UPSC-CMS 2016

114 Questions — Page 11 of 12

All (114)Biochemistry (3)Community Medicine (33)Dermatology (1)Internal Medicine (14)Obstetrics and Gynecology (33)Orthopaedics (2)Pathology (2)Pediatrics (2)Pharmacology (4)Physiology (2)Psychiatry (1)Radiology (2)Surgery (15)

Internal Medicine

1 questions

Q101

Umbilical cord blood stem cells are used to treat all the following diseases except :

Obstetrics and Gynecology

9 questions

Q101

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

Q102

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

Q103

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

Q104

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

Q105

Abnormally low alpha-fetoprotein in maternal serum indicates:

Q106

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?

Q107

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?

Q108

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?

Q109

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?

UPSC-CMS 2016 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs

Question 101: Which of the following is the type of antepartum haemorrhage where blood loss is foetal?

A. Circumvallate placenta
B. Placenta previa
C. Vasa previa (Correct Answer)
D. Abruptio placenta

Explanation: ***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.

Question 102: Which one of the following conditions is not associated with oligohydramnios during pregnancy?

A. Oesophageal atresia (Correct Answer)
B. Post term pregnancy
C. Ruptured membrane
D. Intrauterine growth restriction

Explanation: ***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.

Question 103: A 23 year old presents with recurrent abortions at 16 weeks gestation. She should be investigated for:

A. TORCH infection
B. Hepatitis B infection
C. Balanced paternal translocation
D. Incompetent cervix (Correct Answer)

Explanation: ***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.

Question 104: Which of the following is the most common cause of abortion during first trimester?

A. Antiphospholipid antibody syndrome
B. Progesterone deficiency
C. Chromosomal anomalies of foetus (Correct Answer)
D. Cervical incompetence

Explanation: ***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.

Question 105: Abnormally low alpha-fetoprotein in maternal serum indicates:

A. Meningocele
B. Encephalocele
C. Down's syndrome (Correct Answer)
D. Anencephaly

Explanation: ***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.

Question 106: 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?

A. Operate the patient
B. Follow up with Beta-hCG after one week
C. Follow up with Beta-hCG after 72 hours
D. Repeat the injection of methotrexate (Correct Answer)

Explanation: ***Repeat the injection of methotrexate*** - In this scenario with **rising beta-hCG at 48 hours** (5800 to 7000 IU/ml, a 20.7% increase), some protocols advocate for **early second dose** rather than waiting for day 4-7 assessment, particularly when the rise is significant and initial levels are relatively high. - While standard single-dose methotrexate protocol monitors on **days 4 and 7** with success defined as ≥15% decline between these points, a **substantial rise at 48 hours** may indicate inadequate initial treatment, prompting earlier intervention in some clinical settings. - The decision balances **risk of ectopic rupture** during continued observation versus proceeding with second dose, considering the patient is clinically stable without signs of rupture. *Operate the patient* - Surgical intervention is indicated for **hemodynamic instability**, **ruptured ectopic pregnancy**, **absolute contraindications to methotrexate**, or **failed medical management** (typically after two methotrexate doses). - Since the patient appears clinically stable, only one dose has been given, and there are no signs of rupture mentioned, surgery would be premature at this stage. *Follow up with Beta-hCG after one week* - Standard **single-dose protocol** involves monitoring beta-hCG on **days 4 and 7** post-methotrexate to assess treatment response. - Waiting a full week without any interim assessment when hCG is rising would potentially miss treatment failure and increase risk of rupture, making this approach unsafe. *Follow up with Beta-hCG after 72 hours* - While continued monitoring is part of the standard protocol, **rising beta-hCG at 48 hours** in this case suggests the need for **active intervention** rather than observation alone. - In standard practice, beta-hCG levels are checked on **day 4 (96 hours)** and **day 7**, and a rise at 48 hours doesn't automatically indicate failure, but the clinical decision here favors earlier second dose given the magnitude of rise with relatively high initial levels.

Question 107: 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?

A. Cryotherapy
B. Large loop excision of the transformation zone
C. Repeat Pap immediately
D. To follow up with Pap test at 6 months (Correct Answer)

Explanation: ***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.

Question 108: 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?

A. Testicular feminization syndrome
B. Mixed gonadal dysgenesis
C. Swyer syndrome (Correct Answer)
D. Defective antimüllerian hormone

Explanation: ***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.

Question 109: 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?

A. Monilial vaginitis (Correct Answer)
B. Atrophic vaginitis
C. Gardnerella vaginalis
D. Trichomonal vaginitis

Explanation: ***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.