UPSC-CMS 2022 - Obstetrics and Gynecology Practice Questions

Q: The reference point 'zero' in POPQ (Pelvic Organ Prolapse Quantification) classification is taken as

hymen. ***hymen*** - The **hymen** (or hymenal ring/hymenal caruncles in parous women) is the fixed anatomical reference point (zero point) in the POPQ classification system. - All measurements in POPQ are taken in centimeters relative to the hymenal ring, with **negative values** indicating positions above the hymen and **positive values** indicating descent beyond the hymen. - This landmark was chosen because it is **easily identifiable, reproducible, and remains relatively constant** regardless of the degree of prolapse. *ischial spine* - The **ischial spines** are important anatomical landmarks in the pelvis but are **not** used as the zero reference point in POPQ. - They are used for measuring **total vaginal length (TVL)** - the distance from the hymen to the posterior fornix with the prolapse reduced. - The ischial spines serve as internal palpable landmarks during pelvic examination but not as the measurement reference for prolapse staging. *perineal body* - The **perineal body** is a fibromuscular structure in the perineum and is measured in POPQ (as genital hiatus and perineal body measurements). - However, it is **not the zero reference point** because its position and integrity can be altered by prolapse, childbirth trauma, or surgical procedures. *mid-vagina* - The **mid-vagina** is not a standardized anatomical landmark and is **too variable** to serve as a fixed reference point. - POPQ requires precise, reproducible measurements, which cannot be achieved with such a vague landmark.

Q: Which of the following are the various treatment options for Twin-Twin Transfusion Syndrome (TTTS)?

All of the options. ***All of the options*** - **Laser photocoagulation**, **septostomy**, and **selective fetal reduction** are established treatment modalities for Twin-Twin Transfusion Syndrome (TTTS). - The choice of treatment depends on the **stage of TTTS**, gestational age, and specific presentation of the twins. *Laser photocoagulation* - This procedure involves using a **laser to ablate the anastomotic vessels** on the chorionic plate, which are responsible for the unequal blood flow between twins. - It is currently considered the **gold standard** for treating severe TTTS, particularly in stages II-IV, offering improved survival rates for both twins compared to other methods. *Septostomy* - **Septostomy** involves creating a small perforation in the dividing membrane between the two amniotic sacs to allow amniotic fluid to equilibrate between the sacs. - This can help decompress severe polyhydramnios in the recipient twin, but it does **not address the underlying vascular anastomoses**. - **Amnioreduction** (serial drainage of excess amniotic fluid) is a related but distinct palliative treatment option. *Selective fetal reduction* - This involves **terminating the life of one of the fetuses** in a multifetal pregnancy to improve the chances of survival for the remaining fetus. - It is typically considered in **severe, refractory cases of TTTS** where other treatments have failed or are not feasible, particularly if one twin has severe anomalies or irreversible damage.

Q: Premenstrual Syndrome (PMS) should fulfil which of the following criteria? 1. It is not related to any organic lesion. 2. It regularly occurs during the luteal phase and each ovulatory menstruation cycle. 3. Symptoms must be severe enough to disturb the lifestyle of women and seeks medical help. 4. Symptoms persist after the period also.

1. It is not related to any organic lesion.. ***1. It is not related to any organic lesion.*** - PMS is a **functional disorder** and a diagnosis of exclusion, meaning its symptoms should not be attributable to an underlying physical or organic pathology. - While PMS involves hormonal fluctuations during the **luteal phase**, there is no detectable **structural or organic lesion** causing the symptoms. - This is a fundamental criterion to differentiate PMS from other medical conditions. ***2. It regularly occurs during the luteal phase and each ovulatory menstruation cycle.*** - PMS symptoms characteristically occur during the **luteal phase** (after ovulation and before menstruation) and are a key diagnostic feature. - Symptoms must occur in **most cycles** (typically documented in at least 2 out of 3 consecutive cycles) to establish the diagnosis. - This temporal relationship with the menstrual cycle is essential for diagnosis. ***3. Symptoms must be severe enough to disturb the lifestyle of women and seeks medical help.*** - **Functional impairment** is a fundamental diagnostic criterion for PMS. - Symptoms must cause **clinically significant distress** or interfere with work, school, usual activities, or relationships. - This distinguishes PMS from normal premenstrual symptoms that many women experience without functional impairment. *4. Symptoms persist after the period also.* - A key diagnostic criterion for PMS is that symptoms **resolve or significantly improve** with or shortly after the onset of menstruation. - If symptoms persist throughout the menstrual cycle, it suggests a different diagnosis, such as an underlying mood disorder (e.g., depression or anxiety with premenstrual exacerbation) rather than true PMS. - The cyclic nature with symptom-free interval is essential for PMS diagnosis.

Q: A patient delivered a live healthy baby 4 hours back. Now she has developed persistent severe pain in the perineal region and rectal tenesmus. Local examination reveals a tense and tender purple swelling at the vulva. What is her probable diagnosis?

Vulvar hematoma. ***Vulvar hematoma*** - A **vulvar hematoma** presents with severe, persistent perineal pain and a tense, tender, purple swelling at the vulva, often accompanied by **rectal tenesmus** due to pressure from the expanding hematoma. - This condition typically occurs after childbirth due to **trauma to blood vessels** during delivery, where blood accumulates in the vulvar tissues, forming a palpable mass. - Vulvar hematomas are a type of puerperal hematoma that occur in the superficial tissues and are visible on examination. *Ruptured uterus* - A **ruptured uterus** is an obstetric emergency characterized by sudden, severe abdominal pain, vaginal bleeding, and signs of **fetal distress** or **maternal shock**. - It usually occurs during labor or delivery and is not associated with localized perineal swelling or rectal tenesmus as the primary presentation. *Cervical tear* - A **cervical tear** typically causes persistent, bright red vaginal bleeding after delivery, but the uterus is usually well-contracted. - While it can cause pain, it does not present with a palpable, tense, purple swelling at the vulva or rectal tenesmus. *Perineal tear* - A **perineal tear** causes pain and can be associated with swelling, but it usually presents as a visible laceration or superficial injury. - While it can cause pain and some swelling, it does not typically manifest as a tense, discrete purple mass with pronounced rectal tenesmus unless complicated by hematoma formation.

Q: What is the most immediate intervention in the management of cord prolapse during delivery? 1. Bladder filling 2. Knee-chest position of the patient 3. Preferably caesarean delivery 4. Lifting up the presenting part off the cord

4. Lifting up the presenting part off the cord. ***Correct: Lifting up the presenting part off the cord*** - **Manual elevation of the presenting part** is the **FIRST and most immediate intervention** in cord prolapse to relieve compression on the umbilical cord. - This can be done by inserting a hand into the vagina and pushing the presenting part upward, maintaining this position until delivery. - This immediate action prevents **fetal hypoxia** by restoring blood flow through the umbilical cord. - This maneuver should be maintained continuously while other interventions are being arranged. *Incorrect: Knee-chest position of the patient* - While **maternal positioning** (knee-chest, Trendelenburg, or exaggerated Sims position) is an important immediate intervention, it is the **second step** after manual elevation. - Positioning uses gravity to help relieve pressure on the prolapsed cord but takes slightly longer to implement than manual elevation. - Both interventions are typically done simultaneously, but manual elevation is the most immediate action. *Incorrect: Preferably caesarean delivery* - **Emergency cesarean delivery** is the **definitive management** for most cases of cord prolapse, not the most immediate intervention. - Surgical delivery requires preparation time, anesthesia, and operating room setup. - Immediate interventions (manual elevation, positioning) must be performed first to protect the fetus while preparing for delivery. *Incorrect: Bladder filling* - **Bladder filling** (with 500-700 ml of saline via catheter) is an adjunctive measure that can help elevate the presenting part and relieve cord compression. - This is a secondary intervention, not the most immediate action. - Note: The management involves bladder **filling** (not emptying) to create upward displacement of the presenting part.

Q: Which surgery is most likely to disturb the paracervical nerve plexus resulting in atonicity of the bladder?

Radical hysterectomy. ***Radical hysterectomy*** - This procedure involves extensive dissection around the cervix and upper vagina, increasing the risk of **damage to the paracervical nerve plexus** (Frankenhäuser's plexus). - Damage to this autonomic plexus, which supplies the bladder, can lead to **atonicity** and urinary retention postoperatively due to disrupted innervation. *Simple hysterectomy* - A simple hysterectomy removes the uterus but preserves the parametrial tissues and hence the **paracervical nerve plexus**, minimizing the risk of bladder denervation. - While temporary bladder dysfunction can occur due to local trauma, long-term atonicity is less likely compared to radical procedures. *Myomectomy* - Myomectomy involves the surgical removal of uterine fibroids (myomas) while **preserving the uterus**. - This procedure generally involves minimal dissection in the vicinity of the paracervical nerve plexus, making bladder atonicity an uncommon complication. *Vaginal hysterectomy* - A vaginal hysterectomy removes the uterus through the vagina, with dissection primarily involving the uterosacral and cardinal ligaments. - Although there is some manipulation near the plexus, the **extent of dissection is typically less** than a radical hysterectomy, leading to a lower risk of complete denervation and atonicity.

Q: What is the most common first-line investigation used to assess the patency of fallopian tubes?

Hysterosalpingogram. ***Hysterosalpingogram (HSG)*** - **Hysterosalpingogram (HSG)** is the **most common first-line investigation** for assessing tubal patency in infertility workup. - It involves injecting a radio-opaque contrast dye through the cervix into the uterine cavity and fallopian tubes, followed by X-ray imaging. - HSG effectively visualizes the **uterine cavity anatomy** and **tubal patency**, detecting blockages or abnormalities. - It is **minimally invasive, outpatient-based**, and provides both diagnostic and potentially therapeutic benefit (flushing effect). *Sonohysterogram* - **Sonohysterogram (SIS)** primarily evaluates the **uterine cavity** for intrauterine pathology like polyps, fibroids, or septae using saline infusion and ultrasound. - A modified version (**HyCoSy** - hystero-salpingo-contrast sonography) can assess tubal patency but is **less commonly used** than HSG as a first-line test. - Standard sonohysterogram does not directly visualize tubal patency. *Laparoscopic chromopertubation* - **Laparoscopic chromopertubation** is the **gold standard invasive method** for directly visualizing tubal patency. - A colored dye (methylene blue) is injected through the cervix and observed flowing through the fimbriated ends of the tubes under direct laparoscopic visualization. - It is **reserved for cases** where non-invasive tests are inconclusive or when concurrent treatment of pelvic pathology (adhesions, endometriosis) is planned. - It is **not a first-line test** due to its invasive nature, cost, and need for anesthesia. *CT scan* - **CT scan** is not used for assessing fallopian tube patency. - While it provides excellent anatomical detail of pelvic organs, it cannot effectively demonstrate the patency or flow through the narrow fallopian tube lumen. - CT is useful for evaluating pelvic masses, malignancies, or complications but not for functional tubal assessment.

Question 1

The reference point 'zero' in POPQ (Pelvic Organ Prolapse Quantification) classification is taken as

Accepted Answer

hymen

Answer

perineal body

Answer

ischial spine

Answer

mid-vagina

Question 2

Which of the following are the various treatment options for Twin-Twin Transfusion Syndrome (TTTS)?

Accepted Answer

All of the options

Answer

Laser photocoagulation

Answer

Septostomy

Answer

Selective fetal reduction

Question 3

Which of the following is the MOST CHARACTERISTIC symptom complex of ectopic pregnancy?

1. Acute abdominal pain following amenorrhea
2. Abdominal pain with bleeding P/V
3. Fainting attack with shoulder pain
4. Painless continuous bleeding

Accepted Answer

1. Acute abdominal pain following amenorrhea

Answer

3. Fainting attack with shoulder pain

Answer

4. Painless continuous bleeding

Answer

2. Abdominal pain with bleeding P/V

Question 4

Premenstrual Syndrome (PMS) should fulfil which of the following criteria?

1. It is not related to any organic lesion.
2. It regularly occurs during the luteal phase and each ovulatory menstruation cycle.
3. Symptoms must be severe enough to disturb the lifestyle of women and seeks medical help.
4. Symptoms persist after the period also.

Accepted Answer

1. It is not related to any organic lesion.

Answer

4. Symptoms persist after the period also.

Answer

2. It regularly occurs during the luteal phase and each ovulatory menstruation cycle.

Answer

3. Symptoms must be severe enough to disturb the lifestyle of women and seeks medical help.

Question 5

Which of the following statements is correct regarding constriction ring?

1. Premature rupture of membranes is a high risk factor.
2. It is situated at the junction of upper and lower uterine segment.
3. Uterus never ruptures.
4. The ring is felt per abdomen.

Accepted Answer

1. Premature rupture of membranes is a high risk factor.

Answer

2. It is situated at the junction of upper and lower uterine segment.

Answer

4. The ring is felt per abdomen.

Answer

3. Uterus never ruptures.

Question 6

A patient delivered a live healthy baby 4 hours back. Now she has developed persistent severe pain in the perineal region and rectal tenesmus. Local examination reveals a tense and tender purple swelling at the vulva. What is her probable diagnosis?

Accepted Answer

Vulvar hematoma

Answer

Ruptured uterus

Answer

Cervical tear

Answer

Perineal tear

Question 7

What is the most immediate intervention in the management of cord prolapse during delivery?

1. Bladder filling
2. Knee-chest position of the patient
3. Preferably caesarean delivery
4. Lifting up the presenting part off the cord

Accepted Answer

4. Lifting up the presenting part off the cord

Answer

2. Knee-chest position of the patient

Answer

1. Bladder filling

Answer

3. Preferably caesarean delivery

Question 8

Which of the following statements represents the PRIMARY obstetric significance at the level of plane of least pelvic dimensions?

1. It is a landmark used for pudendal nerve block analgesia.
2. Deep transverse arrest usually occurs at this plane.
3. It is at this plane that the internal rotation of the fetal head occurs during labour.
4. It marks the beginning of the backward curve of the pelvic axis.

Accepted Answer

1. It is a landmark used for pudendal nerve block analgesia.

Answer

4. It marks the beginning of the backward curve of the pelvic axis.

Answer

2. Deep transverse arrest usually occurs at this plane.

Answer

3. It is at this plane that the internal rotation of the fetal head occurs during labour.

Question 9

Which surgery is most likely to disturb the paracervical nerve plexus resulting in atonicity of the bladder?

Accepted Answer

Radical hysterectomy

Answer

Simple hysterectomy

Answer

Myomectomy

Answer

Vaginal hysterectomy

Question 10

What is the most common first-line investigation used to assess the patency of fallopian tubes?

Accepted Answer

Hysterosalpingogram

Answer

Sonohysterogram

Answer

Laparoscopic chromopertubation

Answer

CT scan

UPSC-CMS 2022 — Obstetrics and Gynecology