UPSC-CMS 2016 — Obstetrics and Gynecology
33 Previous Year Questions with Answers & Explanations
A 35 year old nulliparous woman complains of menorrhagia and mass per abdomen. On examination, the positive findings are: she is anaemic, has a pelvic mass of 16-18 weeks size, firm in consistency which moves with the movement of cervix. What is the most likely clinical diagnosis?
Abundant cornified cells in vaginal exfoliative cytology indicate:
Polyhydramnios at term is diagnosed when AFI is more than:
Which of the following is not a potentially teratogenic infection if contracted in pregnancy?
Regarding hypertensive disorders of pregnancy, the following are true except:
Which of the following is not a characteristic of Mayer-Rokitansky-Küster-Hauser syndrome?
The following are used in the staging of carcinoma of the cervix except:
A 58 year old woman, post menopausal for last 8 years comes with history of spotting per vaginum. What is the most likely cause?
A diabetic obese patient comes with history of post-menopausal bleeding. On examination, there is a supra pubic mass and per vagina there is purulent discharge. The probable diagnosis is:
An adolescent girl with stage 1a dysgerminoma is managed by:
UPSC-CMS 2016 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 1: A 35 year old nulliparous woman complains of menorrhagia and mass per abdomen. On examination, the positive findings are: she is anaemic, has a pelvic mass of 16-18 weeks size, firm in consistency which moves with the movement of cervix. What is the most likely clinical diagnosis?
- A. Leiomyoma (Correct Answer)
- B. Adenomyosis
- C. Ovarian tumour
- D. Endometrial carcinoma
Explanation: ***Leiomyoma*** - A **leiomyoma**, or **fibroid**, is a common benign smooth muscle tumor of the uterus, often presenting as **menorrhagia** and a **pelvic mass**. - The mass being **firm, 16-18 weeks size**, and **moving with the cervix** is classic for a uterine fibroid, differentiating it from an adnexal or fixed uterine mass. *Adenomyosis* - Characterized by endometrial tissue within the myometrium, leading to a **globular, tender uterus**, often associated with **dysmenorrhea** and **menorrhagia**. - While it causes menorrhagia, the uterus is typically **tender** and **boggy**, not a firm, discrete mass freely mobile with the cervix. *Ovarian tumour* - An **ovarian tumor** would typically present as an **adnexal mass**, often separate from the uterus and not moving with the cervix. - While an ovarian tumor can cause a pelvic mass, it is less likely to be directly associated with the described menorrhagia or involve the cervix's movement. *Endometrial carcinoma* - Primarily causes **abnormal uterine bleeding**, especially in **postmenopausal women**, but usually does not present as a large, firm, mobile mass detectable on abdominal palpation. - While it can cause menorrhagia, a firm, discrete uterine mass that moves with the cervix is not a typical presentation of **endometrial carcinoma**.
Question 2: Abundant cornified cells in vaginal exfoliative cytology indicate:
- A. Late proliferative phase (Correct Answer)
- B. Late secretory phase
- C. Early secretory phase
- D. Early proliferative phase
Explanation: ***Late proliferative phase*** - During the **late proliferative phase**, estrogen levels are at their peak, leading to significant maturation and cornification of vaginal epithelial cells. - This phase is characterized by a high proportion of **superficial cells**, which are large, polygonal, and have small, pyknotic nuclei, reflecting extensive cornification. *Late secretory phase* - In the **late secretory phase**, progesterone levels are high, which causes an increase in **intermediate cells** and a decrease in superficial (cornified) cells. - The cytology would show a dominance of folded intermediate cells, often in clusters, and a **"navicular cell"** appearance, rather than abundant cornified cells. *Early secretory phase* - The **early secretory phase** is also dominated by progesterone's influence, leading to a shift from superficial to intermediate cells. - There would be a mixture of intermediate and some superficial cells, but not the abundance of **highly cornified cells** seen in the late proliferative phase. *Early proliferative phase* - The **early proliferative phase** follows menstruation and is characterized by rising estrogen, but not yet at its peak. - The cytology would typically show a mixture of **parabasal**, intermediate, and some superficial cells, reflecting the initial regeneration of the epithelium, with less cornification than the late proliferative phase.
Question 3: Polyhydramnios at term is diagnosed when AFI is more than:
- A. 25 cm (Correct Answer)
- B. 15 cm
- C. 20 cm
- D. 10 cm
Explanation: ***25 cm*** - **Polyhydramnios** is diagnosed when the **Amniotic Fluid Index (AFI)** at term is greater than or equal to **25 cm**. - This indicates an excessive amount of **amniotic fluid**, which can be associated with various maternal or fetal complications. *15 cm* - An AFI of 15 cm is within the **normal range** for amniotic fluid volume. - It does not meet the criteria for either **polyhydramnios** or **oligohydramnios**. *20 cm* - An AFI of 20 cm is considered to be in the **upper normal limit** or **borderline high**, but it does not definitively meet the diagnostic criteria for **polyhydramnios**. - Close monitoring would be indicated, but it's not severe polyhydramnios. *10 cm* - An AFI of 10 cm is also within the **normal range** for amniotic fluid volume. - It is neither indicative of too much nor too little amniotic fluid.
Question 4: Which of the following is not a potentially teratogenic infection if contracted in pregnancy?
- A. Chicken pox
- B. Rubella
- C. Influenza virus (Correct Answer)
- D. Cytomegalovirus
Explanation: ***Influenza virus*** - While influenza can cause severe illness in pregnant women, it is **not generally considered teratogenic**, meaning it does not typically cause birth defects like the other listed infections. - The primary risks of influenza in pregnancy are severe maternal complications, **preterm birth**, and **low birth weight**, rather than congenital anomalies. *Chicken pox* - Maternal infection with **varicella-zoster virus (chickenpox)** during the first 20 weeks of pregnancy can lead to **Congenital Varicella Syndrome**, characterized by skin scarring, limb hypoplasia, microphthalmia, and neurological deficits. - Infection late in pregnancy can cause **neonatal varicella**, which can be severe and life-threatening for the newborn. *Rubella* - Maternal infection with **rubella (German measles)**, especially during the first trimester, is a well-known cause of **Congenital Rubella Syndrome (CRS)**. - CRS can result in severe birth defects, including **cataracts**, **heart defects** (e.g., patent ductus arteriosus, pulmonary artery stenosis), and **sensorineural hearing loss**. *Cytomegalovirus* - **Congenital cytomegalovirus (CMV)** infection is a leading cause of **non-hereditary sensorineural hearing loss** and neurodevelopmental disabilities. - While many infected infants are asymptomatic at birth, some develop **microcephaly**, periventricular calcifications, hepatosplenomegaly, and **chorioretinitis**.
Question 5: Regarding hypertensive disorders of pregnancy, the following are true except:
- A. Significant proteinuria is more than/equal to 0.3 g/24hr
- B. Eclampsia may present in the absence of hypertension
- C. A protein:creatinine ratio more than 30 mg/mmol is considered significant
- D. Urinary dipstick result of +1 is equivalent to urinary protein concentration of 300 mg/dl (Correct Answer)
Explanation: ***Urinary dipstick result of +1 is equivalent to urinary protein concentration of 300 mg/dl*** - A protein dipstick result of **+1** is typically considered to represent a protein concentration of **30 mg/dL**, not 300 mg/dL. - A protein concentration of **300 mg/dL** on a dipstick usually corresponds to a result of **+3** or higher. *Significant proteinuria is more than/equal to 0.3 g/24hr* - This statement is **true** according to major guidelines (e.g., ACOG) for the diagnosis of **preeclampsia**. - A 24-hour urine collection yielding **300 mg (0.3 g)** or more of protein is the gold standard for defining significant proteinuria. *Eclampsia may present in the absence of hypertension* - This statement is **true**; while eclampsia typically involves hypertension, seizures can occur with **mild hypertension** or even in its **absence**, especially in women with underlying neurological conditions or atypical presentations. - This highlights the importance of considering eclampsia in pregnant or postpartum women with new-onset seizures, regardless of blood pressure readings. *A protein:creatinine ratio more than 30 mg/mmol is considered significant* - This statement is **true**; a **protein:creatinine ratio (PCR)** of **≥ 30 mg/mmol** (or 0.3 mg/mg) is a reliable and convenient alternative to the 24-hour urine collection for diagnosing significant proteinuria. - This threshold is widely accepted for identifying proteinuria indicative of **preeclampsia** or other renal pathologies.
Question 6: Which of the following is not a characteristic of Mayer-Rokitansky-Küster-Hauser syndrome?
- A. Skeletal abnormalities
- B. Renal abnormalities
- C. Cardiac anomalies (Correct Answer)
- D. Mullerian duct aplasia
Explanation: ***Cardiac anomalies*** - While other systemic abnormalities can be associated with MRKH syndrome, **cardiac anomalies** are generally not considered a characteristic feature. - MRKH syndrome primarily affects the **Müllerian ducts** and is often linked to renal and skeletal issues due to common developmental origins. *Skeletal abnormalities* - **Skeletal abnormalities**, particularly of the **vertebral column** (e.g., scoliosis, fused vertebrae), are commonly associated with MRKH syndrome. - This association is thought to arise from defects in the paraxial mesoderm during embryonic development, which affects both skeletal and Müllerian structures. *Renal abnormalities* - Around 30-50% of individuals with MRKH syndrome also have **renal anomalies**, such as **unilateral renal agenesis**, horseshoe kidney, or renal ectopia. - These abnormalities are due to the close developmental proximity and shared mesodermal origin of the Müllerian ducts and the **urogenital system**. *Mullerian duct aplasia* - **Müllerian duct aplasia** is the **defining characteristic** of MRKH syndrome, leading to the absence or hypoplasia of the uterus and upper vagina. - Individuals typically present with **primary amenorrhea** despite having normal secondary sexual characteristics and functioning ovaries.
Question 7: The following are used in the staging of carcinoma of the cervix except:
- A. Parametrial involvement
- B. Hydroureter (Correct Answer)
- C. Pelvic lymph node involvement
- D. Vaginal involvement
Explanation: ***Hydroureter*** - While hydroureter (ureteral dilatation) can occur in advanced cervical cancer due to ureteral compression, **hydroureter alone is not a FIGO staging criterion**. - The FIGO staging system specifically uses **hydronephrosis or non-functioning kidney** as a criterion for Stage IIIB, not isolated hydroureter. - Hydronephrosis represents kidney involvement, whereas hydroureter refers only to ureteral dilatation, which may not always lead to renal compromise. - This distinction is important: the staging criterion requires **renal involvement/compromise**, not just ureteral changes. *Parametrial involvement* - **Parametrial involvement** is a crucial staging criterion indicating at least **FIGO Stage IIB** disease. - This is assessed by palpation during bimanual examination or confirmed by imaging studies. - Represents lateral extension of the tumor beyond the cervix. *Pelvic lymph node involvement* - **Pelvic lymph node involvement** is a key staging criterion in the **FIGO 2018 staging system**, classified as **Stage IIIC1**. - Assessed through imaging (CT, MRI, PET-CT) or surgical staging. - Significantly impacts prognosis and treatment planning. *Vaginal involvement* - The extent of **vaginal involvement** is a direct FIGO staging criterion. - Involvement of the upper two-thirds indicates **Stage IIA**, while extension to the lower third indicates **Stage IIIA**. - Assessed by careful pelvic examination and imaging.
Question 8: A 58 year old woman, post menopausal for last 8 years comes with history of spotting per vaginum. What is the most likely cause?
- A. Endometrial hyperplasia
- B. Atrophic vaginitis (Correct Answer)
- C. Endometrial carcinoma
- D. Estrogen replacement therapy
Explanation: ***Atrophic vaginitis*** - **Most common cause** of postmenopausal bleeding, accounting for **60-70% of cases**. - Due to **decreased estrogen levels** after menopause, the vaginal epithelium and endometrium become thin, dry, and fragile. - This leads to **easy bleeding** from minimal trauma, presenting as spotting. - In a woman 8 years postmenopausal, atrophic changes are the statistically most likely cause. *Endometrial carcinoma* - **Must always be ruled out** in any woman with postmenopausal bleeding - this is the golden rule. - Accounts for approximately **10% of postmenopausal bleeding cases**. - While statistically less common than atrophy, requires investigation with **endometrial biopsy or transvaginal ultrasound**. - Risk factors include obesity, nulliparity, late menopause, and unopposed estrogen exposure. *Endometrial hyperplasia* - Results from **unopposed estrogen stimulation** causing excessive endometrial growth. - More commonly presents with **heavier or prolonged bleeding** rather than spotting. - Less likely in a woman 8 years postmenopausal without hormone therapy. - Can be a precursor to endometrial carcinoma if left untreated. *Estrogen replacement therapy* - Can cause **breakthrough bleeding or spotting** if used. - The question stem does not mention the patient is on hormone replacement therapy. - If present, would be an important consideration in the differential diagnosis.
Question 9: A diabetic obese patient comes with history of post-menopausal bleeding. On examination, there is a supra pubic mass and per vagina there is purulent discharge. The probable diagnosis is:
- A. Carcinoma endometrium (Correct Answer)
- B. Ovarian carcinoma
- C. Uterine myoma
- D. Carcinoma cervix
Explanation: ***Carcinoma endometrium*** - **Postmenopausal bleeding** is the hallmark symptom, and the patient's **diabetes** and **obesity** are significant risk factors for endometrial carcinoma. - The combination of a **suprapubic mass** (indicating an enlarged uterus or advanced disease) and **purulent vaginal discharge** (suggesting **pyometra** secondary to cervical stenosis caused by tumor) strongly supports this diagnosis. *Ovarian carcinoma* - Ovarian carcinoma primarily presents with vague symptoms like **abdominal distension**, **bloating**, and **pelvic pain**, not typically postmenopausal bleeding as the initial symptom. - While it can cause an abdominal mass, **purulent vaginal discharge** and direct bleeding are not common primary presentations. *Uterine myoma* - **Uterine myomas (fibroids)** are common benign tumors that can cause bleeding, but typically in premenopausal women and characterized by **menorrhagia** or intermenstrual bleeding. - While large fibroids can present as a mass, **postmenopausal bleeding** and especially **purulent discharge** point away from a simple fibroid in this context. *Carcinoma cervix* - **Cervical carcinoma** often presents with **postcoital bleeding** or irregular intermenstrual bleeding, and can cause a mass and discharge. - However, the strong risk factors of **diabetes** and **obesity** are more directly linked to **endometrial cancer** than cervical cancer, and the description of a suprapubic mass suggests a uterine origin rather than primarily cervical.
Question 10: An adolescent girl with stage 1a dysgerminoma is managed by:
- A. Chemotherapy
- B. Bilateral salpingo-oophorectomy alone
- C. Total abdominal hysterectomy with unilateral salpingo-oophorectomy
- D. Unilateral salpingo-oophorectomy alone (Correct Answer)
Explanation: ***Unilateral salpingo-oophorectomy alone*** - For **stage 1a dysgerminoma**, which is confined to one ovary, **fertility-sparing surgery** with unilateral salpingo-oophorectomy is the standard treatment, especially in young patients. - This approach aims to preserve reproductive function while effectively treating the localized tumor, given the **high radiosensitivity** and **chemosensitivity** of dysgerminomas. *Chemotherapy* - While dysgerminomas are sensitive to chemotherapy, it is typically reserved for **advanced stages** (stage 1c or higher), **recurrent disease**, or cases with **residual disease** after surgery. - It is not the primary treatment for **stage 1a disease** when complete surgical resection is achievable, especially when fertility preservation is desired. *Bilateral salpingo-oophorectomy alone* - This procedure would remove both ovaries and fallopian tubes, leading to **sterility and premature menopause**. - It is an **over-treatment** for stage 1a dysgerminoma, as the disease is localized to one ovary, and it is not fertility-sparing. *Total abdominal hysterectomy with unilateral salpingo-oophorectomy* - This extensive surgery involves the removal of the uterus and one ovary/fallopian tube, rendering the patient **infertile**. - It is an **overly aggressive** approach for stage 1a dysgerminoma in an adolescent girl, as the uterus is not involved, and fertility preservation is a crucial consideration.