UPSC-CMS 2025 - Obstetrics and Gynecology Practice Questions

Q: What are the characteristics of dermoid cyst? I. Germ cell ovarian tumour II. Bilateral in 15-20 % cases III. Torsion is common IV. Rupture is common Select the correct answer using the code given below :

I, II and III. ***I, II and III*** - **Dermoid cysts (mature cystic teratomas) are germ cell ovarian tumors** arising from totipotent germ cells, containing mature tissues from all three germ layers (ectoderm, mesoderm, endoderm) - They are **bilateral in 15-20% of cases**, which is a significant percentage for benign ovarian masses - **Torsion is the most common complication** (10-15% of cases) due to their buoyancy, irregular shape, and mobility - **Rupture is relatively uncommon** (spontaneous rupture in only 1-4% of cases), making statement IV incorrect *II and IV only* - While bilaterality (15-20%) is correct, rupture is NOT a common characteristic - This option incorrectly includes statement IV (rupture common) and misses the fundamental classification as a germ cell tumor *I and III only* - Correctly identifies germ cell origin and torsion risk - However, this excludes the significant bilaterality rate (15-20%), which is an important clinical characteristic - Incomplete answer *II, III and IV* - Correctly identifies bilaterality and torsion - Incorrectly states rupture is common (actually occurs in only 1-4% of cases) - Critically fails to mention the germ cell tumor classification, which is fundamental to understanding dermoid cysts

Q: Which one of the following is not a differential diagnosis of chronic inversion of uterus?

Gartner's cyst. ***Gartner's cyst*** - A **Gartner's cyst** is a benign vaginal cyst resulting from remnants of the **Wolffian duct**. - It is typically a **small, asymptomatic lesion** along the lateral vaginal wall and would not be mistaken for a uterine inversion, which involves the uterus turning inside out. - This is **not a differential diagnosis** of chronic uterine inversion. *Fungating cervical malignancy* - An **exophytic (fungating) cervical malignancy** can present as a mass protruding through the cervix. - On examination, it can be confused with an inverted uterus, as both can present with **vaginal bleeding** and a **fleshy mass** visible at or beyond the cervix. - This is a **recognized differential diagnosis** of chronic uterine inversion. *Fibroid polyp* - A **pedunculated submucous fibroid** (fibroid polyp) that prolapses through the cervix is a **classic differential diagnosis** of chronic uterine inversion. - Its appearance as a firm, smooth, fleshy mass protruding through the cervix can closely mimic an inverted uterine fundus. - Differentiation requires careful examination - the attachment site and presence of a pedicle help identify a fibroid polyp. *Cervical prolapse* - **Cervical prolapse** (procidentia) involves the descent of the entire uterus with the cervix leading. - While both conditions involve protrusion beyond the vaginal opening, they are **clinically distinct** - in prolapse, the cervix is visible with its external os, and the uterus remains anatomically normal (not inverted). - However, in exam contexts, **cervical prolapse is sometimes listed as a differential** as both present with a mass at the introitus, though experienced clinicians can readily distinguish them on examination.

Q: A 28 -year-old P_2 ~L_2 presents to Gynaecology OPD with complaints of malodorous vaginal discharge. On examination, the discharge was found to be grayish-white in colour and adherent to vaginal walls. Which one of the following is a bedside diagnostic criterion for the causative organism?

Positive 10% potassium hydroxide test. ***Positive 10% potassium hydroxide test*** - A **positive whiff test** (amine test) with 10% KOH, producing a **fishy odor**, is a characteristic bedside diagnostic criterion for **bacterial vaginosis**. - This test detects the presence of **amines** produced by anaerobic bacteria in the vaginal discharge. *Presence of RBCs in vaginal smear* - The presence of **red blood cells (RBCs)** in a vaginal smear is not a specific diagnostic criterion for bacterial vaginosis. - RBCs may indicate **inflammation**, trauma, or other infections, but not specifically bacterial overgrowth. *Vaginal pH 4.5)** due to the reduction of **lactobacilli** and overgrowth of anaerobic bacteria. - A pH less than 4.5 would suggest a normal vaginal flora or possibly a fungal infection, not bacterial vaginosis. *Positive NAAT test* - **Nucleic acid amplification tests (NAATs)** are used to detect specific pathogens like **Chlamydia** or **Gonorrhea**, not typically bacterial vaginosis. - While NAATs are highly sensitive and specific, they are not a **bedside diagnostic criterion** for bacterial vaginosis.

Q: Which of the following factors are associated with cord prolapse during labour? I. Malpresentations II. Contracted pelvis III. Induction with engaged presenting part IV. Prematurity Select the correct answer using the code given below :

I, II and IV only. ***I, II and IV only*** - **Cord prolapse** occurs when the umbilical cord descends ahead of the presenting fetal part, often due to factors that prevent the presenting part from fitting snugly into the pelvis. - **Malpresentations** (e.g., footling breech, transverse lie), **contracted pelvis** (hindering engagement), and **prematurity** (smaller fetus, more amniotic fluid) all increase the risk by creating a space for the cord to fall through. - **Induction with engaged presenting part** is NOT a risk factor because when the presenting part is well-engaged in the pelvis, it acts as a barrier preventing cord prolapse. *I, II, III and IV* - This option incorrectly includes **induction with engaged presenting part** as a risk factor for cord prolapse. - When the presenting part is engaged, it fills the pelvic inlet and prevents the cord from prolapsing. *III and IV only* - This option is incomplete as it misses crucial risk factors like **malpresentations** and **contracted pelvis**. - **Induction with engaged presenting part** is not a risk factor for cord prolapse. *I, II and III only* - This option incorrectly includes **induction with engaged presenting part** as an association with cord prolapse. - It also omits **prematurity**, which is a significant risk factor due to the disproportionately large amount of amniotic fluid relative to the fetal size.

Q: Which of the following are correct in the treatment of cracked nipple? I. Correct attachment (Latch on) will provide immediate relief from pain and rapid healing. II. If pain, mother should use breast pump and the infant is fed with the expressed milk. III. Antifungal medication (such as miconazole or nystatin) is applied to treat both the mother's nipple and the baby's mouth if there is oral thrush. Select the answer using the code given below:

I, II and III. ***I, II and III*** - All three statements provide accurate and essential interventions for managing **cracked nipples** in breastfeeding mothers. - **Correct latch-on** is fundamental to prevention and healing, expressing milk can provide relief and maintain supply, and **antifungal treatment** is indicated if candidiasis is suspected in both mother and infant. *I and III only* - This option incorrectly omits statement II, which describes a valid and often necessary intervention for managing pain and ensuring continued feeding. - Using a **breast pump** allows the nipple to rest and heal while the infant still receives breast milk. *II and III only* - This option incorrectly omits statement I, which highlights the crucial role of **correct attachment (latch-on)** as the primary solution for preventing and healing cracked nipples. - Without addressing the latch, other interventions may only provide temporary relief. *I and II only* - This option incorrectly omits statement III, which addresses the potential for **candidiasis (thrush)** as a cause of nipple pain and cracking. - If thrush is present, antifungal treatment of both mother and baby is necessary for resolution.

Q: Which of the following are correct regarding puerperal blues ? I. Its incidence is around 50 %. II. There is no specific metabolic or endocrine derangement. III. Treatment is reassurance and psychological support. Select the answer using the code given below :

I, II and III. ***I, II and III*** - Puerperal blues, or **baby blues**, are very common, affecting around **50-80%** of new mothers within a few days postpartum. - It is a transient condition thought to be related to **hormonal shifts** after childbirth, but without a specific, long-lasting metabolic or endocrine derangement requiring medical intervention. Its management involves **reassurance and psychological support**, as it typically resolves on its own without formal psychiatric treatment. *I and II only* - While statement I (incidence around 50%) is correct, and statement II (no specific metabolic or endocrine derangement) is also correct, this option excludes the crucial aspect of management, which is important for understanding the condition. - The typical management of puerperal blues involves reassurance and support, making statement III integral to a complete understanding. *II and III only* - This option correctly identifies the lack of specific derangement and the treatment approach, but it underestimates the prevalence of puerperal blues. - The incidence is significantly higher than implied by excluding statement I, making it a less accurate choice overall. *I and III only* - This option accurately describes the high incidence and the treatment strategy but overlooks the scientific understanding of its etiology. - The lack of a specific metabolic or endocrine derangement (statement II) is a key characteristic differentiating it from more severe postpartum psychiatric conditions.

Q: The Matthews Duncan process has been described for :

marginal separation of placenta in normal labour. ***Marginal separation of placenta in normal labour*** - The **Matthews Duncan method** describes the process of **placental separation** where the placenta detaches from its **edges first**, leading to bleeding from the exposed maternal surface. - This type of separation is one of the two main mechanisms by which the placenta separates from the **uterine wall** during the third stage of labor. *Controlled contraction in active management of third stage of labour* - This refers to techniques like **controlled cord traction** and **fundal massage**, which are part of the active management to expedite placental delivery and prevent hemorrhage. - While it's a part of third stage management, it describes an intervention for placental expulsion, not a specific mechanism of placental detachment. *Central separation of placenta in normal labour* - This is known as the **Schultze method**, where placental separation begins in the **center**, leading to the fetal surface presenting first and less visible bleeding during separation. - The question specifically asks about the **Matthews Duncan process**, which is distinct from central separation. *Reposition of acute inversion of uterus following vaginal delivery* - **Uterine inversion** is a rare but severe complication where the **fundus** collapses through the **cervix**. - Repositioning involves manual or surgical techniques to return the uterus to its normal anatomical position and is unrelated to placental separation mechanisms.

Q: A P1L1 lady after 4 hours of delivery is suffering from persistent, severe pain in the perineal region, rectal tenesmus, bearing down feeling and retention of urine. The probable diagnosis is :

Supralevator hematoma. ***Supralevator hematoma*** - A **supralevator hematoma** typically presents with severe, deep perineal or suprapubic pain, often accompanied by rectal tenesmus, a bearing-down sensation, and urinary retention due to mass effect and nerve compression. - These hematomas are often **not visible externally**, as they are located above the levator ani muscle, making them difficult to diagnose without imaging or a high index of suspicion. *Complete perineal tear* - A **complete perineal tear** involves the anal sphincter and rectal mucosa, causing severe pain, but would typically present with visible disruption of the perineum and often fecal incontinence, rather than a deep, unobservable mass effect. - While severe pain is present, the symptom complex of **rectal tenesmus, bearing down feeling, and urinary retention** in the absence of visible external trauma points away from a simple perineal tear. *Cervical tear* - A **cervical tear** would primarily cause significant **postpartum hemorrhage**, often with bright red blood, rather than the deep perineal pain, rectal tenesmus, and urinary retention described. - While pain can occur, it's usually localized to the cervix or lower abdomen and not associated with a **bearing-down sensation** or difficulty voiding due to a mass. *Vulval hematoma* - A **vulval hematoma** causes severe pain and is usually **visible externally** as a tense, tender, and often discolored swelling of the labia. - While it can cause urinary retention due to pressure on the urethra, the deep, severe pain and **rectal tenesmus** with a "bearing down" feeling, without visible external swelling, make a supralevator hematoma more likely.

Q: According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage labour?

Duration of latent phase of primigravida has not been established. ***Duration of latent phase of primigravida has not been established*** - The **WHO Intrapartum Care Guidelines 2018** state that for both primigravid and multiparous women, the duration of the **latent phase of labor** has significant variability and a specific maximum duration to define prolonged labor has not been established. - This reflects the understanding that the latent phase can be variable and does not necessarily require intervention if the woman and fetus are well. *Duration of active stage of primigravida should not exceed 8 hours* - The 2018 WHO guidelines suggest that the **active phase of first-stage labor** for a **primigravida** can be up to **12 hours** or even longer, as long as there is continuous progress in cervical dilation. - The concept of a rigid 8-hour limit for all primigravidae in the active phase is not supported by current evidence-based guidelines, which emphasize individual progress. *Duration of active stage of multigravida should not exceed 6 hours* - For **multigravid women**, the active phase of the first stage of labor is generally shorter than for primigravidae, but the WHO guidelines do not set a strict upper limit of 6 hours. - Instead, they emphasize that progress in cervical dilation should be monitored, and interventions should be based on a lack of progress along with other clinical indicators, rather than a fixed time frame. *Duration of active stage of primigravida should not exceed 18 hours* - While the active phase of labor can be prolonged, a "should not exceed 18 hours" limit is not explicitly defined in the way it is presented. - The **WHO guidelines** advocate for continuous monitoring of cervical dilation, with an expected rate of at least 1 cm/hour during the active phase, acknowledging that some women may have slower but still physiological progress.

Q: According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position? I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice. II. For a woman without epidural analgesia, upright birthing position may be adopted. III. For a woman with epidural analgesia, lithotomy and supine position only are recommended. Select the answer using the code given below :

I and II only. ***I and II only*** - According to the **WHO Intrapartum Care Guidelines 2018**, for women **without epidural analgesia**, the adoption of **birthing position** should be the **individual woman's choice** (Statement I is correct). - **Upright positions** (including sitting, standing, kneeling, squatting, or hands-and-knees) are specifically **encouraged** for women without epidural as they may reduce duration of second stage of labor and instrumental delivery rates (Statement II is correct). - The WHO guidelines emphasize **woman-centered care** and respect for maternal preferences regarding birthing positions. *I, II and III* - This option is **incorrect** because Statement III is false. - The WHO 2018 guidelines do **NOT** restrict women with epidural analgesia to only lithotomy and supine positions. - Even with epidural, women should be **encouraged to adopt positions of their choice**, including lateral and supported upright positions when feasible. *II and III only* - This option is **incorrect** as it omits Statement I, which correctly reflects the WHO principle of **individual woman's choice** for birthing position. - Statement III is also **false** - women with epidural are not limited to only lithotomy and supine positions according to WHO guidelines. *I and III only* - This option is **incorrect** because Statement III is false. - WHO guidelines advocate for **flexible positioning** even with epidural analgesia, not restriction to lithotomy and supine positions only. - The guidelines support exploring various positions based on maternal comfort, clinical circumstances, and healthcare provider support.

Question 1

What are the characteristics of dermoid cyst?
I. Germ cell ovarian tumour
II. Bilateral in 15-20 % cases
III. Torsion is common
IV. Rupture is common

Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

II and IV only

Answer

I and III only

Answer

II, III and IV

Question 2

Which one of the following is not a differential diagnosis of chronic inversion of uterus?

Accepted Answer

Gartner's cyst

Answer

Fungating cervical malignancy

Answer

Fibroid polyp

Answer

Cervical prolapse

Question 3

A 28 -year-old P_2 ~L_2 presents to Gynaecology OPD with complaints of malodorous vaginal discharge. On examination, the discharge was found to be grayish-white in colour and adherent to vaginal walls. Which one of the following is a bedside diagnostic criterion for the causative organism?

Accepted Answer

Positive 10% potassium hydroxide test

Answer

Presence of RBCs in vaginal smear

Answer

Vaginal pH < 4.5

Answer

Positive NAAT test

Question 4

Which of the following factors are associated with cord prolapse during labour?
I. Malpresentations
II. Contracted pelvis
III. Induction with engaged presenting part
IV. Prematurity

Select the correct answer using the code given below :

Accepted Answer

I, II and IV only

Answer

I, II, III and IV

Answer

III and IV only

Answer

I, II and III only

Question 5

Which of the following are correct in the treatment of cracked nipple?
I. Correct attachment (Latch on) will provide immediate relief from pain and rapid healing.
II. If pain, mother should use breast pump and the infant is fed with the expressed milk.
III. Antifungal medication (such as miconazole or nystatin) is applied to treat both the mother's nipple and the baby's mouth if there is oral thrush.

Select the answer using the code given below:

Accepted Answer

I, II and III

Answer

I and III only

Answer

II and III only

Answer

I and II only

Question 6

Which of the following are correct regarding puerperal blues ?
I. Its incidence is around 50 %.
II. There is no specific metabolic or endocrine derangement.
III. Treatment is reassurance and psychological support.

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

I and II only

Answer

II and III only

Answer

I and III only

Question 7

The Matthews Duncan process has been described for :

Accepted Answer

marginal separation of placenta in normal labour

Answer

controlled contraction in active management of third stage of labour

Answer

central separation of placenta in normal labour

Answer

reposition of acute inversion of uterus following vaginal delivery

Question 8

A P1L1 lady after 4 hours of delivery is suffering from persistent, severe pain in the perineal region, rectal tenesmus, bearing down feeling and retention of urine. The probable diagnosis is :

Accepted Answer

Supralevator hematoma

Answer

Complete perineal tear

Answer

Cervical tear

Answer

Vulval hematoma

Question 9

According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage labour?

Accepted Answer

Duration of latent phase of primigravida has not been established

Answer

Duration of active stage of primigravida should not exceed 8 hours

Answer

Duration of active stage of multigravida should not exceed 6 hours

Answer

Duration of active stage of primigravida should not exceed 18 hours

Question 10

According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position?
I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice.
II. For a woman without epidural analgesia, upright birthing position may be adopted.
III. For a woman with epidural analgesia, lithotomy and supine position only are recommended.

Select the answer using the code given below :

Accepted Answer

I and II only

Answer

I, II and III

Answer

II and III only

Answer

I and III only

UPSC-CMS 2025 — Obstetrics and Gynecology