UPSC-CMS 2020 - Obstetrics and Gynecology Practice Questions

Q: Tumor marker of epithelial ovarian carcinoma is:

CA-125. ***CA-125*** - **CA-125 (Cancer Antigen 125)** is the most widely used and validated tumor marker for detecting and monitoring **epithelial ovarian carcinoma**. - Elevated levels are found in approximately 80% of women with epithelial ovarian cancer, making it useful in guiding treatment decisions and assessing recurrence. *Alpha feto protein* - **Alpha-fetoprotein (AFP)** is primarily elevated in **germ cell tumors** of the ovary (e.g., endodermal sinus tumor) or in hepatocellular carcinoma and some testicular cancers, not epithelial ovarian carcinoma. - Its presence usually indicates a different histological subtype of ovarian malignancy. *Beta HCG* - **Beta-human chorionic gonadotropin (β-hCG)** is a tumor marker utilized for detecting **germ cell tumors**, particularly **choriocarcinoma** and some embryonal carcinomas, as well as pregnancy. - It is not typically elevated in epithelial ovarian carcinoma. *LDH* - **Lactate dehydrogenase (LDH)** is a general marker of **tissue damage or high cell turnover**, elevated in many cancers, including dysgerminoma (an ovarian germ cell tumor), but it is not specific for epithelial ovarian carcinoma. - Due to its lack of specificity, LDH alone is not considered the primary tumor marker for epithelial ovarian cancer.

Q: The most common site of cervical cancer is:

Transformation zone. ***Transformation zone*** - The **transformation zone** is where the squamous epithelium of the **ectocervix** meets the columnar epithelium of the **endocervix**. - This area is highly susceptible to **human papillomavirus (HPV) infection**, which is the primary cause of cervical cancer, making it the most common site of origin. *Endocervix* - The **endocervix** is lined by columnar epithelium and primarily gives rise to **adenocarcinoma**, which is less common than squamous cell carcinoma. - While cervical cancer can occur here, it is not the most frequent site of origin for all types of cervical cancer. *Isthmus* - The **isthmus** is the narrow lower part of the uterus, superior to the cervix. - It is not a primary site for the development of cervical cancer; cancerous changes typically originate within the cervical regions proper. *Ectocervix* - The **ectocervix** is the vaginal portion of the cervix, covered by stratified squamous epithelium. - While **squamous cell carcinomas** frequently occur in the cervix, they mostly originate in the transformation zone, not the ectocervix itself.

Q: The placenta synthesizes all EXCEPT:

Dehydroepiandrosterone. ***Dehydroepiandrosterone*** - **Dehydroepiandrosterone (DHEA)** is primarily synthesized in the **adrenal cortex** of both the fetus and the mother. - The placenta primarily converts DHEA into other steroids, such as **estrogens**, rather than synthesizing DHEA itself. *Oestriol* - The placenta plays a crucial role in synthesizing **oestriol**, particularly by utilizing **androgen precursors** from the fetal adrenal gland. - This synthesis is a key indicator of **feto-placental unit** well-being. *Corticotrophin releasing hormone* - The placenta extensively synthesizes **Corticotropin-releasing hormone (CRH)**, which gradually increases throughout pregnancy. - Placental CRH is thought to be involved in the **timing of parturition** and the regulation of fetal adrenal development. *PAPP-A (Pregnancy Associated Plasma Protein A)* - **PAPP-A** is a glycoprotein synthesized by the **syncytiotrophoblast** cells of the placenta. - It serves as an important biochemical marker in **combined first-trimester screening** for chromosomal abnormalities like Down syndrome.

Q: Withdrawal bleeding following administration of progesterone in a case of secondary amenorrhea indicates all EXCEPT:

Defect in pituitary gland. ***Defect in pituitary gland*** - While withdrawal bleeding after progesterone suggests the problem lies at the **hypothalamic-pituitary level** (anovulation with adequate estrogen), it does **not definitively rule out all pituitary defects**. - The pituitary may still produce sufficient **FSH to stimulate ovarian estrogen production** but have defective **LH surge mechanism** (WHO Group II anovulation). - Examples include **hyperprolactinemia** or **functional hypothalamic amenorrhea** where estrogen production is preserved despite pituitary-hypothalamic dysfunction. - This is the **EXCEPT answer** because the other options are more definitively confirmed by withdrawal bleeding. *Absence of pregnancy* - Withdrawal bleeding after progesterone administration **definitively confirms absence of pregnancy**. - Pregnancy would prevent withdrawal bleeding due to sustained progesterone production by the corpus luteum and placenta. - This is a key diagnostic exclusion in the evaluation of **secondary amenorrhea**. *Endometrium is responsive to estrogen* - The occurrence of withdrawal bleeding **definitively demonstrates** that the endometrium has been exposed to adequate estrogen and has proliferated. - This proliferative endometrium then sheds when progesterone is withdrawn, confirming **normal endometrial responsiveness to hormonal stimulation**. - This rules out **Asherman syndrome** and other uterine factors. *Production of endogenous estrogen* - Withdrawal bleeding **definitively confirms** that there has been sufficient **endogenous estrogen production** to prime the endometrium. - The estrogen causes endometrial thickening, which then sheds when progesterone is withdrawn. - This indicates **adequate ovarian function** in terms of estrogen synthesis and rules out **hypergonadotropic hypogonadism** (ovarian failure).

Q: Monilial vaginitis is commonly associated with all EXCEPT:

Treatment of malaria with chloroquine. ***Treatment of malaria with chloroquine*** - **Chloroquine** is an antimalarial drug and has no direct known association with an increased risk of **monilial vaginitis (candidiasis)**. - Unlike antibiotics, corticosteroids, or immunosuppressants, chloroquine does not significantly alter the vaginal flora or immune response in a way that predisposes to Candida overgrowth. *Prolonged antibiotic therapy* - **Antibiotics** can disrupt the normal vaginal flora by killing off beneficial bacteria (like *Lactobacillus*), leading to an overgrowth of **Candida albicans**. - This altered microbial balance is a common cause of **vulvovaginal candidiasis (VVC)**. *Pregnancy* - Hormonal changes during **pregnancy**, particularly elevated estrogen levels, can increase **glycogen deposition** in vaginal epithelial cells. - This provides a rich food source for **Candida**, making pregnant women more susceptible to **monilial vaginitis**. *Diabetes Mellitus* - **Poorly controlled diabetes mellitus** leads to hyperglycemia, which can result in **elevated glucose levels** in vaginal secretions. - This increased glucose serves as a nutrient for **Candida albicans**, fostering its growth and making diabetic women more prone to recurrent **vaginal yeast infections**.

Q: Which one of the following is NOT a risk factor for the development of placenta previa?

Maternal anaemia. ***Maternal anaemia*** - **Maternal anaemia** is generally considered a *consequence* of conditions like antenatal hemorrhage from placenta previa, rather than a direct risk factor for its development. - While anaemia is common in pregnancy and can exacerbate outcomes, it does not independently increase the likelihood of the placenta implanting abnormally close to or over the cervical os. *Maternal age* - **Advanced maternal age** (typically over 35 years) is a well-established risk factor for placenta previa. - This is thought to be due to an increased incidence of pre-existing uterine abnormalities and degenerative changes in the endometrium. *Previous caesarean section* - A **previous caesarean section** significantly increases the risk of placenta previa due to the presence of a uterine scar. - The placenta may preferentially implant over the scar tissue, which can be less vascular, leading to a lower implantation and potentially previa. *Smoking* - **Smoking** during pregnancy is a recognized risk factor for placenta previa, potentially due to hypoxic-ischemic effects on the endometrium. - It may contribute to abnormal placentation by inducing compensatory placental hypertrophy and extending the placental surface area, increasing the chance of covering the cervical os.

Q: Common clinical presentations of moderate to severe abruption are all EXCEPT:

Prolonged labour. ***Prolonged labour*** - While **placental abruption** can sometimes lead to **uterine dysfunction** and difficulties in labor progression, **prolonged labor** is *not* a characteristic or common clinical presentation of an abruption itself. - The primary concerns with abruption are **hemorrhage**, **fetal compromise**, and rapid progression to delivery due to **uterine irritability**. *Uterine tenderness* - **Uterine tenderness** is a classic and common sign of **placental abruption**, resulting from the extravasation of blood into the myometrium. - This tenderness is often localized over the site of the abruption and can range from mild to severe depending on the extent of the blood collection. *Unexplained preterm labour* - **Placental abruption** is a known cause of **preterm labor**, often presenting as uterine contractions and pain. - The irritation of the uterus by blood and the presence of **prostaglandins** released during the abruption process can trigger premature contractions. *Fetal distress* - **Fetal distress**, indicated by **non-reassuring fetal heart rate patterns** like decelerations or bradycardia, is a common and serious consequence of **placental abruption**. - This occurs due to the reduction in **placental perfusion** and oxygen exchange between the mother and fetus.

Q: Common trisomies resulting in spontaneous abortion are all EXCEPT:

Trisomy 1. ***Trisomy 1*** - **Trisomy 1** is considered **lethal** and results in very early embryonic demise, often before a pregnancy is recognized, making it an extremely rare finding in spontaneous abortions. - The presence of an extra copy of such a large, gene-rich chromosome is **incompatible with early development**. *Trisomy 21* - **Trisomy 21 (Down syndrome)** is the most common autosomal trisomy that can result in a live birth, but it is also a frequent cause of **spontaneous abortion**. - While many pregnancies with Trisomy 21 result in live births, a significant proportion (approximately **75-80%**) end in miscarriage. *Trisomy 18* - **Trisomy 18 (Edwards syndrome)** is a common trisomy found in spontaneous abortions, second only to Trisomy 16. - While it can result in live births, the majority of fetuses with Trisomy 18 **miscarry spontaneously**. *Trisomy 16* - **Trisomy 16** is the most common trisomy identified in early spontaneous abortions, accounting for a large percentage of all chromosomal abnormalities leading to miscarriage. - It is considered **lethal** and is almost exclusively found in miscarried fetuses, with very rare exceptions of mosaic forms.

Q: Diagnostic criteria for PCOS are: 1. Oligo/amenorrhea 2. Hyperandrogenism 3. Polycystic ovaries on ultrasound Which of the above are correct?

1, 2 and 3. ***1, 2 and 3*** - All three listed features are the **Rotterdam criteria** for diagnosing PCOS, which is the most widely used diagnostic system. - The Rotterdam criteria require **at least 2 out of 3** of the following: **(1) oligo-ovulation/anovulation** (clinically presenting as oligo/amenorrhea), **(2) clinical or biochemical hyperandrogenism**, and **(3) polycystic ovaries on ultrasound**. - Since all three listed features are valid diagnostic criteria, the correct answer includes all of them (1, 2, and 3). - Note: Diagnosis requires meeting 2 out of 3 criteria, but all 3 are recognized valid criteria. *2 and 3 only* - This option incorrectly excludes **oligo/amenorrhea** (oligo-ovulation/anovulation). - Oligo/amenorrhea is a core criterion in the Rotterdam criteria and represents the ovulatory dysfunction that is central to PCOS. - Excluding this criterion makes the option incomplete. *1 and 3 only* - This option incorrectly excludes **hyperandrogenism**. - Hyperandrogenism (clinical signs like hirsutism, acne, or biochemical elevation of androgens) is a fundamental criterion in the Rotterdam criteria. - It reflects the hormonal dysregulation that characterizes PCOS and cannot be excluded as a valid diagnostic criterion. *1 and 2 only* - This option incorrectly excludes **polycystic ovaries on ultrasound**. - The ultrasound finding of polycystic ovarian morphology (≥12 follicles measuring 2-9 mm or ovarian volume >10 mL) is an essential criterion in the Rotterdam criteria. - Excluding this morphological feature makes the option incomplete.

Q: Which of the following symptoms can be associated with pelvic organ prolapse? 1. Difficulty in passing urine 2. Incomplete evacuation of urine 3. Urgency and frequency Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - Pelvic organ prolapse can cause **urinary symptoms** due to anatomical distortion affecting the bladder and urethra. - Patients may experience **difficulty in initiating micturition**, the sensation of **incomplete emptying**, **increased urgency**, and **frequency** as common manifestations. *1 and 3 only* - This option is incomplete as it excludes **incomplete evacuation of urine**, which is a frequent symptom of pelvic organ prolapse. - The sensation of incomplete emptying is often due to the physical obstruction or kink in the urethra caused by the prolapsed organ. *2 and 3 only* - This option is incorrect because it dismisses **difficulty in passing urine**, also known as **voiding dysfunction**, which can be a direct result of urethral compression or angulation. - **Voiding dysfunction** is a key symptom that impacts quality of life for women with prolapse. *1 and 2 only* - This choice omits **urgency and frequency**, common irritative symptoms of the bladder often associated with pelvic organ prolapse. - Even without infection, bladder irritation can stem from changes in bladder support and position caused by the prolapse.

Question 1

Tumor marker of epithelial ovarian carcinoma is:

Accepted Answer

CA-125

Answer

Alpha feto protein

Answer

Beta HCG

Answer

LDH

Question 2

The most common site of cervical cancer is:

Accepted Answer

Transformation zone

Answer

Endocervix

Answer

Isthmus

Answer

Ectocervix

Question 3

The placenta synthesizes all EXCEPT:

Accepted Answer

Dehydroepiandrosterone

Answer

Oestriol

Answer

Corticotrophin releasing hormone

Answer

PAPP-A (Pregnancy Associated Plasma Protein A)

Question 4

Withdrawal bleeding following administration of progesterone in a case of secondary amenorrhea indicates all EXCEPT:

Accepted Answer

Defect in pituitary gland

Answer

Absence of pregnancy

Answer

Endometrium is responsive to estrogen

Answer

Production of endogenous estrogen

Question 5

Monilial vaginitis is commonly associated with all EXCEPT:

Accepted Answer

Treatment of malaria with chloroquine

Answer

Prolonged antibiotic therapy

Answer

Pregnancy

Answer

Diabetes Mellitus

Question 6

Which one of the following is NOT a risk factor for the development of placenta previa?

Accepted Answer

Maternal anaemia

Answer

Maternal age

Answer

Previous caesarean section

Answer

Smoking

Question 7

Common clinical presentations of moderate to severe abruption are all EXCEPT:

Accepted Answer

Prolonged labour

Answer

Uterine tenderness

Answer

Fetal distress

Answer

Unexplained preterm labour

Question 8

Common trisomies resulting in spontaneous abortion are all EXCEPT:

Accepted Answer

Trisomy 1

Answer

Trisomy 21

Answer

Trisomy 18

Answer

Trisomy 16

Question 9

Diagnostic criteria for PCOS are:

1. Oligo/amenorrhea
2. Hyperandrogenism
3. Polycystic ovaries on ultrasound

Which of the above are correct?

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 3 only

Answer

1 and 2 only

Question 10

Which of the following symptoms can be associated with pelvic organ prolapse?

1. Difficulty in passing urine
2. Incomplete evacuation of urine
3. Urgency and frequency

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

UPSC-CMS 2020 — Obstetrics and Gynecology