UPSC-CMS 2025 — Obstetrics and Gynecology
29 Previous Year Questions with Answers & Explanations
Which of the following statements about hysterosalpingography, as a diagnostic procedure, are correct? I. Tubal patency assessment following tuboplasty operation II. Diagnosis of uterine synechiae III. Detection of IUD IV. Diagnosis of subserosal fibroid Select the answer using the code given below :
Which of the following are indications of endometrial sampling? I. Routine screening in asymptomatic premenopausal women II. Endometrial polyp III. Postmenopausal bleeding IV. Abnormal uterine bleeding Select the correct answer using the code given below :
A 30-year-old P3L3 female presents in Gynaecology emergency with acute abdominal pain and vaginal bleeding of short duration (1 hour). She gives history of tubal ligation after birth of third child. On examination, right adnexal tenderness was found and os was closed. What is the probable diagnosis?
Which of the following statements are correct regarding audit in Obstetrics and Gynaecology? I. It can replace the out of date clinical practices with better ones. II. It is an efficient educational tool. III. It should be based on scientific evidences with facts and figures. IV. It is not labour-intensive. Select the answer using the code given below :
For which of the following conditions, surgery is indicated in a case of Fibroid Uterus ? I. Symptomatic and failed medical management II. Size >12 weeks III. Pedunculated fibroid Select the correct answer using the code given below :
Which of the following is measured without any straining while examination under POP-Q system?
Which of the following are criteria for opting Le Fort's operation for surgical correction of pelvic organ prolapse? I. Procidentia in old age II. Unfit for long duration surgery III. Associated uterine pathology IV. Coital function no longer required Select the correct answer using the code given below :
Which of the following are Amsel's diagnostic criteria? I. Vaginal pH>4.5 II. Positive Whiff test III. Presence of clue cells >20 % IV. Positive bacterial vaginal culture Select the correct answer using the code given below :
Which of the following are the predictive factors for Fetal Growth Restriction (FGR)? I. Low level of maternal 1^st trimester Beta hCG II. Abnormal uterine artery Doppler at 20-24 weeks of pregnancy III. Fetal echogenic bowel on ultrasound IV. Maternal medical disorder Select the correct answer using the code given below :
Which of the following is the primary surveillance tool in the growth-restricted fetus?
UPSC-CMS 2025 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 1: Which of the following statements about hysterosalpingography, as a diagnostic procedure, are correct? I. Tubal patency assessment following tuboplasty operation II. Diagnosis of uterine synechiae III. Detection of IUD IV. Diagnosis of subserosal fibroid Select the answer using the code given below :
- A. I, II and IV
- B. II, III and IV
- C. I, III and IV
- D. I, II and III (Correct Answer)
Explanation: ***I, II and III*** Hysterosalpingography (HSG) is a radiological procedure that uses contrast material injected into the uterus to visualize the **uterine cavity** and **fallopian tubes** under fluoroscopy. It is specifically useful for: **Statement I - Tubal patency assessment following tuboplasty operation** ✓ - HSG is the standard procedure to evaluate whether fallopian tubes remain patent after reconstructive tubal surgery **Statement II - Diagnosis of uterine synechiae** ✓ - HSG excellently demonstrates intrauterine adhesions (Asherman's syndrome) as filling defects in the uterine cavity **Statement III - Detection of IUD** ✓ - Radiopaque IUDs are easily visualized on HSG, and the procedure can confirm proper IUD position within the uterine cavity **Statement IV - Diagnosis of subserosal fibroid** ✗ - **Subserosal fibroids** project outward from the uterine serosa into the peritoneal cavity - HSG only outlines the **endometrial cavity** and **tubal lumen**, not external uterine surfaces - These fibroids do not impinge on the uterine cavity and therefore cannot be visualized by HSG - Better diagnosed by **ultrasound** or **MRI** *I, II and IV* - While HSG is excellent for assessing tubal patency and diagnosing uterine synechiae (I and II), it cannot diagnose **subserosal fibroids** which are located on the outer surface of the uterus and do not affect the uterine cavity outline. *II, III and IV* - This option correctly identifies HSG's utility in diagnosing **uterine synechiae** and detecting **IUDs**, but incorrectly includes **subserosal fibroids** which cannot be visualized by this procedure. *I, III and IV* - This option accurately includes HSG's role in assessing **tubal patency** and detecting **IUDs**, but mistakenly includes diagnosis of **subserosal fibroids** which require imaging modalities that visualize the external uterine surface.
Question 2: Which of the following are indications of endometrial sampling? I. Routine screening in asymptomatic premenopausal women II. Endometrial polyp III. Postmenopausal bleeding IV. Abnormal uterine bleeding Select the correct answer using the code given below :
- A. I, II and IV
- B. I, III and IV
- C. I, II and III
- D. II, III and IV (Correct Answer)
Explanation: ***II, III and IV*** - **Endometrial polyps** require sampling for histopathological diagnosis and to assess for malignancy, especially when symptomatic or found in postmenopausal women. - **Postmenopausal bleeding** is a red-flag symptom that mandates endometrial sampling to rule out **endometrial hyperplasia** or **endometrial carcinoma**, as 5-10% of cases are associated with malignancy. - **Abnormal uterine bleeding** in premenopausal or perimenopausal women often requires endometrial sampling to investigate underlying causes such as **endometrial hyperplasia**, **polyps**, **endometritis**, or **malignancy**. *I, II and IV* - This option incorrectly includes **routine screening in asymptomatic premenopausal women (I)**, which is NOT an indication for endometrial sampling. - Endometrial sampling is not recommended for routine screening in asymptomatic women without risk factors or concerning symptoms. *I, III and IV* - This option also incorrectly includes **routine screening (I)** as an indication. - Additionally, it excludes **endometrial polyps (II)**, which are a definite indication for endometrial sampling when detected. *I, II and III* - This option incorrectly includes **routine screening (I)** while excluding **abnormal uterine bleeding (IV)**. - **Abnormal uterine bleeding** is one of the most common and important indications for endometrial evaluation across all age groups.
Question 3: A 30-year-old P3L3 female presents in Gynaecology emergency with acute abdominal pain and vaginal bleeding of short duration (1 hour). She gives history of tubal ligation after birth of third child. On examination, right adnexal tenderness was found and os was closed. What is the probable diagnosis?
- A. Complete abortion
- B. Pelvic inflammatory disease
- C. Ectopic pregnancy (Correct Answer)
- D. Appendicitis
Explanation: ***Ectopic pregnancy*** - This patient presents with **acute abdominal pain** and **vaginal bleeding** of short duration, with right adnexal tenderness and a closed os, highly suggestive of an ectopic pregnancy even after a tubal ligation. Tubal ligation does not provide 100% protection against pregnancy. - The history of **tubal ligation** increases the risk for ectopic pregnancy, as fertilization can still occur with the ovum implanting outside the uterus. *Complete abortion* - A complete abortion would typically involve the **passage of all products of conception**, after which the pain and bleeding would subside, and the os would generally be closed or closing. - This patient's symptoms are more acute and localized to the **adnexa**, which is less typical for a complete abortion occurring in a non-pregnant uterus (given the tubal ligation). *Pelvic inflammatory disease* - **Pelvic inflammatory disease (PID)** usually presents with **vaginal discharge/cervicitis**, **fever**, and bilateral abdominal pain. - While adnexal tenderness can be present, the acute onset with vaginal bleeding in a patient post-tubal ligation makes ectopic pregnancy a more concerning and probable diagnosis. *Appendicitis* - **Appendicitis** typically presents with **right lower quadrant pain** that often migrates from the periumbilical region, but usually lacks vaginal bleeding or adnexal tenderness. - The combination of **vaginal bleeding** and adnexal tenderness points away from appendicitis and more towards a gynecological origin.
Question 4: Which of the following statements are correct regarding audit in Obstetrics and Gynaecology? I. It can replace the out of date clinical practices with better ones. II. It is an efficient educational tool. III. It should be based on scientific evidences with facts and figures. IV. It is not labour-intensive. Select the answer using the code given below :
- A. I, II and IV
- B. I, II and III (Correct Answer)
- C. I, III and IV
- D. II, III and IV
Explanation: ***Correct: I, II and III*** - Statement I is correct: Clinical audit aims to improve **patient care** and **outcomes** by systematically reviewing care against explicit criteria, identifying areas for improvement, and implementing changes that **replace outdated practices** with evidence-based approaches. - Statement II is correct: Audit serves as a powerful **educational tool** by providing feedback to clinicians, highlighting best practices, and encouraging critical appraisal of current methods. - Statement III is correct: Effective audits must be based on **scientific evidence** with facts and figures to ensure validity, robustness, and clinical relevance. - Statement IV is **incorrect**: Clinical audit is **labour-intensive**, requiring significant time, resources, and coordination for data collection, analysis, meetings, implementation of changes, and follow-up assessments. *Incorrect: I, II and IV* - While statements I and II are correct, statement IV is incorrect because audit is generally **labour-intensive**, not the opposite. Effective audits involve substantial resource-demanding tasks. *Incorrect: I, III and IV* - While statements I and III are correct (audit replaces outdated practices with evidence-based approaches), statement IV is incorrect as thorough audits require **considerable effort and resources**. *Incorrect: II, III and IV* - While statements II and III are correct (audit as educational tool based on scientific evidence), statement IV is incorrect; audits often require **substantial time and effort** for all phases of the audit cycle.
Question 5: For which of the following conditions, surgery is indicated in a case of Fibroid Uterus ? I. Symptomatic and failed medical management II. Size >12 weeks III. Pedunculated fibroid Select the correct answer using the code given below :
- A. I and II only
- B. I and III only
- C. I, II and III (Correct Answer)
- D. II and III only
Explanation: ***I, II and III*** - **Symptomatic fibroids that have failed medical management** are a primary indication for surgery, as treatment aims to alleviate symptoms like heavy menstrual bleeding, pelvic pain, pressure symptoms, or urinary complaints. - A fibroid uterus size greater than **12 weeks' gestation** is considered a **relative indication for surgery** in most guidelines. Large fibroids (>12 weeks) are more likely to cause pressure symptoms, may be difficult to monitor for growth, and have increased risk of complications. While asymptomatic large fibroids can be observed, size >12 weeks is widely accepted as a surgical indication in standard practice. - **Pedunculated fibroids** (especially subserosal) carry a risk of **torsion**, which can cause acute abdominal pain and ischemia requiring emergency surgery. Pedunculated submucosal fibroids often cause menorrhagia and are typically removed. Thus, pedunculated fibroids are generally considered surgical indications due to these risks. - **All three conditions (I, II, and III)** represent accepted indications for surgical management of fibroid uterus in standard gynecological practice. *I and II only* - This option incorrectly excludes **pedunculated fibroids** as an indication for surgery. - Pedunculated fibroids, particularly those that are subserosal, have a significant risk of torsion, and submucosal pedunculated fibroids commonly cause bleeding requiring surgical intervention. *I and III only* - This option incorrectly excludes **fibroid size >12 weeks** as an indication for surgery. - Large fibroids are difficult to monitor, more likely to be symptomatic, and may cause bulk-related complications warranting surgical consideration even when initial medical management hasn't been attempted. *II and III only* - This option incorrectly excludes **symptomatic fibroids that have failed medical management** as a surgical indication. - Symptomatic relief is the primary goal of fibroid treatment, and when conservative medical measures fail, surgery becomes the definitive treatment option regardless of size or morphology.
Question 6: Which of the following is measured without any straining while examination under POP-Q system?
- A. Point D
- B. TVL (Correct Answer)
- C. GH
- D. Pb
Explanation: ***TVL*** - **Total Vaginal Length (TVL)** is the **only measurement** in the POP-Q system that is taken **exclusively at rest without straining**. - It is measured from the **hymen to the posterior fornix** (or vaginal cuff in post-hysterectomy cases) with the patient in supine lithotomy position. - This measurement reflects the overall depth of the vagina and provides important anatomical context for prolapse assessment. *Point D* - **Point D** represents the location of the **posterior fornix** (or vaginal cuff scar in post-hysterectomy). - In the POP-Q system, Point D is measured **both at rest and with maximal straining** to assess the degree of **uterine descent or vaginal vault prolapse**. - The difference between rest and strain measurements helps quantify the extent of apical support defects. *GH* - **Genital Hiatus (GH)** is measured from the **external urethral meatus to the posterior hymen**. - GH is measured **both at rest and during maximal Valsalva straining** in the standard POP-Q protocol. - The measurement increases with straining as pelvic floor muscles relax, reflecting the functional capacity of the pelvic floor. *Pb* - **Perineal Body (Pb)** is measured from the **posterior margin of the genital hiatus to the mid-anal opening**. - Like GH, Pb is measured **both at rest and with straining** in the POP-Q examination. - Changes with straining can indicate perineal descent or posterior compartment defects like rectocele.
Question 7: Which of the following are criteria for opting Le Fort's operation for surgical correction of pelvic organ prolapse? I. Procidentia in old age II. Unfit for long duration surgery III. Associated uterine pathology IV. Coital function no longer required Select the correct answer using the code given below :
- A. II, III and IV
- B. I and II only
- C. I, II and IV (Correct Answer)
- D. I, III and IV
Explanation: **Correct: I, II and IV** Le Fort's operation (colpocleisis) is an **obliterative procedure** that partially closes the vaginal canal, making it suitable for: - **Procidentia in old age (I)**: Complete uterovaginal prolapse in elderly patients who are ideal candidates for this procedure - **Unfit for long duration surgery (II)**: The procedure is less extensive with shorter operative time, making it appropriate for patients with significant comorbidities who cannot tolerate prolonged reconstructive surgery - **Coital function no longer required (IV)**: This is a **fundamental criterion** as the procedure obliterates the vaginal canal, precluding sexual intercourse *Incorrect: II, III and IV* This option incorrectly includes **"Associated uterine pathology (III)"** which is actually a **contraindication** or relative contraindication for Le Fort's operation. Uterine pathology requiring intervention (e.g., endometrial hyperplasia, fibroids, ongoing bleeding) would necessitate: - Hysterectomy prior to or concurrent with the procedure, OR - Other uterine-specific surgical management - After vaginal closure, the uterus cannot be adequately monitored or accessed for future pathology Le Fort's operation does not address uterine disease and may complicate future management. *Incorrect: I and II only* This option is incomplete as it excludes **"Coital function no longer required (IV)"**, which is an **essential criterion** for any obliterative procedure. The patient's desire to preserve sexual function is a critical factor in surgical planning: - If coital function is desired → Reconstructive surgery (sacrocolpopexy, native tissue repair) - If coital function not required → Obliterative surgery (Le Fort's, total colpocleisis) *Incorrect: I, III and IV* This option incorrectly includes **"Associated uterine pathology (III)"**. Significant uterine pathology is generally a **contraindication** to Le Fort's operation unless: - The pathology is addressed with concurrent hysterectomy, OR - The pathology requires no ongoing surveillance The presence of uterine disease requiring monitoring would make vaginal obliteration inappropriate, as it prevents future access for diagnostic or therapeutic procedures.
Question 8: Which of the following are Amsel's diagnostic criteria? I. Vaginal pH>4.5 II. Positive Whiff test III. Presence of clue cells >20 % IV. Positive bacterial vaginal culture Select the correct answer using the code given below :
- A. I, III and IV
- B. I, II and III (Correct Answer)
- C. I, II and IV
- D. II, III and IV
Explanation: ***I, II and III*** - Amsel's criteria are used for diagnosing **bacterial vaginosis** and include a vaginal pH >4.5, a positive **Whiff test** (amine odor with KOH), and the presence of **clue cells** (>20%) on microscopy. - The presence of at least three out of these four criteria is generally considered diagnostic for bacterial vaginosis. *I, III and IV* - This option incorrectly includes a **positive bacterial vaginal culture** as an Amsel's criterion. - Bacterial vaginal culture is generally not part of Amsel's criteria for diagnosing bacterial vaginosis, as it is often difficult to interpret due to the polymicrobial nature of the condition and doesn't differentiate between normal flora and pathogenic overgrowth. *I, II and IV* - This option also incorrectly includes a **positive bacterial vaginal culture** as an Amsel's criterion. - Amsel's criteria rely on direct, rapid clinical assessment rather than labor-intensive culture methods for diagnosis of bacterial vaginosis. *II, III and IV* - This option incorrectly includes a **positive bacterial vaginal culture** and omits **vaginal pH >4.5**, which is a key component of Amsel's criteria. - The elevated vaginal pH is crucial as it indicates a shift from the normal acidic vaginal environment, making it a critical diagnostic marker.
Question 9: Which of the following are the predictive factors for Fetal Growth Restriction (FGR)? I. Low level of maternal 1^st trimester Beta hCG II. Abnormal uterine artery Doppler at 20-24 weeks of pregnancy III. Fetal echogenic bowel on ultrasound IV. Maternal medical disorder Select the correct answer using the code given below :
- A. I, III and IV
- B. I, II and IV (Correct Answer)
- C. I, II and III
- D. II, III and IV
Explanation: ***I, II and IV*** - A **low first-trimester maternal beta-hCG level** can be associated with placental dysfunction and poor trophoblastic development, which are common causes of FGR. This is an early predictive marker. - **Abnormal uterine artery Doppler** findings at 20-24 weeks indicate increased placental vascular resistance and impaired placental perfusion, which is a strong and validated predictor of FGR. - **Maternal medical disorders** such as chronic hypertension, pre-existing diabetes, antiphospholipid syndrome, chronic kidney disease, or autoimmune disorders are well-established risk factors for FGR due to impaired placental perfusion or maternal-fetal interface dysfunction. *I, III and IV* - While I and IV are correct, **fetal echogenic bowel (III)** is an ultrasonographic finding that may be associated with FGR but is not a predictive factor for it. Echogenic bowel is primarily a marker for conditions like cystic fibrosis, cytomegalovirus infection, fetal aneuploidy, or bowel ischemia. When FGR occurs with echogenic bowel, it's typically because both are manifestations of an underlying condition (e.g., aneuploidy or infection), rather than echogenic bowel predicting FGR development. - The key distinction: predictive factors help identify pregnancies at risk BEFORE FGR develops, while echogenic bowel is typically detected alongside or after growth restriction has begun. *I, II and III* - While I and II are correct, **fetal echogenic bowel (III)** is not a primary predictive factor for FGR as explained above. - More importantly, **maternal medical disorders (IV)** are crucial independent predictors that must be included, as they represent modifiable or manageable risk factors. *II, III and IV* - While II and IV are correct, **fetal echogenic bowel (III)** is not a direct predictive factor for FGR. - A **low first-trimester maternal beta-hCG level (I)** is an important early biochemical predictor of placental dysfunction and subsequent FGR, and should not be excluded.
Question 10: Which of the following is the primary surveillance tool in the growth-restricted fetus?
- A. Umbilical venous pulsation
- B. Uterine artery Doppler
- C. Umbilical artery Doppler (Correct Answer)
- D. Middle cerebral artery Doppler
Explanation: ***Umbilical artery Doppler*** - The **umbilical artery Doppler** is the primary tool for fetal surveillance in **growth-restricted fetuses** because it directly assesses **placental resistance** and **blood flow** to the fetus. - Abnormal findings, such as **increased resistance** or **absent/reversed end-diastolic flow**, indicate **placental insufficiency** and are key indicators for intervention. *Umbilical venous pulsation* - **Umbilical venous pulsation** can be a sign of **cardiac dysfunction** in the fetus but is considered a **late and severe sign** of fetal compromise, not a primary surveillance tool. - Its presence usually indicates significant **cardiac overload** or **venous congestion**, suggesting advanced stages of fetal distress. *Uterine artery Doppler* - **Uterine artery Doppler** is primarily used for **screening** for preeclampsia and fetal growth restriction in the **second trimester**, not as a primary surveillance tool once growth restriction is established. - It assesses **placental bed development** and **maternal uterine blood flow** but doesn't directly monitor the fetal response to placental insufficiency. *Middle cerebral artery Doppler* - **Middle cerebral artery (MCA) Doppler** is used to assess for **brain-sparing effect** in growth-restricted fetuses, indicating the fetus is shunting blood to the brain due to hypoxia. - While important for evaluating the severity of compromise, it is a **secondary surveillance tool** for brain perfusion, not the primary measure of placental function.