UPSC-CMS 2021 - Obstetrics and Gynecology Practice Questions

Q: Which of the following are risk factors for developing pelvic inflammatory disease in females? 1. Use of oral contraception pills 2. Multiple sexual partners 3. Lower socioeconomic status 4. Genetic predisposition

1, 2 and 3. ***1, 2 and 3*** - **Multiple sexual partners** is a well-established major risk factor for PID as it significantly increases exposure to sexually transmitted infections (STIs), particularly *Chlamydia trachomatis* and *Neisseria gonorrhoeae*, which are the primary causative organisms of PID. - **Lower socioeconomic status** is associated with increased PID risk due to reduced access to healthcare services, delayed diagnosis and treatment of STIs, and barriers to preventive care. - **Use of oral contraception pills** has a controversial relationship with PID. While OCPs do not prevent STIs and may be associated with behavioral factors (reduced condom use), the direct relationship remains debated. Some evidence suggests OCPs may actually provide modest protection against ascending infection by thickening cervical mucus. However, this option represents the best available answer among the choices given. *1, 2 and 4* - This incorrectly includes **genetic predisposition**, which is not an established risk factor for PID. PID is primarily an infectious disease driven by behavioral and socioeconomic factors, not genetic susceptibility. *2, 3 and 4* - This incorrectly includes **genetic predisposition** as a risk factor for PID, which lacks evidence-based support. - It also excludes oral contraception pills, making this option incomplete even considering the controversial role of OCPs. *1, 3 and 4* - This incorrectly includes **genetic predisposition** and critically excludes **multiple sexual partners**, which is the most significant and well-established behavioral risk factor for PID. - Missing this key risk factor makes this option clearly incorrect.

Q: A 65 year old postmenopausal lady presents in Gynaecology OPD with abdominal distension and weight loss. On investigation she was diagnosed to have an ovarian tumour. The most common type of ovarian tumour in this woman would be

Epithelial tumor. ***Epithelial tumor*** - **Epithelial ovarian tumors** are the most common type of ovarian cancer, accounting for about **90%** of all cases. - Their incidence significantly increases with age, particularly in **postmenopausal women**, making them the most likely diagnosis in a 65-year-old presenting with abdominal distension and weight loss. *Sex cord tumor* - **Sex cord-stromal tumors** are rare, comprising about **5-8%** of ovarian neoplasms. - While they can occur at any age, they are less common than epithelial tumors and often present with **hormonal symptoms** due to their steroidogenic capacity. *Germ cell tumor* - **Germ cell tumors** are also rare, primarily affecting **younger women and adolescents**, typically under 30 years old. - They tend to grow rapidly and can present with acute symptoms like sudden onset abdominal pain, which is less characteristic for a 65-year-old postmenopausal woman. *Trophoblastic tumor* - **Trophoblastic tumors** (specifically **gestational trophoblastic disease**) are primarily related to pregnancy and occur when there is abnormal proliferation of trophoblastic tissue, such as in a **hydatidiform mole** or **choriocarcinoma**. - These are extremely rare in a postmenopausal woman without a recent pregnancy history and are not considered ovarian tumors in the traditional sense.

Q: Which of the following are the characteristic features of Meigs' syndrome in a female? 1. Right sided hydrothorax 2. Ascites 3. Genital warts 4. Ovarian fibroma

1, 2 and 4. **1, 2 and 4** - **Meigs' syndrome** is defined by the triad of an **ovarian fibroma** (or other benign ovarian tumor), **ascites**, and **right-sided hydrothorax**. - All three components must be present for a clinical diagnosis of Meigs' syndrome. *1, 3 and 4* - While **right-sided hydrothorax** and an **ovarian fibroma** are components of Meigs' syndrome, **genital warts** are not. - **Genital warts** are caused by Human Papillomavirus (HPV) and are not associated with this syndrome. *2, 3 and 4* - **Ascites** and an **ovarian fibroma** are correctly identified as features, but **genital warts** are not part of Meigs' syndrome. - The syndrome specifically requires the presence of a **pleural effusion (hydrothorax)**, typically on the right side. *1, 2, 3 and 4* - This option mistakenly includes **genital warts**, which are not a feature of Meigs' syndrome. - The core diagnostic criteria are limited to the ovarian tumor, ascites, and hydrothorax.

Q: A 25-year-old woman presents to the Gynaecology OPD with complaints of abdominal pain and heavy menstrual bleeding. On examination, there is a mass arising from the hypogastrium corresponding to 16 weeks gravid uterus. Her urine pregnancy test is negative. The most likely diagnosis is

Uterine fibroid. ***Uterine fibroid*** - The combination of **heavy menstrual bleeding (menorrhagia)**, **abdominal pain**, and a **palpable mass in the hypogastrium** corresponding to a 16-week gravid uterus in a young woman with a **negative pregnancy test** is classic for uterine fibroid. - Fibroids (leiomyomas) are **benign smooth muscle tumors** of the uterus that can grow to significant size, causing **bulk-related symptoms** and **abnormal uterine bleeding**. - This represents a **large symptomatic fibroid** with the classic triad: menorrhagia, pelvic mass, and pelvic pressure/pain. *Endometriosis* - While endometriosis can cause **cyclical pelvic pain** and **dysmenorrhea**, it typically does not present as a large, palpable mass mimicking a 16-week gravid uterus. - Endometriomas (chocolate cysts) can form masses but are usually **adnexal** rather than central, and menorrhagia is not the primary symptom. *Ovarian tumour* - An ovarian tumor could present with an **abdominal mass** and **pain**, but heavy menstrual bleeding is not a typical feature unless it's a **hormonally active tumor** (rare). - The description of the mass specifically corresponding to a "**gravid uterus**" suggests a **uterine origin** rather than an adnexal mass. - Ovarian masses are typically felt **laterally** or can be more mobile. *Pelvic inflammatory disease* - PID commonly causes **acute pelvic pain**, **fever**, **vaginal discharge**, and **cervical motion tenderness**, but does not typically manifest as a large, smooth, palpable mass arising from the hypogastrium. - Tubo-ovarian abscesses can form masses but are usually **tender**, **irregular**, and associated with **systemic signs of infection**.

Q: A 39 year old nulliparous female has presented to Gynaecology OPD with complaint of post-coital bleeding for past six months. The first investigation to be offered to this female will be

Pap smear. ***Pap smear*** - **Post-coital bleeding** is a classic symptom of **cervical pathology**, including **cervical cancer**, which a Pap smear is designed to detect. - As a **screening tool**, a Pap smear is the appropriate initial investigation to broadly assess for abnormal cervical cells. *Hysteroscopy* - Hysteroscopy is an invasive procedure primarily used to visualize the **uterine cavity** and would be considered if concerns about intrauterine pathology arise after initial screening. - It's not the first-line investigation for post-coital bleeding, which typically points to a **cervical or vaginal source**. *Ultrasound* - **Pelvic ultrasound** is useful for evaluating uterine, ovarian, and adnexal pathologies but is less effective for directly visualizing the **cervical surface** where post-coital bleeding often originates. - It would be considered if there are other symptoms suggesting uterine or ovarian issues that aren't typically associated with post-coital bleeding alone. *Endometrial biopsy* - An **endometrial biopsy** is indicated for investigating **abnormal uterine bleeding** originating from the endometrium, such as in cases of suspected **endometrial hyperplasia** or cancer. - Post-coital bleeding is generally not an indication for an initial endometrial biopsy unless other findings suggest an endometrial origin.

Q: Which of the following are indications of vaginal examinations during labour? 1. To stretch the vagina intermittently 2. At the onset of labour 3. To monitor progress of labour 4. Following rupture of membranes

2, 3 and 4. ***2, 3 and 4*** * Regular vaginal examinations are crucial for **monitoring the progress of labour**, assessing cervical dilation, effacement, and fetal station. * Examinations at the **onset of labour** establish a baseline for progress, and after **rupture of membranes**, they are important to check for **cord prolapse** and confirm fetal presentation. * *1, 3 and 4* * **Stretching the vagina intermittently** is not a standard indication for vaginal examination in labour. Labour progress is assessed, not physically hastened by stretching. * While monitoring progress and examining after membrane rupture are correct indications, the inclusion of "stretching the vagina" makes this option incorrect. * *1, 2 and 4* * Similar to the previous option, including **stretching the vagina intermittently** as an indication is incorrect. * Vaginal examinations are for assessment, not for mechanically dilating the vagina. * *1, 2 and 3* * This option again incorrectly includes **stretching the vagina intermittently** as an indication. * While examinations at the onset and for monitoring progress are valid, the presence of an incorrect indication makes the entire option invalid.

Q: Which of the following are the clinical features of septic abortion? 1. Persistent tachycardia ≥ 90 bpm 2. Impaired mental status 3. Hypothermia

1, 2 and 3. ***1, 2 and 3*** - **Septic abortion** is a severe infection following an abortion, often presenting with systemic inflammatory response syndrome (SIRS) criteria. - Clinical features such as **persistent tachycardia** (heart rate ≥ 90 bpm), **impaired mental status**, and even **hypothermia** (or fever) are indicators of severe infection and sepsis. *1 and 3 only* - While **persistent tachycardia** and **hypothermia** are indeed clinical features of septic abortion, this option is incomplete as it excludes **impaired mental status**. - **Impaired mental status** is a crucial sign of systemic compromise and organ dysfunction in sepsis. *2 and 3 only* - This option incorrectly omits **persistent tachycardia**, which is a common and important sign of systemic infection and fever in septic abortion. - **Tachycardia** is part of the objective criteria for recognizing sepsis and SIRS. *1 and 2 only* - This option is incomplete as it misses **hypothermia**, which can occur in severe sepsis, particularly in immunocompromised patients or those with severe bloodstream infections. - **Hypothermia** indicates a dysregulated host response to infection, just as fever does.

Q: Which one of the following statements regarding Rh isoimmunization is correct? 1. Liley's chart identifies anemia better than middle cerebral artery Doppler 2. Indirect Coombs test is positive in mother 3. Baby is at risk of developing anemia 4. Direct Coombs test is positive in baby

2, 3 and 4. ***2, 3 and 4 are correct*** - The **indirect Coombs test** identifies **anti-Rh antibodies** in the mother's serum, indicating she has been sensitized to Rh antigens. - The baby is at risk of developing **hemolytic anemia** due to transplacental passage of maternal anti-Rh antibodies, which destroy fetal red blood cells. - The **direct Coombs test** detects **anti-Rh antibodies** coating the baby's red blood cells, confirming immune-mediated hemolysis in the neonate. *1, 2 and 4* - **Middle cerebral artery (MCA) Doppler** is the preferred non-invasive method for detecting **fetal anemia** because it directly assesses blood flow velocity, which increases with anemia. - While Liley's chart was historically used to assess amniotic fluid bilirubin levels (a breakdown product of hemolysis), **MCA Doppler** is now considered more accurate and less invasive for identifying fetal anemia. *1, 3 and 4* - **Liley's chart** analyzes the **bilirubin levels** in amniotic fluid, which is an indirect indicator of hemolysis and fetal anemia. However, **MCA Doppler** is a more direct and accurate method for assessing fetal anemia. - The indirect Coombs test on the mother is a crucial diagnostic step in Rh isoimmunization, identifying the presence of **maternal antibodies**. *1, 2 and 3* - The **direct Coombs test** on the baby is essential for confirming **hemolytic disease of the newborn**, as it detects antibodies bound to the infant's red blood cells. - **Liley's chart** is less accurate than **MCA Doppler** for assessing fetal anemia, as Doppler measurements provide a real-time assessment of fetal blood flow.

Q: Consider the following statements : Statement-1 : In fetal growth restriction there is always oligohydramnios Statement-2 : In fetal growth restriction there is placental insufficiency leading to redistribution of blood flow to fetal brain shunting it from fetal kidney Which one of the following is correct in respect of the above statements ?

Statement-2 is true but Statement-1 is false. ***Statement-2 is true but Statement-1 is false*** **Statement-1 Analysis**: "In fetal growth restriction there is always oligohydramnios" - This statement is **FALSE** due to the absolute term "always" - Oligohydramnios is a **common** but not universal finding in FGR - It occurs more frequently in asymmetric FGR and severe cases with significant placental insufficiency - Early or mild FGR may present with normal amniotic fluid volume - Other types of FGR (symmetric FGR) may not be associated with oligohydramnios **Statement-2 Analysis**: "In fetal growth restriction there is placental insufficiency leading to redistribution of blood flow to fetal brain shunting it from fetal kidney" - This statement is **TRUE** and accurately describes the pathophysiology of FGR - **Placental insufficiency** impairs oxygen and nutrient delivery to the fetus - This triggers **compensatory blood flow redistribution** (brain-sparing effect) - Blood is preferentially shunted to vital organs (brain, heart, adrenals) - Blood flow is reduced to less critical organs, particularly the **kidneys** - Reduced renal perfusion → decreased fetal urine production → oligohydramnios (when present) **Why Other Options are Incorrect:** *Both Statement-1 and Statement-2 are true and Statement-2 is the correct explanation for Statement-1* - Incorrect because Statement-1 is false (oligohydramnios is not "always" present in FGR) *Statement-1 is true but Statement-2 is false* - Incorrect because Statement-1 is false and Statement-2 is true (reverses the actual truth values) *Both Statement-1 and Statement-2 are true and Statement-2 is not the correct explanation for Statement-1* - Incorrect because Statement-1 is false (the absolute qualifier "always" makes it inaccurate)

Q: Which of the following are correct regarding failure rate of contraceptive methods? 1. Depot medroxyprogesterone acetate 0 to 1 per HWY 2. Norplant 0.1 per HWY 3. LNG-IUS 0.02 per HWY 4. Levonorgestrel-only pills 3 per HWY

1, 2 and 3. ***1, 2 and 3*** - **Depot medroxyprogesterone acetate (DMPA)**, **Norplant** (levonorgestrel implants), and **Levonorgestrel-releasing intrauterine system (LNG-IUS)** are highly effective contraceptive methods with very low failure rates, typically below 1 pregnancy per 100 women-years (HWY) for typical use. - The quoted failure rates of 0 to 1 per HWY for DMPA, 0.1 per HWY for Norplant, and 0.02 per HWY for LNG-IUS are consistent with their known efficacy as **long-acting reversible contraceptives (LARCs)** and hormonal methods. *1, 3 and 4* - This option incorrectly includes the failure rate for **levonorgestrel-only pills (minipills)**. While minipills are effective, their typical use failure rate is generally higher than 3 per HWY, often closer to 7-10 pregnancies per 100 women-years due to the strict adherence required for daily dosing. - The failure rates for DMPA and LNG-IUS are accurate, but the inclusion of incorrectly low typical failure rate for levonorgestrel-only pills makes this option incorrect. *1, 2 and 4* - This option is incorrect because the typical failure rate of **levonorgestrel-only pills** is much higher than 3 per HWY in real-world use, often due to missed doses or delayed administration. - While DMPA and Norplant have low failure rates, the inaccuracy for levonorgestrel-only pills makes this choice invalid. *2, 3 and 4* - This option inaccurately suggests that the failure rate for **levonorgestrel-only pills** is 3 per HWY, which is generally lower than their actual typical use failure rates (closer to 7-10 pregnancies per 100 women-years). - The failure rates for Norplant and LNG-IUS are correct, but the error regarding levonorgestrel-only pills renders this option incorrect.

Question 1

Which of the following are risk factors for developing pelvic inflammatory disease in females?

1. Use of oral contraception pills
2. Multiple sexual partners
3. Lower socioeconomic status
4. Genetic predisposition

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 2

A 65 year old postmenopausal lady presents in Gynaecology OPD with abdominal distension and weight loss. On investigation she was diagnosed to have an ovarian tumour. The most common type of ovarian tumour in this woman would be

Accepted Answer

Epithelial tumor

Answer

Sex cord tumor

Answer

Germ cell tumor

Answer

Trophoblastic tumor

Question 3

Which of the following are the characteristic features of Meigs' syndrome in a female?

1. Right sided hydrothorax
2. Ascites
3. Genital warts
4. Ovarian fibroma

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2, 3 and 4

Question 4

A 25-year-old woman presents to the Gynaecology OPD with complaints of abdominal pain and heavy menstrual bleeding. On examination, there is a mass arising from the hypogastrium corresponding to 16 weeks gravid uterus. Her urine pregnancy test is negative. The most likely diagnosis is

Accepted Answer

Uterine fibroid

Answer

Endometriosis

Answer

Ovarian tumour

Answer

Pelvic inflammatory disease

Question 5

A 39 year old nulliparous female has presented to Gynaecology OPD with complaint of post-coital bleeding for past six months. The first investigation to be offered to this female will be

Accepted Answer

Pap smear

Answer

Hysteroscopy

Answer

Ultrasound

Answer

Endometrial biopsy

Question 6

Which of the following are indications of vaginal examinations during labour?

1. To stretch the vagina intermittently
2. At the onset of labour
3. To monitor progress of labour
4. Following rupture of membranes

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 7

Which of the following are the clinical features of septic abortion?

1. Persistent tachycardia ≥ 90 bpm
2. Impaired mental status
3. Hypothermia

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Question 8

Which one of the following statements regarding Rh isoimmunization is correct?

1. Liley's chart identifies anemia better than middle cerebral artery Doppler
2. Indirect Coombs test is positive in mother
3. Baby is at risk of developing anemia
4. Direct Coombs test is positive in baby

Accepted Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Question 9

Consider the following statements :

Statement-1 : In fetal growth restriction there is always oligohydramnios

Statement-2 : In fetal growth restriction there is placental insufficiency leading to redistribution of blood flow to fetal brain shunting it from fetal kidney

Which one of the following is correct in respect of the above statements ?

Accepted Answer

Statement-2 is true but Statement-1 is false

Answer

Both Statement-1 and Statement-2 are true and Statement-2 is the correct explanation for Statement-1

Answer

Statement-1 is true but Statement-2 is false

Answer

Both Statement-1 and Statement-2 are true and Statement-2 is not the correct explanation for Statement-1

Question 10

Which of the following are correct regarding failure rate of contraceptive methods?

1. Depot medroxyprogesterone acetate 0 to 1 per HWY
2. Norplant 0.1 per HWY
3. LNG-IUS 0.02 per HWY
4. Levonorgestrel-only pills 3 per HWY

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

UPSC-CMS 2021 — Obstetrics and Gynecology