UPSC-CMS 2021 — Obstetrics and Gynecology
32 Previous Year Questions with Answers & Explanations
A 43 year old woman presented with serous discharge from a single duct of the nipple of her right breast which was sent for evaluation. She is unlikely to be suffering from
Ideal weight gain during pregnancy for a woman with normal BMI should be
Blood volume increases during pregnancy above nonpregnant level at 30-34 weeks by:
Which of the following are contra-indications to external cephalic version in antenatal management of breech presentation? 1. Antepartum haemorrhage 2. Multiple pregnancy 3. Reactive Non Stress Test 4. Severe oligohydramnios
Antepartum haemorrhage is defined as bleeding from genital tract occurring:
Which one of the following is NOT a risk factor for pre-eclampsia ?
What are Spiegelberg's criteria for diagnosis of ovarian pregnancy? 1. Tube on the affected side must be intact 2. Gestational sac must be in the position of ovary 3. Ovary is connected to uterus by utero-ovarian ligament 4. Ovarian tissue must be detected on the wall on histological examination
Which one of the following statements regarding fetal well being is NOT correct?
Which of the following statements are correct with respect to antenatal USG examination? 1. It helps in detecting gross fetal anomalies 2. It helps in identifying multiple pregnancies 3. It helps in identifying viable pregnancy 4. Best dating is possible with third trimester ultrasound scan
During pregnancy iron supplementation is needed for
UPSC-CMS 2021 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 1: A 43 year old woman presented with serous discharge from a single duct of the nipple of her right breast which was sent for evaluation. She is unlikely to be suffering from
- A. Intraductal Papilloma
- B. Fibrocystic disease (Correct Answer)
- C. Carcinoma
- D. Duct Ectasia
Explanation: ***Fibrocystic disease*** - **Fibrocystic changes** usually present with **lumpy breasts**, pain, and sometimes **multiple** duct nipple discharge, which can be clear or milky. - A **single duct serous discharge** is not a typical presentation, making it less likely given the details. *Intraductal Papilloma* - **Intraductal papilloma** is the **most common cause** of **serous or bloody nipple discharge** from a **single duct**. - This benign tumor grows within the milk ducts and is a frequent finding with the described symptoms. *Carcinoma* - **Ductal carcinoma in situ (DCIS)** or **invasive ductal carcinoma** can present with **unilateral, bloody or serous nipple discharge** from a **single duct**. - The type of discharge and its unilateral, single-duct nature are concerning features that warrant malignancy exclusion. *Duct Ectasia* - **Duct ectasia** can cause nipple discharge which is often **thick, sticky, and multicolored** (green, black, or brown), and may be associated with **nipple inversion**. - While it can be from a single duct, the discharge is typically **not serous** and is more characteristic of a **dilated or inflamed duct**.
Question 2: Ideal weight gain during pregnancy for a woman with normal BMI should be
- A. 11-16 kg (Correct Answer)
- B. More than 18 kg
- C. 7 kg
- D. 18 kg
Explanation: ***11-16 kg*** - For a woman with a **normal Body Mass Index (BMI)** (18.5-24.9), the recommended total weight gain during pregnancy is **11.5 to 16 kg (25 to 35 lbs)**. - This range supports optimal fetal growth and maternal health, reducing risks associated with both inadequate and excessive weight gain. *More than 18 kg* - Gaining more than **18 kg (40 lbs)** during pregnancy, especially for women with a normal BMI, is generally considered **excessive**. - This can increase the risk of complications such as **gestational diabetes**, **hypertension**, **macrosomia**, and **cesarean delivery**. *7 kg* - A total weight gain of only **7 kg (15 lbs)** for a woman with a normal BMI during pregnancy is typically considered **insufficient**. - Inadequate weight gain can lead to a higher risk of delivering a **low birth weight infant** or one who is **small for gestational age**. *18 kg* - A weight gain of **18 kg (approximately 40 lbs)** **exceeds the recommended range** for women with a normal BMI (11.5-16 kg). - This represents the **upper limit** of recommended weight gain for **underweight women** (BMI <18.5), whose target range is 12.5-18 kg (28-40 lbs). - For normal BMI women, 18 kg is considered **excessive** and may increase risks of maternal and fetal complications.
Question 3: Blood volume increases during pregnancy above nonpregnant level at 30-34 weeks by:
- A. Blood volume does not increase at all
- B. by 25-30 per cent
- C. by 40-50 per cent (Correct Answer)
- D. by 10-20 per cent
Explanation: ***by 40-50 per cent*** - During pregnancy, **blood volume significantly increases**, primarily due to hormonal changes, to support the growing fetus and uteroplacental unit, with the peak increase typically occurring around the third trimester. - This expansion involves both **plasma volume (greater increase)** and **red blood cell mass**, leading to a state of physiologic hemodilution. *Blood volume does not increase at all* - This statement is incorrect as a substantial **increase in blood volume is a hallmark of normal pregnancy physiology** to meet increased metabolic demands. - Failure of blood volume to increase would imply a pathologic state, potentially compromising both maternal and fetal well-being. *by 25-30 per cent* - While a significant increase, **25-30% is generally an underestimation** of the full extent of blood volume expansion that occurs in a healthy pregnancy. - The total increase often reaches higher values, particularly when considering the combined rise in plasma and red blood cells. *by 10-20 per cent* - An increase of **10-20% is considerably less** than what is typically observed during a normal pregnancy. - This level of increase would likely be insufficient to adequately support the physiological demands of the mother and fetus.
Question 4: Which of the following are contra-indications to external cephalic version in antenatal management of breech presentation? 1. Antepartum haemorrhage 2. Multiple pregnancy 3. Reactive Non Stress Test 4. Severe oligohydramnios
- A. 1, 2 and 4 (Correct Answer)
- B. 2, 3 and 4
- C. 1, 2, 3 and 4
- D. 1, 2 and 3
Explanation: ***1, 2 and 4*** * **Antepartum haemorrhage**, **multiple pregnancy**, and **severe oligohydramnios** are all contraindications to external cephalic version (ECV) due to increased risks of fetal distress, placental abruption, and uterine rupture. * These conditions either compromise fetal well-being directly or make the procedure significantly more dangerous for both mother and fetus. *2, 3 and 4* * This option incorrectly includes a **reactive non-stress test** as a contraindication, which actually indicates fetal well-being and is a prerequisite for ECV. * Excluding **antepartum haemorrhage** as a contraindication is also incorrect, as it poses a significant risk. *1, 2, 3 and 4* * This option is incorrect because a **reactive non-stress test** is a sign of fetal health and is a requirement *before* performing an ECV, not a contraindication. * Including it diminishes the specificity of contraindications for this procedure. *1, 2 and 3* * This option erroneously lists a **reactive non-stress test** as a contraindication, when in reality, it's a reassuring finding critical for proceeding with ECV. * It also omits **severe oligohydramnios** which is a significant contraindication due to the inability to safely manipulate the fetus.
Question 5: Antepartum haemorrhage is defined as bleeding from genital tract occurring:
- A. Before 20 weeks of pregnancy
- B. After 28 weeks of pregnancy (Correct Answer)
- C. Before 24 weeks of pregnancy
- D. After 34 weeks of pregnancy
Explanation: ***After 28 weeks of pregnancy*** - **Antepartum hemorrhage (APH)** is defined as any bleeding from the genital tract occurring from **28 weeks of gestation** until the onset of labour. - This definition helps differentiate it from bleeding in earlier pregnancy, which is typically classified as **threatened abortion**, **miscarriage**, or other early pregnancy complications. *Before 20 weeks of pregnancy* - Bleeding occurring before 20 weeks of pregnancy is generally referred to as **threatened abortion**, **inevitable abortion**, **incomplete abortion**, or **complete abortion**. - These conditions are distinct from antepartum hemorrhage, which pertains to later stages of pregnancy. *Before 24 weeks of pregnancy* - Similar to before 20 weeks, bleeding before 24 weeks would fall under categories related to **early pregnancy loss or complications**, not antepartum hemorrhage. - The viability of the fetus is often still a critical factor in this gestational range, and management differs. *After 34 weeks of pregnancy* - While bleeding after 34 weeks is a form of antepartum hemorrhage, the definition of APH encompasses any bleeding **from 28 weeks onwards**, making "After 28 weeks of pregnancy" the most accurate and comprehensive definition. - Specifying "after 34 weeks" is too narrow and excludes bleeding events that occur between 28 and 34 weeks which are still considered APH.
Question 6: Which one of the following is NOT a risk factor for pre-eclampsia ?
- A. Pre-existing vascular disease
- B. Placenta previa (Correct Answer)
- C. Obesity
- D. Primigravida
Explanation: ***Placenta previa*** - **Placenta previa** is a condition where the placenta partially or totally covers the mother's cervix, causing **vaginal bleeding** during pregnancy, but it is **not linked to the development of pre-eclampsia**. - It is a placental implantation abnormality characterized by abnormal location, not a risk factor for the systemic vascular and endothelial dysfunction characteristic of pre-eclampsia. - The pathophysiology involves placental position, not the defective placentation or spiral artery remodeling seen in pre-eclampsia. *Pre-existing vascular disease* - Conditions like **chronic hypertension**, **diabetes mellitus**, and **chronic kidney disease** are well-established risk factors for pre-eclampsia. - These diseases impair endothelial function and increase the likelihood of the systemic inflammatory response and vasospasm seen in pre-eclampsia. - Pre-existing vascular dysfunction predisposes to inadequate placental perfusion and abnormal trophoblast invasion. *Obesity* - **Obesity** (BMI ≥30 kg/m²) is a significant risk factor for pre-eclampsia due to its association with **insulin resistance**, chronic inflammation, and endothelial dysfunction. - Maternal obesity leads to heightened oxidative stress, increased inflammatory cytokines, and impaired angiogenesis, contributing to defective placentation. - The risk increases proportionally with increasing BMI. *Primigravida* - Being a **primigravida** (first pregnancy) is an established risk factor for pre-eclampsia, with primiparous women having 2-3 times higher incidence compared to multiparous women. - This is thought to be due to initial exposure to paternal antigens and less robust maternal immune tolerance to placental antigens. - The risk decreases significantly in subsequent pregnancies with the same partner.
Question 7: What are Spiegelberg's criteria for diagnosis of ovarian pregnancy? 1. Tube on the affected side must be intact 2. Gestational sac must be in the position of ovary 3. Ovary is connected to uterus by utero-ovarian ligament 4. Ovarian tissue must be detected on the wall on histological examination
- A. 1, 2 and 3 only
- B. 1, 2, 3 and 4 (Correct Answer)
- C. 2, 3 and 4 only
- D. 1 and 4 only
Explanation: ***1, 2, 3 and 4*** * **Spiegelberg's criteria** are the established diagnostic criteria for **ovarian pregnancy**, first described in 1878. * All four criteria must be met for diagnosis: **(1) intact fallopian tube** on the affected side (rules out tubal pregnancy), **(2) gestational sac must occupy the position of the ovary**, **(3) the ovary must be connected to the uterus by the utero-ovarian ligament** (confirms normal anatomical position), and **(4) ovarian tissue must be histologically identified in the wall of the gestational sac** (definitive confirmation). * The **histological confirmation** of ovarian tissue is essential for definitive diagnosis and distinguishes it from other ectopic pregnancies. *1, 2 and 3 only* * While these three criteria establish the anatomical location and rule out tubal pregnancy, **histological confirmation** of ovarian tissue within the gestational sac wall (criterion 4) is essential for definitive diagnosis. * Without histological proof, other extrauterine pregnancies (such as advanced tubal pregnancies involving the ovary secondarily) could mimic the clinical and imaging features. *2, 3 and 4 only* * The **intact ipsilateral fallopian tube** (criterion 1) is critical for differentiating primary ovarian pregnancy from tubal pregnancy with secondary ovarian involvement. * Without confirming tube integrity, a tubal ectopic that has eroded into or adhered to ovarian tissue cannot be definitively excluded. *1 and 4 only* * These two criteria alone are insufficient; the gestational sac must be demonstrably located in the position of the ovary (criterion 2) and the ovary must maintain its normal anatomical connection to the uterus (criterion 3). * Missing the specific ovarian location and anatomical confirmation would lead to incomplete diagnosis and potential confusion with other forms of ectopic pregnancy.
Question 8: Which one of the following statements regarding fetal well being is NOT correct?
- A. Mothers perceive 88% of fetal movements
- B. Daily fetal movement count is a simple reliable method of fetal well being
- C. Modified Biophysical profile includes Non-stress test and fetal breathing (Correct Answer)
- D. Healthy fetus should have minimum of 10 movements in 12 hours period
Explanation: ***Modified Biophysical profile includes Non-stress test and fetal breathing*** - This statement is incorrect because the **modified biophysical profile (mBPP)** consists of a **Non-stress test (NST)** and an **assessment of amniotic fluid volume (AFV)**, typically measured by the deepest vertical pocket or amniotic fluid index. - Fetal breathing movements are one of the parameters assessed in the full **biophysical profile (BPP)**, but not in the modified version. *Mothers perceive 88% of fetal movements* - This statement is generally considered **correct**. Studies indicate that pregnant individuals are highly sensitive to fetal movements, perceiving a significant majority of them. - This high perception rate makes **fetal movement counting** a valuable tool for monitoring fetal well-being at home. *Daily fetal movement count is a simple reliable method of fetal well being* - This statement is correct. **Daily fetal movement counting (DFMC)**, often referred to as "kick counts," is a simple, non-invasive method for expectant parents to monitor fetal health. - A consistent pattern of fetal movements is a good indicator of **fetal well-being**, and a significant decrease can signal potential problems. *Healthy fetus should have minimum of 10 movements in 12 hours period* - This statement is a common guideline for **fetal movement counting**. Many protocols suggest that a healthy fetus should demonstrate at least **10 distinct movements within a 12-hour period**. - While guidelines can vary (e.g., 6 movements in 2 hours), this particular threshold is widely accepted as an indicator of fetal health.
Question 9: Which of the following statements are correct with respect to antenatal USG examination? 1. It helps in detecting gross fetal anomalies 2. It helps in identifying multiple pregnancies 3. It helps in identifying viable pregnancy 4. Best dating is possible with third trimester ultrasound scan
- A. 3 and 4 only
- B. 1, 2 and 3 only (Correct Answer)
- C. 1 and 2 only
- D. 1, 2, 3 and 4
Explanation: ***Correct: 1, 2 and 3 only*** - Antenatal ultrasound is crucial for detecting **gross fetal anomalies** (e.g., anencephaly, spina bifida, cardiac defects), identifying the presence of **multiple pregnancies** (twins, triplets), and confirming the **viability of the pregnancy** by observing fetal cardiac activity. - Statement 4 is **incorrect** because the best dating is achieved with **first trimester ultrasound** (crown-rump length between 8-13 weeks), not third trimester, as there is less biological variation in fetal size early in gestation. - Third trimester biometry becomes less reliable for dating due to individual growth variations. *Incorrect: 3 and 4 only* - While antenatal ultrasound does help in identifying viable pregnancies (statement 3), **statement 4 is false** - best dating is NOT possible with third-trimester ultrasound scan. - This option also incorrectly omits statements 1 and 2, which are important and correct functions of antenatal ultrasound. - The earliest ultrasound scan in the first trimester provides the most accurate dating (±5-7 days accuracy). *Incorrect: 1 and 2 only* - Antenatal ultrasound indeed helps in detecting **gross fetal anomalies** and **identifying multiple pregnancies** (statements 1 and 2 are correct). - However, this option is **incomplete** as it misses the equally important role of ultrasound in **identifying viable pregnancy** (statement 3). - Assessing viability by checking for fetal heartbeat is one of the primary reasons for early pregnancy ultrasound. *Incorrect: 1, 2, 3 and 4* - Statements 1, 2, and 3 are correct, as antenatal ultrasound is vital for detecting **gross fetal anomalies**, identifying **multiple pregnancies**, and confirming **viable pregnancy**. - However, **statement 4 is incorrect** because the third trimester is not the best time for dating a pregnancy, as fetal biometry becomes less reliable due to individual growth variations. - The most accurate dating is typically achieved in the **first trimester** (CRL measurement at 8-13 weeks gives ±5-7 days accuracy), not the third trimester.
Question 10: During pregnancy iron supplementation is needed for
- A. all pregnant mothers since 6 weeks of pregnancy
- B. only those pregnant mothers who have Hb < 10 gm%
- C. all pregnant mothers from 16 weeks onwards (Correct Answer)
- D. only those pregnant mothers who are not eating green vegetables
Explanation: ***all pregnant mothers from 16 weeks onwards*** - **Physiological anemia** of pregnancy typically manifests around the **second trimester**, necessitating prophylactic iron supplementation. - Starting at **16 weeks** ensures adequate iron stores before the greatest increase in maternal red cell mass and fetal iron demands. *all pregnant mothers since 6 weeks of pregnancy* - Iron requirements do not significantly increase until the **second trimester**, so starting supplementation at **6 weeks** is unnecessarily early for most women. - Early supplementation can lead to side effects like **nausea and constipation** in the first trimester, potentially reducing compliance. *only those pregnant mothers who have Hb < 10 gm%* - Waiting until **hemoglobin levels drop below 10 gm/dL** indicates **established anemia**, which should ideally be prevented. - **Prophylactic supplementation** is recommended for all pregnant women to prevent iron deficiency before it becomes clinically apparent. *only those pregnant mothers who are not eating green vegetables* - While green vegetables are a source of **non-heme iron**, the bioavailability is lower than heme iron, and adequate intake is often insufficient to meet the significantly increased demands of pregnancy. - Dietary intake alone is often **not enough to prevent iron deficiency** in pregnancy, regardless of vegetable consumption patterns.