What are the causes of lactation failure after delivery ? 1. Infrequent suckling 2. Depression or anxiety state in the puerperium 3. Prolactin inhibition Select the correct answer using the code given below :
Secondary arrest of dilatation during the process of labour may be due to which of the following factors ? 1. Poor uterine contractions 2. Cessation of cervical dilatation despite strong uterine contractions 3. Disproportion and malpresentation Select the correct answer using the code given below :
Which of the following correctly defines the first stage of labor? 1. Full dilatation of cervix to the expulsion of the fetus from the birth canal 2. Maternal bearing down efforts and ends with the delivery of the baby 3. The onset of true labor pains and ends with the full dilatation of cervix 4. The formation of bag of waters
Vesicovaginal fistula is classified as complicated if it has which of the following features ? 1. Size - more than 3 cm 2. Bladder involvement - Trigonal/Juxta-urethral 3. Location - Midvaginal 4. Presence of prior radiation Select the correct answer using the code given below :
Which one of the following is a prerequisite for Endometrial Ablation ?
Which of the following days of menstrual cycle is best for endometrial sampling to diagnose ovulation?
A 27-year-old female married for 3 years regularly cohabiting with husband presents to Gynaecology OPD with complaints of inability to conceive for 2 years. During clinical evaluation hysterosalpingography was done which revealed irregular outline of uterine cavity and rigid fallopian tubes with nodulations. Most likely cause for this condition is :
Prophylactic oophorectomy is recommended in high risk women with which of the following ? 1. Carrying BRCA1 or BRCA2 genes 2. Family history of breast, colon, ovarian cancer 3. Patients having tubo-ovarian abscess Select the correct answer using the code given below :
Which one of the following is the distinguishing feature to differentiate Gartner's cyst from Cystocele ?
Surgical treatment by 'ventrosuspension of uterus' is used for what condition ?
UPSC-CMS 2023 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 41: What are the causes of lactation failure after delivery ? 1. Infrequent suckling 2. Depression or anxiety state in the puerperium 3. Prolactin inhibition Select the correct answer using the code given below :
- A. 1 and 2 only
- B. 2 and 3 only
- C. 1 and 3 only
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - **Infrequent suckling** directly reduces the stimulation needed for **prolactin release** and **milk production**, leading to lactation failure. - **Depression or anxiety** can interfere with the **let-down reflex** by inhibiting **oxytocin release** and also decrease a mother's motivation and ability to breastfeed effectively. - Any condition causing **prolactin inhibition**, such as certain medications (e.g., dopamine agonists) or specific medical conditions (e.g., Sheehan's syndrome), will directly prevent milk synthesis. *1 and 2 only* - This option correctly identifies infrequent suckling and emotional states as causes but fails to include **prolactin inhibition**, which is a direct and significant physiological factor in lactation failure. - Excluding **prolactin inhibition** provides an incomplete understanding of all potential causes for inadequate milk production. *2 and 3 only* - This option correctly recognizes the impact of emotional states and prolactin inhibition but overlooks **infrequent suckling**, which is one of the most common behavioral reasons for reduced milk supply. - Lack of adequate and frequent nipple stimulation is crucial for establishing and maintaining a robust milk supply. *1 and 3 only* - This option correctly identifies infrequent suckling and prolactin inhibition but omits the significant role of **maternal psychological states** like depression and anxiety in successful lactation. - Emotional well-being heavily influences the **milk ejection reflex** and overall breastfeeding success.
Question 42: Secondary arrest of dilatation during the process of labour may be due to which of the following factors ? 1. Poor uterine contractions 2. Cessation of cervical dilatation despite strong uterine contractions 3. Disproportion and malpresentation Select the correct answer using the code given below :
- A. 1 and 2 only
- B. 1, 2 and 3 (Correct Answer)
- C. 1 and 3 only
- D. 2 and 3 only
Explanation: ***1, 2 and 3*** - **Secondary arrest of dilatation** refers to a cessation of cervical dilatation in the active phase of labor after the cervix has already begun to dilate, often attributed to **poor uterine contractions** (hypocontractility) hindering cervical progress. - While weak contractions are a common cause, secondary arrest can also occur despite **strong uterine contractions** if there's an underlying mechanical issue, such as **cephalopelvic disproportion** or **fetal malpresentation**, preventing the fetal head from descending and dilating the cervix effectively. *1 and 2 only* - This option incorrectly excludes **disproportion and malpresentation** as potential causes of secondary arrest of dilatation. - Both poor uterine contractions and cessation of dilatation despite strong contractions are valid causes, but overlooking mechanical impediments like disproportion leaves the explanation incomplete. *1 and 3 only* - This option overlooks the scenario where **cervical dilatation ceases despite strong uterine contractions**, which is a distinct presentation of arrest that points to mechanical obstruction rather than purely ineffective contractions. - While poor contractions and disproportion/malpresentation are important, the specified scenario of strong contractions with no progress is also a key factor. *2 and 3 only* - This option incorrectly omits **poor uterine contractions** as a primary and very common cause of secondary arrest of dilatation. - Weak or uncoordinated contractions are often the first factor investigated when cervical progression stalls.
Question 43: Which of the following correctly defines the first stage of labor? 1. Full dilatation of cervix to the expulsion of the fetus from the birth canal 2. Maternal bearing down efforts and ends with the delivery of the baby 3. The onset of true labor pains and ends with the full dilatation of cervix 4. The formation of bag of waters
- A. 1, 2 and 4
- B. 1, 3 and 4
- C. 1, 2 and 3
- D. 2, 3 and 4 (Correct Answer)
Explanation: ***Correct Answer: Only Statement 3*** The **first stage of labor** is accurately defined by **statement 3 only**: "The onset of true labor pains and ends with the full dilatation of cervix" **Statement 3 - The onset of true labor pains and ends with the full dilatation of cervix** ✓ - This is the **accurate and complete definition** of the **first stage of labor** - Begins with regular, progressive uterine contractions - Ends when cervix reaches **10 cm (full) dilatation** - Divided into **latent phase** (0-6 cm) and **active phase** (6-10 cm) - Duration varies but averages 8-12 hours in primigravidas **Why other statements are INCORRECT:** *Statement 1 - Full dilatation of cervix to the expulsion of the fetus* - This describes the **SECOND stage of labor**, NOT the first stage - Second stage: begins at full cervical dilatation (10 cm) and ends with delivery of baby *Statement 2 - Maternal bearing down efforts and ends with the delivery of the baby* - This also describes the **SECOND stage of labor** - Active pushing occurs after full dilatation, not during the first stage *Statement 4 - The formation of bag of waters* - The amniotic sac forms during **pregnancy**, not during labor - Its rupture may occur during labor but does not define the first stage - Not a defining characteristic of any labor stage **Note:** Among the given options, **"2, 3 and 4"** is selected as it contains the correct statement (3). However, strictly speaking, only statement 3 correctly defines the first stage of labor. Statements 2 and 4 do not define the first stage.
Question 44: Vesicovaginal fistula is classified as complicated if it has which of the following features ? 1. Size - more than 3 cm 2. Bladder involvement - Trigonal/Juxta-urethral 3. Location - Midvaginal 4. Presence of prior radiation Select the correct answer using the code given below :
- A. 1, 2 and 4 (Correct Answer)
- B. 1, 2 and 3
- C. 1, 3 and 4
- D. 2, 3 and 4
Explanation: ***1, 2 and 4*** * A vesicovaginal fistula is considered **complicated** if it has a size of **more than 3 cm**, involves the **trigone or juxta-urethral region** of the bladder, or is associated with **prior radiation therapy**. * These factors indicate a greater challenge in surgical repair and a higher risk of recurrence. * Trigonal involvement is complicated because it may involve ureteral orifices, and juxta-urethral fistulas risk urinary continence. *1, 2 and 3* * While a size of more than 3 cm and trigonal/juxta-urethral bladder involvement are criteria for a complicated fistula, a **midvaginal location** is generally not considered a complicating factor on its own. * **Low vaginal (juxta-urethral) fistulas** or those in scarred, immobile areas are more challenging, not midvaginal locations. *1, 3 and 4* * A size of more than 3 cm and prior radiation are indeed factors that classify a fistula as complicated. * However, a **midvaginal location** alone does not typically complicate the repair to the same extent as trigonal bladder involvement or a history of radiation. *2, 3 and 4* * Trigonal/juxta-urethral bladder involvement and prior radiation are definite complicating factors. * Yet, a **midvaginal location** is less of a complicating factor compared to a **large size (more than 3 cm)**, which is a major determinant of fistula complexity.
Question 45: Which one of the following is a prerequisite for Endometrial Ablation ?
- A. Completed childbearing (Correct Answer)
- B. Desire to maintain fertility
- C. Uterine size >16 weeks
- D. Presence of large submucous fibroids
Explanation: ***Correct: Completed childbearing*** **Completed childbearing** is the key **prerequisite** for **endometrial ablation (EA)**. This is a fundamental requirement because: - **EA significantly impairs or destroys fertility** by ablating the endometrial lining essential for implantation - Pregnancy after EA is **rare and high-risk**, with increased chances of **miscarriage, ectopic pregnancy, preterm birth, and placental abnormalities** (placenta accreta, previa) - Patients must be **thoroughly counseled** that EA is intended as a permanent solution and future pregnancy is contraindicated - Most guidelines and consent protocols require documentation that the patient has completed childbearing or accepts permanent loss of fertility - While not an absolute contraindication if a patient insists, the strong recommendation is that childbearing should be complete *Incorrect: Presence of large submucous fibroids* - Large submucous fibroids are a **CONTRAINDICATION**, not a prerequisite - Fibroids distort the uterine cavity, making safe and effective ablation **difficult or impossible** - They may require **hysteroscopic myomectomy** first, or EA may not be appropriate at all - This is the opposite of a prerequisite *Incorrect: Desire to maintain fertility* - This is a strong **CONTRAINDICATION** for EA - EA destroys the endometrium needed for pregnancy - Patients desiring future fertility should pursue other treatments for abnormal uterine bleeding - This directly contradicts the purpose and effects of the procedure *Incorrect: Uterine size >16 weeks* - A uterus larger than **12 weeks' gestation** is a **relative contraindication** or limitation - Increased risk of **incomplete ablation, perforation**, and treatment failure - Large uteri often indicate underlying pathology needing alternative management - This is a contraindication, not a prerequisite
Question 46: Which of the following days of menstrual cycle is best for endometrial sampling to diagnose ovulation?
- A. 8th - 10th day
- B. 12th - 14th day
- C. 16th - 20th day (Correct Answer)
- D. 21st - 23rd day
Explanation: ***16th - 20th day*** - Endometrial sampling during this period, specifically **around days 16-20** of a typical 28-day cycle, falls within the **early-to-mid secretory phase**, when the endometrium begins showing characteristic secretory changes indicative of ovulation. - After ovulation, the **corpus luteum** produces **progesterone**, which transforms the proliferative endometrium into a secretory one, with changes becoming evident by day 16 and progressively more pronounced. - This timeframe captures the **development of secretory changes** including subnuclear vacuolation, stromal edema, and glandular secretion, providing clear histological confirmation of ovulation. *8th - 10th day* - This period corresponds to the **early proliferative phase**, before ovulation has occurred, so the endometrium would not show any secretory changes indicative of ovulation. - Endometrial histology would primarily display **proliferative features** with mitotic activity and straight tubular glands, making it unsuitable for assessing post-ovulatory changes. *12th - 14th day* - This timeframe represents the **late proliferative phase** or the expected time of **ovulation itself**. - While ovulation may be occurring, the endometrium would not yet have developed the **secretory changes** necessary for histological diagnosis of past ovulation, as progesterone effect requires time to manifest. *21st - 23rd day* - This period falls into the **mid-to-late secretory phase**, which shows well-developed secretory changes. - While this would also demonstrate evidence of ovulation, the question specifically identifies the 16th-20th day range as the preferred timeframe for endometrial sampling in clinical practice for ovulation diagnosis.
Question 47: A 27-year-old female married for 3 years regularly cohabiting with husband presents to Gynaecology OPD with complaints of inability to conceive for 2 years. During clinical evaluation hysterosalpingography was done which revealed irregular outline of uterine cavity and rigid fallopian tubes with nodulations. Most likely cause for this condition is :
- A. Genital Tuberculosis (Correct Answer)
- B. Syphilis
- C. Genital Herpes
- D. Gonorrhoea
Explanation: ***Genital Tuberculosis*** - The combination of **infertility**, an **irregular uterine cavity outline**, and **rigid fallopian tubes with nodulations** on hysterosalpingography (HSG) is highly suggestive of genital tuberculosis. - **Tuberculosis** can cause significant scarring and obstruction in the female reproductive tract, leading to these characteristic HSG findings and impaired fertility. *Syphilis* - While syphilis is a sexually transmitted infection, it typically causes **chancre formation**, **rash**, and systemic symptoms; it does not typically lead to the described HSG findings of an irregular uterine cavity or rigid, nodulated fallopian tubes. - Infertility can be a consequence of untreated syphilis (e.g., through miscarriage), but the specific morphological changes seen in the uterus and tubes are not characteristic of this infection. *Genital Herpes* - Genital herpes is caused by the herpes simplex virus and is characterized by recurrent outbreaks of **painful blisters and ulcers** in the genital area. - It does not cause structural changes to the uterus or fallopian tubes that would result in an irregular uterine outline or rigid, nodulated tubes as seen on HSG. *Gonorrhoea* - Gonorrhoea can cause **pelvic inflammatory disease (PID)**, which can lead to tubal damage and infertility; however, the typical HSG findings are often **hydrosalpinx** or extensive peritubal adhesions, rather than rigid, nodulated tubes with an irregular uterine outline. - While it can result in tubal obstruction, the specific pattern described in the question (irregular uterine outline, rigid tubes with nodulations) is more characteristic of the chronic inflammatory and fibrotic changes associated with tuberculosis.
Question 48: Prophylactic oophorectomy is recommended in high risk women with which of the following ? 1. Carrying BRCA1 or BRCA2 genes 2. Family history of breast, colon, ovarian cancer 3. Patients having tubo-ovarian abscess Select the correct answer using the code given below :
- A. 1, 2 and 3
- B. 2 and 3 only
- C. 1 and 3 only
- D. 1 and 2 only (Correct Answer)
Explanation: ***1 and 2 only*** - Prophylactic oophorectomy is strongly recommended for women carrying **BRCA1 or BRCA2 genes** due to a significantly increased lifetime risk of developing ovarian and breast cancer. - A strong **family history of breast, colon, or ovarian cancer**, especially in multiple first-degree relatives or at early ages, indicates a higher genetic predisposition that warrants consideration for prophylactic oophorectomy. *1, 2 and 3* - While carrying BRCA1/2 genes and a significant family history are indications, a **tubo-ovarian abscess (TOA)** is an infectious condition that requires antibiotic treatment and possibly surgical drainage, not a prophylactic oophorectomy for cancer risk reduction. - Prophylactic oophorectomy is performed to reduce cancer risk in genetically predisposed individuals, which is unrelated to the management of an acute infectious process like TOA. *2 and 3 only* - This option incorrectly excludes **BRCA1 or BRCA2 gene carriers**, who are among the highest-risk group for ovarian and breast cancer, making prophylactic oophorectomy a crucial primary prevention strategy. - The inclusion of **tubo-ovarian abscess** as an indication for prophylactic oophorectomy is incorrect, as TOA is an inflammatory condition, not a genetic predisposition to cancer. *1 and 3 only* - This option incorrectly includes **tubo-ovarian abscess (TOA)** as a reason for prophylactic oophorectomy; TOA is an infection requiring specific medical or surgical treatment, not risk-reducing surgery for cancer. - This option incorrectly excludes a **strong family history of breast, colon, or ovarian cancer** as a separate indication for prophylactic oophorectomy, especially when genetic testing might not have identified a specific mutation but a high familial risk remains.
Question 49: Which one of the following is the distinguishing feature to differentiate Gartner's cyst from Cystocele ?
- A. There is no impulse on coughing in cystocele
- B. Gartner's cyst is not reducible (Correct Answer)
- C. Marked cough impulse in Gartner's cyst
- D. Margins are ill-defined in Gartner's cyst
Explanation: ***Gartner's cyst is not reducible*** * **Gartner's cysts** are typically **fixed structures** within the vagina, representing remnants of the Wolffian duct, and therefore cannot be reduced or pushed back into place. * The **immobility** and non-reducibility of the cyst is a key characteristic that helps differentiate it from conditions like cystocele. * A **cystocele** is a prolapse of the bladder into the vagina, which is **reducible** (can be pushed back) and typically shows an impulse on coughing due to increased intra-abdominal pressure. *There is no impulse on coughing in cystocele* * This statement is **incorrect** as a **cystocele** typically **does show a cough impulse** due to increased intra-abdominal pressure transmitted through the prolapsed bladder. * The presence of a cough impulse is a characteristic feature of cystocele, not its absence. *Marked cough impulse in Gartner's cyst* * **Gartner's cysts** are fluid-filled sacs and do not transmit increased intra-abdominal pressure from coughing, therefore they typically **do not have a cough impulse**. * A marked cough impulse is more characteristic of a prolapsed organ, like a cystocele or rectocele, not a fixed cystic structure. *Margins are ill-defined in Gartner's cyst* * **Gartner's cysts** usually have **well-defined margins** as they are encapsulated structures. * Ill-defined margins might suggest an infiltrative process or inflammation, which is not characteristic of a simple Gartner's cyst.
Question 50: Surgical treatment by 'ventrosuspension of uterus' is used for what condition ?
- A. Retroversion of uterus
- B. Vault prolapse
- C. Pelvic organ prolapse (Correct Answer)
- D. Rupture of uterus
Explanation: **Pelvic organ prolapse** * **Ventrosuspension of the uterus**, also known as uteropexy, is a surgical procedure to **reposition and fix the uterus** in its anatomical position and support the vaginal vault, aiming to correct **pelvic organ prolapse**. * This procedure involves attaching sutures from the **anterior uterine wall to the anterior abdominal wall**, either directly to the rectus fascia or other strong ligaments, to alleviate symptoms of prolapse. * *Retroversion of uterus* * **Retroversion** is a common anatomical variant where the uterus is tilted backward, and it typically **does not require surgical intervention** unless associated with severe symptoms like dyspareunia or chronic pelvic pain, which are usually managed via different approaches. * While ventrosuspension could technically reposition a retroverted uterus, it is **not the primary indication** given its generally asymptomatic nature and the availability of less invasive options. * *Vault prolapse* * **Vault prolapse** specifically refers to the descent of the vaginal cuff **after a hysterectomy**, where there is no uterus present to suspend. * Therefore, "ventrosuspension of the uterus" is **not applicable after a hysterectomy** as the uterus is absent. * *Rupture of uterus* * **Uterine rupture** is an obstetric emergency involving a **tear in the uterine wall**, usually occurring during labor, and it is a life-threatening condition for both mother and fetus. * Management involves **immediate surgical repair (laparotomy)** and delivery, not elective suspension procedures like ventrosuspension.