The clinical feature of physiological edema in pregnancy is:
The normal rate of dilatation of the cervix in a primigravida in the active phase of labor is
In the mechanism of normal labour the engaging transverse diameter is
In non-lactating mothers, after delivery, ovulation
Which of the following are the pre-requisites of outlet forceps delivery? 1. Bladder should be empty 2. Membranes should be intact 3. Cervix should be fully dilated 4. Fetal skull has reached level of pelvic floor
The vaginal pH in childbearing age normally ranges between
Primary Dysmenorrhoea can be treated by which of the following? 1. Antiprostaglandin 2. Cyclic combined estrogen and progesterone preparations 3. Pre-sacral neurectomy 4. Uterine curettage
Which of the following is correct regarding obesity and infertility?
Which one of the following is an abnormal parameter in accordance with WHO Semen Analysis Criteria (Normal reference value)?
Which one of the following is the most important haematological condition to be ruled out while investigating a case of puberty menorrhagia ?
UPSC-CMS 2021 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 11: The clinical feature of physiological edema in pregnancy is:
- A. is usually of moderate or severe grade
- B. is associated with cardiac or renal pathology
- C. is present on both lower limbs and abdomen
- D. disappears or markedly reduced on rest (Correct Answer)
Explanation: ***disappears or markedly reduced on rest*** - **Physiological edema** in pregnancy is typically mild and **dependent**, meaning it tends to accumulate in the lower extremities due to **gravity** and increased venous pressure. - When the pregnant individual rests, especially in an elevated position, the gravitational pressure on the lower limbs is reduced, allowing for the **redistribution of fluid** and a decrease in visible swelling. *is usually of moderate or severe grade* - **Physiological edema** is typically **mild** and localized to the ankles and feet. - **Moderate or severe edema**, especially if sudden in onset, generalized, or associated with other symptoms, might indicate a pathological condition like **preeclampsia** or **cardiac dysfunction**. *is associated with cardiac or renal pathology* - **Physiological edema** is a normal part of pregnancy, resulting from hormonal changes, increased blood volume, and uterine pressure, and is **not indicative** of underlying cardiac or renal disease. - Edema linked to **cardiac** or **renal pathology** would typically be more severe, generalized, and accompanied by other specific symptoms or laboratory abnormalities related to the respective organ systems. *is present on both lower limbs and abdomen* - **Physiological edema** predominantly affects the **lower limbs** (ankles, feet, sometimes hands and face) due to gravity and venous stasis, becoming more noticeable later in the day. - While some mild abdominal swelling can occur due to uterine growth, significant **abdominal wall edema** is not a characteristic feature of physiological edema and could suggest other causes.
Question 12: The normal rate of dilatation of the cervix in a primigravida in the active phase of labor is
- A. 1 cm/hour (Correct Answer)
- B. 0.25 cm/hour
- C. 0.75 cm/hour
- D. 0.5 cm/hour
Explanation: ***1 cm/hour*** - The **active phase** of labor in a **primigravida** (first-time mother) is characterized by a cervical dilatation rate of at least 1 cm per hour. - This rate signifies good progress and is often used as a benchmark on a **partogram** to monitor labor. *0.25 cm/hour* - This rate is significantly **slower** than normal for the active phase of labor in a primigravida and would indicate **abnormal labor progression**, possibly requiring intervention. - Such a slow rate might be seen in the **latent phase** or in cases of **protracted labor**. *0.75 cm/hour* - While closer, this rate is still **below the expected minimum** for a primigravida in the active phase, suggesting slightly slower than optimal progress. - It could still indicate a **protracted active phase**, particularly if it persists. *0.5 cm/hour* - This rate is **substantially slower** than the typical progress in the active phase of labor for a primigravida. - It would be a strong indicator of **failure to progress** and would likely warrant a thorough evaluation for potential causes such as **cephalopelvic disproportion** or ineffective uterine contractions.
Question 13: In the mechanism of normal labour the engaging transverse diameter is
- A. Bimastoid diameter (7.5 cm)
- B. Biparietal diameter (9.5 cm) (Correct Answer)
- C. Suboccipitofrontal diameter (10 cm)
- D. Suboccipitobregmatic diameter (9.5 cm)
Explanation: ***Biparietal diameter (9.5 cm)*** - In normal labor, with the fetus in a **flexed attitude**, the **biparietal diameter** is the widest transverse diameter of the fetal head that engages in the maternal pelvis. - This diameter measures approximately **9.5 cm** and indicates the distance between the two parietal eminences. *Bimastoid diameter (7.5 cm)* - The **bimastoid diameter** measures the widest transverse diameter at the base of the skull, going from one mastoid process to the other. - At **7.5 cm**, it is too small to be the primary engaging transverse diameter of the fetal head in normal labor, which involves the broader cranial vault. *Suboccipitofrontal diameter (10 cm)* - The **suboccipitofrontal diameter** is typically the engaging diameter when the fetal head is in a **deflexed attitude** (e.g., military presentation). - This diameter measures approximately **10 cm**, indicating moderate extension, which is not characteristic of normal labor where good flexion is expected. *Suboccipitobregmatic diameter (9.5 cm)* - The **suboccipitobregmatic diameter** is the smallest and most favorable anteroposterior diameter for engagement when the fetal head is **well-flexed**. - While it also measures **9.5 cm**, it is an **anteroposterior diameter**, not a transverse diameter, and hence not the answer to the question regarding transverse engaging diameter.
Question 14: In non-lactating mothers, after delivery, ovulation
- A. may occur as early as 4 weeks
- B. may occur as early as 2 weeks (Correct Answer)
- C. is unusual before 6 weeks
- D. may occur as early as 6 weeks
Explanation: ***may occur as early as 2 weeks*** - In non-lactating mothers, the **hypothalamic-pituitary-ovarian axis** recovers relatively quickly after delivery because it is not suppressed by prolactin. - The earliest documented return of ovulation can be as soon as **2 weeks postpartum**, although 4-6 weeks is more common. *may occur as early as 4 weeks* - While 4 weeks is a common timeframe for ovulation to resume in non-lactating mothers, it is not the **earliest possible occurrence**. - This option misses the possibility of an even earlier return of **fertility**. *is unusual before 6 weeks* - This statement is incorrect as ovulation can, and frequently does, occur **before 6 weeks postpartum** in non-lactating women. - Delaying ovulation until 6 weeks is more typical in breast-feeding women due to **prolactin's inhibitory effect** on gonadotropin-releasing hormone. *may occur as early as 6 weeks* - Similar to the 4-week option, while ovulation can occur at 6 weeks, it is not the **earliest possible time point** for a non-lactating mother. - Assuming 6 weeks as the earliest timeframe could lead to an underestimation of the **risk of conception**.
Question 15: Which of the following are the pre-requisites of outlet forceps delivery? 1. Bladder should be empty 2. Membranes should be intact 3. Cervix should be fully dilated 4. Fetal skull has reached level of pelvic floor
- A. 1, 2 and 4
- B. 1, 3 and 4 (Correct Answer)
- C. 1, 2 and 3
- D. 2, 3 and 4
Explanation: ***1, 3 and 4*** - For an **outlet forceps delivery**, the **bladder must be empty** to prevent trauma during instrumentation and to create more space in the pelvis. - A **fully dilated cervix** (10 cm) is an absolute prerequisite, ensuring that the fetal head can pass without causing cervical lacerations. The **fetal skull must have reached the pelvic floor**, indicating the head is at or beyond +2 station, and the sagittal suture is in the anteroposterior diameter. *1, 2 and 4* - While an **empty bladder** and the **fetal skull at the pelvic floor** are prerequisites, the **membranes should not be intact** for forceps delivery. - Intact membranes would require artificial rupture (amniotomy) before applying forceps to avoid membrane stripping or fetal injury. *1, 2 and 3* - An **empty bladder** and **fully dilated cervix** are essential, but **intact membranes** are not a prerequisite, as they must be ruptured for a safe forceps application. - The fetal head must also be at the **level of the pelvic floor**, which is missing from this option. *2, 3 and 4* - While a **fully dilated cervix** and the **fetal skull at the pelvic floor** are necessary, **intact membranes** are not desirable for forceps delivery, and an **empty bladder** is a crucial missing prerequisite. - Omitting the requirement for an **empty bladder** significantly increases the risk of maternal injury.
Question 16: The vaginal pH in childbearing age normally ranges between
- A. 1 - 2
- B. 7 - 8
- C. 2.5 - 3.5
- D. 4 - 5.5 (Correct Answer)
Explanation: ***4 - 5.5*** - A vaginal pH within the range of **4.0 to 5.5** is considered normal for women of childbearing age, indicating a healthy acidic environment. - This acidic pH is maintained primarily by **Lactobacillus species** bacteria, which produce lactic acid, protecting against pathogenic bacteria. *1 - 2* - A pH range of 1-2 is **extremely acidic** and would be highly corrosive, far outside the physiological range for the vagina. - This level of acidity is typically found in the **stomach**, not the vagina. *7 - 8* - A pH range of 7-8 is considered **alkaline** and suggests an imbalance in the vaginal flora, potentially leading to infections such as **bacterial vaginosis**. - A neutral to alkaline pH is harmful to the normal vaginal microbiota and can promote the growth of opportunistic pathogens. *2.5 - 3.5* - While acidic, a pH of 2.5-3.5 is generally **too low** for a healthy vagina in most women of childbearing age, as the normal range typically starts closer to 4.0. - Although the vagina is acidic, this range is at the **extreme lower end** and might indicate an altered microenvironment.
Question 17: Primary Dysmenorrhoea can be treated by which of the following? 1. Antiprostaglandin 2. Cyclic combined estrogen and progesterone preparations 3. Pre-sacral neurectomy 4. Uterine curettage
- A. 1, 2, 3 and 4
- B. 1, 2 and 4
- C. 2, 3 and 4
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - **Antiprostaglandins (NSAIDs)** are the first-line treatment for primary dysmenorrhea as they inhibit prostaglandin synthesis, reducing uterine contractions and pain. - **Cyclic combined estrogen and progesterone preparations (oral contraceptives)** are second-line therapy that suppress ovulation, leading to a thinner endometrium and reduced prostaglandin production, thereby alleviating dysmenorrhea. - **Pre-sacral neurectomy** is a surgical procedure that may be considered for severe, refractory primary dysmenorrhea that has failed medical management, though it is more commonly used for secondary dysmenorrhea and chronic pelvic pain. *1, 2, 3 and 4* - This option incorrectly includes **uterine curettage**, which is not a treatment for primary dysmenorrhea. - Uterine curettage is a diagnostic or therapeutic procedure for conditions like abnormal uterine bleeding or retained products of conception, not for menstrual pain management. *1, 2 and 4* - This option incorrectly includes **uterine curettage** while excluding pre-sacral neurectomy. - Curettage has no role in primary dysmenorrhea treatment, whereas the other interventions target the underlying pathophysiology. *2, 3 and 4* - This option incorrectly excludes **antiprostaglandins (NSAIDs)**, which are the cornerstone first-line therapy for primary dysmenorrhea. - It also incorrectly includes uterine curettage, which has no role in dysmenorrhea management.
Question 18: Which of the following is correct regarding obesity and infertility?
- A. It is always associated with endometrial atrophy
- B. It is associated with hypergonadotropic hypogonadism
- C. There is no change in HPO axis
- D. It is associated with hypogonadotropic hypogonadism (Correct Answer)
Explanation: ***It is associated with hypogonadotropic hypogonadism*** - **Obesity-related infertility** in men often leads to **decreased testosterone** levels and **impaired spermatogenesis**, driven by altered adipose tissue function affecting the **hypothalamic-pituitary-gonadal (HPG) axis**. - Adipose tissue in obese individuals produces more **estrogen** and **inflammatory cytokines**, which can suppress **gonadotropin-releasing hormone (GnRH)**, leading to reduced LH and FSH levels from the pituitary and subsequently lower testosterone production by the testes. *It is always associated with endometrial atrophy* - While obesity can affect endometrial health, it is more commonly associated with **endometrial hyperplasia** due to increased **estrogen production** from peripheral fat, leading to unopposed estrogen stimulation. - **Endometrial atrophy** is typically seen in states of severe chronic estrogen deficiency, such as post-menopause or severe hypogonadism not directly related to obese states. *It is associated with hypergonadotropic hypogonadism* - **Hypergonadotropic hypogonadism** is characterized by low testosterone (or estrogen) with **elevated LH and FSH levels**, indicating primary gonadal failure (e.g., testicular failure or ovarian failure) where the pituitary is overproducing gonadotropins in an attempt to stimulate the failing gonads. - In obesity, the issue is often at the level of the hypothalamus or pituitary (central), leading to **reduced** rather than elevated gonadotropins. *There is no change in HPO axis* - Obesity significantly impacts the **hypothalamic-pituitary-ovarian (HPO)** axis in women and the **hypothalamic-pituitary-testicular (HPT)** axis in men. - Alterations include increased **leptin** and **insulin resistance**, leading to changes in **GnRH pulsatility**, which disrupts LH and FSH secretion and subsequent gonadal steroid production, thereby affecting fertility.
Question 19: Which one of the following is an abnormal parameter in accordance with WHO Semen Analysis Criteria (Normal reference value)?
- A. Normal morphology of sperms > 14%
- B. Volume < 1.0 ml (Correct Answer)
- C. Progressive forward motility of sperms > 50%
- D. Sperm concentration < 10 million/ml
Explanation: ***Volume < 1.0 ml*** - According to WHO 2010 criteria (5th edition), normal semen volume should be **≥ 1.5 ml** - A volume of **< 1.0 ml is significantly abnormal** and is termed **hypospermia** - This value falls well below the normal reference range and represents a clear abnormality *Normal morphology of sperms > 14%* - WHO criteria state that **≥ 4% of sperms should have normal morphology** (strict criteria) - A morphology of >14% is **well within the normal range** (more than 3 times the threshold) - This represents a normal finding, not an abnormality *Progressive forward motility of sperms > 50%* - WHO guidelines indicate that **progressive motility (PR) should be ≥ 32%** - Progressive forward motility of >50% is **significantly above the threshold** - This indicates excellent sperm motility and is a normal finding *Sperm concentration < 10 million/ml* - Normal reference value for sperm concentration is **≥ 15 million/ml** - While <10 million/ml would be considered abnormal (**oligozoospermia**), the question asks for "an abnormal parameter" - **Volume < 1.0 ml is the best answer** as it represents a more significant deviation from normal values (1.0 vs 1.5 ml threshold) compared to other parameters
Question 20: Which one of the following is the most important haematological condition to be ruled out while investigating a case of puberty menorrhagia ?
- A. Leukemia
- B. G-6PD deficiency
- C. Coagulation disorder (Correct Answer)
- D. Anaemia
Explanation: ***Coagulation disorder*** - Puberty menorrhagia (excessive menstrual bleeding at puberty) is frequently linked to underlying **hemostatic dysfunction**, with **Von Willebrand Disease** being the most common cause. - A coagulation disorder can lead to **uncontrolled bleeding** during menstruation, necessitating thorough investigation to prevent severe blood loss and complications. *Leukemia* - While leukemia can cause **easy bruising** and **bleeding tendencies** due to thrombocytopenia or impaired platelet function, it is less common as the primary cause of isolated menorrhagia in puberty. - Leukemia would typically present with a broader range of symptoms, including systemic signs like **fatigue**, **fever**, and **lymphadenopathy**. *G-6PD deficiency* - G-6PD deficiency is primarily a cause of **hemolytic anemia**, triggered by certain drugs or foods, leading to red blood cell breakdown. - It does not directly cause prolonged or heavy menstrual bleeding (menorrhagia) as a primary symptom. *Anaemia* - Anaemia is often a **consequence** of heavy menstrual bleeding (menorrhagia) rather than its direct cause. - While iron deficiency anemia is common in young women with menorrhagia, addressing the underlying cause of the bleeding is crucial, which might be a coagulation disorder.