UPSC-CMS 2019 Practice Questions

Q: Labour is called normal if it fulfills the following criteria EXCEPT:

Vaginal breech delivery. ***Vaginal breech delivery*** - A **breech presentation** (where the baby's buttocks or feet are descended first) is **definitively NOT considered normal labor**. - Normal labor requires **cephalic (vertex) presentation** as a fundamental criterion. - While vaginal breech delivery may be attempted in select cases, it carries **significantly higher risks** and is classified as **abnormal presentation**, making this the correct answer to the EXCEPT question. *Spontaneous onset at term* - **Spontaneous onset** (not induced) occurring **at term** (37-42 weeks of gestation) is a **core characteristic of normal labor**. - This ensures physiologic readiness and fetal maturity. *Vertex presentation* - **Vertex (cephalic) presentation** with the occiput as the presenting part is the **defining requirement** for normal labor. - This is the optimal presentation allowing the smallest diameter to navigate the birth canal. *Vaginal delivery with episiotomy* - Traditionally, vaginal delivery with episiotomy has been included in definitions of normal labor, though episiotomy itself is a surgical intervention. - **Note**: Modern obstetric guidelines (WHO, NICE) emphasize that **routine episiotomy should be avoided** and normal birth should be spontaneous without operative interventions. However, for examination purposes and based on traditional definitions used in this PYQ, vaginal delivery (even with episiotomy) is distinguished from operative delivery (forceps/vacuum) or cesarean section. - The key distinction: **breech presentation** itself (regardless of delivery mode) makes labor abnormal, whereas episiotomy is a **procedural intervention** during an otherwise potentially normal labor.

Q: Which one of the following methods is NOT used for cervical cancer screening?

Cervical biopsy. ***Cervical biopsy*** - A **cervical biopsy** is a diagnostic procedure performed after an abnormal screening result to confirm the presence of **precancerous** or **cancerous** cells. - It involves removing a tissue sample for histological examination and is not a primary screening method. *VILI* - **Visual Inspection with Lugol's Iodine** (**VILI**) is a method used for cervical cancer screening, particularly in low-resource settings. - It involves applying **Lugol's iodine** to the cervix, where normal glycogen-rich cells stain brown, while abnormal, glycogen-deficient cells remain unstained (yellow). *VIA* - **Visual Inspection with Acetic Acid** (**VIA**) is a cost-effective screening method for cervical cancer, especially in settings where cytology is not readily available. - After applying **acetic acid** to the cervix, abnormal areas with high nuclear-to-cytoplasmic ratio and increased protein content rapidly coagulate the mucus and turn white. *Pap smear* - A **Pap smear** (Papanicolaou test) is a widely used and validated screening test for cervical cancer. - It involves collecting cells from the cervix to detect **dysplastic** or **premalignant changes** and is effective in reducing cervical cancer incidence and mortality.

Q: Consider the following regarding the use of Magnesium Sulphate: 1. Used as tocolytic 2. As neuroprotective agent 3. Used in management of postpartum eclampsia Which of the statements given above are correct?

1, 2 and 3. ***1, 2 and 3*** - **Magnesium sulfate** is a well-established **tocolytic agent**, used to delay preterm labor by relaxing the uterine smooth muscle. - It is also utilized for its **neuroprotective effects** in preterm infants, reducing the risk of cerebral palsy and other neurological sequelae when administered to mothers at risk of preterm birth. - Furthermore, magnesium sulfate is the **drug of choice** for the prevention and management of **eclampsia and pre-eclampsia**, which can occur both during pregnancy and in the postpartum period. *1 and 3 only* - This option correctly identifies the use of **magnesium sulfate** as a **tocolytic** and for **postpartum eclampsia**, but incorrectly omits its significant role as a **neuroprotective agent**. - The neuroprotective effect, particularly in reducing the risk of cerebral palsy in preterm infants, is a crucial indication for magnesium sulfate use. *2 and 3 only* - This option correctly recognizes **magnesium sulfate's** application as a **neuroprotective agent** and in **postpartum eclampsia**, but overlooks its primary role as a **tocolytic** for preterm labor. - Its ability to relax uterine contractions makes it a vital medication in managing threatened preterm delivery. *1 and 2 only* - This option accurately states the use of **magnesium sulfate** as a **tocolytic** and a **neuroprotective agent**, but fails to include its critical role in the management of **postpartum eclampsia**. - Eclampsia, defined by seizures in a pre-eclamptic patient, is effectively prevented and treated with magnesium sulfate.

Q: Which one of the following is NOT a common cause of recurrent abortions?

Maternal diabetes. ***Maternal diabetes*** - While uncontrolled diabetes can increase the risk of **miscarriage** and **birth defects** in general, it is typically not considered a common or direct cause of *recurrent abortions* (defined as three or more consecutive pregnancy losses). - Its effects are often seen in isolated miscarriages or specific fetal anomalies rather than a pattern of repeated losses. *Antiphospholipid syndrome* - This is a well-established cause of recurrent abortions due to the formation of **thrombi** in the placental circulation, leading to impaired blood flow and fetal demise. - It involves the presence of **antiphospholipid antibodies** that interfere with normal pregnancy progression. *Chromosomal abnormality* - Both parental and embryonic chromosomal abnormalities are a very common cause of recurrent pregnancy loss, particularly in the **first trimester**. - These abnormalities often result in non-viable embryos, leading to spontaneous abortion. *TORCH group of infections* - Infections like **Toxoplasmosis, Other (syphilis, parvovirus), Rubella, Cytomegalovirus (CMV), and Herpes simplex virus (HSV)** can cause significant fetal damage and pregnancy loss. - While they can lead to miscarriage, they are generally associated with sporadic miscarriages or specific fetal syndromes rather than recurring abortions in consecutive pregnancies.

Q: The most common cause of early spontaneous abortion is:

Chromosomal abnormality. ***Chromosomal abnormality*** - **Chromosomal abnormalities**, such as aneuploidy (e.g., trisomy, monosomy), are responsible for approximately 50-70% of all **early spontaneous abortions**. - These abnormalities often result in **non-viable embryos** or fetuses, leading to pregnancy loss before 12-20 weeks of gestation. *Teratogens* - **Teratogens** are agents that can cause birth defects, but they are a less common cause of **early spontaneous abortion** compared to chromosomal abnormalities. - While they can lead to fetal demise, their primary impact is often on **fetal development** rather than embryonic non-viability. *Endocrine disorder* - **Endocrine disorders** like uncontrolled diabetes or thyroid disease can increase the risk of spontaneous abortion, but they are not the **most common cause**. - These factors tend to contribute to a smaller percentage of **early pregnancy losses** compared to genetic errors. *Infection* - Certain **infections** (e.g., TORCH infections, bacterial vaginosis) can cause spontaneous abortion, especially if systemic or severe. - However, similar to endocrine disorders, infections are a less frequent cause of **early spontaneous abortion** than chromosomal abnormalities.

Q: Cause of Fetal growth restriction may be: 1. Chromosomal abnormality 2. Congenital abnormality 3. Abnormal cord insertion Which of the statements given above is/are correct?

1, 2 and 3. ***Correct: 1, 2 and 3*** All three statements represent established causes of **Fetal Growth Restriction (FGR)**: - **Chromosomal abnormalities** (trisomy 13, 18, 21, Turner syndrome) cause **intrinsic poor growth potential** of the fetus by disrupting normal cellular development and metabolism, directly leading to FGR. - **Congenital abnormalities** (cardiac defects, renal malformations, CNS anomalies) impair fetal development and nutrient utilization through structural and functional deficits, resulting in FGR. - **Abnormal cord insertion** (velamentous or marginal cord insertion) compromises the efficiency of **nutrient and oxygen transfer** from the placenta to the fetus by reducing vascular support, thus causing placental insufficiency and FGR. *Incorrect: 1 and 3 only* This incorrectly excludes **congenital abnormalities**, which are a well-established independent cause of FGR. Structural malformations directly impair fetal growth through metabolic and functional deficits. *Incorrect: 1 and 2 only* This incorrectly excludes **abnormal cord insertion**, which directly impacts placental function and nutrient supply—a key pathway for uteroplacental insufficiency leading to FGR. *Incorrect: 2 and 3 only* This incorrectly excludes **chromosomal abnormalities**, which are a major genetic cause of intrinsic FGR. Chromosomal defects (e.g., trisomies) are fundamental causes of impaired fetal growth potential.

Q: Which one of the following regarding fetal growth restriction is NOT true?

Delivery always at 34 weeks. ***Delivery always at 34 weeks*** - The timing of delivery in **fetal growth restriction (FGR)** is highly **individualized** and depends on several factors, including the severity of FGR, gestational age, and results of fetal surveillance tests like Doppler studies and biophysical profiles. It is not an absolute rule to deliver all FGR fetuses at 34 weeks. - Early delivery, especially before term, carries risks of **prematurity**, and the decision is made when the risks of continuing the pregnancy outweigh the risks of early delivery. *Biophysical profile is done* - The **biophysical profile (BPP)** is a common method of fetal surveillance used in pregnancies complicated by FGR to assess fetal well-being, including **fetal movements, tone, breathing, amniotic fluid volume,** and **non-stress test results**. - It helps in making decisions about the timing of delivery and ongoing management. *Umbilical artery Doppler studies are done* - **Umbilical artery Doppler studies** are crucial for monitoring FGR, as they assess placental function and fetal compromise by measuring blood flow in the umbilical artery. - Abnormal Doppler findings, such as **absent** or **reversed end-diastolic flow**, indicate increased placental resistance and are important in guiding management and determining the optimal timing of delivery. *Daily fetal movement count is advised* - **Daily fetal movement counting**, or "kick counts," is an important and simple method of fetal surveillance that women can perform at home to monitor fetal well-being. - A significant decrease in fetal movements can signal **fetal compromise** and warrants further evaluation.

Q: Which one of the following statements regarding contraception is NOT true?

Vaginal ring is a barrier method. ***Vaginal ring is a barrier method*** - The **vaginal ring** (e.g., NuvaRing) is a **hormonal contraceptive** that releases estrogen and progestin, not a barrier method. - Its mechanism of action involves **inhibiting ovulation** and altering cervical mucus, unlike barrier methods that physically block sperm. *Copper T can be inserted just after delivery* - The **Copper T (IUD)** can be safely inserted immediately after delivery, ideally within **48 hours**, as a **postpartum IUD insertion**. - This timing is often preferred as the cervix is still dilated, and the woman is already in a healthcare setting. *Implanon is a hormonal contraceptive* - **Implanon** (now Nexplanon) is indeed a **hormonal contraceptive**, containing etonogestrel, a progestin. - It is an implantable rod that provides **long-acting reversible contraception (LARC)** for up to three years. *Copper T can be used as post coital contraception* - The **Copper T IUD** is highly effective as **emergency contraception** when inserted within **5 days** of unprotected intercourse. - It works by preventing fertilization or implantation, making it more effective than emergency contraceptive pills.

Q: A 26 year old P2L2 has just had delivery. What are the contraceptive choices she has at present? 1. Post placental insertion of IUCD 2. Post partum ligation 3. Oral contraceptive pill 4. Lap ligation Select the correct answer using the code given below:

1 and 2 only. **1 and 2 only** - **Post-placental insertion of an IUCD** (Intrauterine Contraceptive Device) is a safe and effective immediate contraception option after delivery, as the cervix is still dilated, facilitating insertion. - **Postpartum ligation** (tubal ligation) is a common and highly effective permanent contraception method that can be performed shortly after delivery, often before discharge from the hospital. *2 only* - This option is incomplete as **post-placental IUCD insertion** is also a viable and often preferred immediate post-delivery contraceptive choice. - Limiting options to only postpartum ligation overlooks another readily available and effective method. *1, 2 and 4* - This option includes **lap ligation**, which typically refers to a laparoscopic procedure and is usually not performed immediately postpartum due to the enlarged uterus and increased vascularity, making it less ideal than ligation performed via mini-laparotomy shortly after delivery. - While laparoscopic approaches are possible later, **postpartum mini-laparotomy ligation** (which '2' likely refers to in this context) is the more immediate and common surgical approach. *1 and 3* - This option includes **oral contraceptive pills**, which are generally not recommended for immediate use in the postpartum period, especially for breastfeeding mothers, due to the potential impact on lactation and an increased risk of thromboembolism in the initial weeks after delivery. - **Progestin-only pills** can be considered later in the postpartum period, but combined oral contraceptives are typically delayed.

Question 1

Labour is called normal if it fulfills the following criteria EXCEPT:

Accepted Answer

Vaginal breech delivery

Answer

Spontaneous onset at term

Answer

Vertex presentation

Answer

Vaginal delivery with episiotomy

Question 2

Which one of the following methods is NOT used for cervical cancer screening?

Accepted Answer

Cervical biopsy

Answer

VILI

Answer

VIA

Answer

Pap smear

Question 3

Consider the following regarding the use of Magnesium Sulphate:

1. Used as tocolytic
2. As neuroprotective agent
3. Used in management of postpartum eclampsia
Which of the statements given above are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Question 4

Which one of the following is NOT a common cause of recurrent abortions?

Accepted Answer

Maternal diabetes

Answer

Antiphospholipid syndrome

Answer

Chromosomal abnormality

Answer

TORCH group of infections

Question 5

Contraindications to Uterine Cerclage for Incompetent os are all EXCEPT:

Accepted Answer

Previous history suggestive of abortion due to incompetent os

Answer

Bulging membrane

Answer

History of vaginal bleeding

Answer

Ruptured membrane

Question 6

The most common cause of early spontaneous abortion is:

Accepted Answer

Chromosomal abnormality

Answer

Teratogens

Answer

Endocrine disorder

Answer

Infection

Question 7

Cause of Fetal growth restriction may be:

1. Chromosomal abnormality
2. Congenital abnormality
3. Abnormal cord insertion

Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Question 8

Which one of the following regarding fetal growth restriction is NOT true?

Accepted Answer

Delivery always at 34 weeks

Answer

Biophysical profile is done

Answer

Umbilical artery Doppler studies are done

Answer

Daily fetal movement count is advised

Question 9

Which one of the following statements regarding contraception is NOT true?

Accepted Answer

Vaginal ring is a barrier method

Answer

Copper T can be inserted just after delivery

Answer

Implanon is a hormonal contraceptive

Answer

Copper T can be used as post coital contraception

Question 10

A 26 year old P2L2 has just had delivery. What are the contraceptive choices she has at present?

1. Post placental insertion of IUCD
2. Post partum ligation
3. Oral contraceptive pill
4. Lap ligation

Select the correct answer using the code given below:

Accepted Answer

1 and 2 only

Answer

2 only

Answer

1, 2 and 4

Answer

1 and 3

UPSC-CMS 2019

Obstetrics and Gynecology