UPSC-CMS 2016 - Obstetrics and Gynecology PYQs Practice Questions

Q: A 35 year old nulliparous woman complains of menorrhagia and mass per abdomen. On examination, the positive findings are: she is anaemic, has a pelvic mass of 16-18 weeks size, firm in consistency which moves with the movement of cervix. What is the most likely clinical diagnosis?

Leiomyoma. ***Leiomyoma*** - A **leiomyoma**, or **fibroid**, is a common benign smooth muscle tumor of the uterus, often presenting as **menorrhagia** and a **pelvic mass**. - The mass being **firm, 16-18 weeks size**, and **moving with the cervix** is classic for a uterine fibroid, differentiating it from an adnexal or fixed uterine mass. *Adenomyosis* - Characterized by endometrial tissue within the myometrium, leading to a **globular, tender uterus**, often associated with **dysmenorrhea** and **menorrhagia**. - While it causes menorrhagia, the uterus is typically **tender** and **boggy**, not a firm, discrete mass freely mobile with the cervix. *Ovarian tumour* - An **ovarian tumor** would typically present as an **adnexal mass**, often separate from the uterus and not moving with the cervix. - While an ovarian tumor can cause a pelvic mass, it is less likely to be directly associated with the described menorrhagia or involve the cervix's movement. *Endometrial carcinoma* - Primarily causes **abnormal uterine bleeding**, especially in **postmenopausal women**, but usually does not present as a large, firm, mobile mass detectable on abdominal palpation. - While it can cause menorrhagia, a firm, discrete uterine mass that moves with the cervix is not a typical presentation of **endometrial carcinoma**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Abundant cornified cells in vaginal exfoliative cytology indicate:

Late proliferative phase. ***Late proliferative phase*** - During the **late proliferative phase**, estrogen levels are at their peak, leading to significant maturation and cornification of vaginal epithelial cells. - This phase is characterized by a high proportion of **superficial cells**, which are large, polygonal, and have small, pyknotic nuclei, reflecting extensive cornification. *Late secretory phase* - In the **late secretory phase**, progesterone levels are high, which causes an increase in **intermediate cells** and a decrease in superficial (cornified) cells. - The cytology would show a dominance of folded intermediate cells, often in clusters, and a **"navicular cell"** appearance, rather than abundant cornified cells. *Early secretory phase* - The **early secretory phase** is also dominated by progesterone's influence, leading to a shift from superficial to intermediate cells. - There would be a mixture of intermediate and some superficial cells, but not the abundance of **highly cornified cells** seen in the late proliferative phase. *Early proliferative phase* - The **early proliferative phase** follows menstruation and is characterized by rising estrogen, but not yet at its peak. - The cytology would typically show a mixture of **parabasal**, intermediate, and some superficial cells, reflecting the initial regeneration of the epithelium, with less cornification than the late proliferative phase. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Polyhydramnios at term is diagnosed when AFI is more than:

25 cm. ***25 cm*** - **Polyhydramnios** is diagnosed when the **Amniotic Fluid Index (AFI)** at term is greater than or equal to **25 cm**. - This indicates an excessive amount of **amniotic fluid**, which can be associated with various maternal or fetal complications. *15 cm* - An AFI of 15 cm is within the **normal range** for amniotic fluid volume. - It does not meet the criteria for either **polyhydramnios** or **oligohydramnios**. *20 cm* - An AFI of 20 cm is considered to be in the **upper normal limit** or **borderline high**, but it does not definitively meet the diagnostic criteria for **polyhydramnios**. - Close monitoring would be indicated, but it's not severe polyhydramnios. *10 cm* - An AFI of 10 cm is also within the **normal range** for amniotic fluid volume. - It is neither indicative of too much nor too little amniotic fluid. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which of the following is not a potentially teratogenic infection if contracted in pregnancy?

Influenza virus. ***Influenza virus*** - While influenza can cause severe illness in pregnant women, it is **not generally considered teratogenic**, meaning it does not typically cause birth defects like the other listed infections. - The primary risks of influenza in pregnancy are severe maternal complications, **preterm birth**, and **low birth weight**, rather than congenital anomalies. *Chicken pox* - Maternal infection with **varicella-zoster virus (chickenpox)** during the first 20 weeks of pregnancy can lead to **Congenital Varicella Syndrome**, characterized by skin scarring, limb hypoplasia, microphthalmia, and neurological deficits. - Infection late in pregnancy can cause **neonatal varicella**, which can be severe and life-threatening for the newborn. *Rubella* - Maternal infection with **rubella (German measles)**, especially during the first trimester, is a well-known cause of **Congenital Rubella Syndrome (CRS)**. - CRS can result in severe birth defects, including **cataracts**, **heart defects** (e.g., patent ductus arteriosus, pulmonary artery stenosis), and **sensorineural hearing loss**. *Cytomegalovirus* - **Congenital cytomegalovirus (CMV)** infection is a leading cause of **non-hereditary sensorineural hearing loss** and neurodevelopmental disabilities. - While many infected infants are asymptomatic at birth, some develop **microcephaly**, periventricular calcifications, hepatosplenomegaly, and **chorioretinitis**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

A 35 year old nulliparous woman complains of menorrhagia and mass per abdomen. On examination, the positive findings are: she is anaemic, has a pelvic mass of 16-18 weeks size, firm in consistency which moves with the movement of cervix. What is the most likely clinical diagnosis?

Accepted Answer

Leiomyoma

Answer

Adenomyosis

Answer

Ovarian tumour

Answer

Endometrial carcinoma

Question 2

Abundant cornified cells in vaginal exfoliative cytology indicate:

Accepted Answer

Late proliferative phase

Answer

Late secretory phase

Answer

Early secretory phase

Answer

Early proliferative phase

Question 3

Polyhydramnios at term is diagnosed when AFI is more than:

Accepted Answer

25 cm

Answer

15 cm

Answer

20 cm

Answer

10 cm

Question 4

Which of the following is not a potentially teratogenic infection if contracted in pregnancy?

Accepted Answer

Influenza virus

Answer

Chicken pox

Answer

Rubella

Answer

Cytomegalovirus

Question 5

Regarding hypertensive disorders of pregnancy, the following are true except:

Accepted Answer

Urinary dipstick result of +1 is equivalent to urinary protein concentration of 300 mg/dl

Answer

Significant proteinuria is more than/equal to 0.3 g/24hr

Answer

Eclampsia may present in the absence of hypertension

Answer

A protein:creatinine ratio more than 30 mg/mmol is considered significant

Question 6

Which of the following is not a characteristic of Mayer-Rokitansky-Küster-Hauser syndrome?

Accepted Answer

Cardiac anomalies

Answer

Skeletal abnormalities

Answer

Renal abnormalities

Answer

Mullerian duct aplasia

Question 7

Which one of the following is not a contraindication for prescribing combined oral contraceptive pills?

Accepted Answer

Pelvic inflammatory disease

Answer

Viral hepatitis

Answer

Well-controlled hypertension

Answer

Thromboembolic disease

Question 8

The following are used in the staging of carcinoma of the cervix except:

Accepted Answer

Hydroureter

Answer

Parametrial involvement

Answer

Pelvic lymph node involvement

Answer

Vaginal involvement

Question 9

A 58 year old woman, post menopausal for last 8 years comes with history of spotting per vaginum. What is the most likely cause?

Accepted Answer

Atrophic vaginitis

Answer

Endometrial hyperplasia

Answer

Endometrial carcinoma

Answer

Estrogen replacement therapy

Question 10

A diabetic obese patient comes with history of post-menopausal bleeding. On examination, there is a supra pubic mass and per vagina there is purulent discharge. The probable diagnosis is:

Accepted Answer

Carcinoma endometrium

Answer

Ovarian carcinoma

Answer

Uterine myoma

Answer

Carcinoma cervix

UPSC-CMS 2016 — Obstetrics and Gynecology