UPSC-CMS 2017 - Obstetrics and Gynecology Practice Questions

Q: A 26 year old woman P1L1 reports with High Grade Squamous Intraepithelial Lesion (HGSIL) on Pap smear (Papanicolaou smear). Further management for her is:

Colposcopy and directed biopsy. ***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.

Q: With reference to the displacement of uterus, the treatment of choice for genuine stress urinary incontinence is:

TVT‐O mid urethral tape. ***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.

Q: 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?

1, 2 and 3. ***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.

Q: 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:

Mayer Rockitansky Kuster Hauser syndrome. ***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.

Q: 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?

Surgical repair of cervical tear. **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 1

A 26 year old woman P1L1 reports with High Grade Squamous Intraepithelial Lesion (HGSIL) on Pap smear (Papanicolaou smear). Further management for her is:

Accepted Answer

Colposcopy and directed biopsy

Answer

Conisation

Answer

VIA, VILI

Answer

LEEP

Question 2

With reference to the displacement of uterus, the treatment of choice for genuine stress urinary incontinence is:

Accepted Answer

TVT‐O mid urethral tape

Answer

Periurethral injection of bulking agents

Answer

Kegel’s perineal exercises

Answer

Kelly's plication

Question 3

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?

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 only

Question 4

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:

Accepted Answer

Mayer Rockitansky Kuster Hauser syndrome

Answer

Klinefelter's syndrome

Answer

Androgen Insensitivity syndrome

Answer

Prader-Willi syndrome

Question 5

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?

Accepted Answer

Surgical repair of cervical tear

Answer

Replacement of inverted uterus

Answer

Intramuscular prostaglandin

Answer

B-Lynch suture

Question 6

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?

Accepted Answer

Two doses of Tetanus Toxoid vaccine should be administered with an interval of four weeks between the two doses

Answer

No Tetanus Toxoid vaccine is required

Answer

Only one dose of Tetanus Toxoid vaccine is required

Answer

Tetanus Immunoglobulin should be administered in the third trimester of pregnancy

UPSC-CMS 2017 — Obstetrics and Gynecology