UPSC-CMS 2024 - Obstetrics and Gynecology Practice Questions

Q: A 16-year-old girl with primary amenorrhoea presents to the gynaecology OPD for evaluation. She has normal secondary sexual characters. Her karyotype is 46,XX and ultrasound reveals normal ovaries and tubes but absent uterus. What is her clinical diagnosis?

Mayer-Rokitansky-Küster-Hauser syndrome. ***Mayer-Rokitansky-Küster-Hauser syndrome (MRKH)*** - This syndrome is characterized by **agenesis of the uterus and upper vagina** in a genotypically and phenotypically normal female (46,XX karyotype, normal ovaries, and normal secondary sexual characteristics). - The presence of **normal secondary sexual characteristics** indicates normal ovarian function and estrogen production, ruling out ovarian failure as the primary cause of amenorrhea. *Primary ovarian failure* - This condition would typically lead to **absent or delayed development of secondary sexual characteristics** due to insufficient estrogen production by the ovaries. - The patient's **normal secondary sexual characteristics** contradict primary ovarian failure. *Androgen insensitivity syndrome* - Individuals with CAIS are **genetically male (46,XY)** but phenotypically female, with **absent or rudimentary uterus** and internal female reproductive organs. - While they have absent menses and normal secondary sexual characteristics (due to peripheral conversion of androgens to estrogens), their **karyotype is 46,XY**, not 46,XX as in this patient. *Turner syndrome* - This syndrome is characterized by a **45,X karyotype**, leading to **gonadal dysgenesis** (streak gonads) and thus absent or delayed secondary sexual characteristics. - The patient's **normal secondary sexual characteristics** and **46,XX karyotype** rule out Turner syndrome.

Q: Which of the following are essential steps of Fothergill's operation? 1. Laparoscopic or vaginal ligation 2. Amputation of cervix 3. Plication of Mackenrodt's ligaments in front of cervix 4. Anterior colporrhaphy Select the correct answer using the code given below.

2, 3 and 4. ***2, 3 and 4*** - **Fothergill's operation** (also known as Manchester operation) is a surgical procedure for **pelvic organ prolapse** that involves amputation of the cervix, plication of Mackenrodt's ligaments, and anterior colporrhaphy. - The goal is to correct **cervical elongation** and provide support to the uterus and bladder. *1, 2 and 3* - This option incorrectly includes "laparoscopic or vaginal ligation" as an essential step. Fothergill's operation does not typically involve ligation of structures; it focuses on correcting prolapse through tissue reshaping and support. - While cervical amputation and plication of Mackenrodt's ligaments are essential, ligation is not a characteristic component. *1, 2 and 4* - This option also incorrectly includes "laparoscopic or vaginal ligation" and misses the crucial step of "plication of Mackenrodt's ligaments in front of cervix." - The plication of these ligaments is fundamental to providing uterine support and is a defining feature of the Fothergill's procedure. *1, 3 and 4* - This option again incorrectly includes "laparoscopic or vaginal ligation" and omits "amputation of the cervix." - Cervical amputation is an essential component of Fothergill's operation, addressing cervical elongation which contributes to prolapse.

Q: Which of the following are indications of cold knife conization? 1. Inconsistent findings between colposcopy, cytology and directed biopsy 2. Persistent CIN-1 lesion in women willing for future fertility 3. Carcinoma in situ 4. Unsatisfactory colposcopic finding where the entire margin of lesion is not visible Select the correct answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - **Inconsistent findings** between colposcopy, cytology, and directed biopsy necessitate a conization to obtain a more definitive diagnosis and rule out higher-grade lesions or early invasion. - **Carcinoma in situ (CIS)**, also known as CIN 3, requires excisional treatment such as cold knife conization to remove the entire lesion and provide a complete pathological assessment of the margins, which is crucial for determining further management. - An **unsatisfactory colposcopic finding**, particularly when the entire transformation zone and thus the margins of the lesion are not visible, indicates that the full extent of the abnormality cannot be adequately assessed. Cold knife conization allows for removal of the entire endocervical canal for comprehensive evaluation. *2, 3 and 4* - This option is incorrect because **persistent CIN-1 lesions**, especially in women desiring future fertility, are often managed with observation and repeat cytology/colposcopy rather than excisional biopsy, due to the high rate of spontaneous regression and the potential for conization to affect cervical competence. *1, 2 and 3* - This option is incorrect as it includes **persistent CIN-1 lesions** as an indication for cold knife conization, which is generally not the primary management strategy due to the typically benign course of CIN-1. *1, 2 and 4* - This option is incorrect because **persistent CIN-1 lesions** are not a standard indication for cold knife conization, particularly when future fertility is a concern.

Q: Which of the following are factors for poor outcome following tuboplasty? 1. Dense pelvic adhesions 2. Length of reconstructed tube less than 4 cm 3. Bilateral hydrosalpinx 4. Reversal after 5 years of sterilization procedure Select the correct answer using the code given below.

1, 2 and 3. ***1, 2 and 3*** - **Dense pelvic adhesions** impair tubal motility and increase the risk of ectopic pregnancy, leading to poor outcomes after tuboplasty. - A **reconstructed tube length less than 4 cm** significantly reduces the available surface area for fertilization and embryo transport, negatively impacting fertility success rates. - **Bilateral hydrosalpinx** indicates severe tubal damage with impaired ciliary function and potentially toxic fluid accumulation, which drastically reduces the chances of successful pregnancy even after surgical repair. *1, 2 and 4* - This option incorrectly includes "Reversal after 5 years of sterilization procedure" while omitting bilateral hydrosalpinx, which is a more significant poor prognostic factor. - While duration since sterilization can influence outcomes, anatomical factors like hydrosalpinx are more critical predictors of tuboplasty failure. *2, 3 and 4* - This option incorrectly omits "Dense pelvic adhesions," which is one of the most important poor prognostic factors in tuboplasty. - Severe pelvic adhesions directly compromise tubal function and significantly increase ectopic pregnancy risk. *1, 3 and 4* - This option incorrectly omits "Length of reconstructed tube less than 4 cm," which is a critical anatomical factor directly influencing tuboplasty success. - Adequate tubal length is essential for proper gamete transport and fertilization; tubes shorter than 4 cm have significantly reduced success rates.

Q: Which of the following conditions are indications of removal of intrauterine device? 1. Persistent irregular uterine bleeding 2. Perforation of uterus 3. Pyelonephritis 4. Pregnancy with device in situ Select the correct answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** - **Persistent irregular uterine bleeding** that does not respond to medical management is an indication for IUD removal according to WHO guidelines and standard clinical practice. After ruling out other causes and attempting conservative management, persistent problematic bleeding warrants removal. - **Uterine perforation** by an IUD is a serious complication requiring immediate removal to prevent further injury, infection, migration of the device, or damage to adjacent organs. - **Pregnancy with an IUD in situ** increases the risk of complications including septic abortion, miscarriage, preterm birth, and chorioamnionitis. If the IUD strings are visible, removal is recommended (preferably in the first trimester). *1 and 2* - While these are both valid indications, this option is incomplete as it omits pregnancy with IUD in situ, which is also a strong indication for removal. *2 and 4* - Both uterine perforation and pregnancy with IUD are indications for removal, but this option incorrectly excludes persistent irregular uterine bleeding, which is also an indication when unresponsive to treatment. *1, 2 and 3* - **Pyelonephritis** (kidney infection) is not an indication for IUD removal as it is a urinary tract infection unrelated to IUD use. The IUD does not cause or complicate pyelonephritis, and treatment involves appropriate antibiotics without device removal.

Q: Consider the following statements regarding LNG-20 (Mirena) : 1. It is a T-shaped IUD filled with natural hormone progesterone. 2. It is associated with a low pregnancy rate (2 per 1000 women). 3. It is associated with a large number of ectopic pregnancies. 4. It is associated with lower menstrual blood loss as compared to copper IUDs. Which of the statements given above is/are correct?

2 and 4. ***Correct Option: Statements 2 and 4*** - **Statement 2 is TRUE**: The Mirena IUD (LNG-20) is highly effective with a very **low pregnancy rate** (approximately 0.2% or 2 per 1000 women per year), making it one of the most reliable forms of contraception. This high efficacy is due to the continuous release of levonorgestrel, which thickens cervical mucus, thins the uterine lining, and inhibits sperm function. - **Statement 4 is TRUE**: Mirena is associated with **significantly reduced menstrual blood loss** compared to copper IUDs. In fact, many women experience amenorrhea (absence of periods) or very light bleeding, which is one of its therapeutic benefits. This makes it useful for treating menorrhagia (heavy menstrual bleeding). *Incorrect Statement 1* - The Mirena IUD contains **synthetic levonorgestrel** (a progestin), NOT natural progesterone. While it is T-shaped, the hormone component is incorrectly described in this statement. *Incorrect Statement 3* - Mirena is NOT associated with a large number of ectopic pregnancies. While there may be a slight increase in the *proportion* of pregnancies that are ectopic IF conception occurs with an IUD in place, the **overall absolute risk of ectopic pregnancy is significantly reduced** compared to women not using contraception. This is because the overall pregnancy rate is so low. *Option: 2, 3 and 4* - Incorrect because statement 3 is false. Mirena does not cause a large number of ectopic pregnancies. *Option: 1, 3 and 4* - Incorrect because both statements 1 and 3 are false. Statement 1 incorrectly identifies the hormone as natural progesterone (it's synthetic levonorgestrel), and statement 3 falsely claims a large number of ectopic pregnancies. *Option: 1 and 2* - Incorrect because statement 1 is false (contains levonorgestrel, not natural progesterone), and this option omits the true statement 4 about reduced menstrual blood loss.

Q: The most common cause of maternal mortality in India is

obstetric haemorrhage. ***Obstetric haemorrhage*** - **Postpartum hemorrhage (PPH)** remains the leading **direct cause** of maternal mortality in India and globally - Most commonly results from **uterine atony** (inadequate uterine contraction after delivery), accounting for approximately 70% of PPH cases - Other causes include retained placental tissue, genital tract trauma, and coagulation disorders - Contributes to approximately **30-35%** of maternal deaths in India according to recent SRS data *Unsafe abortion* - Significant contributor to maternal mortality, particularly in regions with limited access to safe abortion services - Complications include **sepsis, hemorrhage, and uterine perforation** - Ranks as the second or third leading cause depending on the data source, but not the most common overall *Toxaemia of pregnancy* - Also known as **pre-eclampsia and eclampsia**, this is an important cause of maternal mortality - Complications include **eclamptic seizures, stroke, HELLP syndrome, and multi-organ failure** - Ranks third to fourth among direct causes of maternal death in India *Obstructed labour* - Can lead to serious complications including **uterine rupture, postpartum hemorrhage, and sepsis** - With improved access to cesarean sections, the contribution to maternal mortality has decreased - Now contributes less to overall maternal mortality compared to hemorrhage

Question 1

A 16-year-old girl with primary amenorrhoea presents to the gynaecology OPD for evaluation. She has normal secondary sexual characters. Her karyotype is 46,XX and ultrasound reveals normal ovaries and tubes but absent uterus. What is her clinical diagnosis?

Accepted Answer

Mayer-Rokitansky-Küster-Hauser syndrome

Answer

Primary ovarian failure

Answer

Androgen insensitivity syndrome

Answer

Turner syndrome

Question 2

Which of the following are essential steps of Fothergill's operation?

1. Laparoscopic or vaginal ligation
2. Amputation of cervix
3. Plication of Mackenrodt's ligaments in front of cervix
4. Anterior colporrhaphy

Select the correct answer using the code given below.

Accepted Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 3

Which of the following are indications of cold knife conization?

1. Inconsistent findings between colposcopy, cytology and directed biopsy
2. Persistent CIN-1 lesion in women willing for future fertility
3. Carcinoma in situ
4. Unsatisfactory colposcopic finding where the entire margin of lesion is not visible

Select the correct answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 4

Which of the following are factors for poor outcome following tuboplasty?

1. Dense pelvic adhesions
2. Length of reconstructed tube less than 4 cm
3. Bilateral hydrosalpinx
4. Reversal after 5 years of sterilization procedure

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 5

Which of the following conditions are indications of removal of intrauterine device?

1. Persistent irregular uterine bleeding
2. Perforation of uterus
3. Pyelonephritis
4. Pregnancy with device in situ

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1 and 2

Answer

2 and 4

Answer

1, 2 and 3

Question 6

Consider the following statements regarding LNG-20 (Mirena) :

1. It is a T-shaped IUD filled with natural hormone progesterone.
2. It is associated with a low pregnancy rate (2 per 1000 women).
3. It is associated with a large number of ectopic pregnancies.
4. It is associated with lower menstrual blood loss as compared to copper IUDs.

Which of the statements given above is/are correct?

Accepted Answer

2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1 and 2

Question 7

The most common cause of maternal mortality in India is

Accepted Answer

obstetric haemorrhage

Answer

unsafe abortion

Answer

toxaemia of pregnancy

Answer

obstructed labour

UPSC-CMS 2024 — Obstetrics and Gynecology