UPSC-CMS 2020 - Obstetrics and Gynecology Practice Questions

Q: Which one of the following is NOT a method of management of Deep Transverse Arrest with the living fetus?

Delivery by ventouse. ***Delivery by ventouse*** - **Vacuum extraction (ventouse)** requires the fetal head to be engaged and the leading part to be no higher than 1/5th above the symphysis pubis, and it does not allow for rotation once applied. - In a **deep transverse arrest**, the fetal head is unrotated, and direct application of a ventouse without prior rotation is unsafe and ineffective, as it would apply traction in an improper direction, risking scalp injury without resolving the arrest. *Caesarean section* - **Caesarean section** is a viable and often necessary option for deep transverse arrest, especially when other rotational or instrumental delivery methods are contraindicated or unsuccessful. - It ensures safe delivery for both mother and fetus in cases of **cephalopelvic disproportion** or failed operative vaginal delivery. *Manual rotation and application of forceps* - **Manual rotation** involves an obstetrician manually turning the fetal head from the transverse to the occipito-anterior or posterior position. - After successful manual rotation, **forceps** can then be applied to facilitate vaginal delivery, provided there are no other contraindications. *Delivery by application of forceps to the unrotated head* - **Kielland's forceps** are specifically designed for rotation and delivery in cases of **deep transverse arrest** and can be applied to an unrotated head to achieve rotation without prior manual intervention. - While other types of forceps typically require the head to be in an occipito-anterior position, Kielland's forceps allow for the necessary rotation before traction is applied, making it a suitable method for managing deep transverse arrest.

Q: Successful external cephalic version of breech presentation is likely in case all of the following EXCEPT:

Breech with extended legs. ***Breech with extended legs*** - An extended leg presentation (frank breech) makes successful external cephalic version **less likely** because the **fetal legs splint the fetus**, creating a rigid, elongated configuration that resists rotation. - The extended posture restricts fetal mobility necessary for successful manipulation. - Frank breech is the **least favorable type** for ECV success. *Non engaged breech* - A **non-engaged breech** presentation indicates the fetal buttocks or feet are not yet fixed in the maternal pelvis, allowing **greater mobility** and making successful external cephalic version **more likely**. - Lack of engagement means there is ample space for the fetus to turn. *Adequate amniotic fluid* - **Adequate amniotic fluid** provides essential space and cushioning for the fetus to move, which is crucial for a successful external cephalic version. - It reduces friction and allows for easier manipulation of the fetus during the procedure. - Oligohydramnios is a relative contraindication to ECV. *Complete breech with sacroanterior position* - A **complete breech** (with flexed hips and knees) is generally **more favorable** for external cephalic version compared to frank breech, as the flexed posture creates a more compact, mobile configuration. - The fetal position (sacroanterior, sacrotransverse, or sacroposterior) has less impact on ECV success than the **type of breech presentation** (complete vs. frank). - Complete breech allows easier manipulation than the rigid frank breech configuration.

Q: During total abdominal hysterectomy the ureter is likely to undergo injury or ligation during the following steps EXCEPT:

During division and ligation of the round ligaments. ***During division and ligation of the round ligaments*** - The round ligaments are located **far from the ureters**, passing through the **inguinal canal** anteriorly. - They are **anterior and lateral** to the broad ligament and do not cross the ureteral path. - **Ureteral injury is highly unlikely** during their division and ligation, making this the correct answer to the EXCEPT question. *During division and ligation of mackenrodt's and uterosacral ligaments* - The **ureter passes about 1-2 cm lateral to the cervix** at the level of the internal os, in close proximity to the **cardinal (Mackenrodt's) and uterosacral ligaments**. - These ligaments provide significant support to the uterus and are one of the **most common sites of ureteral injury** during hysterectomy. - The ureter is particularly vulnerable during clamping and ligating these structures. *At the vaginal angles while incising the vagina to remove the cervix with the uterus* - The **ureters are at the level of the vaginal fornices** as they course toward the bladder base. - This is a well-recognized **high-risk area** for ureteral injury during vaginal cuff clamping and incision. - The ureter can be inadvertently caught in the clamps applied to control bleeding from the vaginal angles. *During division and ligation of infundibulopelvic ligaments* - The **infundibulopelvic ligament** (IP ligament or suspensory ligament of the ovary) contains the **ovarian vessels**. - The ureter runs along the **pelvic sidewall immediately medial and posterior** to the IP ligament. - This is another **high-risk area** for ureteral injury, especially if the ligament is not elevated adequately away from the pelvic sidewall during clamping.

Q: Which one of the following is NOT a component of active phase in the partograph?

Phase of expulsion. ***Phase of expulsion*** - The **phase of expulsion** (or the second stage of labor) begins after the cervix is fully dilated and ends with the birth of the baby. - While it immediately follows the active phase, it is not considered a component of the **active phase** itself, which primarily focuses on cervical dilation progress. *Acceleration phase* - The **acceleration phase** is an early part of the active phase of labor where the rate of cervical dilation begins to increase. - It marks the transition from the latent phase to the more rapid dilation characteristic of active labor. *Phase of deceleration* - The **phase of deceleration** occurs towards the end of the active phase, just before full cervical dilation, where the rate of dilation slows down. - This phase is typically associated with the advancing fetal head encountering the pelvic floor. *Phase of maximum slope* - The **phase of maximum slope** (or maximum ascent) is the steepest part of the active phase, where cervical dilation occurs at its fastest rate. - This is the most efficient period of cervical change during labor.

Q: The components of partograph are all EXCEPT:

Maternal respiratory rate. ***Maternal respiratory rate*** - While important for overall maternal well-being, **maternal respiratory rate** is not a standard component recorded on a partograph. - The partograph primarily focuses on monitoring fetal well-being, cervical dilation, and uterine contractions to track labor progress. *Fetal heart rate* - **Fetal heart rate** is a crucial component of the partograph, regularly plotted to assess fetal well-being and identify signs of distress. - It helps in detecting fetal hypoxia and guiding interventions if necessary during labor. *Time* - **Time** is a fundamental axis on the partograph, allowing for the plotting of all other parameters against a temporal scale. - This enables the healthcare provider to visualize the progression of labor and identify deviations from normal patterns. *Maternal urine analysis* - **Maternal urine analysis** for protein, acetone, or glucose is a standard component of the partograph. - It helps in assessing maternal hydration status and detecting potential complications like pre-eclampsia or gestational diabetes that might impact labor or fetal health.

Q: Which of the following information are provided by partograph? 1. Colour of liquor 2. Uterine contractions with duration and frequency 3. Dilatation of cervix Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - A **partograph** is a composite graphical record of key maternal and fetal parameters during labor, specifically designed to monitor the progress of labor and to identify deviations from normal. - It includes charting the **colour of liquor**, **uterine contractions (frequency and duration)**, and **cervical dilatation** to assess the progression of labor. *2 and 3 only* - This option is incorrect because the partograph also records the **colour of liquor** in addition to uterine contractions and cervical dilatation. - The colour of liquor provides vital information about fetal well-being, such as the presence of **meconium**, which indicates fetal distress. *1 and 3 only* - This option is incorrect because the partograph also records the **frequency and duration of uterine contractions**, which are crucial for assessing the power and effectiveness of labor. - Uterine contractions are fundamental to the progress of cervical dilatation and fetal descent. *1 and 2 only* - This option is incorrect because the partograph also records the **dilatation of the cervix**, which is the primary indicator of the progress of the first stage of labor. - The rate of cervical dilatation is crucial for determining if labor is progressing normally or if there is a **protracted labor** requiring intervention.

Q: Hysterosalpingography (HSG) is least helpful in detecting which of the following?

Pelvic adhesions. ***Pelvic adhesions*** - HSG primarily visualizes the uterine cavity and fallopian tubes, making it **poorly suited to detect adhesions outside these structures**. - **Pelvic adhesions** are better evaluated with **laparoscopy**, which allows direct visualization of the abdominal and pelvic organs. *Asherman syndrome* - This condition involves **intrauterine adhesions** which manifest as filling defects or synechiae within the uterine cavity on HSG. - HSG is highly effective in detecting these adhesions and their extent. *Congenital uterine anomaly* - HSG can visualize the shape of the uterine cavity and detect various **congenital anomalies** such as a septate, bicornuate, or arcuate uterus. - The contrast dye fills the uterus, outlining its internal morphology. *Tubal patency* - One of the primary uses of HSG is to assess the **patency of the fallopian tubes** by observing the free spill of contrast into the peritoneal cavity. - Blockages or hydrosalpinges can be clearly identified.

Q: Which of the following are characteristics of Trichomonas vaginitis? 1. Presence of greenish frothy discharge 2. Vaginal pH > 4.5 3. Presence of clue cells in microscopic examination 4. Strawberry spots on the vaginal mucosa Select the correct answer using the code given below:

1, 2 and 4. ***1, 2 and 4*** - **Trichomonas vaginalis** infection classically presents with a **greenish, frothy, malodorous vaginal discharge**, and the vaginal pH is typically **elevated (>4.5)** due to the pathogen's metabolic activity. - The presence of **strawberry spots (colpitis macularis)** on the vaginal and cervical mucosa is a hallmark sign, resulting from punctate hemorrhages. *1, 3 and 4* - This option correctly includes **greenish frothy discharge** and **strawberry spots**, which are characteristic of *Trichomonas vaginitis*. - However, the inclusion of "presence of **clue cells**" is incorrect as clue cells are pathognomonic for **bacterial vaginosis**, not *Trichomonas*. *2, 3 and 4* - This option correctly identifies **vaginal pH > 4.5** and **strawberry spots** as features of *Trichomonas vaginitis*. - The presence of **clue cells** is a misattribution to *Trichomonas* infection; instead, clue cells are defining features of **bacterial vaginosis**. *1, 2 and 3* - While **greenish frothy discharge** and **vaginal pH > 4.5** are indeed characteristic of *Trichomonas vaginitis*, the presence of **clue cells** is a diagnostic criterion for **bacterial vaginosis**. - **Strawberry spots** are a distinct feature of *Trichomonas* that is missing from this selection.

Q: Tumor marker of epithelial ovarian carcinoma is:

CA-125. ***CA-125*** - **CA-125 (Cancer Antigen 125)** is the most widely used and validated tumor marker for detecting and monitoring **epithelial ovarian carcinoma**. - Elevated levels are found in approximately 80% of women with epithelial ovarian cancer, making it useful in guiding treatment decisions and assessing recurrence. *Alpha feto protein* - **Alpha-fetoprotein (AFP)** is primarily elevated in **germ cell tumors** of the ovary (e.g., endodermal sinus tumor) or in hepatocellular carcinoma and some testicular cancers, not epithelial ovarian carcinoma. - Its presence usually indicates a different histological subtype of ovarian malignancy. *Beta HCG* - **Beta-human chorionic gonadotropin (β-hCG)** is a tumor marker utilized for detecting **germ cell tumors**, particularly **choriocarcinoma** and some embryonal carcinomas, as well as pregnancy. - It is not typically elevated in epithelial ovarian carcinoma. *LDH* - **Lactate dehydrogenase (LDH)** is a general marker of **tissue damage or high cell turnover**, elevated in many cancers, including dysgerminoma (an ovarian germ cell tumor), but it is not specific for epithelial ovarian carcinoma. - Due to its lack of specificity, LDH alone is not considered the primary tumor marker for epithelial ovarian cancer.

Q: The most common site of cervical cancer is:

Transformation zone. ***Transformation zone*** - The **transformation zone** is where the squamous epithelium of the **ectocervix** meets the columnar epithelium of the **endocervix**. - This area is highly susceptible to **human papillomavirus (HPV) infection**, which is the primary cause of cervical cancer, making it the most common site of origin. *Endocervix* - The **endocervix** is lined by columnar epithelium and primarily gives rise to **adenocarcinoma**, which is less common than squamous cell carcinoma. - While cervical cancer can occur here, it is not the most frequent site of origin for all types of cervical cancer. *Isthmus* - The **isthmus** is the narrow lower part of the uterus, superior to the cervix. - It is not a primary site for the development of cervical cancer; cancerous changes typically originate within the cervical regions proper. *Ectocervix* - The **ectocervix** is the vaginal portion of the cervix, covered by stratified squamous epithelium. - While **squamous cell carcinomas** frequently occur in the cervix, they mostly originate in the transformation zone, not the ectocervix itself.

Question 1

Which one of the following is NOT a method of management of Deep Transverse Arrest with the living fetus?

Accepted Answer

Delivery by ventouse

Answer

Caesarean section

Answer

Manual rotation and application of forceps

Answer

Delivery by application of forceps to the unrotated head

Question 2

Successful external cephalic version of breech presentation is likely in case all of the following EXCEPT:

Accepted Answer

Breech with extended legs

Answer

Non engaged breech

Answer

Adequate amniotic fluid

Answer

Complete breech with sacroanterior position

Question 3

During total abdominal hysterectomy the ureter is likely to undergo injury or ligation during the following steps EXCEPT:

Accepted Answer

During division and ligation of the round ligaments

Answer

During division and ligation of infundibulopelvic ligaments

Answer

During division and ligation of mackenrodt's and uterosacral ligaments

Answer

At the vaginal angles while incising the vagina to remove the cervix with the uterus

Question 4

Which one of the following is NOT a component of active phase in the partograph?

Accepted Answer

Phase of expulsion

Answer

Acceleration phase

Answer

Phase of deceleration

Answer

Phase of maximum slope

Question 5

The components of partograph are all EXCEPT:

Accepted Answer

Maternal respiratory rate

Answer

Fetal heart rate

Answer

Time

Answer

Maternal urine analysis

Question 6

Which of the following information are provided by partograph?

1. Colour of liquor
2. Uterine contractions with duration and frequency
3. Dilatation of cervix

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 3 only

Answer

1 and 2 only

Question 7

Hysterosalpingography (HSG) is least helpful in detecting which of the following?

Accepted Answer

Pelvic adhesions

Answer

Asherman syndrome

Answer

Congenital uterine anomaly

Answer

Tubal patency

Question 8

Which of the following are characteristics of Trichomonas vaginitis?

1. Presence of greenish frothy discharge
2. Vaginal pH > 4.5
3. Presence of clue cells in microscopic examination
4. Strawberry spots on the vaginal mucosa

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 9

Tumor marker of epithelial ovarian carcinoma is:

Accepted Answer

CA-125

Answer

Alpha feto protein

Answer

Beta HCG

Answer

LDH

Question 10

The most common site of cervical cancer is:

Accepted Answer

Transformation zone

Answer

Endocervix

Answer

Isthmus

Answer

Ectocervix

UPSC-CMS 2020 — Obstetrics and Gynecology