS) being involved in any degree during obstetric anal sphincter injury (OASI). - According to the RCOG (Royal College of Obstetricians and Gynaecologists) 2007 classification, this signifies a severe and complete disruption of the external sphincter. *2c* - A **2c tear** would typically refer to a **more extensive second-degree perineal tear** involving deeper muscle layers, but it does **not involve the anal sphincters**. - Second-degree tears involve the skin, vaginal mucosa, and perineal muscles but spare the anal sphincter complex. *3b* - A **3b tear** signifies a **partial tear of the external anal sphincter (EAS)**, with **more than 50%** of the muscle thickness being torn. - While it involves the EAS, it is not a complete tear as described in the question, differentiating it from a 3c tear. *3a* - A **3a tear** indicates an **involvement of the external anal sphincter (EAS)**, specifically a partial tear of the EAS involving **less than 50%** of its thickness. - This is a less severe injury than a 3b or 3c tear and does not represent a complete tear of the EAS.

Q: What are the causes of lactation failure after delivery ? 1. Infrequent suckling 2. Depression or anxiety state in the puerperium 3. Prolactin inhibition Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - **Infrequent suckling** directly reduces the stimulation needed for **prolactin release** and **milk production**, leading to lactation failure. - **Depression or anxiety** can interfere with the **let-down reflex** by inhibiting **oxytocin release** and also decrease a mother's motivation and ability to breastfeed effectively. - Any condition causing **prolactin inhibition**, such as certain medications (e.g., dopamine agonists) or specific medical conditions (e.g., Sheehan's syndrome), will directly prevent milk synthesis. *1 and 2 only* - This option correctly identifies infrequent suckling and emotional states as causes but fails to include **prolactin inhibition**, which is a direct and significant physiological factor in lactation failure. - Excluding **prolactin inhibition** provides an incomplete understanding of all potential causes for inadequate milk production. *2 and 3 only* - This option correctly recognizes the impact of emotional states and prolactin inhibition but overlooks **infrequent suckling**, which is one of the most common behavioral reasons for reduced milk supply. - Lack of adequate and frequent nipple stimulation is crucial for establishing and maintaining a robust milk supply. *1 and 3 only* - This option correctly identifies infrequent suckling and prolactin inhibition but omits the significant role of **maternal psychological states** like depression and anxiety in successful lactation. - Emotional well-being heavily influences the **milk ejection reflex** and overall breastfeeding success.

Q: Secondary arrest of dilatation during the process of labour may be due to which of the following factors ? 1. Poor uterine contractions 2. Cessation of cervical dilatation despite strong uterine contractions 3. Disproportion and malpresentation Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - **Secondary arrest of dilatation** refers to a cessation of cervical dilatation in the active phase of labor after the cervix has already begun to dilate, often attributed to **poor uterine contractions** (hypocontractility) hindering cervical progress. - While weak contractions are a common cause, secondary arrest can also occur despite **strong uterine contractions** if there's an underlying mechanical issue, such as **cephalopelvic disproportion** or **fetal malpresentation**, preventing the fetal head from descending and dilating the cervix effectively. *1 and 2 only* - This option incorrectly excludes **disproportion and malpresentation** as potential causes of secondary arrest of dilatation. - Both poor uterine contractions and cessation of dilatation despite strong contractions are valid causes, but overlooking mechanical impediments like disproportion leaves the explanation incomplete. *1 and 3 only* - This option overlooks the scenario where **cervical dilatation ceases despite strong uterine contractions**, which is a distinct presentation of arrest that points to mechanical obstruction rather than purely ineffective contractions. - While poor contractions and disproportion/malpresentation are important, the specified scenario of strong contractions with no progress is also a key factor. *2 and 3 only* - This option incorrectly omits **poor uterine contractions** as a primary and very common cause of secondary arrest of dilatation. - Weak or uncoordinated contractions are often the first factor investigated when cervical progression stalls.

Q: Which of the following correctly defines the first stage of labor? 1. Full dilatation of cervix to the expulsion of the fetus from the birth canal 2. Maternal bearing down efforts and ends with the delivery of the baby 3. The onset of true labor pains and ends with the full dilatation of cervix 4. The formation of bag of waters

2, 3 and 4. ***Correct Answer: Only Statement 3*** The **first stage of labor** is accurately defined by **statement 3 only**: "The onset of true labor pains and ends with the full dilatation of cervix" **Statement 3 - The onset of true labor pains and ends with the full dilatation of cervix** ✓ - This is the **accurate and complete definition** of the **first stage of labor** - Begins with regular, progressive uterine contractions - Ends when cervix reaches **10 cm (full) dilatation** - Divided into **latent phase** (0-6 cm) and **active phase** (6-10 cm) - Duration varies but averages 8-12 hours in primigravidas **Why other statements are INCORRECT:** *Statement 1 - Full dilatation of cervix to the expulsion of the fetus* - This describes the **SECOND stage of labor**, NOT the first stage - Second stage: begins at full cervical dilatation (10 cm) and ends with delivery of baby *Statement 2 - Maternal bearing down efforts and ends with the delivery of the baby* - This also describes the **SECOND stage of labor** - Active pushing occurs after full dilatation, not during the first stage *Statement 4 - The formation of bag of waters* - The amniotic sac forms during **pregnancy**, not during labor - Its rupture may occur during labor but does not define the first stage - Not a defining characteristic of any labor stage **Note:** Among the given options, **"2, 3 and 4"** is selected as it contains the correct statement (3). However, strictly speaking, only statement 3 correctly defines the first stage of labor. Statements 2 and 4 do not define the first stage.

Q: Vesicovaginal fistula is classified as complicated if it has which of the following features ? 1. Size - more than 3 cm 2. Bladder involvement - Trigonal/Juxta-urethral 3. Location - Midvaginal 4. Presence of prior radiation Select the correct answer using the code given below :

1, 2 and 4. ***1, 2 and 4*** * A vesicovaginal fistula is considered **complicated** if it has a size of **more than 3 cm**, involves the **trigone or juxta-urethral region** of the bladder, or is associated with **prior radiation therapy**. * These factors indicate a greater challenge in surgical repair and a higher risk of recurrence. * Trigonal involvement is complicated because it may involve ureteral orifices, and juxta-urethral fistulas risk urinary continence. *1, 2 and 3* * While a size of more than 3 cm and trigonal/juxta-urethral bladder involvement are criteria for a complicated fistula, a **midvaginal location** is generally not considered a complicating factor on its own. * **Low vaginal (juxta-urethral) fistulas** or those in scarred, immobile areas are more challenging, not midvaginal locations. *1, 3 and 4* * A size of more than 3 cm and prior radiation are indeed factors that classify a fistula as complicated. * However, a **midvaginal location** alone does not typically complicate the repair to the same extent as trigonal bladder involvement or a history of radiation. *2, 3 and 4* * Trigonal/juxta-urethral bladder involvement and prior radiation are definite complicating factors. * Yet, a **midvaginal location** is less of a complicating factor compared to a **large size (more than 3 cm)**, which is a major determinant of fistula complexity.

Q: Which one of the following is a prerequisite for Endometrial Ablation ?

Completed childbearing. ***Correct: Completed childbearing*** **Completed childbearing** is the key **prerequisite** for **endometrial ablation (EA)**. This is a fundamental requirement because: - **EA significantly impairs or destroys fertility** by ablating the endometrial lining essential for implantation - Pregnancy after EA is **rare and high-risk**, with increased chances of **miscarriage, ectopic pregnancy, preterm birth, and placental abnormalities** (placenta accreta, previa) - Patients must be **thoroughly counseled** that EA is intended as a permanent solution and future pregnancy is contraindicated - Most guidelines and consent protocols require documentation that the patient has completed childbearing or accepts permanent loss of fertility - While not an absolute contraindication if a patient insists, the strong recommendation is that childbearing should be complete *Incorrect: Presence of large submucous fibroids* - Large submucous fibroids are a **CONTRAINDICATION**, not a prerequisite - Fibroids distort the uterine cavity, making safe and effective ablation **difficult or impossible** - They may require **hysteroscopic myomectomy** first, or EA may not be appropriate at all - This is the opposite of a prerequisite *Incorrect: Desire to maintain fertility* - This is a strong **CONTRAINDICATION** for EA - EA destroys the endometrium needed for pregnancy - Patients desiring future fertility should pursue other treatments for abnormal uterine bleeding - This directly contradicts the purpose and effects of the procedure *Incorrect: Uterine size >16 weeks* - A uterus larger than **12 weeks' gestation** is a **relative contraindication** or limitation - Increased risk of **incomplete ablation, perforation**, and treatment failure - Large uteri often indicate underlying pathology needing alternative management - This is a contraindication, not a prerequisite

Q: Which of the following days of menstrual cycle is best for endometrial sampling to diagnose ovulation?

21st - 23rd day. ***21st - 23rd day*** - This period corresponds to the **mid-secretory phase** (~7 days post-ovulation), when **progesterone-induced secretory changes** are fully established and most reliable for histological confirmation of ovulation. - The endometrium shows **mature secretory features** including prominent subnuclear vacuoles, stromal edema, and spiral artery development, making it the **textbook recommendation** for endometrial dating. *12th - 14th day* - This represents the **late proliferative phase** or **periovulatory period**, when ovulation is occurring but secretory changes have not yet developed. - Endometrial histology would show **proliferative features** with straight tubular glands and mitotic activity, lacking the progesterone effect needed to diagnose ovulation. *16th - 20th day* - This period falls in the **early secretory phase**, showing only **initial secretory changes** that may be incomplete or unreliable for definitive diagnosis. - While some progesterone effect may be present, the changes are **not fully mature** compared to the optimal 21st-23rd day window recommended in standard gynecology texts. *8th - 10th day* - This corresponds to the **early proliferative phase**, well before ovulation occurs, when estrogen dominates and no secretory changes are present. - Endometrial sampling would show **proliferative endometrium** with no evidence of progesterone effect, making it unsuitable for diagnosing ovulation.

Q: A 27-year-old female married for 3 years regularly cohabiting with husband presents to Gynaecology OPD with complaints of inability to conceive for 2 years. During clinical evaluation hysterosalpingography was done which revealed irregular outline of uterine cavity and rigid fallopian tubes with nodulations. Most likely cause for this condition is :

Genital Tuberculosis. ***Genital Tuberculosis*** - The combination of **infertility**, an **irregular uterine cavity outline**, and **rigid fallopian tubes with nodulations** on hysterosalpingography (HSG) is highly suggestive of genital tuberculosis. - **Tuberculosis** can cause significant scarring and obstruction in the female reproductive tract, leading to these characteristic HSG findings and impaired fertility. *Syphilis* - While syphilis is a sexually transmitted infection, it typically causes **chancre formation**, **rash**, and systemic symptoms; it does not typically lead to the described HSG findings of an irregular uterine cavity or rigid, nodulated fallopian tubes. - Infertility can be a consequence of untreated syphilis (e.g., through miscarriage), but the specific morphological changes seen in the uterus and tubes are not characteristic of this infection. *Genital Herpes* - Genital herpes is caused by the herpes simplex virus and is characterized by recurrent outbreaks of **painful blisters and ulcers** in the genital area. - It does not cause structural changes to the uterus or fallopian tubes that would result in an irregular uterine outline or rigid, nodulated tubes as seen on HSG. *Gonorrhoea* - Gonorrhoea can cause **pelvic inflammatory disease (PID)**, which can lead to tubal damage and infertility; however, the typical HSG findings are often **hydrosalpinx** or extensive peritubal adhesions, rather than rigid, nodulated tubes with an irregular uterine outline. - While it can result in tubal obstruction, the specific pattern described in the question (irregular uterine outline, rigid tubes with nodulations) is more characteristic of the chronic inflammatory and fibrotic changes associated with tuberculosis.

Q: Prophylactic oophorectomy is recommended in high risk women with which of the following ? 1. Carrying BRCA1 or BRCA2 genes 2. Family history of breast, colon, ovarian cancer 3. Patients having tubo-ovarian abscess Select the correct answer using the code given below :

1 and 2 only. ***1 and 2 only*** - Prophylactic oophorectomy is strongly recommended for women carrying **BRCA1 or BRCA2 genes** due to a significantly increased lifetime risk of developing ovarian and breast cancer. - A strong **family history of breast, colon, or ovarian cancer**, especially in multiple first-degree relatives or at early ages, indicates a higher genetic predisposition that warrants consideration for prophylactic oophorectomy. *1, 2 and 3* - While carrying BRCA1/2 genes and a significant family history are indications, a **tubo-ovarian abscess (TOA)** is an infectious condition that requires antibiotic treatment and possibly surgical drainage, not a prophylactic oophorectomy for cancer risk reduction. - Prophylactic oophorectomy is performed to reduce cancer risk in genetically predisposed individuals, which is unrelated to the management of an acute infectious process like TOA. *2 and 3 only* - This option incorrectly excludes **BRCA1 or BRCA2 gene carriers**, who are among the highest-risk group for ovarian and breast cancer, making prophylactic oophorectomy a crucial primary prevention strategy. - The inclusion of **tubo-ovarian abscess** as an indication for prophylactic oophorectomy is incorrect, as TOA is an inflammatory condition, not a genetic predisposition to cancer. *1 and 3 only* - This option incorrectly includes **tubo-ovarian abscess (TOA)** as a reason for prophylactic oophorectomy; TOA is an infection requiring specific medical or surgical treatment, not risk-reducing surgery for cancer. - This option incorrectly excludes a **strong family history of breast, colon, or ovarian cancer** as a separate indication for prophylactic oophorectomy, especially when genetic testing might not have identified a specific mutation but a high familial risk remains.

Q: Which one of the following is the distinguishing feature to differentiate Gartner's cyst from Cystocele ?

Gartner's cyst is not reducible. ***Gartner's cyst is not reducible*** * **Gartner's cysts** are typically **fixed structures** within the vagina, representing remnants of the Wolffian duct, and therefore cannot be reduced or pushed back into place. * The **immobility** and non-reducibility of the cyst is a key characteristic that helps differentiate it from conditions like cystocele. * A **cystocele** is a prolapse of the bladder into the vagina, which is **reducible** (can be pushed back) and typically shows an impulse on coughing due to increased intra-abdominal pressure. *There is no impulse on coughing in cystocele* * This statement is **incorrect** as a **cystocele** typically **does show a cough impulse** due to increased intra-abdominal pressure transmitted through the prolapsed bladder. * The presence of a cough impulse is a characteristic feature of cystocele, not its absence. *Marked cough impulse in Gartner's cyst* * **Gartner's cysts** are fluid-filled sacs and do not transmit increased intra-abdominal pressure from coughing, therefore they typically **do not have a cough impulse**. * A marked cough impulse is more characteristic of a prolapsed organ, like a cystocele or rectocele, not a fixed cystic structure. *Margins are ill-defined in Gartner's cyst* * **Gartner's cysts** usually have **well-defined margins** as they are encapsulated structures. * Ill-defined margins might suggest an infiltrative process or inflammation, which is not characteristic of a simple Gartner's cyst.

Question 1

As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), complete tear of External Anal Sphincter is of degree :

Accepted Answer

3c

Answer

2c

Answer

3b

Answer

3a

Question 2

What are the causes of lactation failure after delivery ?

1. Infrequent suckling
2. Depression or anxiety state in the puerperium
3. Prolactin inhibition

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 and 3 only

Question 3

Secondary arrest of dilatation during the process of labour may be due to which of the following factors ?

1. Poor uterine contractions

2. Cessation of cervical dilatation despite strong uterine contractions

3. Disproportion and malpresentation

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

1 and 3 only

Answer

2 and 3 only

Question 4

Which of the following correctly defines the first stage of labor?

1. Full dilatation of cervix to the expulsion of the fetus from the birth canal

2. Maternal bearing down efforts and ends with the delivery of the baby

3. The onset of true labor pains and ends with the full dilatation of cervix

4. The formation of bag of waters

Accepted Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Question 5

Vesicovaginal fistula is classified as complicated if it has which of the following features ?

1. Size - more than 3 cm

2. Bladder involvement - Trigonal/Juxta-urethral

3. Location - Midvaginal

4. Presence of prior radiation

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 6

Which one of the following is a prerequisite for Endometrial Ablation ?

Accepted Answer

Completed childbearing

Answer

Desire to maintain fertility

Answer

Uterine size >16 weeks

Answer

Presence of large submucous fibroids

Question 7

Which of the following days of menstrual cycle is best for endometrial sampling to diagnose ovulation?

Accepted Answer

21st - 23rd day

Answer

12th - 14th day

Answer

8th - 10th day

Answer

16th - 20th day

Question 8

A 27-year-old female married for 3 years regularly cohabiting with husband presents to Gynaecology OPD with complaints of inability to conceive for 2 years. During clinical evaluation hysterosalpingography was done which revealed irregular outline of uterine cavity and rigid fallopian tubes with nodulations. Most likely cause for this condition is :

Accepted Answer

Genital Tuberculosis

Answer

Syphilis

Answer

Genital Herpes

Answer

Gonorrhoea

Question 9

Prophylactic oophorectomy is recommended in high risk women with which of the following ?

1. Carrying BRCA1 or BRCA2 genes 
2. Family history of breast, colon, ovarian cancer 
3. Patients having tubo-ovarian abscess

Select the correct answer using the code given below :

Accepted Answer

1 and 2 only

Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 3 only

Question 10

Which one of the following is the distinguishing feature to differentiate Gartner's cyst from Cystocele ?

Accepted Answer

Gartner's cyst is not reducible

Answer

There is no impulse on coughing in cystocele

Answer

Marked cough impulse in Gartner's cyst

Answer

Margins are ill-defined in Gartner's cyst

UPSC-CMS 2023 — Obstetrics and Gynecology