UPSC-CMS 2009 - Obstetrics and Gynecology Practice Questions

Q: What is the most common cause of vault prolapse following hysterectomy ?

Failure to identify and repair enterocele. ***Failure to identify and repair enterocele*** - An **enterocele** is a type of **hernia** in which the peritoneum and small bowel descend into the space between the vagina and rectum. - If an existing **enterocele** is not identified and repaired during hysterectomy, it can **worsen over time** and contribute significantly to **vaginal vault prolapse**. *Obesity* - While **obesity** is a risk factor for pelvic organ prolapse in general due to increased intra-abdominal pressure, it is not considered the most common direct cause of **vault prolapse specifically after hysterectomy**. - It contributes to general weakening of pelvic floor support but is less direct in causing vault collapse than a missed enterocele. *Chronic cough* - **Chronic cough** increases intra-abdominal pressure and is a risk factor for the development or worsening of pelvic organ prolapse. - However, similar to obesity, it's a general contributor to prolapse and not typically the most common direct cause of **vault prolapse** as compared to surgical factors. *Diabetes mellitus* - **Diabetes mellitus** can contribute to overall tissue weakness and neuropathy, potentially affecting pelvic floor support over time. - It is not considered a primary or frequent direct cause of **vaginal vault prolapse** following hysterectomy.

Q: Following which of the tubectomy procedures listed below, best result is achieved for reversal sterilization (recanalization procedure) ?

Fallopian ring occlusion. ***Fallopian ring occlusion*** - This method uses a **silicone band** to occlude the fallopian tube, causing minimal damage to the surrounding tissue. - The small segment of the tube affected allows for a **higher success rate** in re-anastomosis during reversal sterilization due to preserved tubal length and integrity. *Electrocoagulation* - This method involves **burning and destroying** a significant segment of the fallopian tube with an electric current. - The extensive tissue damage and scarring make **recanalization difficult** and significantly reduce the success of reversal. *Irving method* - This procedure involves **ligating and dissecting** the fallopian tube, then burying the proximal end into the broad ligament. - The complex anatomical alteration and potential for **significant scarring** make reversal challenging and less successful. *Pomeroy ligation* - This technique involves **ligating and excising a loop** of the fallopian tube, which causes moderate tissue damage and segment removal. - While reversal is possible, the **removal of a tubal segment** can result in a shorter tube and a lower success rate compared to tubal ring occlusion.

Q: Vaccines that can be safely given during pregnancy are the following except

Rubella. ***Rubella*** - The **rubella vaccine** is a **live attenuated vaccine** and is **contraindicated in pregnancy** due to the theoretical risk of congenital rubella syndrome, although no cases have been reported from vaccination during pregnancy. - Women should be vaccinated *before* pregnancy or postpartum, and advised to avoid conception for at least four weeks after vaccination. *Influenza* - The **inactivated influenza vaccine** is highly recommended during **any trimester of pregnancy** to protect both the mother and the newborn from severe influenza-related complications. - Pregnancy alters the immune system and cardiopulmonary function, increasing the risk of severe illness from influenza. *Pneumococcus* - The **pneumococcal polysaccharide vaccine (PPSV23)** and **pneumococcal conjugate vaccine (PCV13)** are considered **safe for pregnant women** who meet the indications for vaccination (e.g., chronic medical conditions). - These vaccines provide protection against serious invasive pneumococcal diseases. *Tetanus* - The **tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine** is **recommended during each pregnancy**, preferably between 27 and 36 weeks gestation. - It provides critical protection against **pertussis** for the newborn and tetanus immunity for the mother.

Q: Which of the following is not an absolute contraindication for insertion of intrauterine device (IUD) ?

Severe dysmenorrhea. ***Severe dysmenorrhea*** - While IUDs (especially copper IUDs) can exacerbate **dysmenorrhea** and **menorrhagia** in some women, it is not an absolute contraindication for insertion. Progestin-releasing IUDs can even improve dysmenorrhea. - The decision to insert an IUD in a patient with severe dysmenorrhea requires careful consideration of the **type of IUD** and potential benefits versus risks, but it is not an outright medical barrier. *Puerperal sepsis* - **Puerperal sepsis** indicates an active infection of the genital tract following childbirth. - Inserting an IUD into an infected uterus carries a high risk of worsening the infection, potentially leading to **septic shock** or **pelvic inflammatory disease (PID)**. *Pelvic tuberculosis* - **Pelvic tuberculosis** is a chronic inflammatory infection of the reproductive organs. - The presence of active pelvic tuberculosis makes the uterus and surrounding tissues highly susceptible to further infection or exacerbation of the existing disease with IUD insertion, leading to severe complications and **abscess formation**. *Endometrial cancer* - **Endometrial cancer** is a malignancy of the uterine lining. - Inserting an IUD into a uterus with cancer could potentially **disseminate cancer cells**, complicate treatment, or mask the progression of the disease.

Question 1

What is the most common cause of vault prolapse following hysterectomy ?

Accepted Answer

Failure to identify and repair enterocele

Answer

Obesity

Answer

Chronic cough

Answer

Diabetes mellitus

Question 2

Following which of the tubectomy procedures listed below, best result is achieved for reversal sterilization (recanalization procedure) ?

Accepted Answer

Fallopian ring occlusion

Answer

Electrocoagulation

Answer

Irving method

Answer

Pomeroy ligation

Question 3

Vaccines that can be safely given during pregnancy are the following except

Accepted Answer

Rubella

Answer

Influenza

Answer

Pneumococcus

Answer

Tetanus

Question 4

Which of the following is not an absolute contraindication for insertion of intrauterine device (IUD) ?

Accepted Answer

Severe dysmenorrhea

Answer

Puerperal sepsis

Answer

Pelvic tuberculosis

Answer

Endometrial cancer

UPSC-CMS 2009 — Obstetrics and Gynecology