UPSC-CMS 2014 - Obstetrics and Gynecology PYQs Practice Questions

Q: Match List-I with List-II and select the correct answer using the code given below the Lists:

A→4 B→2 C→3 D→1. ***A→4 B→2 C→3 D→1*** - **Palmer's sign** refers to **rhythmic uterine contractions** felt by bimanual examination in the **first trimester** of pregnancy. This is often an early sign used to detect pregnancy. - **Braxton Hicks contractions** are characterized by **rhythmic, painless uterine contractions** that are felt per abdomen and typically occur in the **second and third trimesters** of pregnancy. They are often called "practice contractions." - **Goodell's sign** describes the **softening of the cervix** in early pregnancy due to increased vascularity and edema. - **Chadwick's sign** is the **bluish coloration of the vagina and cervix** in pregnancy, also due to increased vascularity and blood flow. *A→1 B→2 C→3 D→4* - This option incorrectly matches Palmer's sign with bluish coloration of the vagina, which is **Chadwick's sign**. - It also incorrectly matches Chadwick's sign with rhythmic uterine contractions in the first trimester, which is **Palmer's sign**. *A→3 B→2 C→1 D→4* - This option incorrectly matches Palmer's sign with softening of the cervix (**Goodell's sign**) and Goodell's sign with bluish coloration of the vagina (**Chadwick's sign**). - It also incorrectly matches Chadwick's sign with rhythmic uterine contractions in the first trimester (**Palmer's sign**). *A→2 B→3 C→1 D→4* - This option incorrectly matches Palmer's sign with Braxton Hicks contractions and Braxton Hicks sign with softening of the cervix, which is **Goodell's sign**. - It also incorrectly matches Goodell's sign with bluish coloration of the vagina (**Chadwick's sign**) and Chadwick's sign with rhythmic contractions in the first trimester (**Palmer's sign**). [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: HELLP syndrome includes the following except:

Leucocytosis. ***Leucocytosis*** - HELLP syndrome is characterized by **hemolysis**, **elevated liver enzymes**, and **low platelet count**. Leucocytosis (an elevated white blood cell count) is **not a defining feature** of HELLP syndrome. - While leucocytosis can occur in conditions associated with inflammation or stress, it is **not a diagnostic criterion** for HELLP syndrome and doesn't represent one of its core components. *Low platelet count* - **Thrombocytopenia** (platelet count below 100,000/microL) is a critical component of HELLP syndrome, representing the "LP" in the acronym. - It results from increased platelet consumption and destruction due to widespread endothelial dysfunction. *Hemolysis* - **Hemolysis** (breakdown of red blood cells) is the "H" in the HELLP acronym. - It is evidenced by findings such as **schistocytes** on peripheral blood smear, elevated **lactate dehydrogenase (LDH)**, and unconjugated **hyperbilirubinemia**. *Elevated liver enzymes* - **Elevated liver enzymes** (e.g., aspartate aminotransferase (AST) and alanine aminotransferase (ALT) being at least twice the upper limit of normal) are the "EL" in HELLP. - This elevation indicates **hepatic dysfunction** and hepatocellular damage, often associated with periportal hemorrhage and fibrin deposition. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Predisposing factors of puerperal sepsis are following except:

Multiparity. ***Multiparity*** - **Multiparity**, defined as having given birth to more than one child, is generally considered a protective factor rather than a predisposing factor for puerperal sepsis. - While it was historically associated with some obstetric complications, modern evidence does not support it as a direct risk factor for puerperal sepsis. *Placenta previa* - **Placenta previa** increases the risk of hemorrhage and the need for interventions such as manual removal of the placenta or cesarean section, all of which elevate the risk of infection. - The abnormal placental implantation itself can lead to a more traumatic delivery and exposure to infection. *Cases of manual removal of placenta* - **Manual removal of the placenta** involves direct digital exploration of the uterine cavity, which introduces bacteria into a potentially sterile environment. - This procedure also causes trauma to the uterine lining, creating an entry point for infection. *Repeated internal examinations specially in the case of premature rupture of membrane* - **Repeated internal examinations**, especially after **premature rupture of membranes (PROM)**, repeatedly introduce microorganisms from the vagina into the sterile uterine cavity. - PROM itself removes the protective barrier against ascending infection, making frequent examinations particularly risky. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Surgical treatment of choice for a 20 year old nulliparous woman with uterine prolapse is:

Sacrocolpopexy. ***Sacrocolpopexy (Sacrohysteropexy variant)*** - For a **young, nulliparous woman**, the procedure of choice is **sacrohysteropexy** (also called sacrocervicopexy), which involves attaching the **uterus/cervix** to the **sacrum** using synthetic mesh, providing durable support while preserving the uterus. - This is ideal for young women as it **preserves fertility potential** and maintains vaginal length and sexual function. - The term sacrocolpopexy in this context refers to the uterine-preserving variant, crucial for women desiring future pregnancy. *Le Forte's repair* - This is an **obliterative procedure** primarily used in elderly women who are **no longer sexually active**, involving partial closure of the vagina. - It is absolutely contraindicated in a young, nulliparous woman who desires future sexual function and pregnancy. *Sling surgery* - **Sling surgery** is primarily indicated for **stress urinary incontinence**, not uterine prolapse. - While incontinence can co-exist with prolapse, a sling alone does not address uterine or vaginal apex support. *Abdominal hysterectomy with pelvic floor repair* - **Hysterectomy** removes the uterus and would **eliminate fertility**, which is unacceptable for a young, nulliparous woman desiring children. - Though effective for prolapse, it is an overly aggressive approach; uterine-preserving procedures like sacrohysteropexy are strongly preferred for fertility preservation. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→4  B→2  C→3  D→1

Answer

A→1  B→2  C→3  D→4

Answer

A→3  B→2  C→1  D→4

Answer

A→2  B→3  C→1  D→4

Question 2

HELLP syndrome includes the following except:

Accepted Answer

Leucocytosis

Answer

Low platelet count

Answer

Hemolysis

Answer

Elevated liver enzymes

Question 3

Predisposing factors of puerperal sepsis are following except:

Accepted Answer

Multiparity

Answer

Placenta previa

Answer

Cases of manual removal of placenta

Answer

Repeated internal examinations specially in the case of premature rupture of membrane

Question 4

Consider the following:

1. Fetal pulmonary hypoplasia
2. Fetal chromosomal anomalies
3. Prostaglandin synthetase inhibitors
4. Amniotic fluid index of 15 cm

Which of the above are associated with oligohydramnios?

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 5

Surgical treatment of choice for a 20 year old nulliparous woman with uterine prolapse is:

Accepted Answer

Sacrocolpopexy

Answer

Le Forte’s repair

Answer

Sling surgery

Answer

Abdominal hysterectomy with pelvic floor repair

Question 6

A 32 years old woman with two live children was brought to emergency with history of missed period for 15 days, spotting since 7 days and pain abdomen since 6 hours. Her pulse was 120 per minute, pallor + +, systolic B.P. 80 mm Hg. There was fullness and tenderness on per abdomen examination. Copper T thread was seen through external os on per speculum examination. On p/ v examination, cervical movements were tender, uterus was anteverted, bulky and soft. There was fullness in pouch of Douglas. Most likely, she is suffering from:

Accepted Answer

Ruptured ectopic pregnancy

Answer

Pelvic inflammatory disease

Answer

Missed abortion with infection

Answer

Threatened abortion

Question 7

A 20 year old primigravida is admitted with full term pregnancy and labour pains. At 4 A.M. she goes into active phase of labour with 4 cm cervical dilatation. Membranes rupture during p/v examination showing clear liquor. A repeat p/v after 4 hours of good uterine contractions reveals a cervical dilatation of 5 cm. What should be the next step in management?

Accepted Answer

Reassess for occipitoposterior position and cephalopelvic disproportion

Answer

Oxytocin drip

Answer

Immediate caesarean section

Answer

Reassess after 4 hours

Question 8

Immediately after third stage of labour in a case of full term delivery, the fundus of the uterus is:

Accepted Answer

At the level of umbilicus

Answer

At the level of xiphisternum

Answer

Below the level of umbilicus

Answer

Just above the symphysis pubis

Question 9

Which one of the following is not a complication of shoulder dystocia?

Accepted Answer

Placental abruption

Answer

Brachial plexus palsy

Answer

Postpartum haemorrhage

Answer

Facial palsy

Question 10

Which of the following methods for induction of labour should not be used in the patient with previous lower segment caesarean section?

Accepted Answer

Vaginal prostaglandin gel

Answer

Stripping of the membrane

Answer

Oxytocin drip

Answer

Oral prostaglandin tablet

UPSC-CMS 2014 — Obstetrics and Gynecology