Obstetrics and Gynecology
10 questionsA 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:
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 ?
UPSC-CMS 2012 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 61: 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 62: 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 63: 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 64: 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 65: 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 66: 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 67: 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 68: 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.
Question 69: 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 70: 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**.