UPSC-CMS 2010 - Obstetrics and Gynecology Practice Questions

Q: In a lady with a regular 28-day menstrual cycle, what is the 'safe period'?

First and last seven days. ***First and last seven days*** - In a typical 28-day cycle, **ovulation** usually occurs around day 14. Sperm can survive for up to 5 days, and the egg is viable for about 24 hours. Therefore, avoiding unprotected intercourse from approximately day 7 to day 19 would be considered within the fertile window. The "safe period" refers to days with a lower probability of conception. - The **first seven days** (including menstruation) and the **last seven days** (preceding the next menstrual period) are generally considered the least fertile times, as they are furthest from ovulation. *Initial 14 days* - This period includes the follicular phase, leading up to and including **ovulation**. - The **fertile window** typically encompasses several days before ovulation, the day of ovulation, and the day after, making the initial 14 days a high-risk period, not a safe one. *Later 14 days* - This period includes the **luteal phase** after ovulation has occurred. - While the latter part of this period (days 21-28) is generally less fertile, the days immediately following ovulation (around days 15-18) still carry a risk of conception if the egg is viable or if ovulation was delayed. *First seven days only* - While the first seven days are generally considered a **low-risk period**, relying solely on this neglects the increased risk shortly before and during ovulation. - This option only covers a portion of the "safe period" and does not account for the reduced fertility towards the end of the menstrual cycle.

Q: The risk of progression to endometrial cancer from simple hyperplasia without atypia is

1%. ***1%*** - The risk of **simple endometrial hyperplasia without atypia** progressing to endometrial cancer is very low, typically cited as less than 1%. - This low risk is why conservative management and surveillance are often sufficient for this type of hyperplasia. *8-10%* - This percentage is more indicative of the risk of progression for **complex endometrial hyperplasia without atypia**, which has a higher propensity for malignant transformation. - Simple hyperplasia without atypia carries a much lower risk due to its less abnormal glandular architecture and lack of cytologic atypia. *25-30%* - This value represents the risk of progression for **atypical endometrial hyperplasia (endometrial intraepithelial neoplasia)**, which is considered a precursor lesion to endometrial cancer. - The presence of **cytological atypia** significantly increases the risk of malignant transformation. *3-5%* - This risk range is typically associated with **complex endometrial hyperplasia without atypia**, which is higher than simple hyperplasia but considerably lower than atypical hyperplasia. - While it has abnormal architectural features, the absence of **cellular atypia** keeps the risk below that of atypical lesions.

Q: Worldwide, which is the most commonly used copper-bearing intrauterine contraceptive device?

Copper T-380. ***Copper T-380*** - The **Copper T-380A (ParaGard)** is the most widely used and effective non-hormonal IUD globally. - Its **380 mm² copper surface area** provides high contraceptive efficacy for up to 10 years. *Copper-7* - This was an earlier generation copper IUD with a **smaller copper surface area** and a distinct 7-shaped design. - It had a higher expulsion rate and was **largely replaced** by more effective T-shaped devices. *GyneFix* - **GyneFix** is a frameless copper IUD consisting of copper sleeves on a surgical thread, which is knotted into the uterine fundus. - While effective, its market penetration and global usage are **significantly less** compared to the Copper T-380. *Copper T-200* - The **Copper T-200** was an earlier T-shaped copper IUD with **200 mm² of copper surface area**. - It had a **shorter lifespan** and lower efficacy compared to the T-380, leading to its obsolescence in many regions.

Q: The following are the contra-indications to the use of combined oral contraceptive pills, except

bronchial asthma. ***bronchial asthma*** - **Bronchial asthma** is not a contraindication for the use of combined oral contraceptive pills (COCs). COCs do not worsen asthma symptoms or increase the risk of asthma exacerbations. - While some medications can interact with asthma treatment, COCs generally have no significant adverse effects on respiratory function or asthma management. *active viral hepatitis* - **Active viral hepatitis** is a contraindication because COCs are metabolized in the liver, and their use could further impair liver function in a patient with active inflammation. - The liver is crucial for metabolizing estrogens and progestins, and compromised liver function can lead to altered drug levels and increased risk of adverse effects. *history of deep venous thrombosis* - A **history of deep venous thrombosis (DVT)** is a significant contraindication due to the increased risk of **thromboembolism** associated with combined oral contraceptive pills. - Estrogen components in COCs can increase the synthesis of clotting factors and decrease natural anticoagulants, raising the risk of future thrombotic events. *breastfeeding* - **Breastfeeding**, especially during the first six weeks postpartum, is a relative contraindication for combined oral contraceptive pills. - Estrogen in COCs can reduce milk supply and potentially pass into breast milk, affecting the infant. Progestin-only contraceptives are generally preferred for breastfeeding mothers.

Q: Mini pill should be started on the

first day of the cycle. ***first day of the cycle*** - Starting the **mini-pill** (progestin-only pill) on the **first day of the menstrual cycle** ensures **immediate contraceptive protection** without need for backup contraception. - Current guidelines allow starting within the **first 5 days of the cycle** for immediate protection, but day 1 is the most conservative and traditional recommendation. - The mini-pill works primarily through **cervical mucus thickening** (which occurs within 48 hours) and may inconsistently suppress ovulation in some women. *fifth day of the cycle* - Starting on the fifth day of the cycle **can still provide immediate protection** according to current guidelines, as it falls within the acceptable first 5-day window. - However, for maximum certainty and following traditional teaching, day 1 remains the preferred recommendation. - If started after day 5, **backup contraception for 48 hours** would be needed. *second day of the cycle* - Starting on the second day falls within the **first 5 days of the cycle** and provides immediate contraceptive protection according to current evidence-based guidelines. - The **first day** is traditionally emphasized in older guidelines and remains the most conservative approach. - No backup contraception needed when started within this timeframe. *third day of the cycle* - Starting on the third day is within the **first 5-day window** where immediate protection is achieved. - However, traditional teaching (especially relevant for this 2010 exam question) emphasized starting on **day 1** for optimal compliance and immediate efficacy. - Modern guidelines confirm no backup needed if started within first 5 days of true menstrual bleeding.

Q: What is the sequence of events in termination of pregnancy by medical method?

Mifepristone — Misoprostol — Bleeding — USG. ***Mifepristone — Misoprostol — Bleeding — USG*** - The process begins with **mifepristone**, a progesterone receptor antagonist that **blocks progesterone action**, leading to **cervical softening** and **sensitization of the uterus to prostaglandins**. - This is followed by **misoprostol** (24-48 hours later), a prostaglandin analogue, which **induces uterine contractions** and causes **expulsion of uterine contents**, leading to bleeding. A follow-up **ultrasound (USG)** after 2 weeks confirms completion. *Mifepristone — Misoprostol — USG — Bleeding* - While mifepristone and misoprostol are correctly sequenced, the **bleeding** typically occurs *before* the follow-up ultrasound, as it's the clinical sign of successful expulsion. - The ultrasound would be performed *after* the expected expulsion and bleeding to confirm complete termination and rule out complications. *Misoprostol — Mifepristone — USG — Bleeding* - This sequence is incorrect because **mifepristone must be given first** to block progesterone and prepare the uterus. - Administering **misoprostol before mifepristone** would be less effective as the uterus would not be primed for cervical softening and increased sensitivity to prostaglandins. *Mifepristone — Bleeding — Misoprostol — USG* - While mifepristone is given first, **significant bleeding** typically occurs *after* the administration of misoprostol, which actively induces contractions and expels the uterine contents. - This sequence incorrectly places **bleeding before misoprostol**, implying it happens immediately after mifepristone alone, which is not the typical response.

Q: The ideal distension medium for operative hysteroscopy using electro-cautery is

1.5% glycine. ***1.5% glycine*** - **1.5% glycine** is an **electrically non-conductive hypotonic fluid**, making it the **ideal distension medium** for operative hysteroscopy using **monopolar electro-cautery**. - It allows safe transmission of electrical current without dispersion, enabling effective tissue cutting and coagulation. - Provides excellent visualization during operative procedures and can clear blood and debris effectively. - **Risk consideration**: Prolonged procedures with excessive absorption can lead to **hyponatremia, hypo-osmolality syndrome, and glycine toxicity** (causing visual disturbances and encephalopathy), requiring careful fluid balance monitoring. *CO₂* - **CO₂** is used exclusively for **diagnostic hysteroscopy**, not operative procedures. - While it is non-conductive, it provides **poor visibility when bleeding occurs** as it cannot clear blood or debris. - **Contraindicated in operative hysteroscopy** due to high risk of **gas embolism** when vessels are opened during surgery. - Rapid absorption can occur through opened blood vessels, making it unsafe for electrosurgical procedures. *5% dextrose saline* - **Dextrose saline** solutions are **electrically conductive** due to the saline component, causing current dispersion during monopolar electro-cautery. - Would lead to **non-target tissue damage** and ineffective surgical effect. - Also carries risk of **fluid overload and electrolyte disturbances** with excessive absorption. *N-saline* - **Normal saline** is an **electrically conductive** solution and is **contraindicated for monopolar electro-cautery** as it disperses electrical current. - It is the **preferred medium for bipolar electro-cautery** where the electrical circuit is contained between the two poles of the instrument. - Safe, isotonic, and no risk of hyponatremia, but cannot be used with monopolar systems.

Q: A 16-year-old girl presents with primary amenorrhoea and repeated periodic pain. On examination, a suprapubic mass is felt up to the umbilicus. The most likely diagnosis is

cryptomenorrhoea. ***cryptomenorrhoea*** - Primary amenorrhoea with a palpable suprapubic mass and repeated periodic pain is highly suggestive of **cryptomenorrhoea**, where menstrual blood accumulates due to an outflow tract obstruction. - The accumulated blood (often due to an imperforate hymen or transverse vaginal septum) forms a **hematocolpos**, leading to the palpable suprapubic mass and cyclical pain. *uterine leiomyoma* - **Uterine leiomyomas** are benign tumors that are rare in adolescents, especially as a cause of primary amenorrhea. - While they can cause a palpable mass, they typically present with **menorrhagia** or pelvic pressure, not primary amenorrhea with cyclical pain due to retained menstrual flow. *bladder-neck hypertrophy* - **Bladder-neck hypertrophy** is an uncommon condition in adolescent females and primarily causes obstructive urinary symptoms, not primary amenorrhea or a palpable suprapubic mass from retained menstrual blood. - It would manifest as difficulty voiding or recurrent urinary tract infections, unrelated to menstrual function. *large ovarian cyst* - A **large ovarian cyst** can present as a pelvic/suprapubic mass and cause pain, but it would not typically cause **primary amenorrhoea** with cyclical pain representing trapped menstrual blood. - Ovarian cysts usually interfere with menstrual regularity or cause acute pain, but not complete absence of menstruation due to an anatomical obstruction of the outflow tract.

Question 1

In a lady with a regular 28-day menstrual cycle, what is the 'safe period'?

Accepted Answer

First and last seven days

Answer

Initial 14 days

Answer

Later 14 days

Answer

First seven days only

Question 2

The risk of progression to endometrial cancer from simple hyperplasia without atypia is

Accepted Answer

1%

Answer

8-10%

Answer

25-30%

Answer

3-5%

Question 3

Worldwide, which is the most commonly used copper-bearing intrauterine contraceptive device?

Accepted Answer

Copper T-380

Answer

Copper-7

Answer

GyneFix

Answer

Copper T-200

Question 4

The following are the contra-indications to the use of combined oral contraceptive pills, except

Accepted Answer

bronchial asthma

Answer

active viral hepatitis

Answer

history of deep venous thrombosis

Answer

breastfeeding

Question 5

Mini pill should be started on the

Accepted Answer

first day of the cycle

Answer

fifth day of the cycle

Answer

second day of the cycle

Answer

third day of the cycle

Question 6

What is the sequence of events in termination of pregnancy by medical method?

Accepted Answer

Mifepristone — Misoprostol — Bleeding — USG

Answer

Mifepristone — Misoprostol — USG — Bleeding

Answer

Misoprostol — Mifepristone — USG — Bleeding

Answer

Mifepristone — Bleeding — Misoprostol — USG

Question 7

The ideal distension medium for operative hysteroscopy using electro-cautery is

Accepted Answer

1.5% glycine

Answer

5% dextrose saline

Answer

N-saline

Answer

CO₂

Question 8

A 16-year-old girl presents with primary amenorrhoea and repeated periodic pain. On examination, a suprapubic mass is felt up to the umbilicus. The most likely diagnosis is

Accepted Answer

cryptomenorrhoea

Answer

uterine leiomyoma

Answer

bladder-neck hypertrophy

Answer

large ovarian cyst

UPSC-CMS 2010 — Obstetrics and Gynecology