UPSC-CMS 2009 - Obstetrics and Gynecology PYQs Practice Questions

Q: The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

During labour. ***During labour*** - The **highest risk** of mother-to-child HIV transmission occurs during labor and delivery due to the infant's exposure to maternal blood and genital secretions. - The process of passing through the **birth canal** can lead to inoculation with HIV-infected cells and viral particles. *Third trimester* - While some transmission can occur in the third trimester, the risk is significantly **lower** than during labor. - The placenta generally provides a barrier, though there's a risk of **transplacental passage** if the placental integrity is compromised. *First trimester* - The **lowest risk** of HIV transmission occurs during the first trimester. - The developing fetus is relatively protected by the placenta, and the viral load in maternal blood might be lower compared to later stages without intervention. *During breast feeding* - **Breastfeeding** is a known route of HIV transmission, but its risk is generally **lower per exposure** compared to labor and delivery, especially if the mother is on antiretroviral therapy. - The risk is **cumulative** over the duration of breastfeeding. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What is the most commonly observed fetal effect in women receiving magnesium sulphate therapy for pre-eclampsia/eclampsia ?

Respiratory depression. ***Respiratory depression*** - Magnesium sulfate readily crosses the placenta, leading to elevated magnesium levels in the fetus, which can cause **central nervous system depression** and **respiratory depression** at birth. - This is the **most commonly observed fetal effect**, manifesting as neonatal hypermagnesemia with respiratory compromise, hypotonia, and decreased reflexes. - The effect is due to magnesium's role as a **neuromuscular blocker**, reducing acetylcholine release at the neuromuscular junction. *Intestinal obstruction* - There is no direct link between maternal magnesium sulfate therapy and an increased risk of **fetal intestinal obstruction**. - Intestinal obstruction in neonates is typically associated with **structural anomalies** or conditions like meconium ileus, not magnesium exposure. *Variability in fetal heart rate pattern* - While magnesium sulfate can cause **decreased fetal heart rate variability** as a monitoring finding, this is not the "most commonly observed fetal effect." - Decreased variability is a **transient monitoring change** during therapy, whereas respiratory depression is a direct clinical effect observed at birth. - The question asks for the most common **fetal effect**, and respiratory depression at delivery is more clinically significant and commonly encountered. *Cerebral palsy* - Magnesium sulfate is actually used as a **neuroprotective agent** in preterm births to **reduce the risk of cerebral palsy**. - It does not cause cerebral palsy; rather, it provides fetal neuroprotection when given for preterm labor <32 weeks gestation. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Consider the following markers: 1. Nuchal translucency 2. PAPP-A 3. GTT 4. Inhibin A Which of the above markers are included in the first trimester screening of Down's syndrome?

1 and 2. ***1 and 2*** - **Nuchal translucency (NT)** measurement and **Pregnancy-associated plasma protein A (PAPP-A)** are the key components of first-trimester screening for Down syndrome (combined test at 11-14 weeks). - Increased NT thickness (≥3.5 mm) and low PAPP-A levels are associated with higher risk of **trisomy 21 (Down syndrome)**. - This is typically combined with free β-hCG for the complete first-trimester combined screening. *2, 3 and 4* - This option incorrectly includes **GTT (Glucose Tolerance Test)**, which screens for **gestational diabetes mellitus**, not chromosomal abnormalities. - **Inhibin A** is a marker used in **second-trimester screening** (quadruple test at 15-20 weeks), not first trimester. - It correctly includes PAPP-A but omits the essential NT measurement. *1 and 4* - This option correctly includes **Nuchal translucency** but incorrectly adds **Inhibin A**. - **Inhibin A** is elevated in Down syndrome but is measured in the **second trimester** as part of the quad screen (AFP, hCG, uE3, Inhibin A). - It omits **PAPP-A**, which is the crucial biochemical marker for first-trimester screening. *2 and 3 only* - This option correctly includes **PAPP-A** but incorrectly includes **GTT**, which is completely unrelated to aneuploidy screening. - It omits **Nuchal translucency**, the most important ultrasound marker in first-trimester Down syndrome screening. - GTT is performed at 24-28 weeks for gestational diabetes screening. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

Accepted Answer

During labour

Answer

Third trimester

Answer

First trimester

Answer

During breast feeding

Question 2

Which one of the following statements is not correct about obstetric cholestasis ?

Accepted Answer

Associated with markedly high bilirubin and raised liver enzymes

Answer

It results in pruritus without rash

Answer

It is an indication of termination of pregnancy at 37 weeks

Answer

Risk of recurrence is high in future pregnancies

Question 3

What is the most commonly observed fetal effect in women receiving magnesium sulphate therapy for pre-eclampsia/eclampsia ?

Accepted Answer

Respiratory depression

Answer

Intestinal obstruction

Answer

Variability in fetal heart rate pattern

Answer

Cerebral palsy

Question 4

Spiegelberg's criteria for diagnosis of ovarian pregnancy include the following except

Accepted Answer

Gestational sac is connected with infundibulopelvic ligament

Answer

Gestational sac must occupy the position of ovary

Answer

Ovarian tissue should be present in the wall of gestational sac on histopathology

Answer

Tube on the affected side must be intact

Question 5

Consider the following markers:

1. Nuchal translucency
2. PAPP-A
3. GTT
4. Inhibin A

Which of the above markers are included in the first trimester screening of Down's syndrome?

Accepted Answer

1 and 2

Answer

2, 3 and 4

Answer

1 and 4

Answer

2 and 3 only

Question 6

The following changes may be seen in pre-eclampsia except

Accepted Answer

Hemodilution

Answer

Thrombocytopenia

Answer

Decreased antithrombin III

Answer

Elevated uric acid

Question 7

"Variable decelerations" on an electronic fetal heart rate monitor imply

Accepted Answer

Umbilical cord compression

Answer

Fetal head compression

Answer

Utero-placental insufficiency

Answer

Fetal anemia

Question 8

What is the maternal risk of using misoprostol for ripening of cervix during induction of labour?

Accepted Answer

Tachysystole/hyperstimulation of uterus

Answer

Bradycardia

Answer

Hypotension

Answer

Tachycardia

Question 9

A 25 year old patient who has had an abortion four months ago has come with the history of profuse vaginal bleeding. On examination uterus is bulky, both the ovaries are enlarged, pregnancy test is positive. What is the probable clinical diagnosis ?

Accepted Answer

Choriocarcinoma

Answer

Ectopic pregnancy

Answer

Incomplete abortion

Answer

Malignant ovarian tumor

Question 10

Uterine rupture is most commonly encountered after which one of the following surgeries?

Accepted Answer

Classical cesarean

Answer

Hysterotomy

Answer

Metroplasty

Answer

Myomectomy

UPSC-CMS 2009 — Obstetrics and Gynecology