UPSC-CMS 2020 - Obstetrics and Gynecology Practice Questions

Q: A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true regarding the above case? 1. Bartholin's abscess may be the likely diagnosis 2. It is to be managed by marsupialisation 3. Gonococcus is the most common pathogenic organism Select the correct answer using the code given below:

1 and 2 only. ***1 and 2 only*** - The presentation of **painful, unilateral vulvar swelling for 3 days** is highly suggestive of a **Bartholin's abscess**, making statement 1 correct. - **Marsupialization** is a valid surgical management option for Bartholin's abscess. While **incision and drainage with Word catheter placement** is preferred for acute cases, marsupialization can be performed and is especially indicated for recurrent cases. Statement 2 is considered true as marsupialization is an accepted treatment modality. - **Statement 3 is false**: Gonococcus is NOT the most common organism. **Polymicrobial infections** (E. coli, Staphylococcus, Streptococcus, anaerobes) are most common in current practice. Gonococcus accounts for <10% of cases. *3 only* - This option is incorrect because statement 3 alone is false (Gonococcus is not the most common organism), while statements 1 and 2 are true. - Selecting only statement 3 contradicts the clinical presentation and current microbiology data. *1, 2 and 3* - This option is incorrect because **statement 3 is false**. Gonococcus is no longer the most common pathogenic organism causing Bartholin's abscesses. - **Polymicrobial infections** predominate in modern practice, making this combination incorrect. *1 and 3 only* - This option is incorrect because it excludes statement 2 (marsupialization is a valid management option) while including statement 3 (which is false regarding Gonococcus being the most common organism). - This combination is medically inaccurate on both counts.

Q: Which one of the following is NOT a sign of separation of placenta?

The fundal height reduces further. ***The fundal height reduces further*** - A **reduction in fundal height** is not a sign of placental separation; rather, the fundus often rises slightly as the separated placenta descends into the lower uterine segment. - After separation, the uterus typically becomes **globular** and the fundus may rise to a level above the umbilicus. *Apparent lengthening of the cord with slight gush of vaginal bleeding* - **Lengthening of the umbilical cord** outside the vagina is a classic sign of placental separation, indicating the placenta has descended. - A **gush of blood** often occurs as the placenta detaches from the uterine wall, releasing pooled blood from the retroplacental space. *Uterus becomes globular, firm and ballotable* - After separation, the uterus contracts strongly, becoming more **globular** and **firm** as it expels the placenta. - The uterus may feel **ballotable** if the placenta is still within the uterine cavity but detached. *Slight bulging in the suprapubic region* - A **slight bulging in the suprapubic region** (above the symphysis pubis) indicates that the separated placenta has descended into the lower uterine segment or vagina, creating a palpable mass. - This sign is often referred to as a "boggy" or "fullness" sensation in the lower abdomen due to the descended placenta.

Q: Consider the following cardinal movements of mechanism of normal labor: 1. Engagement 2. Internal rotation 3. Flexion 4. Restitution 5. Crowning 6. External rotation What is the correct sequence of movements in labor in occipito-lateral position?

1, 3, 2, 5, 4 and 6. ***1, 3, 2, 5, 4 and 6*** - This sequence accurately represents the order of events during normal vaginal delivery **in occipito-lateral position**, starting with **engagement** and progressing through the cardinal movements. - The sequence follows: **Engagement (1)** → **Flexion (3)** → **Internal rotation (2)** from occipito-lateral to occipito-anterior → **Crowning (5)** during extension phase → **Restitution (4)** → **External rotation (6)**. - While **crowning** is not technically a cardinal movement, it occurs during the **extension** phase and marks the emergence of the fetal head at the introitus. - In **occipito-lateral position**, internal rotation is essential for converting the position to occipito-anterior for delivery. *3, 1, 2, 4, 6 and 5* - This sequence incorrectly places **flexion before engagement**, which is physiologically impossible as the fetal head must first engage in the pelvic inlet before significant flexion occurs. - **Crowning** is placed after external rotation, but crowning occurs during the extension phase, well before restitution and external rotation. *1, 2, 3, 4, 5 and 6* - This sequence incorrectly places **internal rotation before flexion**, whereas flexion typically occurs first to reduce the presenting diameter and facilitate internal rotation. - The sequence also places **crowning after restitution**, which contradicts the normal progression where crowning occurs during extension, before restitution. *2, 1, 3, 4, 5 and 6* - This sequence incorrectly begins with **internal rotation before engagement**, which is physiologically impossible as the fetal head must be engaged in the pelvis before it can rotate. - **Engagement** must always be the first cardinal movement.

Q: Visual inspection based screening test with 5 % acetic acid is used for the screening of which one of the following cancers?

Cervix cancer. ***Cervix cancer*** - Visual inspection with **acetic acid (VIA)** is a widely used, low-cost screening method for **cervical cancer**, particularly in low-resource settings. - Acetic acid causes abnormal (dysplastic or cancerous) cervical cells to turn **white (acetowhite lesion)**, making them visible to the naked eye. *Oral cancer* - Screening for **oral cancer** typically involves a visual and tactile examination of the oral cavity by a dentist or healthcare provider. - While acetic acid can highlight some oral lesions, it is **not a standard diagnostic or screening tool** for oral cancer like it is for cervical cancer. *Lung cancer* - Screening for **lung cancer** usually involves **low-dose computed tomography (LDCT)** for high-risk individuals. - There is **no role for acetic acid** in the screening or diagnosis of lung cancer. *Breast cancer* - Screening for **breast cancer** is primarily done through **mammography**, clinical breast exams, and sometimes MRI. - **Acetic acid** has **no application** in the detection or screening of breast cancer.

Q: Which one of the following IUDs is associated with a low pregnancy rate (0.2 per 100), less number of ectopic pregnancies and lower menstrual blood loss?

LNG-20 (Mirena). ***LNG-20 (Mirena)*** - This **levonorgestrel-releasing IUD** (Mirena) has a very low pregnancy rate (0.2 per 100 women-years). - It significantly **reduces menstrual blood loss** and cramps and is associated with a lower risk of ectopic pregnancies compared to copper IUDs because it thins the endometrial lining, making implantation less likely. *Cu T-380A* - The **Cu T-380A copper IUD** has a slightly higher pregnancy rate (around 0.6-0.8 per 100 women-years) compared to Mirena. - It is known to **increase menstrual blood loss** and dysmenorrhea, which is contrary to the question's criteria. *ML-Cu 375* - The **Multiload Cu 375** is another type of copper IUD, with a pregnancy rate similar to or slightly higher than the TCu-380A. - Like other copper IUDs, it typically **increases menstrual flow** and may worsen menstrual pain. *Progestasert* - **Progestasert** was an early progesterone-releasing IUD that had a higher failure rate and a shorter lifespan (1 year) compared to newer LNG-IUDs. - While it aimed to reduce menstrual blood loss, its **overall efficacy and duration of action** were inferior to the LNG-20 system.

Question 1

A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true regarding the above case?

1. Bartholin's abscess may be the likely diagnosis
2. It is to be managed by marsupialisation
3. Gonococcus is the most common pathogenic organism

Select the correct answer using the code given below:

Accepted Answer

1 and 2 only

Answer

3 only

Answer

1, 2 and 3

Answer

1 and 3 only

Question 2

Which one of the following is NOT a sign of separation of placenta?

Accepted Answer

The fundal height reduces further

Answer

Apparent lengthening of the cord with slight gush of vaginal bleeding

Answer

Uterus becomes globular, firm and ballotable

Answer

Slight bulging in the suprapubic region

Question 3

Consider the following cardinal movements of mechanism of normal labor:

1. Engagement
2. Internal rotation
3. Flexion
4. Restitution
5. Crowning
6. External rotation

What is the correct sequence of movements in labor in occipito-lateral position?

Accepted Answer

1, 3, 2, 5, 4 and 6

Answer

3, 1, 2, 4, 6 and 5

Answer

1, 2, 3, 4, 5 and 6

Answer

2, 1, 3, 4, 5 and 6

Question 4

Visual inspection based screening test with 5 % acetic acid is used for the screening of which one of the following cancers?

Accepted Answer

Cervix cancer

Answer

Oral cancer

Answer

Lung cancer

Answer

Breast cancer

Question 5

Which one of the following IUDs is associated with a low pregnancy rate (0.2 per 100), less number of ectopic pregnancies and lower menstrual blood loss?

Accepted Answer

LNG-20 (Mirena)

Answer

Cu T-380A

Answer

ML-Cu 375

Answer

Progestasert

UPSC-CMS 2020 — Obstetrics and Gynecology