A 26 year old woman P1L1 reports with High Grade Squamous Intraepithelial Lesion (HGSIL) on Pap smear (Papanicolaou smear). Further management for her is:
With reference to the displacement of uterus, the treatment of choice for genuine stress urinary incontinence is:
Regarding placental separation in III stage of labour, consider the following statements: 1. Separation of placenta occurs at decidua spongiosa 2. In Schultze method, separation of placenta starts at centre 3. In Matthews Duncan's method, separation begins at margin Which of the statements given above is/are correct?
A 16 year old girl presents with primary amenorrhea with absent vagina, cervix and uterus in the presence of normal secondary sexual characteristics. Ovaries are present on USG. The most probable diagnosis is:
A 32 year old woman is noted to have 1200 cc of blood loss following a spontaneous vaginal delivery and delivery of placenta. The uterine fundus is palpated and noted to be firm. Which of the following is the most likely treatment for this patient?
A pregnant woman visits a medical officer for an antenatal check up. The woman mentions that she had received two doses of Tetanus Toxoid vaccine four years ago. Which of the following steps should the medical officer take with regard to administration of Tetanus Toxoid vaccine as per the Government of India recommended schedule?
UPSC-CMS 2017 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 21: A 26 year old woman P1L1 reports with High Grade Squamous Intraepithelial Lesion (HGSIL) on Pap smear (Papanicolaou smear). Further management for her is:
- A. Colposcopy and directed biopsy (Correct Answer)
- B. Conisation
- C. VIA, VILI
- D. LEEP
Explanation: ***Colposcopy and directed biopsy*** - A diagnosis of **High-Grade Squamous Intraepithelial Lesion (HGSIL)** from a Pap smear necessitates further investigation with **colposcopy**. - **Colposcopy** allows for direct visualization of the cervix, and **directed biopsies** are taken from suspicious areas to confirm the diagnosis and assess the extent of the lesion. *Conisation* - **Conisation (cone biopsy)** is a surgical procedure to remove a cone-shaped piece of tissue from the cervix. - It is typically performed *after* colposcopy and biopsy have confirmed a high-grade lesion or cervical cancer, not as the initial diagnostic step for HGSIL. *VIA, VILI* - **Visual inspection with acetic acid (VIA)** and **visual inspection with Lugol's iodine (VILI)** are screening methods for cervical cancer, particularly in resource-limited settings. - While useful for screening, they are not appropriate for managing a confirmed HGSIL diagnosis, which requires a more precise evaluation. *LEEP* - **LEEP (Loop Electrosurgical Excision Procedure)** is a common treatment for HGSIL. - Like conisation, LEEP is a therapeutic procedure used *after* a definitive diagnosis has been made through colposcopy and biopsy, not as the initial step for evaluating an HGSIL Pap smear.
Question 22: With reference to the displacement of uterus, the treatment of choice for genuine stress urinary incontinence is:
- A. Periurethral injection of bulking agents
- B. Kegel’s perineal exercises
- C. TVT‐O mid urethral tape (Correct Answer)
- D. Kelly's plication
Explanation: ***TVT‐O mid urethral tape*** - **TVT-O (tension-free vaginal tape-obturator)** is a minimally invasive surgical procedure that provides support to the mid-urethra, effectively treating genuine **stress urinary incontinence (SUI)**. - This procedure aims to restore the anatomical support mechanisms of the urethra, preventing urine leakage during activities that increase abdominal pressure. *Periurethral injection of bulking agents* - This method involves injecting materials around the urethra to increase its bulk and improve coaptation, but it is generally reserved for patients who are not suitable for surgery or as a secondary treatment, and typically has **lower long-term success rates** compared to tape procedures. - While it can improve continence in some cases, it addresses the issue by increasing urethral resistance rather than restoring proper anatomical support. *Kegel’s perineal exercises* - **Kegel exercises** aim to strengthen the **pelvic floor muscles**, which can be effective for mild SUI by improving urethral support and sphincter function. - However, for genuine SUI, which often involves significant anatomical changes or urethral hypermobility, these exercises are typically used as a **first-line conservative treatment** and may not be sufficient on their own. *Kelly’s plication* - **Kelly's plication**, also known as the **Kelly stitch**, is an older surgical procedure that involves plicating (folding and suturing) the periurethral fascia to provide urethral support. - This procedure has largely been replaced by more effective and less invasive mid-urethral tape procedures like TVT-O due to **higher failure rates** and potential complications.
Question 23: Regarding placental separation in III stage of labour, consider the following statements: 1. Separation of placenta occurs at decidua spongiosa 2. In Schultze method, separation of placenta starts at centre 3. In Matthews Duncan's method, separation begins at margin Which of the statements given above is/are correct?
- A. 1, 2 and 3 (Correct Answer)
- B. 1 and 2 only
- C. 2 and 3 only
- D. 1 only
Explanation: ***1, 2 and 3*** - Correctly states that placental separation occurs at the level of the **decidua spongiosa**, which is the physiological cleavage plane permitting placental detachment after birth. - Correctly identifies that in the **Schultze method**, placental separation starts centrally, leading to the fetal surface presenting first. In the **Matthews Duncan method**, separation begins at the margin, causing the maternal surface to present first. *1 and 2 only* - This option is incorrect because while statements 1 and 2 are true, statement 3 is also correct and needs to be included for a complete answer. - It overlooks the accurate description of the **Matthews Duncan method** of placental separation. *2 and 3 only* - This option is incorrect because it fails to acknowledge the fundamental physiological fact that placental separation occurs at the **decidua spongiosa**, which is statement 1. - It omits the correct statement regarding the physiological plane of **placental separation**. *1 only* - This option is incorrect because it only includes statement 1, which is true, but excludes the correct statements 2 and 3 regarding the different methods of placental separation. - It does not account for the accurate descriptions of both the **Schultze** and **Matthews Duncan** methods.
Question 24: A 16 year old girl presents with primary amenorrhea with absent vagina, cervix and uterus in the presence of normal secondary sexual characteristics. Ovaries are present on USG. The most probable diagnosis is:
- A. Klinefelter's syndrome
- B. Mayer Rockitansky Kuster Hauser syndrome (Correct Answer)
- C. Androgen Insensitivity syndrome
- D. Prader-Willi syndrome
Explanation: ***Mayer Rokitansky Küster Hauser syndrome*** - This syndrome is characterized by **agenesis or hypoplasia of the Müllerian ducts**, leading to the absence of the vagina, cervix, and uterus. - The presence of **normal secondary sexual characteristics** and **ovaries** confirms that ovarian function (estrogen production) is intact and the karyotype is typically 46, XX. *Klinefelter's syndrome* - This is a chromosomal disorder in males (47, XXY) characterized by **primary hypogonadism**, small testes, and often infertility. - It would present as a male, not a 16-year-old girl with an absent uterus. *Androgen Insensitivity syndrome* - In this syndrome, individuals are **genetically male (46, XY)** but appear female due to target tissue insensitivity to androgens. - They typically have a short, blind-ending vagina but **lack a uterus, fallopian tubes, and ovaries**, having undescended testes instead. *Prader-Willi syndrome* - This is a genetic disorder characterized by **intellectual disability**, obesity, short stature, and **hypogonadism**. - It does not involve agenesis of the female reproductive organs and is not primarily linked to primary amenorrhea with absent reproductive structures.
Question 25: A 32 year old woman is noted to have 1200 cc of blood loss following a spontaneous vaginal delivery and delivery of placenta. The uterine fundus is palpated and noted to be firm. Which of the following is the most likely treatment for this patient?
- A. Replacement of inverted uterus
- B. Intramuscular prostaglandin
- C. Surgical repair of cervical tear (Correct Answer)
- D. B-Lynch suture
Explanation: **Surgical repair of cervical tear** - The patient presents with **postpartum hemorrhage** (over 1000 mL blood loss) despite a **firm uterine fundus**, which indicates that **uterine atony** is unlikely to be the cause. - A firm uterus in the presence of continuous bleeding suggests a **genital tract laceration**, with a cervical tear being a common site. Surgical repair is necessary to stop the bleeding. *Replacement of inverted uterus* - **Uterine inversion** is characterized by the collapse of the uterine fundus into or through the cervix, which would present as a **soft, non-palpable fundus** or a mass in the vagina. - This patient's fundus is noted to be **firm**, ruling out uterine inversion as the cause of her hemorrhage. *Intramuscular prostaglandin* - **Prostaglandins** (like carboprost tromethamine) are used to treat **uterine atony**, which is characterized by a **soft, boggy uterus**. - The patient's uterus is described as **firm**, indicating that uterine atony is not the primary cause of her hemorrhage. *B-Lynch suture* - The **B-Lynch suture** is a surgical technique primarily used to manage **refractory uterine atony** that has not responded to medical management. - Since the uterus is firm and not atonic, this intervention would not be appropriate for the underlying cause of bleeding in this patient.
Question 26: A pregnant woman visits a medical officer for an antenatal check up. The woman mentions that she had received two doses of Tetanus Toxoid vaccine four years ago. Which of the following steps should the medical officer take with regard to administration of Tetanus Toxoid vaccine as per the Government of India recommended schedule?
- A. No Tetanus Toxoid vaccine is required
- B. Only one dose of Tetanus Toxoid vaccine is required (Correct Answer)
- C. Two doses of Tetanus Toxoid vaccine should be administered with an interval of four weeks between the two doses
- D. Tetanus Immunoglobulin should be administered in the third trimester of pregnancy
Explanation: ***Only one dose of Tetanus Toxoid vaccine is required*** - As per the Government of India's antenatal care guidelines, a pregnant woman who has received **two doses of Tetanus Toxoid (TT) vaccine previously** should receive a **single booster dose** during pregnancy. - Since the woman received two doses **four years ago** (more than 3 years), a booster dose is necessary to ensure adequate protection, as immunity may have waned over time. - This single booster dose is sufficient to **reactivate immune memory** and ensure adequate protection for both the mother and the newborn against tetanus during the current pregnancy. *No Tetanus Toxoid vaccine is required* - This is incorrect because even with two prior doses, the **4-year interval** means immunity levels may have declined below protective thresholds. - A booster dose is essential to ensure **optimal antibody levels** during pregnancy and at delivery for protection against neonatal and maternal tetanus. *Two doses of Tetanus Toxoid vaccine should be administered with an interval of four weeks between the two doses* - This schedule (TT1 and TT2) is recommended for women who have **never been vaccinated** or have received **less than 2 doses** previously. - Since this woman has already completed a **primary series of 2 doses**, she only requires a **single booster dose**, not a repeat of the full primary series. - Administering two doses would be unnecessary overtreatment given her vaccination history. *Tetanus Immunoglobulin should be administered in the third trimester of pregnancy* - **Tetanus Immunoglobulin (TIG)** provides passive immunity and is used for **post-exposure prophylaxis** in high-risk situations (contaminated wounds) with uncertain vaccination status. - TIG is **not part of routine antenatal immunization** in India for women with documented prior TT vaccination. - Active immunization with TT vaccine is the standard preventive approach during pregnancy.