UPSC-CMS 2017 — Obstetrics and Gynecology
26 Previous Year Questions with Answers & Explanations
An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?
A 28 year old P1L1 presents with severe pain in her abdomen and is taken for laparotomy. On opening the abdomen pseudomyxoma peritonei is present. What should be the probable reason?
In a 40 year old woman, pap smear shows atypical glandular cells. The next step of management should be:
A 50 year old P4L4 has a simple left ovarian cyst of 10cm. Ca 125 is 30u/ml. Treatment of choice would be:
A seven year old girl with precocious puberty is found to be having a 10 cm ovarian cyst on USG. The most likely etiology is
A 17 year old girl presents with an ovarian cyst of 5cm. The cyst is echo free, unilocular and CA 125 of 8U/ml. What is most appropriate management?
Most probable cause of heavy bleeding in a P2L2 during tenth day post partum is:
Combined contraceptive pills give protection from the following EXCEPT:
A woman presents with heavy foul smelling discharge with sharply demarcated ulcers without induration on the perineum and the labia majora. Inguinal lymphadenopathy is also present. What is the most probable diagnosis?
A 28 year old woman develops amenorrhoea after having dilatation and curettage. The most likely diagnosis is :
UPSC-CMS 2017 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 1: An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?
- A. Trichomoniasis
- B. Gonorrhoea (Correct Answer)
- C. Syphilis
- D. Candidiasis
Explanation: ***Gonorrhoea*** - This presentation, including **yellow/green vaginal discharge**, a **Bartholin cyst**, and **proctitis**, is highly suggestive of **gonorrhoea**. - *Neisseria gonorrhoeae* can cause inflammation in these specific areas and is a known cause of **infertility** due to pelvic inflammatory disease. *Trichomoniasis* - Characterized by a **frothy, foul-smelling, yellow-green discharge** and often involves **cervical petechiae** (strawberry cervix). - While it causes vaginal discharge, **Bartholin cysts** and **proctitis** are not typical features. *Syphilis* - The primary stage presents as a **painless chancre**, secondary syphilis involves a **rash** and **lymphadenopathy**, and tertiary syphilis has severe organ involvement. - It does not typically present with the specific combination of **Bartholin cyst**, vaginal discharge, and **proctitis**. *Candidiasis* - Causes a **thick, white, "cottage cheese-like" discharge** associated with significant **pruritus** and **vaginal irritation**. - It does not typically lead to **Bartholin cysts** or **proctitis**.
Question 2: A 28 year old P1L1 presents with severe pain in her abdomen and is taken for laparotomy. On opening the abdomen pseudomyxoma peritonei is present. What should be the probable reason?
- A. Mucinous cystadenoma of ovary (Correct Answer)
- B. Rupture of dermoid tumor
- C. Endometriosis
- D. Serous cystadenoma of ovary
Explanation: ***Mucinous cystadenoma of ovary*** - **Pseudomyxoma peritonei** is most frequently caused by the rupture of a low-grade mucinous tumor, often originating from the **appendix** or, less commonly, the **ovary**. - A **mucinous cystadenoma of the ovary**, upon rupture, can release mucinous material into the peritoneal cavity, leading to the characteristic "jelly belly" appearance. *Rupture of dermoid tumor* - Rupture of a **dermoid tumor** (mature cystic teratoma) can cause **chemical peritonitis** due to the release of sebaceous material and hair, but it does not typically lead to pseudomyxoma peritonei. - The contents of a dermoid tumor are usually **fatty** or **keratinous**, not mucinous. *Endometriosis* - **Endometriosis** involves endometrial-like tissue growing outside the uterus, causing pelvic pain and adhesions. - It does not involve the production of a large volume of mucinous material and is therefore not a cause of pseudomyxoma peritonei. *Serous cystadenoma of ovary* - A ruptured **serous cystadenoma** would release serous (watery) fluid, not mucinous material. - While it can cause ascites, it does not produce the characteristic thick, gelatinous material seen in pseudomyxoma peritonei.
Question 3: In a 40 year old woman, pap smear shows atypical glandular cells. The next step of management should be:
- A. Hysteroscopy and directed endometrial biopsy
- B. Colposcopic directed cervical biopsy
- C. Colposcopy, cervical biopsy, endocervical curettage and endometrial biopsy (Correct Answer)
- D. Repeat pap smear after three months
Explanation: ***Colposcopy, cervical biopsy, endocervical curettage and endometrial biopsy*** - Atypical glandular cells (AGC) on a Pap smear require comprehensive evaluation of both the **cervix** and the **endometrium** due to the potential for underlying **adenocarcinoma** or its precursors. - This thorough workup includes visually inspecting the cervix (**colposcopy**), sampling any abnormal cervical areas (**cervical biopsy**), assessing the endocervical canal (**endocervical curettage**), and evaluating the uterine lining (**endometrial biopsy**). *Hysteroscopy and directed endometrial biopsy* - While an **endometrial biopsy** is crucial for evaluating glandular abnormalities, particularly in a woman over 35, it alone is insufficient. - This option **neglects the cervical component**, which is also a common site for glandular abnormalities detected by AGC. *Colposcopic directed cervical biopsy* - This approach focuses solely on the **cervix** and would miss potential pathology within the **endometrium**, which is a significant concern with AGC. - In a 40-year-old woman, the risk of **endometrial adenocarcinoma** is substantial enough to warrant endometrial sampling. *Repeat pap smear after three months* - Repeating a Pap smear is **inappropriate for AGC**, as these findings carry a high risk of underlying significant pathology (up to 20-60% for high-grade lesions or cancer). - Delaying definitive evaluation could lead to the **progression of undetected cancer**.
Question 4: A 50 year old P4L4 has a simple left ovarian cyst of 10cm. Ca 125 is 30u/ml. Treatment of choice would be:
- A. Medical management with oral contraceptives
- B. Laparoscopic cystectomy
- C. TAH + BSO (Total abdominal hysterectomy + Bilateral salpingo-oophorectomy)
- D. Laparoscopic bilateral oophorectomy (BSO) (Correct Answer)
Explanation: ***Laparoscopic bilateral oophorectomy (BSO)*** - For a 50-year-old postmenopausal woman (P4L4) with a **simple ovarian cyst** of 10cm and **normal CA-125** (30 u/ml), **laparoscopic bilateral salpingo-oophorectomy (BSO)** is the treatment of choice. - **Bilateral removal** is preferred in postmenopausal women to eliminate future ovarian cancer risk and prevent contralateral ovarian pathology, as the ovaries no longer have hormonal function. - **Laparoscopic approach** provides adequate treatment with minimal morbidity, faster recovery, and lower complication rates compared to laparotomy. - The **normal CA-125** and **simple cyst characteristics** suggest benign pathology, making minimally invasive surgery appropriate. *Medical management with oral contraceptives* - **Oral contraceptives** are contraindicated in postmenopausal women and ineffective for simple ovarian cysts in this age group. - OCPs work on functional cysts in premenopausal women but have no role in postmenopausal ovarian masses. - Increased **thromboembolic risk** in women over 50 makes OCPs inappropriate. *TAH + BSO (Total abdominal hysterectomy + Bilateral salpingo-oophorectomy)* - While BSO is appropriate, adding **hysterectomy is unnecessary** for isolated ovarian pathology and increases surgical morbidity. - **Open approach** (laparotomy) carries higher complication rates, longer hospital stay, and prolonged recovery compared to laparoscopy. - Current guidelines favor **minimally invasive surgery** when feasible for benign-appearing ovarian masses. *Laparoscopic cystectomy* - **Cystectomy alone** (ovarian preservation) is inappropriate in a 50-year-old postmenopausal woman as it leaves ovarian tissue at risk for future malignancy. - This fertility-preserving approach is only indicated in younger women desiring fertility; at age 50 post-menopause, **complete bilateral oophorectomy** is standard of care to reduce ovarian cancer risk.
Question 5: A seven year old girl with precocious puberty is found to be having a 10 cm ovarian cyst on USG. The most likely etiology is
- A. Choriocarcinoma
- B. Benign cystic teratoma
- C. Granulosa cell tumour (Correct Answer)
- D. Brenner tumour
Explanation: ***Granulosa cell tumour*** - This tumor is a common cause of **sexual precocity** in girls because it produces **estrogen**, leading to premature development of secondary sexual characteristics. - Granulosa cell tumors can grow to a significant size, like the **10 cm ovarian cyst** described, and are often malignant or borderline. *Choriocarcinoma* - Ovarian choriocarcinoma is a **highly malignant germ cell tumor** that typically secretes **human chorionic gonadotropin (hCG)**, not estrogen. - While it can cause precocious pseudopuberty by stimulating ovarian steroidogenesis through hCG, it is a very rare primary ovarian tumor. *Benign cystic teratoma* - These are **common germ cell tumors** that contain tissues from all three germ layers; however, they are usually **hormonally inactive** and do not typically cause precocious puberty. - While they can form large cysts, the presence of precocious puberty points away from this diagnosis. *Brenner tumour* - **Brenner tumors** are uncommon epithelial ovarian tumors that are typically **solid and benign**, though malignant forms exist. - They are generally **hormonally inactive** and do not cause precocious puberty; they also typically occur in older women.
Question 6: A 17 year old girl presents with an ovarian cyst of 5cm. The cyst is echo free, unilocular and CA 125 of 8U/ml. What is most appropriate management?
- A. Laparoscopy for cyst removal
- B. Conservative with follow up ultrasound (Correct Answer)
- C. Laparotomy for cyst removal
- D. Medical treatment
Explanation: ***Conservative with follow up ultrasound*** - A 5cm **unilocular, echo-free ovarian cyst** in a 17-year-old with a normal **CA-125** (8 U/mL is well within the normal range, typically <35 U/mL) is highly suggestive of a **benign functional cyst**. - Expectant management with **serial ultrasound follow-up** is the most appropriate initial approach, as these cysts often resolve spontaneously. *Laparoscopy for cyst removal* - This is an **invasive procedure** that is not indicated for a likely benign, asymptomatic ovarian cyst, especially given the young age of the patient. - Surgical intervention would only be considered if the cyst persists, grows significantly, causes symptoms, or shows suspicious features on imaging. *Laparotomy for cyst removal* - **Laparotomy** is an even more invasive surgical approach than laparoscopy, involving a larger incision, and is reserved for cases where malignancy is strongly suspected or for very large, complex cysts that cannot be removed laparoscopically. - Given the benign characteristics of the cyst, this approach is unwarranted. *Medical treatment* - There is **no specific medical treatment** (e.g., medication) that effectively resolves functional ovarian cysts. - While hormonal contraceptives can sometimes suppress the formation of new functional cysts, they do not typically treat an existing one of this nature.
Question 7: Most probable cause of heavy bleeding in a P2L2 during tenth day post partum is:
- A. Infected episiotomy wound
- B. Resumption of menstruation
- C. Retained bits of cotyledons and membranes (Correct Answer)
- D. Subinvolution of placental site
Explanation: ***Retained bits of cotyledons and membranes*** - **Retained placental fragments** prevent the uterus from contracting effectively, leading to uterine atony and heavy bleeding. - This typically presents as secondary postpartum hemorrhage, which occurs **24 hours to 6 weeks postpartum**, consistent with bleeding on the tenth day. *Infected episiotomy wound* - An infected episiotomy wound would primarily cause **local pain**, **swelling**, **redness**, and **purulent discharge**, not heavy uterine bleeding. - While infection can exacerbate pain and discomfort, it does not directly lead to **prolonged or excessive uterine hemorrhage**. *Resumption of menstruation* - Menstruation typically resumes much later postpartum, especially in breastfeeding individuals, often **months after delivery**. - Bleeding on the tenth day is likely related to the **postpartum state** and not a return to normal menstrual cycles. *Subinvolution of placental site* - Subinvolution refers to the failure of the uterus to return to its normal size and state, which can cause **prolonged lochia** and bleeding. - While a possible cause of later postpartum bleeding, **retained placental tissue** is a more direct and common cause for significant hemorrhage on the tenth day.
Question 8: Combined contraceptive pills give protection from the following EXCEPT:
- A. Cancer of cervix (Correct Answer)
- B. Cancer of endometrium
- C. Cancer of ovary
- D. Ectopic pregnancy
Explanation: ***Cancer of cervix*** - Combined oral contraceptives (COCs) do not protect against **cervical cancer**; in fact, long-term use is associated with a slightly **increased risk**, potentially due to increased exposure to **HPV** or hormonal effects on the cervix. - The primary protection against cervical cancer is **HPV vaccination** and regular **cervical screening** (Pap smears). *Cancer of endometrium* - COCs provide significant protection against **endometrial cancer** by causing endometrial atrophy and suppressing cell proliferation, which mitigates the risk posed by unopposed estrogen. - This protective effect is observed even after discontinuing COCs. *Cancer of ovary* - COCs significantly reduce the risk of **ovarian cancer**, particularly epithelial ovarian cancer, through the suppression of ovulation. - The protective effect increases with the duration of COC use and can persist for many years after discontinuation. *Ectopic pregnancy* - COCs are highly effective in preventing **pregnancy** altogether, thereby drastically reducing the risk of both uterine and **ectopic pregnancies**. - While not 100% effective, their contraceptive action makes ectopic pregnancy very rare in users compared to non-users.
Question 9: A woman presents with heavy foul smelling discharge with sharply demarcated ulcers without induration on the perineum and the labia majora. Inguinal lymphadenopathy is also present. What is the most probable diagnosis?
- A. Tuberculosis
- B. Chancroid (Correct Answer)
- C. Trichomoniasis
- D. Gonorrhoea
Explanation: ***Chancroid*** - The presence of **heavy, foul-smelling discharge** with **sharply demarcated, painful ulcers** that are **not indurated** on the perineum and labia majora, along with **inguinal lymphadenopathy**, is highly characteristic of chancroid, caused by *Haemophilus ducreyi*. - The **lack of induration** and the **painful nature** of the ulcers are key differentiating features from syphilis (painless chancre with induration). - The **tender inguinal lymphadenopathy** can progress to form suppurative buboes, which is pathognomonic for chancroid. *Tuberculosis* - While tuberculosis can cause genital ulcers, they are typically **chronic, painless**, and often associated with systemic symptoms like weight loss and night sweats, which are not described here. - Genital tuberculosis is less likely to present with acute, foul-smelling discharge and sharply demarcated, non-indurated ulcers with prominent lymphadenopathy in this manner. *Trichomoniasis* - Trichomoniasis causes a **frothy, yellowish-green, foul-smelling vaginal discharge** and can lead to **vaginal irritation** and sometimes "strawberry cervix," but it **does not cause discrete ulcers** on the perineum or labia majora. - This is primarily a vaginitis caused by *Trichomonas vaginalis*, not an ulcerative condition. - Inguinal lymphadenopathy is not a feature of trichomoniasis. *Gonorrhoea* - Gonorrhoea usually presents with a **purulent vaginal or cervical discharge**, dysuria, and pelvic pain in women, but it **does not typically cause ulcers** on the perineum or labia. - This is a mucosal infection affecting the endocervix primarily, not causing ulcerative lesions. - While disseminated gonococcal infection can occur, the predominant presenting feature of ulcers points away from gonorrhoea.
Question 10: A 28 year old woman develops amenorrhoea after having dilatation and curettage. The most likely diagnosis is :
- A. Kallman syndrome
- B. Turner syndrome
- C. Asherman syndrome (Correct Answer)
- D. Anorexia nervosa
Explanation: ***Asherman syndrome*** - It is characterized by the formation of **intrauterine adhesions** or **synechiae** that occur due to trauma to the endometrial lining, most commonly following a **D&C procedure**. - These adhesions can lead to **amenorrhea**, hypomenorrhea, infertility, and recurrent pregnancy loss due to the obstruction of the uterine cavity. *Kallman syndrome* - This is a **congenital hypogonadotropic hypogonadism** characterized by a deficiency in GnRH production and an associated **anosmia** (loss of smell), neither of which are suggested by the clinical presentation. - Patients typically present with **primary amenorrhea** and delayed puberty, not secondary amenorrhea following a D&C. *Turner syndrome* - A **chromosomal disorder (45, XO)** leading to **gonadal dysgenesis** and ovarian failure. - It typically presents with **primary amenorrhea**, short stature, webbed neck, and other distinct physical features, which are not mentioned here. *Anorexia nervosa* - This is an **eating disorder** associated with severe caloric restriction and low body weight. - It can cause **hypothalamic amenorrhea** due to impaired GnRH pulsatility but is usually accompanied by significant weight loss and psychological symptoms, not typically heralded by a D&C.