UPSC-CMS 2018 — Obstetrics and Gynecology

33 Questions — Page 4 of 4

All Subjects Anatomy (5)Biochemistry (1)Community Medicine (31)ENT (2)Forensic Medicine (1)Internal Medicine (7)Obstetrics and Gynecology (33)Orthopaedics (1)Pathology (1)Pediatrics (5)Pharmacology (4)Physiology (3)Radiology (2)Surgery (23)

Q31

In the process of MTP (Medical Termination of Pregnancy) done by suction and evacuation, it was realized that perforation of uterus occurred with cannula. The next step should be:

Q32

Consider the following statements regarding MTP (Medical Termination of Pregnancy): 1. Suction and evacuation can be done up till 12 weeks. 2. Medical methods can be used up till 10 weeks 3. Manual vacuum aspiration (MVA) syringe can be used up to 6 weeks Which of the statements given above is/are correct?

Q33

A 47 year old post menopausal lady was on adjuvant hormonal treatment with Tamoxifen for 3 years for Carcinoma Breast. She came to Outpatient Department with history of passing blood clots per vagina. She is probably suffering from:

UPSC-CMS 2018 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs

Question 31: In the process of MTP (Medical Termination of Pregnancy) done by suction and evacuation, it was realized that perforation of uterus occurred with cannula. The next step should be:

A. Manual vacuum aspiration
B. Laparotomy with exploration of bowel (Correct Answer)
C. Complete the evacuation with curette
D. Wait and watch

Explanation: ***Laparotomy with exploration of bowel*** - **Uterine perforation** during suction and evacuation abortion with a **cannula** (large instrument) carries high risk of bowel or vascular injury and necessitates surgical intervention. - **Laparotomy** (or laparoscopy in stable patients) allows for direct visualization of the injury, assessment of any associated bowel or vascular damage, and repair of the perforation. - Given the mechanism (cannula perforation), the risk of **intra-abdominal organ injury** is significant, warranting exploration. *Manual vacuum aspiration* - This procedure is used for uterine evacuation, not for managing a **uterine perforation**. - Continuing with aspiration after perforation risks aggravating the injury and causing further damage to internal organs. *Complete the evacuation with curette* - Using a **curette** after perforation would worsen the uterine injury and potentially cause damage to intra-abdominal organs. - The immediate concern is the perforation and its sequelae, not completing the abortion via the transcervical route. *Wait and watch* - While **small uterine perforations** from dilators without suspected visceral injury may be managed conservatively with close observation, **cannula perforation** represents a **high-risk mechanism**. - Given the size of the instrument and risk of bowel injury, immediate surgical exploration is required rather than expectant management.

Question 32: Consider the following statements regarding MTP (Medical Termination of Pregnancy): 1. Suction and evacuation can be done up till 12 weeks. 2. Medical methods can be used up till 10 weeks 3. Manual vacuum aspiration (MVA) syringe can be used up to 6 weeks Which of the statements given above is/are correct?

A. 2 only (Correct Answer)
B. 1 only
C. 2 and 3
D. 1 and 3

Explanation: **2 only** - **Medical methods** for abortion, primarily using medications like **mifepristone** and **misoprostol**, are generally recommended and most effective for pregnancies up to **10 weeks of gestation**. - Beyond 10 weeks, the success rate decreases, and the risk of complications increases, making surgical methods more appropriate. *1 only* - **Suction and evacuation**, also known as **vacuum aspiration**, is a surgical method typically performed for pregnancies up to **14-16 weeks** of gestation, not limited to 12 weeks. - After 12 weeks, the procedure may be referred to as D&C (dilation and curettage) or D&E (dilation and evacuation), depending on the gestational age and technique used. *2 and 3* - While statement 2 is correct, statement 3 is incorrect because **Manual Vacuum Aspiration (MVA)** using a syringe can be safely and effectively used for pregnancies up to **10-12 weeks** of gestation, not just up to 6 weeks. - MVA is a versatile and often preferred method for early pregnancy termination due to its simplicity and effectiveness. *1 and 3* - Both statements 1 and 3 are incorrect in their specified gestational limits. Suction and evacuation can be performed beyond 12 weeks, and MVA can be used beyond 6 weeks, up to 10-12 weeks.

Question 33: A 47 year old post menopausal lady was on adjuvant hormonal treatment with Tamoxifen for 3 years for Carcinoma Breast. She came to Outpatient Department with history of passing blood clots per vagina. She is probably suffering from:

A. Uterine fibroid
B. Carcinoma Endometrium (Correct Answer)
C. Carcinoma Vagina
D. Carcinoma Vulva

Explanation: ***Carcinoma Endometrium*** - **Tamoxifen** acts as an **estrogen agonist** in the endometrium, increasing the risk of **endometrial hyperplasia** and **carcinoma**. - Postmenopausal vaginal bleeding or passing blood clots is a significant warning sign for **endometrial cancer**. *Uterine fibroid* - While fibroids can cause abnormal uterine bleeding, they are less likely to cause sudden, significant bleeding with clots in a **postmenopausal woman** on Tamoxifen without other symptoms. - Tamoxifen is not a direct cause of uterine fibroid development or enlargement. *Carcinoma Vagina* - **Vaginal carcinoma** is rarer than endometrial carcinoma and typically presents with a **vaginal mass** or bleeding with intercourse, not usually significant clotting in this context. - Tamoxifen is not directly linked to an increased risk of primary vaginal carcinoma. *Carcinoma Vulva* - **Vulvar carcinoma** presents as a **lesion** or **sore on the vulva** and symptoms like itching, pain, or bleeding from the lesion itself, not typically as vaginal blood clots. - The use of Tamoxifen does not significantly increase the risk of vulvar carcinoma.