A woman who is being investigated for infertility is diagnosed to have a nulliparous prolapse of the uterus. The most appropriate management will be
Which of the following is not an outcome of gonococcal salpingitis ?
A parous woman complains of itching in the vulva. On examination, there is local redness and swelling and white flakes around the introitus. The most probable diagnosis is
The characteristic features of inguinal lymph nodes associated with a primary syphilitic lesion of the vulva are
The common manifestations of genital tuberculosis include the following except
A 60-year-old woman is diagnosed with genital malignancy. On physical examination she is found to have the enlargement of superficial inguinal lymph nodes. The most likely organ involved is
What is the recommendation for use of Levonorgestrel for the purpose of emergency contraception ?
UPSC-CMS 2012 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 31: A woman who is being investigated for infertility is diagnosed to have a nulliparous prolapse of the uterus. The most appropriate management will be
- A. Ring pessary (Correct Answer)
- B. Cervical amputation
- C. Sling operation
- D. Fothergill repair
Explanation: ***Ring pessary*** - A ring pessary can provide **symptomatic relief** for uterine prolapse while allowing the woman to continue trying to conceive and carry a pregnancy. - It is a **non-surgical** and reversible option, making it suitable for women who desire future fertility. *Cervical amputation* - This procedure, such as a **Manchester Fothergill operation**, involves amputation of the cervix and can compromise future fertility and cervical competence during pregnancy. - It is a **definitive surgical treatment** usually reserved for women who have completed childbearing. *Sling operation* - Sling operations, such as sacral colpopexy, involve suspending the uterus or vaginal vault. These are generally performed for **pelvic organ prolapse** in women who are not planning future pregnancies or for more severe prolapse. - These procedures can **interfere with future fertility** and the natural physiological changes during pregnancy and labor. *Fothergill repair* - The Fothergill repair (or Manchester operation) involves **cervical amputation**, anterior colporrhaphy, and posterior colpoperineorrhaphy. It is a surgical procedure aimed at correcting uterine prolapse. - While effective for prolapse, it is **not suitable for women desiring future fertility** due to the cervical amputation and potential impact on pregnancy.
Question 32: Which of the following is not an outcome of gonococcal salpingitis ?
- A. Ovarian cyst (Correct Answer)
- B. Hydrosalpinx
- C. Multiple tubal blocks
- D. Salpingitis isthmica nodosa
Explanation: ***Ovarian cyst*** - **Ovarian cysts** are fluid-filled sacs that develop on the ovary, typically benign and functional in nature, arising from normal ovarian follicular development or hormonal imbalances. - Gonococcal salpingitis **does not directly cause ovarian cyst formation**—the pathogenesis of functional ovarian cysts is primarily related to **hormonal regulation** of the menstrual cycle, not infectious inflammation of the fallopian tubes. - While severe pelvic inflammatory disease can theoretically involve ovarian inflammation (oophoritis), this does not result in typical ovarian cyst formation. *Hydrosalpinx* - **Hydrosalpinx** is a well-recognized sequela of gonococcal salpingitis, where the **fimbriated end of the fallopian tube becomes sealed** due to inflammation and adhesion formation. - This results in **accumulation of serous fluid** within the obstructed tube, creating a dilated, fluid-filled fallopian tube visible on imaging. - Hydrosalpinx is a major cause of **tubal factor infertility** and often requires surgical intervention. *Multiple tubal blocks* - Gonococcal salpingitis is a leading cause of **pelvic inflammatory disease (PID)**, which produces severe inflammation, scarring, and adhesion formation within the fallopian tubes. - The resulting **fibrosis and strictures** create multiple points of obstruction along the tube, impairing ovum and sperm transport. - This is a major cause of **tubal factor infertility** and increases the risk of **ectopic pregnancy**. *Salpingitis isthmica nodosa* - **Salpingitis isthmica nodosa (SIN)** is characterized by **diverticula of tubal epithelium** extending into the muscular wall of the isthmic portion of the fallopian tube, creating a nodular appearance. - While its exact etiology remains debated, it is frequently associated with **chronic inflammatory processes** including prior episodes of salpingitis, though some consider it primarily a developmental anomaly. - SIN is associated with increased risk of **ectopic pregnancy** and **infertility**.
Question 33: A parous woman complains of itching in the vulva. On examination, there is local redness and swelling and white flakes around the introitus. The most probable diagnosis is
- A. Trichomoniasis
- B. Gonorrhoea
- C. Candidiasis (Correct Answer)
- D. Pyogenic vulvovaginitis
Explanation: ***Candidiasis*** - The symptoms of **itching**, **redness**, **swelling** of the vulva, and **white flakes** (often described as "cottage cheese-like") around the introitus are highly characteristic of vulvovaginal **candidiasis (yeast infection)**. - This condition is common, especially in parous women, and is caused by an overgrowth of *Candida* species. *Trichomoniasis* - Typically presents with a **foamy, greenish-yellow discharge**, a **foul odor**, and often **punctate hemorrhages** on the cervix (strawberry cervix). - While it can cause itching and irritation, the presence of **white flakes** is not a characteristic feature. *Gonorrhoea* - Often **asymptomatic** in women or presents with **purulent vaginal discharge**, **dysuria**, and **pelvic pain**. - It does not typically cause **white flakes** around the introitus and the discharge is usually not itchy initially. *Pyogenic vulvovaginitis* - This is a general term for bacterial vulvovaginitis that would present with signs of **bacterial infection**, such as a **malodorous discharge** and significant inflammation. - While it can cause redness and swelling, the description of **white flakes** is not specific to pyogenic infections and points more towards a fungal etiology.
Question 34: The characteristic features of inguinal lymph nodes associated with a primary syphilitic lesion of the vulva are
- A. Painful, tender nodes which become matted together to form an abscess
- B. Firm, shotty, painless nodes that do not suppurate (Correct Answer)
- C. Non-suppurative tender enlarged nodes
- D. Painful inflamed nodes which undergo necrosis and develop a chronic sinus
Explanation: **Firm, shotty, painless nodes that do not suppurate** - Lymphadenopathy in **primary syphilis** typically presents as **firm, bilateral, painless**, and non-suppurative lymph nodes, often described as "shotty." - These nodes are usually discrete and do not tend to mat together or form abscesses, reflecting the inflammatory response to **_Treponema pallidum_**. *Painful, tender nodes which become matted together to form an abscess* - **Painful, matted, and suppurative** lymph nodes are more characteristic of other infections, such as those caused by bacterial pathogens like **_Staphylococcus aureus_** or **_Streptococcus pyogenes_**, or conditions like **lymphogranuloma venereum**. - These features are generally not associated with the indolent inflammatory response seen in primary syphilis. *Non-suppurative tender enlarged nodes* - While the nodes in primary syphilis are **non-suppurative and enlarged**, they are typically **painless**, not tender. - **Tenderness** can suggest a more acute or active inflammatory process, and the absence of pain is a key distinguishing feature of syphilitic lymphadenopathy. *Painful inflamed nodes which undergo necrosis and develop a chronic sinus* - **Necrotic lymph nodes** with **chronic sinus formation** are indicative of severe and chronic infections such as **tuberculosis (scrofula)** or deep fungal infections, or conditions like **cat-scratch disease** in some cases. - These aggressive features are not consistent with the typical presentation of primary syphilis.
Question 35: The common manifestations of genital tuberculosis include the following except
- A. Pelvic pain
- B. Foul-smelling vaginal discharge (Correct Answer)
- C. Amenorrhoea
- D. Infertility
Explanation: ***Foul-smelling vaginal discharge*** - While infections can cause vaginal discharge, a **foul-smelling discharge** is typically associated with bacterial vaginosis or trichomoniasis, not primarily with genital tuberculosis due to its granulomatous nature. - Genital tuberculosis often presents with **non-specific symptoms** or no symptoms at all, rather than purulent or foul-smelling discharge. *Pelvic pain* - **Chronic pelvic pain** is a very common symptom of genital tuberculosis, often due to inflammation and involvement of pelvic organs. - The pain can be constant or intermittent and may be difficult to localize. *Amenorrhoea* - **Amenorrhea**, particularly secondary amenorrhoea, can occur due to endometrial damage or destruction caused by the tuberculous infection. - This can lead to **intrauterine adhesions (Asherman's syndrome)** or functional impairment of the endometrium, hindering menstruation. *Infertility* - **Infertility** is one of the most frequent and significant manifestations of genital tuberculosis, especially in women. - It often results from **tubal occlusion** or distortion, endometrial damage, or ovarian dysfunction caused by the disease, leading to an inability to conceive or carry a pregnancy to term.
Question 36: A 60-year-old woman is diagnosed with genital malignancy. On physical examination she is found to have the enlargement of superficial inguinal lymph nodes. The most likely organ involved is
- A. Adnexa
- B. Vulva (Correct Answer)
- C. Cervix
- D. Uterus
Explanation: ***Vulva (Correct Answer)*** - The **vulva** drains primarily to the **superficial inguinal lymph nodes**, making its malignancy the most likely cause of their enlargement. - Unlike deeper pelvic organs, vulvar cancer metastases travel directly to these easily palpable nodes. - This is a key anatomical principle: **external genitalia → superficial inguinal nodes**. *Adnexa (Incorrect)* - Malignancies of the **adnexa** (ovaries, fallopian tubes) typically metastasize via the **para-aortic or pelvic lymph nodes**, not the superficial inguinal nodes. - These follow the ovarian vessels along the infundibulopelvic ligament. - Distant inguinal node involvement would indicate advanced disease, but initial spread is not to these nodes. *Cervix (Incorrect)* - Cervical cancer primarily metastasizes to the **pelvic lymph nodes** (e.g., obturator, internal iliac, external iliac), with superficial inguinal nodes rarely involved unless there is extensive local spread. - The lymphatic drainage of the cervix is distinct from that of the external genitalia. *Uterus (Incorrect)* - Uterine cancer (endometrial or uterine body) typically spreads to the **pelvic** and **para-aortic lymph nodes**, following the ovarian and uterine vessels. - Like cervical cancer, superficial inguinal lymph node involvement is uncommon and usually a sign of very advanced or unusual spread.
Question 37: What is the recommendation for use of Levonorgestrel for the purpose of emergency contraception ?
- A. Two tablets of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 96 hours (Correct Answer)
- B. One tablet of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 72 hours
- C. None of the options
- D. One tablet of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 120 hours
Explanation: ***Two tablets of 0.75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 96 hours*** - This represents the **correct total dose of 1.5 mg** (0.75 mg × 2 tablets) for emergency contraception. - The standard regimen for **levonorgestrel emergency contraception** can be administered as either a **single dose of 1.5 mg** or as **two doses of 0.75 mg taken 12 hours apart**. - Current WHO guidelines recommend taking both tablets together (single 1.5 mg dose) for ease of compliance, which is equally effective as the split-dose regimen. - The **96-hour window** is within the acceptable timeframe, as levonorgestrel EC can be effective for up to **120 hours** (5 days) after unprotected intercourse, though efficacy is highest within **72 hours**. - The phrase "soon after" reasonably implies taking the tablets together or in quick succession, which aligns with current practice. *One tablet of 0.75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 72 hours* - This option specifies only a **single 0.75 mg tablet**, which is **half the required total dose (1.5 mg)** for emergency contraception. - While the **72-hour window** is correct for optimal efficacy, the **insufficient dosage** makes this option incorrect. *One tablet of 0.75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 120 hours* - This option also presents an **insufficient dose of only 0.75 mg** when the standard requirement is **1.5 mg total**. - Although **120 hours** represents the maximum effective window for levonorgestrel EC, the inadequate dosage makes this incorrect. *None of the options* - This is incorrect because **Option 3** appropriately describes the recommended total dose and timeframe for levonorgestrel emergency contraception based on current guidelines.