UPSC-CMS 2016 - Obstetrics and Gynecology Practice Questions

Q: Polyhydramnios is not caused by which one of the following?

Single kidney. ***Single kidney*** - A single kidney or other renal agenesis conditions typically lead to **oligohydramnios**, not polyhydramnios, because fetal urine production is reduced or absent. - The fetal urinary system is crucial for maintaining amniotic fluid volume, and its malfunction results in decreased fluid. *Spina bifida* - **Neural tube defects** such as spina bifida can contribute to polyhydramnios by affecting fetal swallowing mechanisms or increasing fluid secretion from exposed meninges. - While not the most common cause, severe forms can impair neural control over fetal fluid regulation. *Oesophageal atresia* - This condition prevents the fetus from **swallowing amniotic fluid**, leading to its accumulation in the amniotic sac. - Fetal swallowing is a primary mechanism for amniotic fluid reabsorption, and its mechanical obstruction results in polyhydramnios. *Anencephaly* - **Anencephaly** is a severe **neural tube defect** where the brain and skull fail to develop, often leading to impaired fetal swallowing and excessive urination. - The exposed meninges can also leak cerebrospinal fluid into the amniotic sac, further contributing to polyhydramnios.

Q: Which of the following is the type of antepartum haemorrhage where blood loss is foetal?

Vasa previa. ***Vasa previa*** - In **vasa previa**, foetal blood vessels traverse the foetal membranes unprotected across the cervical os, making them vulnerable to rupture during labor or membrane rupture, leading to **foetal blood loss**. - This condition is often suspected when **foetal bradycardia** or sinusoidal heart rate patterns appear following membrane rupture, especially if accompanied by vaginal bleeding. *Circumvallate placenta* - This refers to a placental anomaly where the chorionic plate is smaller than the basal plate, causing the membranes to fold back and create an elevated ring around the umbilical cord insertion. - While it can be associated with higher rates of **antepartum hemorrhage**, preterm labor, or foetal growth restriction, the blood loss is typically maternal in origin, from marginal placental separation. *Placenta previa* - **Placenta previa** occurs when the placenta partially or completely covers the cervical os, leading to painless vaginal bleeding in the second or third trimester. - The hemorrhage in placenta previa is **maternal blood loss** due to the separation of the maternal decidua from the placental villi. *Abruptio placenta* - **Abruptio placenta** involves the premature separation of a normally implanted placenta from the uterine wall. - The bleeding in abruptio placenta is predominantly **maternal blood**, often accumulating between the placenta and uterine wall, and is typically associated with abdominal pain and uterine tenderness.

Q: Which one of the following conditions is not associated with oligohydramnios during pregnancy?

Oesophageal atresia. ***Oesophageal atresia*** - **Oesophageal atresia** hinders the fetus from swallowing amniotic fluid, leading to an *increase* in amniotic fluid, a condition known as **polyhydramnios**, not oligohydramnios. - The inability of the fetus to properly absorb and excrete amniotic fluid through the gastrointestinal tract is the primary mechanism. *Post term pregnancy* - In **post-term pregnancies** (beyond 40 weeks), placental function can decline, reducing blood flow to the kidneys which can decrease fetal urine production. - Decreased fetal urine output is a major contributor to **oligohydramnios**. *Ruptured membrane* - A **ruptured membrane** (premature rupture of membranes) directly allows amniotic fluid to leak out of the uterus. - This leakage results in a reduction of the total amniotic fluid volume, causing **oligohydramnios**. *Intrauterine growth restriction* - In **intrauterine growth restriction (IUGR)**, the fetus experiences chronic stress and reduced perfusion due to placental insufficiency. - This often leads to **redistribution of fetal blood flow** away from non-essential organs like kidneys, decreasing urine production and contributing to oligohydramnios.

Q: A 23 year old presents with recurrent abortions at 16 weeks gestation. She should be investigated for:

Incompetent cervix. ***Incompetent cervix*** - Recurrent abortions, particularly in the **second trimester** (around 16 weeks gestation), are highly suggestive of an incompetent cervix. - An incompetent cervix dilates painlessly and prematurely without contractions, leading to **fetal loss**. *TORCH infection* - TORCH infections (Toxoplasmosis, Other [syphilis, varicella-zoster, parvovirus B19], Rubella, Cytomegalovirus, and Herpes) typically cause **fetal anomalies** or **early pregnancy loss**, or affect the neonate. - While they can cause miscarriage, recurrent losses at 16 weeks without other symptoms are less characteristic of isolated TORCH infections. *Hepatitis B infection* - **Hepatitis B infection** can be transmitted to the fetus, but it is not a direct cause of recurrent second-trimester abortions. - The primary concern with Hepatitis B in pregnancy is **vertical transmission** to the neonate. *Balanced paternal translocation* - A **balanced translocation** in either parent can lead to recurrent miscarriages, but these typically occur earlier in pregnancy due to genetically unbalanced conceptions. - While possible, the specific timing of 16 weeks recurrent loss points more strongly towards an anatomical issue like an incompetent cervix.

Q: Which of the following is the most common cause of abortion during first trimester?

Chromosomal anomalies of foetus. ***Chromosomal anomalies of foetus*** - **Chromosomal anomalies** are the leading cause of **sporadic first-trimester abortions**, accounting for up to 50-70% of cases. - These anomalies, such as **aneuploidy (e.g., trisomy 16, monosomy X)**, often lead to developmental abnormalities incompatible with life. *Antiphospholipid antibody syndrome* - While a significant cause of **recurrent pregnancy loss**, particularly in the second and third trimesters, it is less common than chromosomal anomalies for **sporadic first-trimester abortions**. - It causes abortions through **thrombotic events** in the placental vasculature. *Progesterone deficiency* - **Inadequate progesterone levels** can contribute to early pregnancy loss by compromising endometrial support for the embryo. - However, it is a less frequent cause of first-trimester abortion compared to **chromosomal abnormalities**. *Cervical incompetence* - **Cervical incompetence** primarily causes **second-trimester losses** due to the inability of the cervix to retain the pregnancy under increasing pressure. - It is not a common cause of first-trimester abortion, which is typically due to issues with the early embryo or implantation.

Q: Abnormally low alpha-fetoprotein in maternal serum indicates:

Down's syndrome. ***Down's syndrome*** - Abnormally **low alpha-fetoprotein (AFP)** levels in maternal serum are a key indicator for increased risk of **Down's syndrome (Trisomy 21)**. - This is often part of a quad screen (AFP, hCG, unconjugated estriol, inhibin A) used for **prenatal screening** for chromosomal abnormalities. *Meningocele* - This is a type of **spina bifida** where the meninges protrude through a defect in the vertebrae. - While a neural tube defect, it typically results in **elevated AFP** levels in maternal serum due to leakage of fetal protein. *Encephalocele* - An encephalocele is a **neural tube defect** where a sac-like protrusion of the brain and its surrounding membranes occurs through an opening in the skull. - Similar to other open neural tube defects, it is usually associated with **elevated levels of AFP** in maternal serum. *Anencephaly* - This is a severe **neural tube defect** characterized by the absence of a major portion of the brain, skull, and scalp. - Anencephaly invariably leads to very **high levels of AFP** in maternal serum due to direct leakage from exposed neural tissue.

Q: A 35 year old married woman with no risk factors for cervical cancer is having Pap smear showing 'atypical squamous cells of undetermined significance (ASCUS)' for the first time. What is the further step in the management?

To follow up with Pap test at 6 months. ***To follow up with Pap test at 6 months*** - For **ASCUS** (atypical squamous cells of undetermined significance) in women with **no risk factors** and a first-time finding, **repeat Pap testing** in 6-12 months is the recommended initial follow-up strategy. - This approach allows for the possibility of **spontaneous regression** of minor cellular changes, avoiding unnecessary immediate interventions. *Cryotherapy* - **Cryotherapy** is a treatment for **cervical intraepithelial neoplasia (CIN)**, a more severe finding than ASCUS. - It would be **premature and excessive** for an initial finding of ASCUS, which may resolve on its own. *Large loop excision of the transformation zone* - **LLETZ** is a procedure used to **remove abnormal cervical cells**, typically for **high-grade CIN** or persistent CIN, not for ASCUS. - Performing LLETZ for ASCUS would be an **overtreatment** and carries procedural risks without clear benefit. *Repeat Pap immediately* - Repeating the Pap smear **immediately** after an ASCUS finding is generally **not recommended** as it is unlikely to provide new diagnostic information due to the rapid cellular turnover. - A 6-month interval allows for potential cellular changes to become more definitive, whether for improvement or progression.

Q: For a primary amenorrhea individual having an XY karyotype, normal infantile female external and internal genitalia, fibrous bands in place of gonads, and lack of development of secondary sexual characters, what is the most probable diagnosis?

Swyer syndrome. ***Swyer syndrome*** - **Swyer syndrome**, or **46,XY complete gonadal dysgenesis**, is characterized by an XY karyotype with female external and internal genitalia, but rudimentary gonads (streak gonads) that appear as fibrous bands. - The absence of functional testes leads to a lack of **androgen production** and **Müllerian inhibiting factor (MIF)**, resulting in a female phenotype, primary amenorrhea, and absent secondary sexual characteristics. *Testicular feminization syndrome* - In **Testicular feminization syndrome**, or **Androgen Insensitivity Syndrome (AIS)**, individuals have functional testes producing androgens but the target cells are unresponsive. - This leads to male internal gonads (testes) but female external genitalia and normal breast development, which contradicts the described "fibrous bands in place of gonad" and "lack of development of secondary sexual characters." *Mixed gonadal dysgenesis* - **Mixed gonadal dysgenesis** usually involves mosaicism (e.g., 45,X/46,XY), leading to an asymmetrical development of gonads, typically with a streak gonad on one side and a dysgenetic testis on the other. - This often results in ambiguous genitalia and a different hormonal profile than described. *Defective antimüllerian hormone* - A **defective antimüllerian hormone (AMH)** or its receptor would result in the persistence of Müllerian structures (uterus, fallopian tubes) in an individual with an XY karyotype and male external genitalia. - This condition does not explain the lack of secondary sexual characteristics or the presence of fibrous bands instead of testes.

Q: A lady who is using oral contraceptive pills comes with a complaint of vaginal discharge and pruritus vulvae. On local examination, there is curdy white discharge from the vagina. What is the most likely clinical diagnosis?

Monilial vaginitis. ***Monilial vaginitis*** - The classic presentation of **curdy white discharge** and **pruritus vulvae** is highly suggestive of vulvovaginal candidiasis (**monilial vaginitis**), often exacerbated by **oral contraceptive pill** use. - OCPs can alter vaginal flora and increase glycogen content, promoting the growth of *Candida* species. *Atrophic vaginitis* - This condition is caused by **estrogen deficiency**, typically seen in **postmenopausal women**, and is unlikely in a woman using oral contraceptive pills. - Symptoms include **vaginal dryness**, irritation, and dyspareunia, usually without a thick, curdy discharge. *Gardnerella vaginalis* - *Gardnerella vaginalis* causes **bacterial vaginosis**, characterized by a **thin, gray, malodorous ("fishy") discharge**, not a curdy white one. - There is typically no significant vulval pruritus with *Gardnerella* infection. *Trichomonal vaginitis* - **Trichomoniasis** presents with a **frothy, greenish-yellow discharge** and often a **"strawberry cervix"** on examination, which is distinct from the described curdy white discharge. - It is a sexually transmitted infection, and while pruritus can occur, the discharge characteristics are different.

Question 1

Polyhydramnios is not caused by which one of the following?

Accepted Answer

Single kidney

Answer

Spina bifida

Answer

Oesophageal atresia

Answer

Anencephaly

Question 2

Which of the following is the type of antepartum haemorrhage where blood loss is foetal?

Accepted Answer

Vasa previa

Answer

Circumvallate placenta

Answer

Placenta previa

Answer

Abruptio placenta

Question 3

Which one of the following conditions is not associated with oligohydramnios during pregnancy?

Accepted Answer

Oesophageal atresia

Answer

Post term pregnancy

Answer

Ruptured membrane

Answer

Intrauterine growth restriction

Question 4

A 23 year old presents with recurrent abortions at 16 weeks gestation. She should be investigated for:

Accepted Answer

Incompetent cervix

Answer

TORCH infection

Answer

Hepatitis B infection

Answer

Balanced paternal translocation

Question 5

Which of the following is the most common cause of abortion during first trimester?

Accepted Answer

Chromosomal anomalies of foetus

Answer

Antiphospholipid antibody syndrome

Answer

Progesterone deficiency

Answer

Cervical incompetence

Question 6

Abnormally low alpha-fetoprotein in maternal serum indicates:

Accepted Answer

Down's syndrome

Answer

Meningocele

Answer

Encephalocele

Answer

Anencephaly

Question 7

A patient of ectopic pregnancy had beta-hCG of 5800 IU/ml. Medical management was done by single dose methotrexate. Beta-hCG repeated after 48 hours was found 7000 IU/ml. What will you do further?

Accepted Answer

Repeat the injection of methotrexate

Answer

Operate the patient

Answer

Follow up with Beta-hCG after one week

Answer

Follow up with Beta-hCG after 72 hours

Question 8

A 35 year old married woman with no risk factors for cervical cancer is having Pap smear showing 'atypical squamous cells of undetermined significance (ASCUS)' for the first time. What is the further step in the management?

Accepted Answer

To follow up with Pap test at 6 months

Answer

Cryotherapy

Answer

Large loop excision of the transformation zone

Answer

Repeat Pap immediately

Question 9

For a primary amenorrhea individual having an XY karyotype, normal infantile female external and internal genitalia, fibrous bands in place of gonads, and lack of development of secondary sexual characters, what is the most probable diagnosis?

Accepted Answer

Swyer syndrome

Answer

Testicular feminization syndrome

Answer

Mixed gonadal dysgenesis

Answer

Defective antimüllerian hormone

Question 10

A lady who is using oral contraceptive pills comes with a complaint of vaginal discharge and pruritus vulvae. On local examination, there is curdy white discharge from the vagina. What is the most likely clinical diagnosis?

Accepted Answer

Monilial vaginitis

Answer

Atrophic vaginitis

Answer

Gardnerella vaginalis

Answer

Trichomonal vaginitis

UPSC-CMS 2016 — Obstetrics and Gynecology