UPSC-CMS 2019 - Obstetrics and Gynecology PYQs Practice Questions

Q: Which of the following is NOT the hormonal basis for hyperemesis gravidarum?

Excess of Human Placental Lactogen. ***Excess of Human Placental Lactogen*** - **Human placental lactogen (hPL)** is primarily involved in **metabolic adaptation** during pregnancy, promoting insulin resistance and glucose availability for the fetus. - While essential for fetal growth, hPL has **no direct causal link** to the pathophysiology of nausea and vomiting in hyperemesis gravidarum. *High serum levels of Estrogen* - **Elevated estrogen levels** during pregnancy are believed to contribute to nausea and vomiting by affecting **gastrointestinal motility** and the central chemoreceptor trigger zone. - The rapid increase and high concentrations of estrogen correlate with the severity of symptoms in many pregnant women. *Excess of Progesterone* - **High progesterone levels** can cause **relaxation of smooth muscle**, including that of the gastrointestinal tract, leading to delayed gastric emptying and increased gastroesophageal reflux. - These effects can exacerbate nausea and vomiting, making it a contributing factor to hyperemesis gravidarum. *Excess of Chorionic Gonadotropin* - **High levels of human chorionic gonadotropin (hCG)** are strongly implicated in the etiology of hyperemesis gravidarum, with symptoms often correlating with peaks in hCG levels in early pregnancy. - hCG is thought to stimulate the **thyroid gland** (due to structural similarity to TSH) and directly affect the **chemoreceptor trigger zone** in the brain, inducing nausea and vomiting. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Consider the following statements regarding pregnancy with Rh isoimmunization: 1. Indirect coombs test is performed in mother 2. Methergin is withheld at delivery of anterior shoulder 3. Middle cerebral artery peak systolic velocity is an accurate method to predict fetal anemia Which of the statements given above are correct?

1 and 3 only. ***1 and 3 only*** - The **indirect Coombs test (IAT)** is performed on the mother's serum to detect **Rh antibodies**, which is essential for diagnosing and monitoring Rh isoimmunization. - **Middle cerebral artery peak systolic velocity (MCA-PSV)** >1.5 MoM is a non-invasive and highly accurate ultrasound method to predict moderate to severe **fetal anemia** in Rh-isoimmunized pregnancies, guiding the need for intrauterine transfusion. - Statement 2 is **incorrect**: While minimizing fetomaternal hemorrhage is important in Rh isoimmunization, there is **no specific evidence-based guideline** that Methergine should be routinely withheld at delivery of the anterior shoulder in Rh-negative mothers. The focus is on **timely Anti-D administration** (within 72 hours postpartum) rather than avoiding specific uterotonics. *1 and 2 only* - Statement 1 is correct, but statement 2 is incorrect. - Methergine (methylergonovine) is not specifically contraindicated in Rh isoimmunization; its main contraindications include **hypertension and preeclampsia** due to vasoconstrictive effects. - Prevention of Rh sensitization focuses on **Anti-D immunoglobulin administration**, not withholding uterotonics. *2 and 3 only* - Statement 3 is correct regarding **MCA-PSV** accuracy for fetal anemia detection. - Statement 2 is incorrect: Methergine withholding is not a standard practice specifically for Rh isoimmunization management. *1, 2 and 3* - Statements 1 and 3 are correct. - Statement 2 is incorrect: There is no established protocol to withhold Methergine at delivery of the anterior shoulder specifically for Rh isoimmunization. Management focuses on **preventing sensitization through Anti-D prophylaxis**, **monitoring with antibody titers**, and **detecting fetal anemia via MCA-PSV**, not on avoiding specific uterotonics. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: In pregnancy with Down syndrome consider the following biomarkers: 1. β HCG is raised 2. α FP is raised 3. Inhibin A is decreased Which of the above statements is/are correct?

1 only. ***1 only*** - In pregnancies affected by **Down syndrome (Trisomy 21)**, the levels of **β-hCG** (human chorionic gonadotropin) are typically found to be **elevated**. This is a well-established biochemical marker used in prenatal screening. - The increased production of β-hCG is thought to be from the **placenta**, which may be functioning differently in pregnancies with Down syndrome. *1, 2 and 3* - This option is incorrect because while **β-hCG is raised**, **α-fetoprotein (αFP)** is typically **decreased** in pregnancies with Down syndrome, not raised. - Furthermore, **inhibin A** is usually **raised**, not decreased, making both statements 2 and 3 false for Down syndrome. *1 and 2 only* - This option is incorrect because although **β-hCG is raised**, **α-fetoprotein (αFP)** is characteristically **decreased** in pregnancies with Down syndrome, making statement 2 inaccurate. - The elevated αFP is usually associated with **neural tube defects** or other fetal anomalies. *2 and 3 only* - This option is incorrect as both statements 2 and 3 are factually wrong for Down syndrome. **α-fetoprotein (αFP)** is typically **decreased**, not raised, in pregnancies with Down syndrome. - Similarly, **inhibin A** levels are typically **raised**, not decreased, in such pregnancies, often incorporated into the quad screen for prenatal screening. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 25 year old G2P1L1, Rh –ve woman presented at 30 weeks gestation to the antenatal clinic, the indirect Coomb's test (ICT) was found to be positive. What would be the next line of management?

ICT titers to be closely monitored at weekly intervals. **ICT titers to be closely monitored at weekly intervals** - A **positive Indirect Coombs Test (ICT)** in an Rh-negative pregnant woman indicates the presence of maternal antibodies against fetal Rh antigens. The next step is to monitor the **titer** to assess the risk of **hemolytic disease of the fetus and newborn (HDFN)**. - Serial monitoring of ICT titers, typically every 2-4 weeks, helps to determine if the antibody levels are increasing, which would indicate a heightened risk to the fetus and necessitate further intervention. *Anti D to be given* - **Anti-D immunoglobulin** is administered to prevent **sensitization** in Rh-negative mothers who have not yet formed antibodies. - Since the ICT is already positive, the mother has already been **sensitized** and produced antibodies, making Anti-D administration ineffective at this stage. *Baby is to be delivered as soon as possible* - Premature delivery carries significant risks for the neonate due to **immaturity of organ systems**. - Delivery is usually reserved for cases of severe fetal compromise, not simply a positive ICT without further evidence of fetal anemia. *Amniocentesis for estimation of bilirubin by Liley's chart is to be done* - **Amniocentesis** for bilirubin estimation using **Liley's chart** is an invasive procedure that carries risks, including **infection** and **fetal loss**. - It is typically reserved for cases where **ICT titers are critically high** or there is evidence of fetal anemia on **Doppler ultrasound**, not as the initial management step for a positive ICT. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Given below are the Obstetric maneuvers and their indications. Which one of the following is correctly matched?

Ritgen's maneuver – Controlled delivery of fetal head. ***Ritgen's maneuver*** - This maneuver is used for the **controlled delivery of the fetal head** to prevent rapid expulsion, which can lead to maternal perineal trauma. - It involves applying pressure to the fetal chin through the perineum while simultaneously applying pressure to the occiput to facilitate slow and controlled extension of the head. *McRobert's maneuver* - McRobert's maneuver is used to manage **shoulder dystocia**, not after the delivery of the head in a breech presentation. - It involves hyperflexing the mother's hips towards her abdomen to rotate the symphysis pubis and increase the pelvic outlet dimension. *Lovset's maneuver* - Lovset's maneuver is used to deliver the **arms in a breech presentation**, not the foot. - It involves rotating the fetal trunk to bring the anterior shoulder under the maternal symphysis pubis, allowing the delivery of the posterior arm. *Pinard's maneuver* - Pinard's maneuver is used for the delivery of the **extended legs in a breech presentation**, not an extended arm. - It involves pressure in the popliteal fossa to flex the knee, allowing the foot to be grasped and delivered. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

Which of the following is NOT the hormonal basis for hyperemesis gravidarum?

Accepted Answer

Excess of Human Placental Lactogen

Answer

High serum levels of Estrogen

Answer

Excess of Progesterone

Answer

Excess of Chorionic Gonadotropin

Question 2

Consider the following statements regarding pregnancy with Rh isoimmunization:

1. Indirect coombs test is performed in mother
2. Methergin is withheld at delivery of anterior shoulder
3. Middle cerebral artery peak systolic velocity is an accurate method to predict fetal anemia Which of the statements given above are correct?

Accepted Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1, 2 and 3

Question 3

In pregnancy with Down syndrome consider the following biomarkers:

1. β HCG is raised
2. α FP is raised
3. Inhibin A is decreased
Which of the above statements is/are correct?

Accepted Answer

1 only

Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Question 4

A 25 year old G2P1L1, Rh –ve woman presented at 30 weeks gestation to the antenatal clinic, the indirect Coomb's test (ICT) was found to be positive. What would be the next line of management?

Accepted Answer

ICT titers to be closely monitored at weekly intervals

Answer

Anti D to be given

Answer

Baby is to be delivered as soon as possible

Answer

Amniocentesis for estimation of bilirubin by Liley's chart is to be done

Question 5

Given below are the Obstetric maneuvers and their indications. Which one of the following is correctly matched?

Accepted Answer

Ritgen's maneuver – Controlled delivery of fetal head

Answer

McRobert's maneuver – After coming head of breech

Answer

Lovset's maneuver – Delivery of foot in breech

Answer

Pinard's maneuver – Delivery of extended arm

Question 6

The Maternal serum α-fetoprotein level is elevated in all EXCEPT:

Accepted Answer

Down syndrome

Answer

Omphalocele

Answer

Intra uterine death

Answer

Neural tube defect

Question 7

Which one of the following statements regarding Bartholin's glands is NOT true?

Accepted Answer

Gonococci is the most common cause of Bartholin's abscess

Answer

The duct is lined by columnar epithelium

Answer

Duct opens in the groove between hymen and labia minora at 4 and 8 o'clock positions

Answer

They are situated in superficial perineal pouch

Question 8

An 18-year-old unmarried girl comes with complaints of heavy, prolonged bleeding during menses. Which among the following investigations is NOT usually advised?

Accepted Answer

Dilatation and curettage

Answer

Urine pregnancy test

Answer

Coagulation profile

Answer

Ultrasound uterus and adnexa

Question 9

Consider the following statements regarding infertility:

1. Endometrial biopsy provides information regarding ovulatory factor
2. Both tubal and peritoneal factors can be assessed at laparoscopy
3. Unexplained infertility may be due to luteal phase defect Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Question 10

Which one of the following about primary dysmenorrhea is NOT true?

Accepted Answer

Pain increases following pregnancy and delivery

Answer

Most commonly seen in adolescents and young women

Answer

Pain is related to uterine hypoxia

Answer

Always confined to ovulatory cycles

UPSC-CMS 2019 — Obstetrics and Gynecology