Obstetrics and Gynecology
9 questionsWhich of the following statements are correct regarding peripartum cardiomyopathy? 1. It is usually seen in multiparous women. 2. Echocardiography shows ejection fraction less than 45%. 3. ACE inhibitors are contraindicated. 4. History of prior heart disease is mostly present. Select the answer using the code given below.
A 28-year-old female G2P1L1 with history of previous cesarean presents to the gynaecology emergency in labour. On examination, she is hypotensive, foetal heart sounds are absent and foetal parts are easily palpable. What is her diagnosis?
A 24-year-old primigravida comes to ANC clinic at 8 months amenorrhoea. Her BP is found to be 160/100 mm Hg. Lab findings reveal thrombocytopenia, increased SGOT/SGPT and LDH. What is her diagnosis?
A patient, who is 2 months pregnant, reports to a hospital with complaints of increased vaginal bleeding and pain in lower abdomen. Internal examination reveals dilated internal os of cervix and products of conception are felt through it. What is her likely clinical diagnosis?
Which of the following is a common pathology that increases the risk of uterine injury during abdominal hysterectomy?
Which of the following is confirmatory for the diagnosis of bicornuate uterus?
Which of the following are useful investigations for diagnosis of unresponsive endometrium as a cause of primary amenorrhoea? 1. Karyotype 2. Progesterone challenge test 3. Hormonal studies 4. Hysterosalpingography Select the correct answer using the code given below.
A 25-year-old female comes to the gynaecology OPD for evaluation of secondary amenorrhoea. She gives history of previous dilatation and curettage, and her FSH levels are 8 IU/L. The probable cause of amenorrhoea is
Which of the following criteria are required to be fulfilled for hospitalization in a case of pelvic inflammatory disease? 1. Coexisting pregnancy 2. Mild fever and pain responding well to antibiotics 3. Suspected tubo-ovarian abscess 4. Coexistent HIV infection Select the correct answer using the code given below.
UPSC-CMS 2024 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 51: Which of the following statements are correct regarding peripartum cardiomyopathy? 1. It is usually seen in multiparous women. 2. Echocardiography shows ejection fraction less than 45%. 3. ACE inhibitors are contraindicated. 4. History of prior heart disease is mostly present. Select the answer using the code given below.
- A. 1, 2 and 3
- B. 1, 3 and 4
- C. 1 and 2 only (Correct Answer)
- D. 3 and 4 only
Explanation: ***1 and 2 only*** - **Peripartum cardiomyopathy** (PPCM) is more common in **multiparous women**, particularly those with a history of preeclampsia, hypertension, or multiple pregnancies. - The diagnostic criteria for PPCM include the development of **heart failure** in the last month of pregnancy or within five months postpartum, with an **ejection fraction (EF) less than 45%** (often <40%) and no other identifiable cause. *1, 2 and 3* - While statements 1 and 2 are correct, **ACE inhibitors** are generally **contraindicated during pregnancy** due to teratogenic effects, but **can be used postpartum** for PPCM treatment, especially if not breastfeeding. - The contraindication during pregnancy does not universally apply to the entire peripartum period or postpartum management. *1, 3 and 4* - Statements 1 and 3 are incorrect in parts; while multiparity is a risk factor, statement 3 regarding ACE inhibitors is nuanced as they can be used postpartum. - PPCM is diagnosed in the absence of **prior heart disease**, meaning it is a *new onset* cardiomyopathy; therefore, statement 4 is incorrect. *3 and 4 only* - Both statements 3 and 4 are incorrect because ACE inhibitors can be used postpartum, and PPCM is characterized by the absence of prior heart disease. - The diagnostic criteria for PPCM specifically exclude cases where pre-existing heart disease can explain the heart failure.
Question 52: A 28-year-old female G2P1L1 with history of previous cesarean presents to the gynaecology emergency in labour. On examination, she is hypotensive, foetal heart sounds are absent and foetal parts are easily palpable. What is her diagnosis?
- A. Hydatidiform mole
- B. Oligohydramnios
- C. Abruptio placentae
- D. Uterine rupture (Correct Answer)
Explanation: ***Uterine rupture*** - The patient's presentation with **hypotension**, **absent fetal heart sounds**, and **easily palpable fetal parts** following a previous cesarean section strongly suggests uterine rupture. - A **previous cesarean section** is a significant risk factor for uterine rupture, as the scar tissue can be weakened and tear during labor. *Hydatidiform mole* - This condition involves abnormal growth of placental tissue, often presenting with a **grape-like appearance** and **high hCG levels**. - It does not typically cause acute maternal hypotension or easily palpable fetal parts in the context of labor. *Oligohydramnios* - Characterized by **low amniotic fluid volume**, which can lead to complications such as **fetal compression** or developmental issues. - It does not directly cause maternal hypotension, absent fetal heart sounds, or the sensation of easily palpable fetal parts during active labor. *Abruptio placentae* - Involves the **premature separation of the placenta** from the uterine wall, leading to vaginal bleeding, abdominal pain, and fetal distress. - While it can cause fetal compromise and maternal hypotension, the finding of **easily palpable fetal parts** is more indicative of a disrupted uterus rather than just placental separation.
Question 53: A 24-year-old primigravida comes to ANC clinic at 8 months amenorrhoea. Her BP is found to be 160/100 mm Hg. Lab findings reveal thrombocytopenia, increased SGOT/SGPT and LDH. What is her diagnosis?
- A. Eclampsia
- B. Hepatitis B
- C. HELLP syndrome (Correct Answer)
- D. Obstetric cholestasis
Explanation: ***HELLP syndrome*** - **HELLP syndrome** is characterized by **hemolysis**, **elevated liver enzymes** (SGOT/SGPT, LDH), and **low platelet count (thrombocytopenia)**, all of which are present in this patient with severe hypertension. - It is a severe form of **preeclampsia** and requires prompt recognition and management due to high maternal and fetal morbidity and mortality. *Eclampsia* - Eclampsia involves the occurrence of **new-onset grand mal seizures** in a woman with preeclampsia, which is not mentioned in the patient's presentation. - While preeclampsia (high BP) is present, the defining feature of eclampsia (seizures) is absent. *Hepatitis B* - **Hepatitis B** infection can cause elevated liver enzymes, but it typically presents with symptoms such as **abdominal pain, nausea, jaundice**, and may not involve hypertension or thrombocytopenia. - The combination of severe hypertension and thrombocytopenia makes hepatitis B an unlikely primary diagnosis in this context. *Obstetric cholestasis* - **Obstetric cholestasis** is characterized by **pruritus (itching)**, especially on the palms and soles, and elevated bile acids, often with only mildly elevated liver enzymes. - It does not typically cause **severe hypertension** or **thrombocytopenia**.
Question 54: A patient, who is 2 months pregnant, reports to a hospital with complaints of increased vaginal bleeding and pain in lower abdomen. Internal examination reveals dilated internal os of cervix and products of conception are felt through it. What is her likely clinical diagnosis?
- A. Inevitable abortion (Correct Answer)
- B. Threatened abortion
- C. Incomplete abortion
- D. Septic abortion
Explanation: ***Inevitable abortion*** - This diagnosis is characterized by **vaginal bleeding**, **lower abdominal pain**, and a **dilated cervix** with **products of conception palpable through the cervical os**. - The dilation of the internal os and products protruding through it indicate that the abortion process **cannot be halted** and will inevitably proceed to completion, distinguishing it from a threatened abortion. - In inevitable abortion, the products may be felt through the dilated os but have not yet been fully expelled from the uterus. *Threatened abortion* - While there is vaginal bleeding and a viable intrauterine pregnancy, the **cervix remains closed**, and there is no expulsion of fetal tissue. - The symptoms are milder, and with appropriate management, the pregnancy can often continue successfully. *Incomplete abortion* - This involves the **partial expulsion of the products of conception**, meaning some tissue has already passed out of the uterus, but some remains inside. - The key difference is that in incomplete abortion, **part of the products have been expelled**, with retained tissue remaining in the uterus, often requiring intervention (such as surgical evacuation) to remove the retained tissue. - The patient would typically report passage of tissue. *Septic abortion* - This is a serious complication involving an **infection of the uterus** during an abortion, presenting with **fever, chills, foul-smelling or purulent vaginal discharge**, in addition to bleeding and pain. - The clinical picture provided (bleeding, pain, dilated os, palpable products of conception) does not include signs of infection such as fever or other systemic symptoms of sepsis.
Question 55: Which of the following is a common pathology that increases the risk of uterine injury during abdominal hysterectomy?
- A. Hydrosalpinx
- B. Pelvic endometriosis (Correct Answer)
- C. Ovarian teratoma
- D. Adenomyosis
Explanation: ***Pelvic endometriosis*** - Pelvic endometriosis causes **dense adhesions, anatomical distortion, and obliteration of normal tissue planes**, making surgical dissection technically challenging during hysterectomy. - The **fibrotic adhesions** bind pelvic organs together, obscure surgical landmarks, and increase the risk of inadvertent injury to the uterus, bladder, ureters, and bowel. - Studies show that **endometriosis is a significant risk factor** for intraoperative complications, including uterine perforation and vascular injury. - The **distorted pelvic anatomy** requires careful dissection and may necessitate modifications in surgical technique. *Hydrosalpinx* - Hydrosalpinx is a **fluid-filled, dilated fallopian tube** resulting from distal tubal obstruction, typically from prior pelvic inflammatory disease. - While it may be encountered during hysterectomy, it does **not distort the uterine anatomy or create adhesions** that would increase the risk of uterine injury. - Hydrosalpinx is generally easily separated from surrounding structures. *Ovarian teratoma* - Ovarian teratoma (dermoid cyst) is a **benign germ cell tumor of the ovary** containing mature tissues from all three germ layers. - It is typically **well-encapsulated and does not cause significant pelvic adhesions** unless there has been rupture or torsion. - It does not increase the risk of uterine injury during hysterectomy. *Adenomyosis* - Adenomyosis is **endometrial tissue within the myometrium**, causing an enlarged, boggy, tender uterus. - While adenomyosis is often an **indication for hysterectomy**, it is an intrinsic uterine condition that does **not cause pelvic adhesions or anatomical distortion**. - The uterus may be more vascular and bulky, but this does not specifically increase the risk of uterine injury during standard hysterectomy technique.
Question 56: Which of the following is confirmatory for the diagnosis of bicornuate uterus?
- A. Hysteroscopy
- B. Hysterectomy
- C. Hysteroscopy and laparoscopy (Correct Answer)
- D. Dilatation and curettage
Explanation: ***Hysteroscopy and laparoscopy*** - **Hysteroscopy** allows visualization of the uterine cavity, revealing two distinct hemi-cavities separated by a septum or deep indentation. - **Laparoscopy** provides external visualization of the uterus, confirming the presence of two separate uterine horns and distinguishing a bicornuate uterus from a septate uterus by identifying the deep indentation on the fundus and the angle between the horns greater than 75 degrees. *Hysteroscopy* - While hysteroscopy can visualize the **internal uterine cavity** and may suggest dual cavities, it alone cannot definitively distinguish between a deeply septate uterus and a bicornuate uterus. - It does not offer a view of the **external uterine contour**, which is crucial for diagnosis. *Hysterectomy* - A hysterectomy is the **surgical removal of the uterus**, which is a definitive treatment but not a diagnostic procedure for uterine anomalies. - This procedure would only reveal the uterine anatomy after its removal, which is not the purpose of a **confirmatory diagnostic evaluation**. *Dilatation and curettage* - This procedure involves **dilating the cervix** and **scraping the lining of the uterus**, primarily used for diagnostic sampling or therapeutic abortion. - It does not provide any information about the **uterine morphology** or congenital anomalies like a bicornuate uterus.
Question 57: Which of the following are useful investigations for diagnosis of unresponsive endometrium as a cause of primary amenorrhoea? 1. Karyotype 2. Progesterone challenge test 3. Hormonal studies 4. Hysterosalpingography Select the correct answer using the code given below.
- A. 2, 3 and 4
- B. 1, 2 and 3 (Correct Answer)
- C. 1, 2 and 4
- D. 1, 3 and 4
Explanation: ***1, 2 and 3*** - In the workup of primary amenorrhea with suspected **unresponsive endometrium**, a systematic approach is essential to differentiate between end-organ failure and central causes. - **Karyotyping** is important as chromosomal abnormalities like **Turner syndrome (45,X)** can present with primary amenorrhea due to **gonadal dysgenesis**, leading to hypoestrogenism and thus an endometrium that appears "unresponsive" due to lack of estrogen priming, not intrinsic endometrial pathology. - **Progesterone challenge test** is a key diagnostic tool: withdrawal bleeding indicates adequate estrogen and a responsive endometrium; **no bleeding despite adequate estrogen** suggests either true endometrial unresponsiveness (Asherman's syndrome, Müllerian agenesis) or estrogen deficiency. - **Hormonal studies** (FSH, LH, estradiol) are crucial to interpret the progesterone challenge test and distinguish between **hypergonadotropic hypogonadism** (ovarian failure with high FSH/LH), **hypogonadotropic hypogonadism** (low FSH/LH/estrogen), and eugonadal amenorrhea with endometrial factors. *2, 3 and 4* - While **hysterosalpingography (HSG)** can visualize structural uterine abnormalities (Asherman's syndrome, Müllerian anomalies), it is typically performed **after** initial hormonal assessment. - This option excludes **karyotyping**, which is essential in the initial evaluation of primary amenorrhea to rule out chromosomal causes that present with hypoestrogenism and secondary endometrial unresponsiveness. - The systematic approach starts with hormonal evaluation and progesterone challenge before proceeding to imaging studies. *1, 2 and 4* - This option excludes **hormonal studies**, which are fundamental to the diagnostic algorithm. - Without FSH, LH, and estradiol levels, it is impossible to properly interpret a progesterone challenge test or determine whether the "unresponsive endometrium" is due to estrogen deficiency, ovarian failure, or true endometrial pathology. - Hormonal studies guide the next steps in investigation and management. *1, 3 and 4* - This option excludes the **progesterone challenge test**, which is a simple, cost-effective screening test to assess estrogen status and endometrial responsiveness. - While HSG provides anatomical information, the progesterone challenge test is typically performed earlier in the diagnostic algorithm to determine if further invasive imaging is warranted. - A systematic hormonal evaluation with progesterone challenge should precede invasive procedures like HSG.
Question 58: A 25-year-old female comes to the gynaecology OPD for evaluation of secondary amenorrhoea. She gives history of previous dilatation and curettage, and her FSH levels are 8 IU/L. The probable cause of amenorrhoea is
- A. incomplete abortion
- B. Asherman syndrome (Correct Answer)
- C. premature ovarian failure
- D. Sheehan syndrome
Explanation: ***Asherman syndrome*** - This syndrome is characterized by the formation of **intrauterine adhesions** or scarring, often following uterine procedures such as **dilatation and curettage (D&C)**. - The **normal FSH level** (8 IU/L) indicates intact ovarian function, ruling out primary ovarian issues and pointing towards a structural uterine problem as the cause of secondary amenorrhea. *incomplete abortion* - An incomplete abortion would typically present with **vaginal bleeding and abdominal pain**, not secondary amenorrhea, unless it occurred significantly in the past and led to complications. - While D&C can be performed for incomplete abortion, the primary cause of amenorrhea in this context would be the subsequent formation of uterine adhesions, not the incomplete abortion itself. *premature ovarian failure* - This condition involves the cessation of ovarian function before age 40, which would result in **elevated FSH levels** due to lack of negative feedback from estrogen. - The patient's **normal FSH level** (8 IU/L) makes premature ovarian failure an unlikely diagnosis in this case. *Sheehan syndrome* - Sheehan syndrome is caused by **ischemic necrosis of the pituitary gland** typically following severe postpartum hemorrhage, leading to panhypopituitarism. - It would present with symptoms of **multiple hormone deficiencies**, including low FSH and LH (due to pituitary failure), along with other anterior pituitary hormone deficiencies, which contradicts the normal FSH and lack of mention of postpartum hemorrhage.
Question 59: Which of the following criteria are required to be fulfilled for hospitalization in a case of pelvic inflammatory disease? 1. Coexisting pregnancy 2. Mild fever and pain responding well to antibiotics 3. Suspected tubo-ovarian abscess 4. Coexistent HIV infection Select the correct answer using the code given below.
- A. 1, 3 and 4 (Correct Answer)
- B. 1, 2 and 4
- C. 1, 2 and 3
- D. 2, 3 and 4
Explanation: ***1, 3 and 4*** - **Coexisting pregnancy** is a critical indication for hospitalization in PID due to the increased risk of adverse pregnancy outcomes, including **septic abortion**, preterm birth, and disseminated infection. - **Suspected tubo-ovarian abscess (TOA)** requires inpatient management because it can lead to **sepsis**, rupture, and peritonitis, necessitating aggressive intravenous antibiotics and potentially surgical intervention. - **Coexistent HIV infection** is an important hospitalization criterion as immunocompromised patients may experience more severe PID, atypical presentations, and a higher risk of systemic complications or treatment failure. *1, 2 and 4* - This option incorrectly includes "Mild fever and pain responding well to antibiotics," which signifies a less severe course typically managed **outpatient**. - The other conditions (pregnancy, HIV) are valid reasons for hospitalization, but the presence of mild, responsive symptoms argues against inpatient care. *1, 2 and 3* - This option also incorrectly includes "Mild fever and pain responding well to antibiotics," which would typically allow for **outpatient management**. - While pregnancy and suspected TOA are strong indications for hospitalization, mild symptoms that resolve quickly with antibiotics do not warrant inpatient admission. *2, 3 and 4* - This option mistakenly includes "Mild fever and pain responding well to antibiotics," which is a criterion for **outpatient management**, not hospitalization. - It excludes "Coexisting pregnancy," which is a significant reason for inpatient care due to potential maternal and fetal risks.
Pathology
1 questionsWhich of the following are correct regarding pathology of stress urinary incontinence? 1. Hypermobility of urethra 2. Descent of bladder neck and proximal urethra below pelvic diaphragm 3. Lowered urethral pressure 4. Increased detrusor activity
UPSC-CMS 2024 - Pathology UPSC-CMS Practice Questions and MCQs
Question 51: Which of the following are correct regarding pathology of stress urinary incontinence? 1. Hypermobility of urethra 2. Descent of bladder neck and proximal urethra below pelvic diaphragm 3. Lowered urethral pressure 4. Increased detrusor activity
- A. 2 and 4
- B. 3 and 4
- C. 1, 2 and 4
- D. 1 and 2
- E. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - **Hypermobility of the urethra**, **descent of the bladder neck and proximal urethra below the pelvic diaphragm**, and **lowered urethral pressure** are all key pathological factors in stress urinary incontinence. - **Statements 1 and 2** represent **urethral hypermobility** (Type 1 and 2 stress incontinence), where anatomical changes lead to inadequate urethral support during increased intra-abdominal pressure. - **Statement 3** represents **intrinsic sphincter deficiency (ISD)** or Type 3 stress incontinence, characterized by lowered urethral closure pressure due to weakness of the urethral sphincter mechanism itself. - Both mechanisms result in **stress urinary incontinence** - involuntary urine loss during activities that increase intra-abdominal pressure (coughing, sneezing, exercise). *1 and 2* - While **hypermobility of the urethra** and **descent of the bladder neck** are correct for stress urinary incontinence, this answer is incomplete as it excludes **lowered urethral pressure** (intrinsic sphincter deficiency), which is also a recognized pathological mechanism of stress incontinence. *2 and 4* - **Increased detrusor activity** is characteristic of **urge incontinence** (overactive bladder), not stress urinary incontinence, where the primary issue is urethral support or sphincter competence. - This option incorrectly includes a feature of urge incontinence rather than stress incontinence. *3 and 4* - **Increased detrusor activity** is related to urge incontinence, where involuntary bladder contractions cause leakage, which is distinct from stress incontinence. - This option is incorrect because it excludes the hypermobility mechanism and includes urge incontinence pathology. *1, 2 and 4* - Although **hypermobility of the urethra** and **descent of the bladder neck** are correct for stress urinary incontinence, **increased detrusor activity** is a characteristic of urge incontinence. [1] - This option inaccurately combines stress and urge incontinence mechanisms. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 972-973.