Which of the following conditions is best treated by a posterior colpotomy?
Menopause is associated with the following except:
Which one of the following conditions simulates the menstrual pattern of pain?
Which of the undermentioned conditions does not cause postmenopausal vaginal bleeding?
Defective fusion of the Mullerian ducts may give rise to which of the following?
For a woman who has had unprotected intercourse two days ago, which one of the following emergency contraceptive methods is LEAST preferred as first-line emergency contraception?
Deep transverse arrest of head in labour occurs in:
Early deceleration of foetal heart rate in labour is due to:
McRoberts manoeuvre is used during labour for management of:
Which one of the following is not a suitable condition for outlet forceps application?
UPSC-CMS 2016 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 11: Which of the following conditions is best treated by a posterior colpotomy?
- A. Pyosalpinx
- B. Pyometra
- C. Pelvic abscess (Correct Answer)
- D. Pelvic haematocele
Explanation: ***Pelvic abscess*** - A **posterior colpotomy** allows for direct access and drainage of a pelvic abscess located in the **cul-de-sac** (pouch of Douglas). - This minimally invasive surgical approach provides effective relief for loculated pelvic infections. - **Most definitive indication** for posterior colpotomy as it allows complete drainage of purulent material. *Pyosalpinx* - Refers to a pus-filled fallopian tube, which is typically located **laterally to the uterus** and not easily accessible via a posterior colpotomy. - Drainage of a pyosalpinx usually requires a **laparoscopic or open abdominal approach**. *Pyometra* - Characterized by **pus accumulation within the uterine cavity**, which is drained via the cervix, not the posterior vaginal fornix. - **Cervical dilation** and drainage are the primary treatment, not colpotomy. *Pelvic haematocele* - Involves a collection of **blood in the pelvic cavity**, often within the cul-de-sac. - While technically accessible via colpotomy, **pelvic haematoceles are usually managed conservatively** or require laparoscopy to identify and control the bleeding source. - Colpotomy drainage alone is insufficient as it doesn't address the underlying cause of bleeding.
Question 12: Menopause is associated with the following except:
- A. Delusion (Correct Answer)
- B. Loss of libido
- C. Ischemic heart disease
- D. Osteoporosis
Explanation: ***Delusion*** - Delusions are a feature of **psychotic disorders** and are not directly associated with the physiological changes of menopause. - While menopause can affect mood and cognitive function, it does not typically cause **psychotic symptoms** like delusions. *Loss of libido* - The decline in **estrogen levels** during menopause can lead to vaginal dryness and discomfort during intercourse, which can contribute to a loss of libido. - Hormonal changes also directly impact sexual desire, making it a common menopausal symptom. *Ischemic heart disease* - Estrogen has a **cardioprotective effect**, and its decline after menopause increases women's risk for **ischemic heart disease**. - The absence of estrogen contributes to changes in lipid profiles and endothelial function, predisposing women to cardiovascular events. *Osteoporosis* - Estrogen plays a crucial role in maintaining **bone density**, and its reduction during menopause accelerates bone loss. - This loss of bone mass significantly increases the risk of **osteoporosis** and fractures in postmenopausal women.
Question 13: Which one of the following conditions simulates the menstrual pattern of pain?
- A. Adenomyosis (Correct Answer)
- B. Intramural fibroid
- C. Granulosa cell tumour of ovary
- D. Haematometra
Explanation: ***Adenomyosis*** - Adenomyosis is characterized by the presence of **endometrial tissue within the myometrium**, which responds cyclically to hormonal changes, similar to normal endometrium. - This leads to **dysmenorrhea** (painful periods) and **menorrhagia** (heavy bleeding) due to the cyclic growth and shedding of endometrial tissue within the uterine muscular wall. *Intramural fibroid* - Intramural fibroids are **benign uterine tumors** within the muscular wall that can cause heavy bleeding and pressure symptoms. - While they can cause pain and heavy bleeding, the pain is typically not directly related to a **menstrual pattern of cyclic pain** in the same manner as adenomyosis, as the fibroid tissue itself does not undergo cyclic shedding. *Granulosa cell tumour of ovary* - This is a **sex cord-stromal tumor** of the ovary that often produces **estrogen**, which can lead to irregular uterine bleeding or postmenopausal bleeding. - It does not directly cause pain that simulates a **regular menstrual pattern**, as its hormonal effects are typically sustained or irregular, not cyclic in the way normal menstruation or adenomyosis pain is. *Haematometra* - Haematometra is the accumulation of **menstrual blood within the uterus** due to an obstruction of the outflow tract, such as cervical stenosis. - This condition causes increasing pain and distension as blood accumulates, but the pain is usually **constant or progressively worsening**, not cyclic in a pattern that simulates normal menstruation, and typically leads to **amenorrhea** rather than patterned bleeding.
Question 14: Which of the undermentioned conditions does not cause postmenopausal vaginal bleeding?
- A. Carcinoma of cervix
- B. Senile vaginitis
- C. Prolapse of uterus with decubitus ulcer
- D. Benign cystic teratoma of ovary (Correct Answer)
Explanation: ***Benign cystic teratoma of ovary*** - A **benign cystic teratoma** of the ovary is a germ cell tumor that typically does **not cause hormonal changes** leading to vaginal bleeding. - While it can cause symptoms such as **abdominal pain** or a palpable mass, it is not directly associated with postmenopausal vaginal bleeding. *Carcinoma of cervix* - **Cervical cancer** is a well-known cause of both **intermenstrual** and **postmenopausal vaginal bleeding**, especially following intercourse. - The abnormal growth of cells on the cervix can be fragile and bleed easily, leading to the symptom. *Senile vaginitis* - Also known as **atrophic vaginitis**, this condition occurs due to the **thinning and inflammation** of the vaginal walls due to decreased estrogen levels after menopause. - The fragile, dry tissues can easily tear and bleed, leading to postmenopausal bleeding or spotting. *Prolapse of uterus with decubitus ulcer* - A **decubitus ulcer** can form on the prolapsed cervix or vaginal wall due to **chronic friction and irritation**, particularly in cases of severe uterine prolapse. - The raw, ulcerated surface readily **bleeds**, especially with minor trauma or straining, causing postmenopausal vaginal bleeding.
Question 15: Defective fusion of the Mullerian ducts may give rise to which of the following?
- A. Imperforate anus
- B. Absence of the ovaries
- C. Imperforate hymen
- D. Uterus bicornis unicollis (Correct Answer)
Explanation: ***Uterus bicornis unicollis*** - This condition results from the **incomplete fusion** of the two Müllerian ducts, leading to a uterus with a **septum** or two distinct uterine cavities but a single cervix and vagina. - The Müllerian ducts are embryological structures that develop into the **female reproductive tract**, including the uterus, fallopian tubes, cervix, and upper two-thirds of the vagina. *Imperforate anus* - This congenital condition is due to the **failure of the anal membrane to rupture** during development, not related to Müllerian duct fusion. - It affects the **gastrointestinal tract** and is not derived from Müllerian structures. *Absence of the ovaries* - The **ovaries** develop from the **gonadal ridges** and are distinct from the Müllerian ducts; therefore, their absence is not due to defective Müllerian fusion. - Conditions like **gonadal dysgenesis** can lead to absent or streak ovaries. *Imperforate hymen* - An imperforate hymen results from the failure of the **hymen to canalize** during fetal development, leading to an obstruction of the vaginal introitus. - The hymen is formed from the **urogenital sinus**, which is embryologically distinct from the Müllerian ducts.
Question 16: For a woman who has had unprotected intercourse two days ago, which one of the following emergency contraceptive methods is LEAST preferred as first-line emergency contraception?
- A. Levonorgestrel 1.5 mg
- B. LNG IUD
- C. Yuzpe regimen (Correct Answer)
- D. Ulipristal acetate
Explanation: ***Yuzpe regimen*** - The **Yuzpe regimen** uses higher doses of combined oral contraceptive pills, leading to more side effects like nausea and vomiting and generally lower efficacy compared to newer methods. - It involves taking two doses of estrogen and progestin, making it less convenient and less effective, especially after **48 hours**, compared to progestin-only or ulipristal acetate pills. *Levonorgestrel 1.5 mg* - **Levonorgestrel (LNG)** 1.5 mg, taken as a single dose, is a highly effective and widely recommended first-line emergency contraceptive within **72 hours** of unprotected intercourse. - It primarily works by **inhibiting or delaying ovulation**, without causing significant side effects in most women. *LNG IUD* - While an **LNG IUD** can be used as emergency contraception, it is not typically considered a first-line *oral* method; it is placed by a healthcare provider and can provide long-term contraception. - It is effective if inserted within **5 days** of unprotected intercourse, making it a highly effective option that also offers ongoing contraception. *Ulipristal acetate* - **Ulipristal acetate (UPA)** is a highly effective emergency contraceptive, even up to **120 hours (5 days)** after unprotected intercourse. - It works by delaying or inhibiting ovulation and is generally more effective than levonorgestrel, especially when taken more than **72 hours** post-coitally.
Question 17: Deep transverse arrest of head in labour occurs in:
- A. Anthropoid pelvis
- B. Platypelloid pelvis
- C. Gynaecoid pelvis
- D. Android pelvis (Correct Answer)
Explanation: ***Android pelvis*** - An **android pelvis** has a heart-shaped inlet with a narrow forepelvis, causing the fetal head to engage in a transverse or occiput posterior position. - The narrow midpelvis and convergent side walls in an android pelvis can lead to deep **transverse arrest**, as the fetal head cannot easily rotate to the anterior position. *Anthropoid pelvis* - The **anthropoid pelvis** is characterized by a long anteroposterior diameter and a relatively narrow transverse diameter. - This pelvic shape typically favors engagement in the **occiput anterior** or **occiput posterior** positions, making deep transverse arrest less common. *Platypelloid pelvis* - A **platypelloid pelvis** has a wide transverse diameter and a very short anteroposterior diameter, leading to a flattened shape. - This shape often results in the fetal head engaging in the **transverse position**, but arrest usually occurs at the inlet rather than deep in the pelvis, or the head fails to engage at all. *Gynaecoid pelvis* - The **gynaecoid pelvis** is considered the ideal female pelvis, with a rounded inlet and adequate diameters in all planes. - This shape allows for easy engagement and rotation of the fetal head, making deep **transverse arrest** very unlikely.
Question 18: Early deceleration of foetal heart rate in labour is due to:
- A. Hyperpyrexia
- B. Umbilical cord compression
- C. Congenital heart block
- D. Foetal head compression (Correct Answer)
Explanation: ***Foetal head compression*** - **Early decelerations** are a direct result of **foetal head compression** during uterine contractions, leading to increased intracranial pressure. - This pressure causes a **reflex vagal response**, resulting in **slowing of the foetal heart rate** which mirrors the contraction pattern. *Hyperpyrexia* - **Maternal hyperpyrexia** typically causes **foetal tachycardia**, which is an elevated heart rate, not deceleration. - This is a response to the increased maternal and foetal metabolic rate and can be a sign of infection. *Umbilical cord compression* - **Umbilical cord compression** usually leads to **variable decelerations**, which are sharp, abrupt drops in heart rate not uniformly related to contractions. - This occurs due to transient occlusion of the umbilical vessels, reducing blood flow to the foetus. *Congenital heart block* - **Congenital heart block** is a persistent bradycardia (slow heart rate) that is present throughout labour and is not directly linked to uterine contractions. - It is a structural abnormality of the foetal cardiac conduction system.
Question 19: McRoberts manoeuvre is used during labour for management of:
- A. Delivery of after coming head of breech
- B. Shoulder dystocia (Correct Answer)
- C. Normal labour to assist extension of head
- D. Extended arms of breech during assisted breech delivery
Explanation: ***Shoulder dystocia*** - **McRoberts manoeuvre** involves sharp flexion of the maternal thighs against the abdomen, which straightens the **sacrum** and rotates the **symphysis pubis** anteriorly. - This maneuver increases the functional size of the pelvic outlet and helps to dislodge the impacted fetal shoulder in cases of **shoulder dystocia**. - It is the **first-line intervention** for managing shoulder dystocia and is successful in resolving the majority of cases. *Delivery of after coming head of breech* - Management of an after-coming head in breech delivery typically involves maneuvers like the **Mauriceau-Smellie-Veit** maneuver or **Prague maneuver**. - **McRoberts manoeuvre** does not directly facilitate the delivery of the fetal head in a breech presentation. *Normal labour to assist extension of head* - In normal labor, the fetal head typically delivers by **extension** as it passes under the symphysis pubis, and no specific maneuver is usually required. - McRoberts manoeuvre is a specific intervention for a complication (**shoulder dystocia**), not a routine aid for head extension during normal delivery. *Extended arms of breech during assisted breech delivery* - Extended arms in a breech presentation are managed by maneuvers designed to free the arms, such as **Løvset's maneuver**. - **McRoberts manoeuvre** primarily addresses shoulder impaction, not arm entrapment in breech delivery.
Question 20: Which one of the following is not a suitable condition for outlet forceps application?
- A. Cervix fully dilated
- B. Membranes absent
- C. Head is above ischial spine level (Correct Answer)
- D. Vertex presentation
Explanation: ***Head is above ischial spine level*** - For **outlet forceps** application, the fetal head must be engaged, meaning the **leading point of the skull** is at or below the **level of the ischial spines (+2 station or lower)**. - If the head is above the ischial spines, it indicates a higher station, making **outlet forceps** an inappropriate and potentially dangerous choice, as it could lead to fetal or maternal injury. *Cervix fully dilated* - This is a **prerequisite** for any type of **forceps delivery**, including outlet forceps. - Performing forceps delivery with a partially dilated cervix risks severe **cervical lacerations** and other maternal complications. *Membranes absent* - This condition refers to **ruptured membranes**, which is a **necessary condition** for safe forceps application. - Intact membranes would prevent proper application of the forceps blades to the fetal head and increase the risk of **fetal scalp injury**. *Vertex presentation* - **Outlet forceps** are primarily used for **vertex presentations** (head-first), where the fetal head is oriented optimally for delivery. - Other presentations, such as **breech** or **transverse**, are **contraindications** for outlet forceps and typically require **cesarean section** or other delivery methods.