Obstetrics and Gynecology
6 questionsConsider the following statements regarding oligohydramnios: 1. It is defined on USG when maximum vertical pocket of liquor is less than 3 cm. 2. It is defined on USG when AFI is less than 5 cm. 3. It is associated with increased risk of cord compression during labor. 4. It is commonly seen in post-term pregnancies. Select the correct answer using the code given below.
Which of the following are correct about endocrine changes in normal pregnancy? 1. Increase in levels of maternal serum iodine 2. Increase in serum levels of Corticotropin-Releasing Hormone (CRH) 3. Increase in serum levels of aldosterone Select the answer using the code given below.
Which of the following features are correct regarding onset of true labour? 1. Regular uterine contractions 2. Progressive cervical dilation and effacement 3. Presence of show 4. Labour and delivery are synonymous Select the answer using the code given below.
According to the WHO Intrapartum Care Guidelines, 2018, the active phase of labour starts from what dilation of cervix?
The diameter of engagement of foetal skull in marked deflexion is
Which of the following are correct regarding pathological findings of placenta accreta? 1. Absence of decidua basalis 2. Absence of Nitabuch's fibrinoid layer 3. Loss of normal hypoechoic retroplacental myometrial zone in ultrasonography Select the answer using the code given below.
UPSC-CMS 2024 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 41: Consider the following statements regarding oligohydramnios: 1. It is defined on USG when maximum vertical pocket of liquor is less than 3 cm. 2. It is defined on USG when AFI is less than 5 cm. 3. It is associated with increased risk of cord compression during labor. 4. It is commonly seen in post-term pregnancies. Select the correct answer using the code given below.
- A. 1 and 2 only
- B. 1, 2 and 4
- C. 1, 3 and 4
- D. 2, 3 and 4 (Correct Answer)
Explanation: ***2, 3 and 4*** - This option correctly identifies the accurate definitions and associations of **oligohydramnios**. - Statement 2 correctly defines oligohydramnios as **AFI < 5 cm** using the Amniotic Fluid Index method. - Statement 3 is correct: oligohydramnios is associated with increased risk of **cord compression** during labor due to reduced cushioning effect of amniotic fluid. - Statement 4 is correct: oligohydramnios is commonly seen in **post-term pregnancies** (> 42 weeks) due to placental insufficiency and reduced fetal urine production. *1 and 2 only* - Statement 1 is **incorrect**: oligohydramnios is defined as maximum vertical pocket (MVP) **< 2 cm**, not < 3 cm. - This option excludes the important clinical associations of cord compression and post-term pregnancy. *1, 2 and 4* - Statement 1 is **incorrect**: the correct cutoff for MVP is **< 2 cm**, not < 3 cm. - This option misses the crucial risk of **cord compression** during labor. *1, 3 and 4* - Statement 1 is **incorrect**: oligohydramnios by MVP method is defined as **< 2 cm**, not < 3 cm. - This option misses the alternative and commonly used definition via **AFI < 5 cm**.
Question 42: Which of the following are correct about endocrine changes in normal pregnancy? 1. Increase in levels of maternal serum iodine 2. Increase in serum levels of Corticotropin-Releasing Hormone (CRH) 3. Increase in serum levels of aldosterone Select the answer using the code given below.
- A. 1 and 2 only
- B. 1 and 3 only
- C. 2 and 3 only (Correct Answer)
- D. 1, 2 and 3
Explanation: ***2 and 3 only*** - **Corticotropin-releasing hormone (CRH)** levels increase dramatically during pregnancy, produced by the **placenta**, influencing the timing of labor and fetal development. - **Aldosterone** levels significantly increase during pregnancy to help maintain **fluid balance** and counteract the natriuretic effects of increased progesterone and vasodilation. *1 and 2 only* - While CRH levels do increase, **maternal serum iodine levels do not increase**; rather, there is an increased demand for iodine and a decrease in serum iodine concentration due to increased renal clearance and transfer to the fetus. - This option incorrectly states an increase in maternal serum iodine. *1 and 3 only* - Although aldosterone levels increase, **maternal serum iodine levels do not increase** during normal pregnancy. - This option incorrectly implies an increase in serum iodine while correctly identifying an increase in aldosterone. *1, 2 and 3* - This option is incorrect because **maternal serum iodine levels do not increase** in normal pregnancy; instead, there is often a relative iodine deficiency due to increased demand and excretion. - Only CRH and aldosterone levels increase among the choices provided.
Question 43: Which of the following features are correct regarding onset of true labour? 1. Regular uterine contractions 2. Progressive cervical dilation and effacement 3. Presence of show 4. Labour and delivery are synonymous Select the answer using the code given below.
- A. 2, 3 and 4
- B. 1, 2 and 3 (Correct Answer)
- C. 1, 3 and 4
- D. 1, 2 and 4
Explanation: ***Correct: 1, 2 and 3*** - **Regular uterine contractions** (statement 1) are a hallmark of true labor, occurring at regular intervals with increasing frequency, duration, and intensity. - **Progressive cervical dilation and effacement** (statement 2) is the definitive diagnostic criterion for true labor, distinguishing it from false labor (Braxton Hicks contractions). - **Presence of 'show'** (statement 3) - the expulsion of the cervical mucus plug mixed with blood - is a common and reliable indicator of true labor onset. - Statement 4 is **incorrect**: labor and delivery are **not synonymous**. **Labor** is the entire process of childbirth (contractions, cervical changes, descent of fetus), while **delivery** refers specifically to the expulsion of the baby. *Incorrect: 2, 3 and 4* - Incorrectly includes statement 4, which falsely claims labor and delivery are synonymous. - Omits statement 1 (regular uterine contractions), which is a fundamental feature of true labor. *Incorrect: 1, 3 and 4* - Incorrectly includes statement 4 about labor and delivery being synonymous. - Critically omits statement 2 (progressive cervical dilation and effacement), which is the most important diagnostic criterion for true labor. *Incorrect: 1, 2 and 4* - Incorrectly includes statement 4, which is false. - Omits statement 3 (presence of show), which is a valid indicator of true labor onset.
Question 44: According to the WHO Intrapartum Care Guidelines, 2018, the active phase of labour starts from what dilation of cervix?
- A. 4 cm
- B. 3 cm
- C. 6 cm
- D. 5 cm (Correct Answer)
Explanation: ***5 cm*** - According to the **WHO Intrapartum Care Guidelines, 2018**, the active first stage of labor is defined as starting when the cervix is dilated to **5 cm**. - The WHO guidelines state: "The active first stage is the period of time from 5 cm of cervical dilatation until full cervical dilatation." - This updated definition aims to reduce unnecessary interventions, as cervical dilation before 5 cm (latent phase) can be slow and variable, which is part of normal labor progression. *6 cm* - **6 cm cervical dilation** is beyond the threshold defined by WHO 2018 guidelines for the start of active phase. - While some clinicians may use 6 cm as a benchmark in practice, the **official WHO 2018 guideline** specifically designates **5 cm** as the starting point. *4 cm* - Historically, **4 cm cervical dilation** was considered the start of the active phase in older definitions (Friedman curve). - This earlier benchmark led to premature diagnosis of "failure to progress" and increased interventions. - The **WHO 2018 guidelines** revised this upward to **5 cm** to reflect a more expectant management approach for slow but normal labor progression. *3 cm* - A **cervical dilation of 3 cm** is typically within the latent phase of labor, where cervical changes are usually slower and less predictable. - Defining the active phase at this early stage would significantly increase the possibility of diagnosing **abnormal labor patterns** prematurely and lead to unnecessary interventions.
Question 45: The diameter of engagement of foetal skull in marked deflexion is
- A. suboccipitofrontal diameter
- B. occipitofrontal diameter (Correct Answer)
- C. suboccipitobregmatic diameter
- D. mentovertebral diameter
Explanation: ***occipitofrontal diameter*** - In cases of **marked deflexion** (also called **persistent occipitoposterior** or **military attitude** in some contexts), the fetal head presents with extension, causing the **occipitofrontal diameter** to engage. - This diameter extends from the **occipital protuberance to the root of the nose (glabella)**, measuring approximately **11.5 cm**. - This represents a **moderately extended** attitude of the fetal head, making vaginal delivery more challenging than with flexion. *suboccipitofrontal diameter* - This diameter measures about **10.0 cm** and engages with **partial deflexion**. - It extends from the **subocciput to the glabella** (center of forehead). - This is an intermediate position between full flexion and marked deflexion. *suboccipitobregmatic diameter* - This is the diameter of engagement in a **well-flexed head** (normal vertex presentation), measuring approximately **9.5 cm**. - It extends from the **subocciput to the bregma** (anterior fontanelle). - This is the **ideal diameter** for vaginal birth as it presents the smallest diameter. *mentovertical diameter* - This diameter is relevant in **brow presentation** (maximum deflexion/extension), measuring about **13-13.5 cm**. - It extends from the **chin (mentum) to the vertex**. - Brow presentation is **highly unfavorable** for vaginal delivery due to this very large engaging diameter and typically requires cesarean section.
Question 46: Which of the following are correct regarding pathological findings of placenta accreta? 1. Absence of decidua basalis 2. Absence of Nitabuch's fibrinoid layer 3. Loss of normal hypoechoic retroplacental myometrial zone in ultrasonography Select the answer using the code given below.
- A. 1 and 3 only
- B. 1, 2 and 3 (Correct Answer)
- C. 1 and 2 only
- D. 2 and 3 only
Explanation: **Correct: 1, 2 and 3** - **Placenta accreta** is pathologically defined by the **direct adherence of villi to the myometrium** due to a deficient or absent decidua. - The absence of both the **decidua basalis** and the **Nitabuch's fibrinoid layer** allows for the abnormal trophoblast invasion and adherence to the myometrium. - On ultrasound, this condition is characterized by the **loss of the normal hypoechoic retroplacental myometrial zone**, which indicates the absence of a clear boundary between the placenta and the uterine wall. - All three findings (statements 1, 2, and 3) are correct pathological and diagnostic features of placenta accreta. *Incorrect: 1 and 3 only* - This option is incomplete as it omits the crucial role of the **Nitabuch's fibrinoid layer** absence in the pathology of placenta accreta. - The Nitabuch's layer normally acts as a protective barrier against deep placental invasion, and its absence is a key pathological feature. *Incorrect: 1 and 2 only* - While both the absence of decidua basalis and Nitabuch's fibrinoid layer are definitive pathological findings, this option fails to include the important **ultrasonographic feature** that aids in antenatal diagnosis. - The **loss of the retroplacental hypoechoic zone** is a critical diagnostic sign in clinical practice. *Incorrect: 2 and 3 only* - This option is incorrect because it overlooks the primary pathological feature of placenta accreta, which is the **absence of the decidua basalis**. - The decidua basalis normally forms the maternal component of the placenta, and its absence is fundamental to the abnormal adherence.
Pediatrics
1 questionsA 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?
UPSC-CMS 2024 - Pediatrics UPSC-CMS Practice Questions and MCQs
Question 41: A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?
- A. Cephalhaematoma (Correct Answer)
- B. Subgaleal haemorrhage
- C. Caput succedaneum
- D. Intraventricular haemorrhage
Explanation: ***Cephalhaematoma*** - A **cephalhaematoma** is a collection of blood between the **pericranium** and the skull bone, which is characteristically limited by the **suture lines**. This perfectly matches the clinical description. - It is often associated with **traumatic deliveries** like forceps delivery due to shearing forces on the skull and can appear hours to days after birth. *Subgaleal haemorrhage* - A **subgaleal haemorrhage** involves bleeding into the **potential space between the epicranial aponeurosis and the periosteum** (galea aponeurotica). - Unlike cephalhaematoma, it is **not limited by suture lines** and can spread across the entire scalp, potentially leading to significant blood loss. *Caput succedaneum* - **Caput succedaneum** is an **oedematous swelling of the fetal scalp** caused by pressure during head engagement, leading to fluid accumulation above the periosteum. - It is present at birth, often **crosses suture lines**, and usually resolves within a few days, differentiating it from a blood collection limited by sutures. *Intraventricular haemorrhage* - **Intraventricular haemorrhage** is bleeding into the brain's ventricular system and is a serious condition most commonly seen in **premature infants**. - It involves **bleeding within the brain** itself, not an external scalp swelling, and presents with neurological symptoms.
Physiology
3 questionsWhich one of the following statements is correct regarding foetal physiology?
Which of the following are advantages of state of haemodilution during pregnancy? 1. Optimum gaseous exchange between maternal and foetal circulation due to decreased blood viscosity 2. Protection against adverse effect of blood loss during delivery 3. Increased oxygen carrying capacity of blood Select the correct answer using the code given below.
Onset of labour is initiated by which of the following?
UPSC-CMS 2024 - Physiology UPSC-CMS Practice Questions and MCQs
Question 41: Which one of the following statements is correct regarding foetal physiology?
- A. Foetal pancreas secretes insulin as early as 20 weeks.
- B. Haematopoiesis is demonstrated first in the yolk sac by 14th day. (Correct Answer)
- C. Meconium appears at 16 weeks.
- D. Breathing movements are identified at 26 weeks.
Explanation: **Haematopoiesis is demonstrated first in the yolk sac by 14th day.** - **Hematopoiesis** (blood cell formation) begins as early as the 14th day of gestation within the **yolk sac**, which is the primary site for this process during the initial weeks. - This early development is crucial for meeting the oxygen and nutrient demands of the rapidly growing embryo. *Foetal pancreas secretes insulin as early as 20 weeks.* - The fetal pancreas begins to secrete some insulin as early as **10-12 weeks** of gestation, although significant secretion and functional maturity develop later. - By **20 weeks**, the fetal pancreas is well-differentiated, but insulin production starts earlier than this specific time point. *Meconium appears at 16 weeks.* - **Meconium** typically begins to form around **10-14 weeks** of gestation, but its appearance at the anus (often indicating a bowel movement) is usually noted later in the third trimester or at birth. - The formation at 16 weeks is too late for its initial appearance and too early for its common clinical observation. *Breathing movements are identified at 26 weeks.* - Fetal **breathing movements** can be identified much earlier, often by **18-20 weeks** of gestation using ultrasound. - These movements are intermittent and contribute to lung development, although they do not involve air exchange.
Question 42: Which of the following are advantages of state of haemodilution during pregnancy? 1. Optimum gaseous exchange between maternal and foetal circulation due to decreased blood viscosity 2. Protection against adverse effect of blood loss during delivery 3. Increased oxygen carrying capacity of blood Select the correct answer using the code given below.
- A. 1, 2 and 3
- B. 1 and 3 only
- C. 2 and 3 only
- D. 1 and 2 only (Correct Answer)
Explanation: ***1 and 2 only*** - **Haemodilution** during pregnancy, characterized by a disproportionate increase in plasma volume relative to red blood cell mass, leads to decreased blood **viscosity**. - A lower blood viscosity facilitates more efficient **gaseous exchange** (oxygen and carbon dioxide) between the maternal and fetal circulations at the placenta, and also offers a degree of protection against the effects of **blood loss during delivery** by maintaining circulating volume. *1, 2 and 3* - While haemodilution promotes efficient gaseous exchange and protects against blood loss, it does **not increase the oxygen carrying capacity** of the blood. - In fact, the relative decrease in red blood cell concentration leads to physiological anemia of pregnancy, which reduces the oxygen-carrying capacity (though total oxygen delivery may be maintained by increased cardiac output). *2 and 3 only* - This option correctly identifies protection against blood loss but incorrectly states an **increased oxygen carrying capacity**. - The primary mechanism for improved oxygen delivery is enhanced blood flow due to reduced viscosity and increased cardiac output, not an increased concentration of oxygen carriers. *1 and 3 only* - This option correctly identifies improved gaseous exchange but incorrectly suggests an **increased oxygen carrying capacity**. - Protection against blood loss is a significant benefit of pregnancy-induced haemodilution, which is overlooked in this choice.
Question 43: Onset of labour is initiated by which of the following?
- A. Increased level of progesterone immediately before labour
- B. Uterine distension
- C. Increased synthesis of myometrial receptors for oxytocin due to effect of oestrogen (Correct Answer)
- D. Increased CRH and ACTH from foetal hypothalamic-pituitary-adrenal axis
Explanation: ***Increased synthesis of myometrial receptors for oxytocin due to effect of oestrogen*** - **Estrogen** plays a crucial role in initiating labor by increasing the number of **oxytocin receptors** in the myometrium, making the uterus more sensitive to oxytocin's contractile effects. - **Oxytocin** then stimulates strong, coordinated uterine contractions essential for cervical dilation and expulsion of the fetus. *Increased level of progesterone immediately before labour* - During pregnancy, **progesterone** maintains uterine quiescence and prevents premature contractions. - The withdrawal or decrease in the inhibitory effect of progesterone, not an increase, is thought to be involved in the onset of labor. *Uterine distension* - While **uterine distension** contributes to uterine irritability and can trigger some contractions, it is not the primary initiator of true labor. - It is a physical factor that complements hormonal changes but doesn't independently start the complex cascade of labor. *Increased CRH and ACTH from foetal hypothalamic-pituitary-adrenal axis* - An increase in **fetal corticotropin-releasing hormone (CRH)** and **adrenocorticotropic hormone (ACTH)** leads to increased fetal cortisol. - Fetal cortisol then signals the placenta to produce more estrogen and less progesterone, thereby indirectly contributing to labor initiation, but it's not the direct trigger for contractions.