UPSC-CMS 2022 — Obstetrics and Gynecology
32 Previous Year Questions with Answers & Explanations
During the first stage of labour, the intrauterine pressure is increased up to
Which of the following is the most widely used screening test for cervical cancer?
Serum level of CA 125 is raised in which of the following conditions?
Following vaginal delivery, uterus becomes non-pregnant size by
Indications and prerequisites for delivery with the ventouse include which of the following? 1. Delay in the second stage of labour 2. Non-reassuring fetal heart rate 3. Gestation age less than 34 weeks of pregnancy 4. Vertex presentation.
Which of the following fetal infections is MOST commonly associated with significant intrauterine growth restriction?
Missed abortion is not diagnosed if
In which of the following situations might delayed cord clamping be contraindicated?
Which of the following best defines gestational hypertension?
A 27-year-old female is complaining of grayish white discharge with fishy odour. There is no history of itching associated with discharge. Which one of the following is the most likely diagnosis?
UPSC-CMS 2022 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 1: During the first stage of labour, the intrauterine pressure is increased up to
- A. 40–50 mm of Hg (Correct Answer)
- B. 100–120 mm of Hg
- C. 8–10 mm of Hg
- D. 2–3 mm of Hg
Explanation: ***40–50 mm of Hg*** - This pressure range is typical during **uterine contractions** in the first stage of labor, effectively causing cervical effacement and dilation. - These pressures provide sufficient force to facilitate the progression of labor while maintaining adequate **uteroplacental blood flow** between contractions. *100–120 mm of Hg* - This pressure range is generally too high for the first stage of labor and is more commonly seen in the **second stage** or during prolonged, abnormal contractions. - Such elevated pressures could potentially compromise **fetal well-being** due to reduced uteroplacental perfusion. *8–10 mm of Hg* - This pressure range represents the **resting tone** of the uterus between contractions, not the peak pressure during a contraction. - It is too low to cause significant cervical changes or *advance labor*. *2–3 mm of Hg* - This pressure is significantly below the normal resting tone of the uterus and is not associated with any stage of active labor. - Such low pressures would indicate **uterine inactivity** or atony, not active contractions.
Question 2: Which of the following is the most widely used screening test for cervical cancer?
- A. Pap test (Correct Answer)
- B. Visual inspections with acetic acid
- C. HPV DNA test
- D. Endocervical curettage
Explanation: ***Pap test*** - The **Pap test** (Papanicolaou test) is the most widely used and effective screening test for cervical cancer globally. - It involves collecting cells from the **cervix** to detect **precancerous** and cancerous changes early. *Endocervical curettage* - **Endocervical curettage** is a diagnostic procedure used to obtain tissue samples from the endocervical canal, typically performed after an abnormal Pap test. - It is a **biopsy procedure**, not a primary screening test for general populations. *Visual inspections with acetic acid* - **Visual inspection with acetic acid (VIA)** is a lower-cost screening method used in resource-limited settings. - It involves applying acetic acid to the cervix and observing for **acetowhite changes**, but its sensitivity and specificity are not as high as the Pap test. *HPV DNA test* - The **HPV DNA test** detects high-risk types of human papillomavirus, which are responsible for most cervical cancers. - While it's increasingly used, especially in conjunction with the Pap test (co-testing) or as primary screening in some settings, the **Pap test** remains the most **widely established** and utilized primary screening method.
Question 3: Serum level of CA 125 is raised in which of the following conditions?
- A. Epithelial ovarian cancer
- B. Pelvic inflammatory disease
- C. Endometriosis
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **CA 125** levels can be elevated in various gynecological conditions, both malignant and benign. - While most recognized for its role in **epithelial ovarian cancer**, it is not exclusively specific to this condition. *Epithelial ovarian cancer* - **CA 125** is a commonly used tumor marker for **epithelial ovarian cancer**, playing a role in its diagnosis, monitoring, and recurrence detection. - While elevated in a high percentage of advanced ovarian cancers, it can also be normal in early-stage disease. *Pelvic inflammatory disease* - **Inflammation** of the pelvic organs, such as in **Pelvic Inflammatory Disease (PID)**, can cause an increase in **CA 125** levels. - The elevation is typically due to the irritation of the peritoneal surface or the presence of inflammatory exudates. *Endometriosis* - **Endometriosis**, a condition where endometrial-like tissue grows outside the uterus, is a well-known cause of elevated **CA 125**. - The level of **CA 125** often correlates with the severity and extent of the endometrial implants.
Question 4: Following vaginal delivery, uterus becomes non-pregnant size by
- A. 9 weeks postpartum
- B. 8 weeks postpartum
- C. 6 weeks postpartum (Correct Answer)
- D. 4 weeks postpartum
Explanation: ***6 weeks postpartum*** - This period allows for sufficient **myometrial contraction** and involution to return the uterus to its pre-pregnancy size through the process of **autolysis** and fundal descent. - The uterine weight decreases significantly from about 1000g immediately after delivery to approximately 50-70g by 6 weeks. - By the end of the puerperium (6 weeks), complete uterine involution is achieved. *9 weeks postpartum* - By 9 weeks, uterine involution would have been completed much earlier, and the uterus would have attained its **non-pregnant size** several weeks prior. - This timeframe is typically beyond the normal window for the completion of uterine regression. *8 weeks postpartum* - Similar to 9 weeks, by 8 weeks postpartum, the uterus would have already returned to its **non-pregnant state**. - The process of **involution** is usually completed well before this mark. *4 weeks postpartum* - While significant **uterine involution** occurs by 4 weeks, the uterus may still be slightly larger and heavier than its pre-pregnancy size. - Complete return to the **non-pregnant state** typically requires an additional two weeks.
Question 5: Indications and prerequisites for delivery with the ventouse include which of the following? 1. Delay in the second stage of labour 2. Non-reassuring fetal heart rate 3. Gestation age less than 34 weeks of pregnancy 4. Vertex presentation.
- A. 1, 2 and 4 (Correct Answer)
- B. 2, 3 and 4
- C. 1, 2 and 3
- D. 1, 3 and 4
Explanation: ***1, 2 and 4*** - **Ventouse delivery** is indicated for **delay in the second stage of labor** and **non-reassuring fetal heart rate**, when expeditious delivery is required. - A crucial prerequisite is **vertex presentation**, ensuring proper application of the vacuum cup to the fetal head. *2, 3 and 4* - **Gestation age less than 34 weeks of pregnancy** is a contraindication for ventouse delivery due to the increased risk of **fetal scalp trauma** and **intracranial hemorrhage** in premature infants. - While **non-reassuring fetal heart rate** and **vertex presentation** are valid points, the inclusion of premature gestation makes this option incorrect. *1, 2 and 3* - Again, **gestation age less than 34 weeks of pregnancy** is a contraindication, not an indication or prerequisite, for ventouse delivery. - Although **delay in the second stage** and **non-reassuring fetal heart rate** are correct factors, the inclusion of prematurity renders this option incorrect. *1, 3 and 4* - This option incorrectly lists **gestation age less than 34 weeks of pregnancy** as a prerequisite. - While **delay in the second stage** and **vertex presentation** are appropriate, the prematurity contraindication makes this an unsuitable choice.
Question 6: Which of the following fetal infections is MOST commonly associated with significant intrauterine growth restriction?
- A. Human papillomavirus infection
- B. Rubella infection
- C. Toxoplasmosis
- D. Cytomegalovirus infection (Correct Answer)
Explanation: ***Cytomegalovirus infection*** - **Cytomegalovirus (CMV)** is the **most common congenital infection** and the **leading cause of intrauterine growth restriction (IUGR)** among the TORCH infections. - CMV has a direct cytopathic effect on fetal tissues and significantly impairs placental function, leading to severe and consistent growth restriction. - Congenital CMV infection affects approximately **0.5-1% of all live births**, with **IUGR being one of the most prominent features** in symptomatic cases. - Other manifestations include microcephaly, intracranial calcifications, hepatosplenomegaly, sensorineural hearing loss, and neurodevelopmental impairment. *Human papillomavirus infection* - **Human papillomavirus (HPV)** is primarily associated with genital warts and cervical dysplasia in mothers. - While vertical transmission can occur (causing juvenile-onset recurrent respiratory papillomatosis), HPV **does not cause IUGR**. - HPV is **not part of the TORCH infections** and has no association with fetal growth restriction. *Rubella infection* - **Congenital rubella syndrome** is characterized by the classic triad: cataracts, cardiac defects (patent ductus arteriosus), and sensorineural hearing loss. - While rubella **can cause IUGR**, it is far less common in modern practice due to widespread **MMR vaccination**. - The incidence of congenital rubella has dramatically decreased, making it a less frequent cause of IUGR compared to CMV. *Toxoplasmosis* - **Congenital toxoplasmosis** presents with the classic triad: hydrocephalus, intracranial calcifications, and chorioretinitis. - While toxoplasmosis **can contribute to growth restriction**, IUGR is not its most prominent or consistent feature. - **CMV remains the most common and most consistently associated** TORCH infection with significant IUGR in clinical practice.
Question 7: Missed abortion is not diagnosed if
- A. USG shows fetus with cardiac activity (Correct Answer)
- B. uterus is smaller than gestational age
- C. external os is closed
- D. vaginal bleed is brownish in colour
Explanation: ***USG shows fetus with cardiac activity*** - The presence of **fetal cardiac activity** on ultrasound is the definitive sign of a viable pregnancy, ruling out missed abortion. - Missed abortion is characterized by a **non-viable intrauterine pregnancy** (no cardiac activity) with a closed cervix, and would not be diagnosed if cardiac activity is detected. *uterus is smaller than gestational age* - A uterus consistently smaller than expected for gestational age can be a sign of a **non-viable pregnancy** or **intrauterine growth restriction**, both of which could be associated with missed abortion. - However, this finding alone is not diagnostic and needs confirmation with ultrasound to assess fetal viability. *external os is closed* - A **closed external os** is characteristic of a missed abortion, where the products of conception are retained within the uterus. - In a missed abortion, the cervix often remains closed, preventing the expulsion of the non-viable pregnancy. *vaginal bleed is brownish in colour* - **Brownish vaginal bleeding** indicates old or deoxygenated blood, which is a common symptom of a threatened abortion or missed abortion. - This type of bleeding suggests that the pregnancy may not be progressing normally and often prompts further investigation to assess fetal viability.
Question 8: In which of the following situations might delayed cord clamping be contraindicated?
- A. Placental abruption with maternal compromise
- B. Need for immediate neonatal resuscitation where delayed clamping interferes (Correct Answer)
- C. Severe maternal hemorrhage requiring immediate resuscitation
- D. Cord prolapse requiring immediate delivery
Explanation: ***Need for immediate neonatal resuscitation where delayed clamping interferes*** - If a neonate requires **immediate resuscitation** (e.g., due to severe birth asphyxia), delaying cord clamping would delay essential life-saving interventions - The priority is to establish effective **ventilation and circulation** in the newborn, which necessitates prompt cutting of the cord for transfer to a resuscitation area - **Current guidelines** recommend immediate cord clamping when the baby requires immediate positive pressure ventilation or other advanced resuscitation measures *Severe maternal hemorrhage requiring immediate resuscitation* - Severe maternal hemorrhage primarily affects the mother and necessitates rapid maternal resuscitation - This does **not inherently contraindicate** delayed cord clamping for the stable neonate - If the infant is healthy and does not require immediate intervention, delayed clamping can still be practiced while the maternal emergency is managed *Placental abruption with maternal compromise* - Placental abruption with maternal compromise is a severe obstetric emergency for the mother - Similar to severe maternal hemorrhage, it does **not automatically contraindicate** delayed cord clamping if the infant is stable - However, if abruption has led to fetal compromise requiring immediate neonatal resuscitation, then delayed cord clamping would be contraindicated due to the need for immediate neonatal intervention *Cord prolapse requiring immediate delivery* - While cord prolapse is an obstetric emergency requiring immediate delivery, delayed cord clamping is **not directly contraindicated** by the prolapse once delivery has occurred - The contraindication arises only if there's an urgent need to intervene in the neonate that would be delayed by waiting - The prolapse primarily dictates delivery timing, not cord clamping timing
Question 9: Which of the following best defines gestational hypertension?
- A. Sustained rise of blood pressure to 140/90 mmHg or more on two occasions 4-6 hours apart with proteinuria after 20 weeks of gestation
- B. Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 12 weeks of gestation
- C. Sustained rise of blood pressure to 150/100 mmHg or more on at least two occasions 2 hours apart after 20 weeks of gestation
- D. Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 20 weeks of gestation in a previously normotensive woman (Correct Answer)
Explanation: **Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 20 weeks of gestation in a previously normotensive woman** - **Gestational hypertension** is defined by a new onset of **hypertension** (≥140/90 mmHg) occurring for the first time **after 20 weeks of gestation**, without accompanying **proteinuria** or other systemic signs of preeclampsia. - The elevated blood pressure must be recorded on at least **two occasions 4-6 hours apart** to ensure it's a sustained elevation and not a transient spike. - The woman must be **previously normotensive** (normal blood pressure before pregnancy). *Sustained rise of blood pressure to 140/90 mmHg or more on two occasions 4-6 hours apart with proteinuria after 20 weeks of gestation* - The presence of **proteinuria** along with hypertension after 20 weeks of gestation defines **preeclampsia**, not gestational hypertension. - Gestational hypertension specifically excludes proteinuria or other signs of end-organ damage. *Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 12 weeks of gestation* - The onset of hypertension defining gestational hypertension must occur **after 20 weeks of gestation**. Hypertension before this period is typically considered **chronic hypertension**. - While the blood pressure criteria and timing are otherwise correct, the gestational age onset is incorrect for gestational hypertension. *Sustained rise of blood pressure to 150/100 mmHg or more on at least two occasions 2 hours apart after 20 weeks of gestation* - The threshold for hypertension in pregnancy is **140/90 mmHg**, not 150/100 mmHg; blood pressure at or above 160/110 mmHg indicates **severe hypertension**. - While recordings 2 hours apart might be relevant in some contexts, the standard for diagnosis of gestational hypertension usually specifies **4-6 hours apart** to confirm sustained elevation.
Question 10: A 27-year-old female is complaining of grayish white discharge with fishy odour. There is no history of itching associated with discharge. Which one of the following is the most likely diagnosis?
- A. Trichomoniasis
- B. Urinary tract infection
- C. Bacterial vaginosis (Correct Answer)
- D. Candidiasis
Explanation: ***Bacterial vaginosis*** - The classic presentation includes **grayish-white vaginal discharge** with a **fishy odor**, especially after intercourse, and **absence of itching**. - This clinical picture aligns perfectly with **Amsel's criteria** for bacterial vaginosis, which include vaginal pH >4.5, clue cells on microscopy, and a positive whiff test. *Trichomoniasis* - Characteristically presents with a **frothy, greenish-yellow discharge** and often causes **vulvovaginal itching and irritation**, which are not reported here. - While it can cause a foamy discharge and sometimes a foul odor, the specific symptom profile given is less typical for trichomoniasis. *Urinary tract infection* - Primarily involves symptoms such as **dysuria (painful urination)**, frequent urination, and urgency, rather than vaginal discharge. - A UTI does not typically present with a "fishy-smelling grayish-white discharge" as its primary symptom. *Candidiasis* - Typically presents with a **thick, white, "cottage cheese-like" discharge** and is almost always associated with significant **vulvovaginal itching and burning**. - The absence of itching and the description of a grayish, fishy-smelling discharge make candidiasis highly unlikely.