UPSC-CMS 2018 - Obstetrics and Gynecology Practice Questions

Q: For vaginal breech delivery, ideal selection criteria would include: 1. Fetus not compromised 2. Adequate pelvis 3. Flexed breech presentation 4. Estimated fetal weight < 3.5 kg Select the correct answer using the code given below:

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All listed criteria (fetus not compromised, adequate pelvis, **flexed breech presentation**, and estimated fetal weight < 3.5 kg) are considered **ideal selection criteria** for a safe vaginal breech delivery. - **Flexed (frank) breech** with hips flexed and knees extended is the **most favorable type** for vaginal delivery, as it presents the smallest diameter and has the lowest risk of cord prolapse. - While many institutions now favor elective cesarean section for breech presentations, these criteria represent conditions under which a **vaginal delivery can be safely attempted** with minimal risk. *2 and 4 only* - This option is incomplete as it correctly identifies adequate pelvis and estimated fetal weight < 3.5 kg but omits other crucial factors like **fetal well-being** and the **type of breech presentation**. - A successful vaginal breech delivery also requires the fetus to be **uncompromised** and ideally in a **flexed (frank) breech** presentation. *1, 3 and 4 only* - This option overlooks the critical importance of an **adequate maternal pelvis**, which is fundamental for allowing the passage of the fetus during vaginal delivery regardless of fetal presentation. - While fetal status, presentation, and weight are important, a **contracted or inadequate pelvis** would contraindicate vaginal delivery. *1, 2 and 3 only* - This option excludes the **estimated fetal weight** being less than 3.5 kg, which is a significant factor in assessing the feasibility of vaginal breech delivery. - Larger fetuses (typically >3.5-4 kg) have a **higher risk of birth trauma** and **head entrapment** during vaginal breech delivery, even with an adequate pelvis and favorable presentation.

Q: Consider the following presentations: 1. Brow presentation 2. Left mento anterior position 3. Occipito posterior position 4. Breech presentation In which of the above Vaginal delivery is NOT possible?

1 only. ***1 only*** - A **brow presentation** presents the fetal head at an unfavorable diameter (**mentovertical diameter**), making vaginal delivery impossible due to **mechanical obstruction**. - With the brow presenting, the head cannot adequately mold or engage in the maternal pelvis, necessitating a **cesarean section** for safe delivery. *1, 2 and 3* - While **brow presentation** (1) is not amenable to vaginal delivery, **left mento anterior position** (2) generally allows for successful vaginal delivery. - **Occipito posterior position** (3) can often be delivered vaginally, sometimes requiring rotation, making this option incorrect. *4 only* - **Breech presentation** (4) can sometimes be delivered vaginally, although it carries higher risks and often warrants a **cesarean section**, but it is not universally impossible. - This option incorrectly suggests that only breech presentation is impossible for vaginal delivery, while brow presentation is a definitive contraindication. *1 and 3 only* - **Brow presentation** (1) is indeed a contraindication for vaginal delivery. - However, **occipito posterior position** (3) does not inherently preclude vaginal delivery, as many cases can be delivered vaginally, making this option incorrect.

Q: Which one of the following regarding amniotic fluid is true?

It reveals information about fetal lung maturity and wellbeing. **_It reveals information about fetal lung maturity and wellbeing_** - Amniotic fluid analysis, specifically looking at the **lecithin-to-sphingomyelin (L/S) ratio** and the presence of **phosphatidylglycerol**, helps assess fetal lung maturity. - It also provides genetic information through **amniocentesis**, which can indicate fetal wellbeing by detecting chromosomal abnormalities or infections. *It is decreased in gestational diabetes* - **Gestational diabetes** is typically associated with **polyhydramnios** (excessive amniotic fluid volume) due to fetal hyperglycemia leading to increased fetal urination. - Oligohydramnios (decreased amniotic fluid) can occur in cases of uncontrolled diabetes with associated fetal renal anomalies or placental insufficiency, but it is not the primary association with gestational diabetes. *The volume is highest at 28 weeks* - The **amniotic fluid volume** typically peaks around **32-34 weeks of gestation**, not 28 weeks. - After this peak, the volume gradually decreases until term due to changes in production and reabsorption. *It is decreased in duodenal atresia in baby* - **Duodenal atresia** and other high gastrointestinal obstructions prevent the fetus from swallowing and absorbing amniotic fluid, leading to an **increase in amniotic fluid volume (polyhydramnios)**. - Oligohydramnios is more commonly associated with conditions like renal agenesis or chronic uteroplacental insufficiency.

Q: Consider the following statements regarding changes in pregnancy: 1. Plasma volume increases up to 30–50% 2. Pregnancy is a hypercoagulable state 3. Hematocrit is decreased 4. Total plasma protein concentration increases Which of the statements given above is/are correct?

1, 2 and 3 only. ***1, 2 and 3 only*** - **Statement 1 is correct**: Plasma volume increases significantly by **30-50%** during pregnancy, representing a key physiological adaptation. - **Statement 2 is correct**: Pregnancy is inherently a **hypercoagulable state** due to increased clotting factors (I, VII, VIII, IX, X, fibrinogen), decreased protein S, and reduced fibrinolysis—an adaptive mechanism to prevent excessive bleeding during delivery. - **Statement 3 is correct**: Hematocrit **decreases** due to physiological hemodilution; plasma volume increases proportionally more (40-50%) than red blood cell mass (20-30%), resulting in physiological anemia of pregnancy. - **Statement 4 is incorrect**: Total plasma protein concentration actually **decreases** during pregnancy (not increases) due to the hemodilution effect; albumin typically decreases from ~4.0 to ~3.0 g/dL. *1 and 2 only* - While statements 1 and 2 are correct, this option incorrectly excludes **statement 3 (decreased hematocrit)**, which is a well-established physiological change during pregnancy caused by hemodilution. *1 only* - Statement 1 is correct, but this option excludes both the **hypercoagulable state (statement 2)** and **decreased hematocrit (statement 3)**, which are both fundamental pregnancy-related changes. *1, 2, 3 and 4* - Statements 1, 2, and 3 are all correct. However, **statement 4 is incorrect** because total plasma protein concentration **decreases** (not increases) during pregnancy due to the disproportionate increase in plasma volume compared to protein synthesis. *3 and 4 only* - Statement 3 is correct, but **statement 4 is incorrect** (plasma protein concentration decreases, not increases). Additionally, this option incorrectly excludes statements 1 and 2, which are both correct and represent important physiological adaptations in pregnancy.

Q: A 50 year old postmenopausal woman comes with complaints of bleeding per vaginum. Which one of the following investigations is NOT required?

Diagnostic laparoscopy. ***Diagnostic laparoscopy*** - **Diagnostic laparoscopy** is NOT indicated in the routine workup of **postmenopausal bleeding** as it does not allow direct visualization of the **endometrial cavity**, which is the primary site of pathology in PMB. - It is an invasive surgical procedure used to visualize pelvic and abdominal organs **externally** and is reserved for evaluating conditions like **endometriosis**, **pelvic inflammatory disease**, **adnexal masses**, or **ectopic pregnancy**. - The key investigations for PMB focus on evaluating the **endometrium** and **cervix**, not the peritoneal cavity or external surface of pelvic organs. *Hysteroscopy* - **Hysteroscopy** involves direct visualization of the **uterine cavity** and is crucial for identifying and biopsying focal lesions like **polyps**, **submucosal fibroids**, or **endometrial cancer** that can cause postmenopausal bleeding. - It allows for targeted biopsy of suspicious areas that might be missed by blind endometrial sampling. *Pap smear* - A **Pap smear** is essential for screening for **cervical cancer** and **precancerous lesions** of the cervix, which can present as postmenopausal bleeding. - Although it primarily screens the cervix, abnormal cytology indicates the need for further investigation with colposcopy and biopsy. *Endometrial biopsy* - **Endometrial biopsy** is the **gold standard** for investigating postmenopausal bleeding, as the most common cause is **endometrial cancer** or **hyperplasia**. - It provides histological samples of the endometrium to rule out malignancy and confirm benign causes like **atrophic endometrium**.

Q: Which one of the following is NOT an emergency contraception method?

Norplant. ***Norplant*** - **Norplant** is a brand name for a **subdermal implant** that provides long-term contraception (up to 5 years) and is not used as an emergency method. - Its mechanism involves the continuous release of a progestin, thereby inhibiting ovulation and thickening cervical mucus over an extended period. *Levonorgestrel* - **Levonorgestrel** is a common and effective form of **emergency contraception**, taken as a single dose or two doses within 72-120 hours of unprotected intercourse. - It works primarily by inhibiting or delaying **ovulation** and preventing fertilization, not by inducing abortion. *Intra uterine contraceptive device* - The **copper intrauterine device (IUD)** is the most effective method of emergency contraception, effective up to 5 days after unprotected intercourse. - It primarily prevents implantation by causing a **spermicidal inflammatory reaction** within the uterus. *High dose oral contraceptive pill* - High-dose **combined oral contraceptive pills** ("Yuzpe method") can be used as emergency contraception, taken in two doses 12 hours apart within 72 hours of unprotected sex. - This method utilizes the **estrogen and progestin** in the pills to prevent ovulation and fertilization.

Q: Which of the statements regarding anemia in pregnancy is NOT true?

If mother is severely anemic, the fetus is also severely anemic. ***If mother is severely anemic, the fetus is also severely anemic*** - The **placenta** actively transports iron and other essential nutrients to the fetus, even when the mother is severely anemic, to ensure fetal development. - This protective mechanism means that while maternal anemia can affect fetal growth and development, it does not typically result in **severe fetal anemia** unless there are additional complications. *Iron deficiency anemia is most common in Tropics* - **Iron deficiency anemia** is indeed very common in tropical regions, largely due to dietary factors, increased parasitic infections (like hookworm), and **malaria**, which further depletes iron stores and affects red blood cell production. *Faulty dietary habit is one of the factors responsible for anemia* - A diet **lacking in iron-rich foods** (e.g., red meat, fortified cereals) and **vitamin C** (which aids iron absorption) is a primary cause of iron deficiency anemia. - **Vegetarian or vegan diets** that are not properly supplemented can also contribute to iron deficiency. *Mild anemia is most common* - Due to the **physiological hemodilution** that occurs during pregnancy (plasma volume increases more than red blood cell mass), a mild decrease in hemoglobin concentration is common. - This **physiological anemia** is usually not associated with adverse outcomes if the hemoglobin level remains within an acceptable range.

Q: Which one of the following statements about male sterilization is NOT true?

It is performed under general anaesthesia. ***It is performed under general anaesthesia*** - **Vasectomies** are most commonly performed in an outpatient setting under a **local anaesthetic**, not general anaesthesia. - The procedure involves minimal discomfort, and the patient remains awake, reducing risks associated with general anaesthesia. *It is safer and less expensive* - **Male sterilization (vasectomy)** is generally considered safer than female sterilization (tubal ligation) due to its less invasive nature. - It is also typically less expensive due to the simpler outpatient procedure and local anaesthesia. *Most men develop antisperm antibodies* - After a vasectomy, a significant number of men (approximately 50-70%) develop **antisperm antibodies**. - These antibodies are usually not clinically significant but can interfere with fertility if a reversal is attempted. *It has a low failure rate* - **Vasectomy** is highly effective, with a very **low failure rate** once confirmed by a negative post-vasectomy semen analysis. - The failure rate is typically less than 1%, making it one of the most reliable forms of contraception.

Q: Which of the following is NOT a method of second Trimester abortion?

Intra-amniotic KCl instillation. ***Intra-amniotic KCl instillation*** - Intra-amniotic KCl instillation is **NOT an abortion method** but rather a **feticide procedure** used to induce fetal demise before the actual termination. - It involves injecting potassium chloride directly into the fetal heart or amniotic sac to cause fetal asystole, and **must be followed by another method** (medical induction or D&E) to complete the abortion. - It is used primarily in **late second trimester and beyond** when legally or ethically required to ensure fetal demise prior to expulsion, but is **not a standalone abortion method**. *Hysterotomy* - Hysterotomy is a **surgical method** of abortion that involves making an incision in the uterus (similar to cesarean section) to remove the fetus. - While rarely used today due to **higher maternal morbidity** compared to D&E or medical methods, it **remains a recognized second-trimester abortion method**. - It may be considered in specific situations such as failed medical abortion, cervical pathology preventing D&E, or when other methods are contraindicated. *Mifepristone and PGE1* - This combination is a **standard medical abortion method** for the second trimester. - Mifepristone (antiprogestogen) sensitizes the uterus to prostaglandins, and PGE1 (misoprostol) induces uterine contractions and cervical ripening. - It is **safe, effective, and commonly used** for second-trimester medical termination. *PGE2 analog* - **Prostaglandin E2 analogs** (such as dinoprostone) are established methods for second-trimester abortion. - They induce uterine contractions and cervical ripening, and can be administered vaginally, extra-amniotically, or intravenously. - They are a **standard medical induction method** for second-trimester termination.

Question 1

For vaginal breech delivery, ideal selection criteria would include:

1. Fetus not compromised
2. Adequate pelvis
3. Flexed breech presentation
4. Estimated fetal weight < 3.5 kg

Select the correct answer using the code given below:

Accepted Answer

1, 2, 3 and 4

Answer

2 and 4 only

Answer

1, 3 and 4 only

Answer

1, 2 and 3 only

Question 2

Consider the following presentations:

1. Brow presentation
2. Left mento anterior position
3. Occipito posterior position
4. Breech presentation

In which of the above Vaginal delivery is NOT possible?

Accepted Answer

1 only

Answer

1, 2 and 3

Answer

4 only

Answer

1 and 3 only

Question 3

Which one of the following regarding amniotic fluid is true?

Accepted Answer

It reveals information about fetal lung maturity and wellbeing

Answer

It is decreased in gestational diabetes

Answer

The volume is highest at 28 weeks

Answer

It is decreased in duodenal atresia in baby

Question 4

Consider the following statements regarding changes in pregnancy:

1. Plasma volume increases up to 30–50%
2. Pregnancy is a hypercoagulable state
3. Hematocrit is decreased
4. Total plasma protein concentration increases

Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3 only

Answer

1 and 2 only

Answer

1 only

Answer

1, 2, 3 and 4

Answer

3 and 4 only

Question 5

A 30 year old lady, mother of 3 children presents with mass descending per vaginum. On examination it is found to have stage 3 prolapse, moderate cystocele, no posterior vaginal wall prolapse. The recommended surgery would be:

Accepted Answer

Manchester operation

Answer

Vaginal hysterectomy

Answer

Rectocele repair

Answer

Cystocele repair

Question 6

A 50 year old postmenopausal woman comes with complaints of bleeding per vaginum. Which one of the following investigations is NOT required?

Accepted Answer

Diagnostic laparoscopy

Answer

Hysteroscopy

Answer

Pap smear

Answer

Endometrial biopsy

Question 7

Which one of the following is NOT an emergency contraception method?

Accepted Answer

Norplant

Answer

Levenorgestrel

Answer

Intra uterine contraceptive device

Answer

High dose oral contraceptive pill

Question 8

Which of the statements regarding anemia in pregnancy is NOT true?

Accepted Answer

If mother is severely anemic, the fetus is also severely anemic

Answer

Iron deficiency anemia is most common in Tropics

Answer

Faulty dietary habit is one of the factors responsible for anemia

Answer

Mild anemia is most common

Question 9

Which one of the following statements about male sterilization is NOT true?

Accepted Answer

It is performed under general anaesthesia

Answer

It is safer and less expensive

Answer

Most men develop antisperm antibodies

Answer

It has a low failure rate

Question 10

Which of the following is NOT a method of second Trimester abortion?

Accepted Answer

Intra-amniotic KCl instillation

Answer

Hysterotomy

Answer

Mifepristone and PGE1

Answer

PGE2 analog

UPSC-CMS 2018 — Obstetrics and Gynecology