The incidence of congenital fetal anomalies is highest when a pregnancy is complicated by
A parous woman notices a bulge at the vulva that diminishes in size following micturition. She also finds it difficult to initiate micturition. What is the likely diagnosis ?
A 30-year-old woman presents with three-month amenorrhoea, pain abdomen for the last two days and fainting attacks for the last eight hours. On examination, her pulse rate is 102/min, and she has (1+) pallor. On abdominal palpation, she has tenderness. She is provisionally diagnosed with ectopic pregnancy. The most likely site of implantation within the fallopian tube is in the
An 18-year-old girl presents with primary amenorrhoea and gives a history of cyclical colicky abdominal pain. The most probable diagnosis is
A 20-year-old married woman anxious to get pregnant has cyclical cramps and sharp lower abdominal pain which lasts for 3 days starting from the day of her menstrual flow. Her menstrual periods are regular but heavy. On clinical examination, her pelvis is normal. The most probable diagnosis is
Which of the following statements regarding functional epimenorrhoea is not correct ?
In a patient with dysfunctional uterine bleeding with cyclical menorrhagia, the first line drug is
The pelvic examination of a woman reveals that the cervix is directed forwards, the body is backward, but it can be anteposed easily. The examination does not demonstrate any other abnormality. The most probable diagnosis is
A 20-year-old young woman, who was delivered two months ago at home by a nurse, presents with a complaint of something protruding through the vulva. The clinical examination reveals a cystocele, rectocele, and the cervix 1 cm above the introitus. The most appropriate management will be
Which of the following are the features of backache due to genital prolapse? 1. The pain is experienced on getting up in the morning. 2. The patient complains of a diffuse pain over the sacrum. 3. There is no local tenderness. 4. The pain occurs more commonly among multiparous than nulliparous women. Select the correct answer using the code given below:
UPSC-CMS 2012 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 21: The incidence of congenital fetal anomalies is highest when a pregnancy is complicated by
- A. Hydramnios detectable on clinical examination
- B. Maternal diabetes (Correct Answer)
- C. Congenital heart disease of the mother
- D. Intrauterine growth retardation of the foetus
Explanation: ***Maternal diabetes*** - **Poorly controlled maternal diabetes** significantly increases the risk of various congenital anomalies due to the teratogenic effects of hyperglycemia. - This includes defects like **sacral agenesis**, cardiovascular malformations, neural tube defects, and renal anomalies. *Hydramnios detectable on clinical examination* - **Hydramnios (polyhydramnios)**, an excess of amniotic fluid, is often associated with fetal anomalies, particularly those affecting swallowing (e.g., esophageal atresia) or urination. - However, it is a *marker* or *consequence* of a potential anomaly, rather than the primary cause of the highest incidence of anomalies. *Congenital heart disease of the mother* - While maternal congenital heart disease can influence pregnancy outcomes and may have a genetic component, it does not, by itself, lead to the highest overall incidence of *fetal congenital anomalies* compared to uncontrolled diabetes. - The risk of congenital heart disease in the fetus of a mother with congenital heart disease is increased, but this is a specific risk, not a broad increase in all anomalies. *Intrauterine growth retardation of the foetus* - **Intrauterine growth restriction (IUGR)** is a condition where the fetus is smaller than expected for its gestational age and is a common complication in pregnancies with underlying issues. - IUGR can be *caused* by placental insufficiency, genetic disorders, or infections, some of which may also cause congenital anomalies, but IUGR itself is not the condition that directly leads to the highest incidence of congenital anomalies.
Question 22: A parous woman notices a bulge at the vulva that diminishes in size following micturition. She also finds it difficult to initiate micturition. What is the likely diagnosis ?
- A. Cystocele (Correct Answer)
- B. Uterine prolapse
- C. Fibroid polyp
- D. Vaginal cyst in the pouch of Douglas
Explanation: ***Cystocele*** - A **cystocele** (bladder prolapse) presents as a bulge in the vagina, which can reduce in size after urination if some urine is expelled. - **Difficulty initiating micturition** (voiding dysfunction) is common as the prolapsed bladder neck can obstruct the urethra. *Uterine prolapse* - This condition involves the **uterus descending** into the vaginal canal. - While it can cause a vulvar bulge, the symptoms described (diminishing with micturition, difficulty with initiation) are not typical for isolated uterine prolapse. *Fibroid polyp* - A **fibroid polyp** is a benign tumor that can protrude through the cervix and vagina, causing a vulvar mass. - It typically does not fluctuate with micturition or cause difficulty in initiating urination. *Vaginal cyst in the pouch of Douglas* - A **vaginal cyst** in the pouch of Douglas (e.g., an enterocele) is a herniation of the small bowel through the vaginal wall. - While it can cause a bulge, it would not typically diminish in size specifically with micturition or primarily cause difficulty in initiating urination.
Question 23: A 30-year-old woman presents with three-month amenorrhoea, pain abdomen for the last two days and fainting attacks for the last eight hours. On examination, her pulse rate is 102/min, and she has (1+) pallor. On abdominal palpation, she has tenderness. She is provisionally diagnosed with ectopic pregnancy. The most likely site of implantation within the fallopian tube is in the
- A. Interstitial region of the tube
- B. Ampullary region of the tube (Correct Answer)
- C. Isthmic region of the tube
- D. Infundibular region of the tube
Explanation: ***Ampullary region of the tube*** - The **ampulla** is the **widest and most tortuous part** of the fallopian tube, making it the most common site for egg fertilization and subsequent **ectopic implantation** (around 70-80% of cases). - Its larger lumen initially accommodates the growing embryo, but eventually, rupture and symptoms like **abdominal pain, amenorrhea**, and **fainting** (due to hemorrhage) occur. *Interstitial region of the tube* - Implantation in the **interstitial portion** (within the uterine wall) is less common but carries the highest risk of **massive hemorrhage** as it is surrounded by a rich vascular supply from the uterus. - Rupture usually occurs later, and symptoms can be more catastrophic due to its proximity to the uterine vessels. *Isthmic region of the tube* - The **isthmus** is the **narrowest part** of the fallopian tube. Ectopic pregnancies here are less common than in the ampulla but tend to rupture earlier due to the limited space. - Symptoms often present acutely and earlier in gestation compared to ampullary pregnancies due to the confined space. *Infundibular region of the tube* - Implantation in the **infundibulum** (fimbrial end) is the rarest site of tubal ectopic pregnancy, often described as an **abdominal pregnancy** if the ovum expels from the tube and implants elsewhere in the abdomen. - This location presents unique diagnostic and management challenges, often leading to later diagnosis and atypical symptoms.
Question 24: An 18-year-old girl presents with primary amenorrhoea and gives a history of cyclical colicky abdominal pain. The most probable diagnosis is
- A. Encysted tuberculosis
- B. Haematocolpos (Correct Answer)
- C. Full bladder
- D. Ovarian cyst
Explanation: ***Haematocolpos*** - **Primary amenorrhoea** combined with **cyclical colicky abdominal pain** strongly suggests an outflow tract obstruction, leading to the accumulation of menstrual blood. - **Haematocolpos** is the accumulation of menstrual blood in the vagina caused by an imperforate hymen or other anomalies, leading to distension and pain. *Encysted tuberculosis* - While tuberculosis can affect the reproductive system, it typically presents with **chronic abdominal pain**, weight loss, and infertility, not primary amenorrhoea with cyclical pain. - **Encysted tuberculosis** would not directly cause the cyclical colicky pain related to menstrual flow blockage. *Full bladder* - A **full bladder** can cause suprapubic discomfort but generally doesn't present as primary amenorrhoea or cyclical colicky abdominal pain. - This condition is easily resolved by urination and is not a chronic, cyclical issue. *Ovarian cyst* - **Ovarian cysts** can cause abdominal pain, which may be cyclical, but they do not cause primary amenorrhoea as the problem is with ovarian function or morphology, not menstrual outflow. - The pain is usually dull, aching, or sharp upon rupture, distinct from the **colicky pain** associated with retained menstrual blood.
Question 25: A 20-year-old married woman anxious to get pregnant has cyclical cramps and sharp lower abdominal pain which lasts for 3 days starting from the day of her menstrual flow. Her menstrual periods are regular but heavy. On clinical examination, her pelvis is normal. The most probable diagnosis is
- A. Primary dysmenorrhoea (Correct Answer)
- B. Adenomyosis
- C. Uterine leiomyomata
- D. Endometriosis
Explanation: ***Primary dysmenorrhoea*** - This is the **most probable diagnosis** given the classic presentation of **cyclical cramping pain starting on day 1 of menstruation** lasting 3 days. - Primary dysmenorrhea is caused by **excessive prostaglandin production** from the endometrium, leading to uterine cramping and can be associated with **heavy menstrual bleeding**. - The **normal pelvic examination** is a key feature distinguishing primary from secondary causes of dysmenorrhea. - Typically affects young women in their **late teens to early 20s**, shortly after menarche when ovulatory cycles are established. *Endometriosis* - While endometriosis causes cyclical pain, the pain typically begins **1-2 days before menstruation** rather than starting precisely on day 1. - Associated symptoms often include **dyspareunia, dyschezia, and infertility**, which are not mentioned in this case. - Though pelvic examination can be normal in early endometriosis, the **pain timing pattern** does not fit the classic presentation. *Adenomyosis* - Characterized by **endometrial tissue within the myometrium**, typically presents with a **diffusely enlarged, tender, boggy uterus** on examination. - More common in women over 30 years, particularly those with **previous pregnancies**. - The patient's **normal pelvic examination** and young age make adenomyosis unlikely. *Uterine leiomyomata* - These **benign fibroids** typically cause heavy menstrual bleeding with **pressure symptoms** rather than severe cyclical cramping pain. - Usually result in an **irregularly enlarged uterus** on pelvic examination. - The patient's **normal pelvic examination** excludes this diagnosis.
Question 26: Which of the following statements regarding functional epimenorrhoea is not correct ?
- A. It is seen more frequently at the ends of reproductive life
- B. The cycle is reduced to an arbitrary limit of 21 days or less
- C. It is a cyclic bleeding
- D. If epimenorrhoea is associated with heavy menstrual loss it is called menometrorrhagia (Correct Answer)
Explanation: ***If epimenorrhoea is associated with heavy menstrual loss it is called menometrorrhagia*** - This statement is **INCORRECT** - when epimenorrhoea (frequent regular cycles) is associated with heavy bleeding, it should be called **epimenorrhagia** or **polymenorrhagia**. - **Menometrorrhagia** specifically refers to **irregular AND heavy bleeding**, not just frequent and heavy bleeding. - The key difference: epimenorrhoea maintains **regular cyclicity** (just more frequent), whereas metrorrhagia implies **irregular, acyclic bleeding**. *It is seen more frequently at the ends of reproductive life* - This is **CORRECT** - functional epimenorrhoea commonly occurs during **adolescence** (as cycles are maturing) and **perimenopause** (due to hormonal fluctuations, particularly anovulatory cycles). - Both periods are characterized by unstable hypothalamic-pituitary-ovarian axis function. *The cycle is reduced to an arbitrary limit of 21 days or less* - This is **CORRECT** - epimenorrhoea (polymenorrhea) is defined as menstrual cycles occurring at intervals of **21 days or less**. - Normal menstrual cycle length is 21-35 days; anything less than 21 days is considered epimenorrhoea. *It is a cyclic bleeding* - This is **CORRECT** - functional epimenorrhoea indicates that bleeding is **still cyclical and regular**, occurring at predictable (though shortened) intervals. - This distinguishes it from **metrorrhagia** (irregular, acyclic bleeding) and confirms ovulatory or regular hormonal cycling.
Question 27: In a patient with dysfunctional uterine bleeding with cyclical menorrhagia, the first line drug is
- A. Progesterone
- B. Oestrogen and progesterone
- C. Tranexamic acid (Correct Answer)
- D. Oestrogen
Explanation: ***Tranexamic acid*** - **Tranexamic acid** is an **antifibrinolytic** agent that reduces menstrual blood loss by inhibiting the breakdown of blood clots. - It is often considered a **first-line medical treatment** for heavy menstrual bleeding, including cyclical menorrhagia due to its effectiveness and non-hormonal nature. *Progesterone* - While progesterone can be used to manage dysfunctional uterine bleeding, it is typically used for **anovulatory bleeding** or to regulate the cycle, not primarily as a first-line agent for acute, cyclical menorrhagia where heavy bleeding is the main concern. - Its mechanism involves stabilizing the **endometrial lining** and can lead to withdrawal bleeding when stopped. *Oestrogen and progesterone* - Combination oral contraceptives (containing both oestrogen and progesterone) are effective in regulating menstrual cycles and reducing blood loss. - However, for acute, cyclical menorrhagia, especially if the patient does not need contraception, **tranexamic acid** is often preferred as a first-line non-hormonal option due to its rapid effect on bleeding. *Oestrogen* - Oestrogen can be used in cases of acute, very heavy bleeding to rapidly **stabilize the endometrium** and stop hemorrhage, often at high doses. - It helps in the **proliferation of the endometrium** but is not the first-line choice for ongoing cyclical menorrhagia as it can cause its own set of side effects and doesn't address the primary issue of excessive fibrinolysis.
Question 28: The pelvic examination of a woman reveals that the cervix is directed forwards, the body is backward, but it can be anteposed easily. The examination does not demonstrate any other abnormality. The most probable diagnosis is
- A. Posterior wall tumour of the uterus
- B. An ovarian cyst in the pouch of Douglas
- C. Retroverted uterus (Correct Answer)
- D. Pelvic endometriosis
Explanation: ***Retroverted uterus*** - A **retroverted uterus** means the cervix is directed forward and the uterine body tilts backward, which aligns with the description. - The ability to easily **antepose** (bring forward) the uterus indicates it's a mobile, normal variant rather than a fixed pathological condition. *Posterior wall tumour of the uterus* - A tumor would typically present as a **fixed, hard mass** and would likely make anteposing the uterus difficult or impossible. - It would also likely cause **symptoms** such as abnormal bleeding or pain, which are not mentioned. *An ovarian cyst in the pouch of Douglas* - An ovarian cyst in the pouch of Douglas would be palpable as a **separate adnexal mass** and would not inherently cause the uterine body to be *retroverted*. - While it could displace the uterus, the primary description is of the uterine position itself, not an external mass causing displacement. *Pelvic endometriosis* - Endometriosis commonly causes a **fixed retroverted uterus** due to adhesions, making it difficult or impossible to antepose. - It would also typically be associated with **dyspareunia**, dysmenorrhea, and other pain symptoms, none of which are noted.
Question 29: A 20-year-old young woman, who was delivered two months ago at home by a nurse, presents with a complaint of something protruding through the vulva. The clinical examination reveals a cystocele, rectocele, and the cervix 1 cm above the introitus. The most appropriate management will be
- A. Sling operation
- B. Fothergill's operation
- C. Anterior colporrhaphy, posterior colporrhaphy and perineal repair (Correct Answer)
- D. Vaginal hysterectomy
Explanation: ***Anterior colporrhaphy, posterior colporrhaphy and perineal repair*** - This patient presents with a **cystocele** (anterior vaginal wall defect), **rectocele** (posterior vaginal wall defect), and **cervical descent** (uterovaginal prolapse). The indicated combined procedure addresses all three components. - **Anterior colporrhaphy** repairs the cystocele, **posterior colporrhaphy** repairs the rectocele, and the **perineal repair** strengthens the pelvic floor (levator ani muscles and perineal body). *Sling operation* - A sling operation (e.g., midurethral sling) is primarily used for **stress urinary incontinence**, which is not explicitly mentioned as the primary complaint or severe symptom in this case. - While urinary incontinence can co-exist with prolapse, a sling alone would not address the significant vaginal wall and cervical prolapse described. *Fothergill's operation* - Fothergill's operation (also known as Manchester operation) is typically performed for **cervical elongation** with uterine prolapse in women who desire to retain their uterus. - This patient has a cystocele and rectocele, and while the cervix is low, the primary issue is generalized pelvic floor weakness affecting multiple compartments. *Vaginal hysterectomy* - While **vaginal hysterectomy** is often performed for uterine prolapse, the patient is only 2 months postpartum and very young, and preserving her uterus might be desirable. - Furthermore, a hysterectomy would only address the uterine component of the prolapse and would not inherently correct the **cystocele** or **rectocele**, which would still require colporrhaphies.
Question 30: Which of the following are the features of backache due to genital prolapse? 1. The pain is experienced on getting up in the morning. 2. The patient complains of a diffuse pain over the sacrum. 3. There is no local tenderness. 4. The pain occurs more commonly among multiparous than nulliparous women. Select the correct answer using the code given below:
- A. 1 and 2 only
- B. 1, 2 and 3
- C. 1 and 4
- D. 2, 3 and 4 (Correct Answer)
Explanation: ***2, 3 and 4*** - **Diffuse sacral pain** (2) and **lack of local tenderness** (3) are characteristic of backache related to **genital prolapse**, differentiating it from musculoskeletal causes. - **Multiparity** (4) is a significant risk factor for pelvic organ prolapse due to damage to pelvic floor muscles and connective tissues during childbirth. *1 and 2 only* - While diffuse sacral pain is typical, pain experienced primarily on getting up in the morning (1) is more commonly associated with inflammatory conditions like **ankylosing spondylitis** or **degenerative disc disease**, not directly with genital prolapse. - Genital prolapse pain tends to worsen with prolonged standing or activity and be relieved by rest, particularly by lying down. *1, 2 and 3* - The feature of pain on getting up in the morning (1) is inconsistent with typical prolapse-related backache, which usually manifests with activity or prolonged standing. - While diffuse sacral pain (2) and no local tenderness (3) are correct, their combination with an incorrect feature makes this option less accurate. *1 and 4* - Pain on getting up in the morning (1) is not a primary characteristic of backache due to genital prolapse. - While multiparity (4) is a correct risk factor, combining it with an inaccurate pain characteristic makes this option incomplete.