UPSC-CMS 2012 - Obstetrics and Gynecology Practice Questions

Q: A woman who is being investigated for infertility is diagnosed to have a nulliparous prolapse of the uterus. The most appropriate management will be

Ring pessary. ***Ring pessary*** - A ring pessary can provide **symptomatic relief** for uterine prolapse while allowing the woman to continue trying to conceive and carry a pregnancy. - It is a **non-surgical** and reversible option, making it suitable for women who desire future fertility. *Cervical amputation* - This procedure, such as a **Manchester Fothergill operation**, involves amputation of the cervix and can compromise future fertility and cervical competence during pregnancy. - It is a **definitive surgical treatment** usually reserved for women who have completed childbearing. *Sling operation* - Sling operations, such as sacral colpopexy, involve suspending the uterus or vaginal vault. These are generally performed for **pelvic organ prolapse** in women who are not planning future pregnancies or for more severe prolapse. - These procedures can **interfere with future fertility** and the natural physiological changes during pregnancy and labor. *Fothergill repair* - The Fothergill repair (or Manchester operation) involves **cervical amputation**, anterior colporrhaphy, and posterior colpoperineorrhaphy. It is a surgical procedure aimed at correcting uterine prolapse. - While effective for prolapse, it is **not suitable for women desiring future fertility** due to the cervical amputation and potential impact on pregnancy.

Q: A parous woman complains of itching in the vulva. On examination, there is local redness and swelling and white flakes around the introitus. The most probable diagnosis is

Candidiasis. ***Candidiasis*** - The symptoms of **itching**, **redness**, **swelling** of the vulva, and **white flakes** (often described as "cottage cheese-like") around the introitus are highly characteristic of vulvovaginal **candidiasis (yeast infection)**. - This condition is common, especially in parous women, and is caused by an overgrowth of *Candida* species. *Trichomoniasis* - Typically presents with a **foamy, greenish-yellow discharge**, a **foul odor**, and often **punctate hemorrhages** on the cervix (strawberry cervix). - While it can cause itching and irritation, the presence of **white flakes** is not a characteristic feature. *Gonorrhoea* - Often **asymptomatic** in women or presents with **purulent vaginal discharge**, **dysuria**, and **pelvic pain**. - It does not typically cause **white flakes** around the introitus and the discharge is usually not itchy initially. *Pyogenic vulvovaginitis* - This is a general term for bacterial vulvovaginitis that would present with signs of **bacterial infection**, such as a **malodorous discharge** and significant inflammation. - While it can cause redness and swelling, the description of **white flakes** is not specific to pyogenic infections and points more towards a fungal etiology.

Q: The characteristic features of inguinal lymph nodes associated with a primary syphilitic lesion of the vulva are

Firm, shotty, painless nodes that do not suppurate. **Firm, shotty, painless nodes that do not suppurate** - Lymphadenopathy in **primary syphilis** typically presents as **firm, bilateral, painless**, and non-suppurative lymph nodes, often described as "shotty." - These nodes are usually discrete and do not tend to mat together or form abscesses, reflecting the inflammatory response to **_Treponema pallidum_**. *Painful, tender nodes which become matted together to form an abscess* - **Painful, matted, and suppurative** lymph nodes are more characteristic of other infections, such as those caused by bacterial pathogens like **_Staphylococcus aureus_** or **_Streptococcus pyogenes_**, or conditions like **lymphogranuloma venereum**. - These features are generally not associated with the indolent inflammatory response seen in primary syphilis. *Non-suppurative tender enlarged nodes* - While the nodes in primary syphilis are **non-suppurative and enlarged**, they are typically **painless**, not tender. - **Tenderness** can suggest a more acute or active inflammatory process, and the absence of pain is a key distinguishing feature of syphilitic lymphadenopathy. *Painful inflamed nodes which undergo necrosis and develop a chronic sinus* - **Necrotic lymph nodes** with **chronic sinus formation** are indicative of severe and chronic infections such as **tuberculosis (scrofula)** or deep fungal infections, or conditions like **cat-scratch disease** in some cases. - These aggressive features are not consistent with the typical presentation of primary syphilis.

Q: The common manifestations of genital tuberculosis include the following except

Foul-smelling vaginal discharge. ***Foul-smelling vaginal discharge*** - While infections can cause vaginal discharge, a **foul-smelling discharge** is typically associated with bacterial vaginosis or trichomoniasis, not primarily with genital tuberculosis due to its granulomatous nature. - Genital tuberculosis often presents with **non-specific symptoms** or no symptoms at all, rather than purulent or foul-smelling discharge. *Pelvic pain* - **Chronic pelvic pain** is a very common symptom of genital tuberculosis, often due to inflammation and involvement of pelvic organs. - The pain can be constant or intermittent and may be difficult to localize. *Amenorrhoea* - **Amenorrhea**, particularly secondary amenorrhoea, can occur due to endometrial damage or destruction caused by the tuberculous infection. - This can lead to **intrauterine adhesions (Asherman's syndrome)** or functional impairment of the endometrium, hindering menstruation. *Infertility* - **Infertility** is one of the most frequent and significant manifestations of genital tuberculosis, especially in women. - It often results from **tubal occlusion** or distortion, endometrial damage, or ovarian dysfunction caused by the disease, leading to an inability to conceive or carry a pregnancy to term.

Q: A 60-year-old woman is diagnosed with genital malignancy. On physical examination she is found to have the enlargement of superficial inguinal lymph nodes. The most likely organ involved is

Vulva. ***Vulva (Correct Answer)*** - The **vulva** drains primarily to the **superficial inguinal lymph nodes**, making its malignancy the most likely cause of their enlargement. - Unlike deeper pelvic organs, vulvar cancer metastases travel directly to these easily palpable nodes. - This is a key anatomical principle: **external genitalia → superficial inguinal nodes**. *Adnexa (Incorrect)* - Malignancies of the **adnexa** (ovaries, fallopian tubes) typically metastasize via the **para-aortic or pelvic lymph nodes**, not the superficial inguinal nodes. - These follow the ovarian vessels along the infundibulopelvic ligament. - Distant inguinal node involvement would indicate advanced disease, but initial spread is not to these nodes. *Cervix (Incorrect)* - Cervical cancer primarily metastasizes to the **pelvic lymph nodes** (e.g., obturator, internal iliac, external iliac), with superficial inguinal nodes rarely involved unless there is extensive local spread. - The lymphatic drainage of the cervix is distinct from that of the external genitalia. *Uterus (Incorrect)* - Uterine cancer (endometrial or uterine body) typically spreads to the **pelvic** and **para-aortic lymph nodes**, following the ovarian and uterine vessels. - Like cervical cancer, superficial inguinal lymph node involvement is uncommon and usually a sign of very advanced or unusual spread.

Question 1

A woman who is being investigated for infertility is diagnosed to have a nulliparous prolapse of the uterus. The most appropriate management will be

Accepted Answer

Ring pessary

Answer

Cervical amputation

Answer

Sling operation

Answer

Fothergill repair

Question 2

Which of the following is not an outcome of gonococcal salpingitis ?

Accepted Answer

Ovarian cyst

Answer

Hydrosalpinx

Answer

Multiple tubal blocks

Answer

Salpingitis isthmica nodosa

Question 3

A parous woman complains of itching in the vulva. On examination, there is local redness and swelling and white flakes around the introitus. The most probable diagnosis is

Accepted Answer

Candidiasis

Answer

Trichomoniasis

Answer

Gonorrhoea

Answer

Pyogenic vulvovaginitis

Question 4

The characteristic features of inguinal lymph nodes associated with a primary syphilitic lesion of the vulva are

Accepted Answer

Firm, shotty, painless nodes that do not suppurate

Answer

Painful, tender nodes which become matted together to form an abscess

Answer

Non-suppurative tender enlarged nodes

Answer

Painful inflamed nodes which undergo necrosis and develop a chronic sinus

Question 5

The common manifestations of genital tuberculosis include the following except

Accepted Answer

Foul-smelling vaginal discharge

Answer

Pelvic pain

Answer

Amenorrhoea

Answer

Infertility

Question 6

A 60-year-old woman is diagnosed with genital malignancy. On physical examination she is found to have the enlargement of superficial inguinal lymph nodes. The most likely organ involved is

Accepted Answer

Vulva

Answer

Adnexa

Answer

Cervix

Answer

Uterus

Question 7

What is the recommendation for use of Levonorgestrel for the purpose of emergency contraception ?

Accepted Answer

Two tablets of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 96 hours

Answer

One tablet of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 72 hours

Answer

None of the options

Answer

One tablet of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 120 hours

UPSC-CMS 2012 — Obstetrics and Gynecology