UPSC-CMS 2012 - Obstetrics and Gynecology PYQs Practice Questions

Q: Consider the following statements regarding HCG : 1. HCG is a glycoprotein with two subunits α and β. 2. HCG levels reach the maximum between the 60th and 70th day in a normal pregnancy. 3. HCG is secreted by the syncytiotrophoblast. Which of the statements given above is/are correct ?

1, 2 and 3. ***Correct: 1, 2 and 3*** - **Human Chorionic Gonadotropin (HCG)** is a **glycoprotein hormone** composed of **alpha (α) and beta (β) subunits**, making statement 1 correct - HCG is primarily secreted by the **syncytiotrophoblast** cells of the placenta, confirming statement 3 - In a normal pregnancy, HCG levels typically **peak between 60-70 days (8-10 weeks)** after the last menstrual period, supporting statement 2 - All three statements are factually accurate regarding HCG structure, secretion, and physiological levels *Incorrect: 2 and 3 only* - This option incorrectly excludes statement 1 about HCG being a glycoprotein with α and β subunits - The structural composition of HCG as a heterodimeric glycoprotein is a fundamental characteristic *Incorrect: 1 and 2 only* - This option incorrectly excludes statement 3 about syncytiotrophoblast being the source of HCG - The syncytiotrophoblast is the outer layer of the trophoblast responsible for HCG secretion *Incorrect: 1 and 3 only* - This option incorrectly excludes statement 2 about HCG peak timing during pregnancy - Understanding that HCG peaks at 8-10 weeks (60-70 days) is crucial for monitoring early pregnancy [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which one of the following statements is not correct regarding the haemodynamic changes occurring during a pregnancy?

The systemic vascular resistance is increased. ***The systemic vascular resistance is increased*** - During normal pregnancy, **systemic vascular resistance (SVR)** actually **decreases** due to vasodilation induced by factors like **prostaglandins** and **nitric oxide**. - A decrease in systemic vascular resistance helps accommodate the increased blood volume and cardiac output, ensuring adequate perfusion to the uteroplacental unit and other organs. *The cardiac output is increased* - **Cardiac output (CO)** progressively **increases** during pregnancy, peaking in the second and third trimesters. - This increase is primarily due to a rise in both **heart rate** and **stroke volume**. *The serum colloid pressure is decreased* - **Serum colloid osmotic pressure** (oncotic pressure) **decreases** in pregnancy due to a disproportionate increase in plasma volume relative to the increase in albumin production. - This leads to **dilutional hypoalbuminemia**, contributing to physiological edema. *The stroke volume is increased* - **Stroke volume (SV)** significantly **increases** during pregnancy, driven by increased end-diastolic volume and enhanced myocardial contractility. - This rise in stroke volume is a major contributor to the overall increase in cardiac output. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A multiparous patient has been diagnosed to have foetal demise on a sonographic examination at 16 weeks of pregnancy. The ideal method for termination is

High vaginal insertion of dinoprostone gel. ***High vaginal insertion of dinoprostone gel*** - **Dinoprostone gel** (PGE2) is a **prostaglandin** that softens the cervix and stimulates uterine contractions, making it an ideal agent for medical induction in cases of fetal demise, particularly in the second trimester. - Its **vaginal insertion** allows for controlled, localized delivery and absorption, promoting efficient uterine evacuation while minimizing systemic side effects. *Extra-amniotic ethacridine* - **Ethacridine lactate** is typically used for **mid-trimester abortion** by direct instillation into the extra-amniotic space. - While effective, it carries a higher risk of infection and uterine rupture compared to prostaglandin administration for fetal demise at 16 weeks. *Dilation and evacuation (D&E)* - **D&E** is a surgical procedure commonly used for **second-trimester abortions**, involving cervical dilation and surgical removal of uterine contents. - While an option, medical induction with prostaglandins is generally preferred for **fetal demise** at 16 weeks due to lower risks of uterine injury and adhesions, as well as providing a more natural expulsion process. *Hysterectomy with tubectomy* - **Hysterectomy with tubectomy** (removal of the uterus and fallopian tubes) is a major surgical procedure that is **not indicated** for termination of pregnancy due to fetal demise. - It is reserved for severe medical conditions or desires for permanent sterilization, given its irreversible nature and significant surgical risks. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 30-year-old third gravida, who has a 3-year-old child and had undergone a MTP one year ago, has presented with 30-weeks pregnancy. She complains of having vaginal bleeding 2 hours ago. She has not received any antenatal care. Her pulse is 78 beats per minute, and the BP is 102/58 mmHg. The most appropriate management will include: 1. Ultrasonographic evaluation 2. Watch for labour 3. Hospitalisation and bed rest 4. Speculum examination of vagina and cervix 5. I.V. fluid drip Select the appropriate combination:

1, 3 and 5. ***1, 3 and 5*** - This patient presents with **third-trimester vaginal bleeding** without prior antenatal care, which is a significant red flag requiring immediate investigation and management. An **ultrasonographic evaluation** is crucial to determine the cause of bleeding, especially to rule out **placenta previa** or **abruptio placentae**, which dictate further management. - **Hospitalization and bed rest** are essential to stabilize the patient, monitor the bleeding, and prepare for potential complications. Initiating an **I.V. fluid drip** is critical for maintaining **hemodynamic stability**, especially given her low blood pressure of 102/58 mmHg, and for providing immediate venous access. *2, 3 and 4* - **Watching for labor** without first establishing the cause of bleeding is inappropriate and potentially dangerous, as active management might be needed. - A **speculum examination** should *not* be the initial step before an ultrasound, as a digital or speculum exam in cases of undiagnosed placenta previa can provoke severe hemorrhage. *1 and 2* - While an **ultrasound (1)** is necessary to diagnose the cause of bleeding, **watching for labor (2)** without further intervention or stabilization is insufficient for a woman with third-trimester bleeding, especially with no prior antenatal care. - This option misses crucial components like hospitalization, bed rest, and IV fluids, which are part of initial stabilization. *1, 4 and 5* - **Ultrasonographic evaluation (1)** and **I.V. fluid drip (5)** are appropriate, but **speculum examination of the vagina and cervix (4)** should be avoided until placenta previa is ruled out by ultrasound. - A digital or speculum exam could exacerbate bleeding if **placenta previa** is present, making this a potentially harmful step in the initial management. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 35-year-old woman presents with complaints of profuse vaginal bleeding. She also has a history of abortion 4 months ago. On examination, the uterus is soft and bulky, both ovaries are enlarged and cystic, and the pregnancy test is positive. The probable diagnosis is

Persistent trophoblastic disease. ***Persistent trophoblastic disease*** - The history of **abortion 4 months ago** followed by **profuse vaginal bleeding**, a **positive pregnancy test**, and a **bulky uterus** strongly suggests persistent trophoblastic disease (PTD). - The presence of **bilaterally enlarged cystic ovaries** (theca-lutein cysts) is also characteristic, resulting from ovarian stimulation by persistently high levels of hCG. *Malignant ovarian tumour* - While it can cause vaginal bleeding, a **positive pregnancy test** and the finding of a **bulky uterus** are generally not primary features of most ovarian malignancies. - Ovarian tumours are less likely to present with the rapid development of bilateral, **cystic enlargement** associated with a recent pregnancy and persistent hCG. *Incomplete abortion* - While it causes **vaginal bleeding** and a **bulky uterus**, it typically occurs much more acutely and closer to the time of the abortion itself, not four months later. - An incomplete abortion would usually result in a **negative or rapidly declining pregnancy test** due to the absence of viable trophoblastic tissue. *Dysfunctional uterine bleeding* - This diagnosis usually implies bleeding without a clear organic cause and would not be associated with a **positive pregnancy test** or **enlarged, cystic ovaries**. - DUB is a diagnosis of exclusion after other causes, including **gestational** trophoblastic disease, have been ruled out. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

Consider the following statements regarding HCG :

1. HCG is a glycoprotein with two subunits α and β.

2. HCG levels reach the maximum between the 60th and 70th day in a normal pregnancy.

3. HCG is secreted by the syncytiotrophoblast.
Which of the statements given above is/are correct ?

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 and 3 only

Question 2

Which one of the following statements is not correct regarding the haemodynamic changes occurring during a pregnancy?

Accepted Answer

The systemic vascular resistance is increased

Answer

The cardiac output is increased

Answer

The serum colloid pressure is decreased

Answer

The stroke volume is increased

Question 3

A multiparous patient has been diagnosed to have foetal demise on a sonographic examination at 16 weeks of pregnancy. The ideal method for termination is

Accepted Answer

High vaginal insertion of dinoprostone gel

Answer

Extra-amniotic ethacridine

Answer

Dilation and evacuation (D&E)

Answer

Hysterectomy with tubectomy

Question 4

A 30-year-old third gravida, who has a 3-year-old child and had undergone a MTP one year ago, has presented with 30-weeks pregnancy. She complains of having vaginal bleeding 2 hours ago. She has not received any antenatal care. Her pulse is 78 beats per minute, and the BP is 102/58 mmHg.

The most appropriate management will include:

1. Ultrasonographic evaluation
2. Watch for labour
3. Hospitalisation and bed rest
4. Speculum examination of vagina and cervix
5. I.V. fluid drip

Select the appropriate combination:

Accepted Answer

1, 3 and 5

Answer

2, 3 and 4

Answer

1 and 2

Answer

1, 4 and 5

Question 5

A 35-year-old woman presents with complaints of profuse vaginal bleeding. She also has a history of abortion 4 months ago. On examination, the uterus is soft and bulky, both ovaries are enlarged and cystic, and the pregnancy test is positive. The probable diagnosis is

Accepted Answer

Persistent trophoblastic disease

Answer

Malignant ovarian tumour

Answer

Incomplete abortion

Answer

Dysfunctional uterine bleeding

Question 6

An elderly gravida with 36-weeks pregnancy presents with severe pregnancy induced hypertension (PIH), severe abdominal pain, per vaginal bleeding and loss of foetal movements. The diagnosis is

Accepted Answer

Abruptio placenta

Answer

Vasa praevia

Answer

Rupture of uterus

Answer

Placenta praevia

Question 7

A young female patient presents with a history of two months amenorrhoea and complaints of severe lower abdominal pain, syncopal attacks and minimal per vaginal bleeding. On examination, she has tachycardia and appears pale. The clinical diagnosis is

Accepted Answer

Ectopic pregnancy

Answer

Missed abortion

Answer

Molar pregnancy

Answer

Inevitable abortion

Question 8

A 30-year-old woman with history of previous three abortions, has been found to have antiphospholipid antibodies. What will be the treatment of choice in the subsequent pregnancy?

Accepted Answer

Aspirin and Heparin

Answer

Corticosteroids

Answer

Aspirin

Answer

Heparin

Question 9

In the rhesus-negative mothers, the factors which influence the development of rhesus incompatibility include all except

Accepted Answer

Maternal age >35 years

Answer

Amniocentesis

Answer

Incoordinate uterine action

Answer

Placental abruption

Question 10

A vaginal examination conducted during the second stage of labour reveals occipito-posterior position of the vertex. This occipito-posterior position of the vertex was diagnosed on the basis of which of the following findings ?

Accepted Answer

Posterior fontanelle positioned posteriorly with the sagittal suture anteroposterior

Answer

Anterior fontanelle not reached

Answer

Posterior fontanelle in the subpubic area

Answer

Sagittal suture in transverse in the pelvic cavity

UPSC-CMS 2012 — Obstetrics and Gynecology