Anatomy
1 questionsThe following are the contents of broad ligament EXCEPT:
UPSC-CMS 2018 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 41: The following are the contents of broad ligament EXCEPT:
- A. Internal iliac artery (Correct Answer)
- B. Uterine and ovarian arteries with their branches
- C. Fallopian tube
- D. Ovarian ligament
Explanation: ***Internal iliac artery*** - The **internal iliac artery** is a large pelvic artery supplying various pelvic organs and **does NOT traverse within the broad ligament itself**. [2] - While its branches (like the uterine artery) enter the broad ligament, the main trunk of the internal iliac artery is located more posteriorly and laterally on the **pelvic sidewall**, outside the broad ligament. [1] - This is the correct answer to this EXCEPT question. *Uterine and ovarian arteries with their branches* - These **ARE contents of the broad ligament**, making this option incorrect. [1] - The **uterine artery** travels within the base of the broad ligament (cardinal ligament region), providing blood supply to the uterus. [2] - The **ovarian artery** travels within the suspensory ligament of the ovary, which is a lateral fold of the broad ligament, to supply the ovary. [1] *Fallopian tube* - This **IS a content of the broad ligament**, making this option incorrect. [3] - The **fallopian tube** (uterine tube) is enclosed within the superior free margin of the broad ligament, specifically within the **mesosalpinx** (the portion of broad ligament between fallopian tube and ovary). [1] - It extends laterally from the uterus, providing a pathway for ova. *Ovarian ligament* - This **IS a content of the broad ligament**, making this option incorrect. - The **ovarian ligament** is a fibrous cord that connects the medial pole of the ovary to the lateral aspect of the uterus, running within the posterior layer of the broad ligament. [3] - It helps to anchor the ovary to the uterus.
Obstetrics and Gynecology
9 questionsWhich of the following are the hypotheses for the onset of Labor? 1. Uterine distension 2. Activation of fetal hypothalamic-pituitary-adrenal axis 3. Increase in prostaglandins 4. Increase in serum calcium levels Select the correct answer using the code given below:
Which of following statements regarding Puerperal sepsis are correct? 1. Multiple per vaginal examinations increase the risk 2. Group A and B beta-haemolytic Streptococcus are among the responsible microorganisms 3. Retained bits of placenta and membrane predispose 4. Vaginal packing can decrease the risk Select the correct answer using the code given below:
In case of Labour complicated with cord prolapse, which of the following statements are correct? 1. Reposition the patient in exaggerated Sims position 2. To replace the cord in the vagina 3. To replace the cord inside the uterus 4. Early amniotomy can prevent cord prolapse Select the correct answer using the code given below:
Which one of the following is true regarding normal menstrual physiology?
Which one of the following is NOT a feature of Candida Vaginitis?
Which of the following is NOT a high risk factor for developing endometrial carcinoma?
All of the following are the features of functional ovarian cyst EXCEPT:
Gestational trophoblastic disease is a spectrum comprising which of the following entities? 1. Complete Hydatidiform mole 2. Partial Hydatidiform mole 3. Invasive mole 4. Choriocarcinoma Select the correct answer using the code given below:
Which of the following is NOT a component of Fothergill’s operation as a conservative surgery for uterovaginal prolapse?
UPSC-CMS 2018 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 41: Which of the following are the hypotheses for the onset of Labor? 1. Uterine distension 2. Activation of fetal hypothalamic-pituitary-adrenal axis 3. Increase in prostaglandins 4. Increase in serum calcium levels Select the correct answer using the code given below:
- A. 1 and 3 only
- B. 2, 3 and 4
- C. 1, 2 and 4
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - The **uterine distension hypothesis** suggests that the stretching of the uterus or cervix beyond a certain point triggers labor contractions, similar to how stretching muscle fibers can induce contraction. - The **activation of the fetal hypothalamic-pituitary-adrenal (HPA) axis** is believed to play a crucial role, as the fetal adrenal glands mature and produce cortisol and dehydroepiandrosterone sulfate (DHEA-S), which initiate changes in placental hormone production. These changes include a decrease in progesterone and an increase in estrogen, making the uterus more sensitive to contractions. - An **increase in prostaglandins** (PGE2 & PGF2α) is well-established in initiating and maintaining labor. Prostaglandins cause cervical ripening and promote uterine contractions, contributing significantly to the onset of labor. *1 and 3 only* - This option correctly identifies uterine distension and increased prostaglandins but omits the crucial role of the **activation of the fetal HPA axis**, which is a significant factor in signaling the readiness for birth. - The fetal HPA axis initiates hormonal changes that contribute to uterine contractility and cervical ripening, making its exclusion incomplete. *2, 3 and 4* - This option correctly includes activation of the fetal HPA axis and increased prostaglandins, but it incorrectly includes an **increase in serum calcium levels** as a primary hypothesis for the onset of labor. - While calcium is essential for muscle contraction in general, its significant increase as a direct trigger for labor onset is not a recognized standalone hypothesis like the others. *1, 2 and 4* - This option correctly includes uterine distension and activation of the fetal HPA axis but **incorrectly includes an increase in serum calcium levels** as a primary hypothesis for the onset of labor. - It also **omits the critical role of increased prostaglandins**, which are well-known to be directly involved in cervical ripening and uterine contractions during labor.
Question 42: Which of following statements regarding Puerperal sepsis are correct? 1. Multiple per vaginal examinations increase the risk 2. Group A and B beta-haemolytic Streptococcus are among the responsible microorganisms 3. Retained bits of placenta and membrane predispose 4. Vaginal packing can decrease the risk Select the correct answer using the code given below:
- A. 1, 3 and 4
- B. 1, 2 and 3 (Correct Answer)
- C. 2, 3 and 4
- D. 1, 2 and 4
Explanation: ***1, 2 and 3*** - **Multiple per vaginal examinations** introduce exogenous bacteria from the perineum into the sterile uterine cavity, increasing the risk of infection. - **Group A and B beta-haemolytic Streptococcus** are common causative organisms, especially Group A, which can cause severe, rapidly progressive puerperal sepsis. - **Retained products of conception** (placental or membrane fragments) provide a nidus for bacterial growth and interfere with uterine involution, creating a favorable environment for infection. *1, 3 and 4* - This option incorrectly includes "Vaginal packing can decrease the risk" and excludes a correct statement. - While multiple vaginal examinations and retained tissue increase risk, **vaginal packing** can actually increase the risk of infection by creating an anaerobic environment and trapping bacteria. *2, 3 and 4* - This option incorrectly includes "Vaginal packing can decrease the risk" and excludes a correct statement. - The identified microorganisms and role of retained products are correct, but vaginal packing is not a preventive measure for puerperal sepsis. *1, 2 and 4* - This option incorrectly includes "Vaginal packing can decrease the risk" and excludes a correct statement. - While multiple vaginal examinations and specific streptococcal species are correctly identified as risk factors or causes, vaginal packing is not a beneficial intervention.
Question 43: In case of Labour complicated with cord prolapse, which of the following statements are correct? 1. Reposition the patient in exaggerated Sims position 2. To replace the cord in the vagina 3. To replace the cord inside the uterus 4. Early amniotomy can prevent cord prolapse Select the correct answer using the code given below:
- A. 1 only (Correct Answer)
- B. 1 and 2 only
- C. 3 and 4 only
- D. 1, 2, 3 and 4
Explanation: ***Correct: 1 only*** **Statement 1 - Reposition the patient in exaggerated Sims position** ✓ - **Correct** - Immediate repositioning (knee-chest, Trendelenburg, or exaggerated Sims position) is crucial to reduce pressure on the prolapsed cord and relieve compression - This helps displace the presenting part away from the cord using gravity **Statement 2 - To replace the cord in the vagina** ✗ - **Incorrect** - Manipulation or replacement of the prolapsed cord is **contraindicated** as it can cause vasospasm and further compromise fetal circulation - The correct approach is to **elevate the presenting part manually** (pushing it up off the cord) while keeping the cord moist and warm, NOT to reposition the cord itself **Statement 3 - To replace the cord inside the uterus** ✗ - **Incorrect** - This is contraindicated as it carries high risk of uterine infection, cord trauma, and vasospasm - Does not reliably prevent recurrence of prolapse **Statement 4 - Early amniotomy can prevent cord prolapse** ✗ - **Incorrect** - Early amniotomy actually **increases** the risk of cord prolapse, especially when the presenting part is not well-engaged - It removes the cushioning effect of forewaters that help keep the cord in place **Correct management of cord prolapse includes:** - Immediate repositioning (Trendelenburg/knee-chest position) - Manual elevation of presenting part to relieve cord compression - Keeping the prolapsed cord moist and warm - Avoiding cord manipulation - Emergency cesarean delivery or instrumental delivery if feasible *Incorrect: 1 and 2 only* - While statement 1 is correct, statement 2 (replacing the cord in vagina) is medically incorrect and contraindicated *Incorrect: 3 and 4 only* - Both statements are incorrect as explained above *Incorrect: 1, 2, 3 and 4* - Only statement 1 is correct; statements 2, 3, and 4 are all incorrect
Question 44: Which one of the following is true regarding normal menstrual physiology?
- A. Ovulation occurs after 12 hours of LH peak (Correct Answer)
- B. Ovulation occurs after 48 hours of LH surge
- C. Oestradiol levels peak at 48 hours prior to ovulation
- D. LH surge duration is typically 12-24 hours
Explanation: ***Ovulation occurs after 12 hours of LH peak*** - Ovulation typically occurs approximately **10-12 hours after the luteinizing hormone (LH) peak** and about 34-36 hours after the initial rise in LH. This delay allows for the final maturation of the oocyte. - The **LH surge** is the crucial hormonal signal that triggers the ovulation process in the mature follicle. *Ovulation occurs after 48 hours of LH surge* - This statement is incorrect as **ovulation occurs much sooner** after the LH surge, typically within 34-36 hours from the onset of the surge, and 10-12 hours after its peak. - A 48-hour delay would mean the oocyte would likely be past its optimal viability for fertilization. *Oestradiol levels peak at 48 hours prior to ovulation* - **Estradiol levels peak approximately 24-36 hours before ovulation**, not 48 hours. This peak in estradiol is what triggers the surge in LH. - The timing of the estradiol peak is crucial in initiating the positive feedback loop that leads to the LH surge. *LH surge duration is typically 12-24 hours* - The **LH surge typically lasts for about 48 hours**, not 12-24 hours. A surge of this duration ensures sufficient time for the final maturation of the oocyte and the process of follicular rupture. - The prolonged nature of the LH surge is essential for the completion of meiosis I in the oocyte and the weakening of the follicular wall.
Question 45: Which one of the following is NOT a feature of Candida Vaginitis?
- A. Yeast-buds and pseudohyphae forms can be seen under the microscope
- B. Metronidazole is the treatment of choice (Correct Answer)
- C. Pruritus is out of proportion to discharge
- D. Discharge is thick and curdy
Explanation: ***Metronidazole is the treatment of choice*** - **Metronidazole** is the drug of choice for **bacterial vaginosis** and **trichomoniasis**, not candidal vaginitis. - The primary treatment for **Candida vaginitis** involves **azole antifungal agents** (e.g., fluconazole, miconazole, clotrimazole). *Yeast-buds and pseudohyphae forms can be seen under the microscope* - Microscopic examination of vaginal discharge revealing **yeast buds** and **pseudohyphae** is a classic diagnostic finding for **Candida vaginitis**. - This observation directly confirms the presence of **Candida** organisms. *Pruritus is out of proportion to discharge* - In **Candida vaginitis**, **intense pruritus** (itching) is a hallmark symptom, often severe and disproportionate to the amount of vaginal discharge. - This characteristic itching is due to the inflammatory response triggered by the Candida infection. *Discharge is thick and curdy* - The typical vaginal discharge associated with **Candida vaginitis** is often described as **thick, white, and "cottage cheese-like"** or curdy. - This distinct appearance is a key clinical indicator of a yeast infection.
Question 46: Which of the following is NOT a high risk factor for developing endometrial carcinoma?
- A. Delayed menopause
- B. Hypertension
- C. Multiparity (Correct Answer)
- D. Obesity
Explanation: ***Multiparity*** - **Multiparity** (having multiple live births) is generally considered a **protective factor** against endometrial carcinoma, as it leads to periods of reduced estrogen exposure. - Frequent pregnancies interrupt prolonged exposure to unopposed estrogen, which is a major driver of endometrial proliferation. *Delayed menopause* - **Delayed menopause** increases the total lifetime exposure to **endogenous estrogen**, which is a significant risk factor for endometrial carcinoma. - Prolonged estrogen exposure without sufficient progesterone to balance its effects promotes endometrial hyperplasia and potential malignant transformation. *Hypertension* - **Hypertension** is an independent risk factor for endometrial carcinoma, often associated with other metabolic conditions like **obesity** and **diabetes**. - It contributes to a pro-inflammatory and pro-carcinogenic environment, although the exact mechanisms are complex and involve hormonal and metabolic pathways. *Obesity* - **Obesity** is a major risk factor due to the increased peripheral conversion of androgens to **estrogen** in adipose tissue. - Higher levels of estrogen lead to **unopposed estrogen stimulation** of the endometrium, promoting hyperplasia and increasing the risk of carcinoma.
Question 47: All of the following are the features of functional ovarian cyst EXCEPT:
- A. Usually < 7 cm in diameter
- B. Unilocular
- C. Spontaneous regression occurs
- D. Usually symptomatic (Correct Answer)
Explanation: ***Correct Answer: Usually symptomatic*** - Functional ovarian cysts are typically **asymptomatic** and discovered incidentally during pelvic examination or imaging studies. - Most patients have no symptoms; when symptoms occur, they are usually mild (pelvic pressure, dull ache). - Being "usually symptomatic" is **NOT a feature** of functional cysts, making this the correct answer to this EXCEPT question. *Incorrect: Usually < 7 cm in diameter* - Most functional ovarian cysts (follicular cysts, corpus luteum cysts) are relatively small, typically measuring **less than 5-7 cm** in diameter. - Cysts larger than 7 cm may warrant further evaluation to rule out neoplastic etiology. - This **IS a feature** of functional cysts. *Incorrect: Unilocular* - Functional cysts are characteristically **simple in structure**: unilocular (single-chambered), thin-walled, containing clear anechoic fluid. - Complex features (septations, solid components, thick walls) suggest neoplastic or other pathologic cysts. - This **IS a feature** of functional cysts. *Incorrect: Spontaneous regression occurs* - Functional ovarian cysts are by definition **transient** and typically resolve spontaneously within **1-3 menstrual cycles** without intervention. - This self-limiting nature is a key characteristic distinguishing them from persistent or neoplastic cysts. - This **IS a feature** of functional cysts.
Question 48: Gestational trophoblastic disease is a spectrum comprising which of the following entities? 1. Complete Hydatidiform mole 2. Partial Hydatidiform mole 3. Invasive mole 4. Choriocarcinoma Select the correct answer using the code given below:
- A. 1, 2 and 3 only
- B. 1 and 4 only
- C. 2, 3 and 4 only
- D. 1, 2, 3 and 4 (Correct Answer)
Explanation: **1, 2, 3 and 4** - **Gestational trophoblastic disease (GTD)** encompasses a spectrum of conditions arising from abnormal proliferation of trophoblastic tissue, including both benign and malignant forms. - This spectrum correctly includes **complete hydatidiform mole**, **partial hydatidiform mole**, **invasive mole**, and **choriocarcinoma**, as well as the rare placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). *1, 2 and 3 only* - This option incorrectly excludes **choriocarcinoma**, which is a highly malignant form of gestational trophoblastic neoplasia (GTN) and a crucial part of the GTD spectrum. - While complete, partial, and invasive moles are part of the spectrum, omitting choriocarcinoma makes this answer incomplete. *1 and 4 only* - This option incompletely covers the spectrum by excluding **partial hydatidiform mole** and **invasive mole**, both of which are common and important entities within GTD. - It highlights two extremes (benign complete mole and malignant choriocarcinoma) but misses intermediate forms. *2, 3 and 4 only* - This option incorrectly omits **complete hydatidiform mole**, which is the most common precursor to gestational trophoblastic neoplasia and a central component of the GTD spectrum. - Excluding complete mole would provide an incomplete understanding of the disease's origins and manifestations.
Question 49: Which of the following is NOT a component of Fothergill’s operation as a conservative surgery for uterovaginal prolapse?
- A. Amputation of cervix
- B. Plication of Mackenrodt’s ligaments
- C. Cervicopexy (Correct Answer)
- D. Anterior colporrhaphy
Explanation: ***Cervicopexy*** - **Cervicopexy** involves fixing the cervix to a stable structure, which is generally part of reconstructive surgeries for prolapse but isn't a primary component of Fothergill's operation. - Fothergill's operation focuses on excising excess cervical tissue and strengthening the supports, rather than suspending the entire cervix. *Amputation of cervix* - **Cervical amputation** (also known as trachelorrhaphy in some contexts or Sturmdorf sutures) is a key step, where the elongated cervix is amputated to reduce its length and thus improve uterine support. - This step addresses the hypertrophied cervix often seen with uterovaginal prolapse, especially in cases of cervical elongation. *Plication of Mackenrodt's ligaments* - **Plication of Mackenrodt's (cardinal) ligaments** is crucial to shorten and strengthen the main uterine supports, helping to restore the uterus to its normal position. - This tightens the cardinal and uterosacral ligaments, enhancing the anatomical support for the uterus and cervix. *Anterior colporrhaphy* - **Anterior colporrhaphy** is almost always performed concurrently to repair the often present **cystocele** and strengthen the anterior vaginal wall. - This addresses defects in the anterior vaginal wall, preventing or correcting bladder prolapse and further stabilizing the pelvic floor.