UPSC-CMS 2023 - Obstetrics and Gynecology PYQs Practice Questions

Q: Which of the following hormones is the best indicator of maternal-fetal placental unit?

Estriol. ***Estriol*** - **Estriol** is the **best indicator of the maternal-fetal placental unit** because its production requires the integrated function of **all three components**: - **Fetal adrenal glands** produce DHEA-S (dehydroepiandrosterone sulfate) - **Fetal liver** performs 16α-hydroxylation of DHEA-S - **Placenta** converts 16α-OH-DHEA-S to estriol through aromatization - Any dysfunction in the fetus, placenta, or their interaction will be reflected in **decreased estriol levels**, making it the most comprehensive indicator of the **complete fetoplacental unit**. - Clinically used to assess fetal well-being, especially in conditions like **placental insufficiency** or **fetal adrenal hypoplasia**. *Human placental lactogen* - **hPL** is solely produced by the **syncytiotrophoblast** of the placenta and reflects **placental mass** and function. - While it correlates with placental viability, it does **not require fetal contribution** and therefore only indicates **placental function alone**, not the integrated maternal-fetal-placental unit. - Useful for assessing placental sufficiency but less comprehensive than estriol for evaluating the complete unit. *Progesterone* - **Progesterone** is initially produced by the **corpus luteum** (first 8-10 weeks) and later by the **placenta**. - Essential for maintaining pregnancy through uterine relaxation and endometrial support, but its levels reflect **placental function** rather than the integrated fetal-placental unit. - Does not require fetal contribution for its synthesis. *Prolactin* - **Prolactin** is primarily produced by the **maternal anterior pituitary gland**, with smaller amounts from the decidua. - Involved in mammary gland development and lactation preparation but is **not a product of the fetoplacental unit**. - Does not indicate the functioning of the maternal-fetal placental unit. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: During a normal pregnancy, the changes occurring in the urinary tract include the following except

Hypertonicity of the ureteric smooth muscle. ***Hypertonicity of the ureteric smooth muscle*** - Ureteric smooth muscle actually exhibits **reduced tone** and **hypoactivity** during pregnancy due to the relaxing effects of **progesterone**. - This **hypoactivity** contributes to ureteral dilatation and urinary stasis, making **hypertonicity** an incorrect statement. *Dilatation of the ureters* - **Progesterone** causes relaxation of smooth muscle throughout the body, including the ureters, leading to their **dilatation** and hydronephrosis. - Mechanical compression of the ureters by the gravid uterus, especially the right ureter, also contributes to this dilatation. *Elevation and thickening of the trigone* - The increased vascularity and hormonal influences during pregnancy cause the bladder trigone to become **edematous and elevated**. - This anatomical change can make the trigone more prominent during cystoscopic examination. *Increase in the Glomerular filtration rate* - Renal blood flow and GFR **increase by 30-50%** during pregnancy, primarily due to increased cardiac output and renal vasodilation. - This physiological adaptation is crucial for excreting fetal and maternal waste products. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: The daily requirement of calcium during normal pregnancy is

1000 mg. ***1000 mg*** - This is the daily calcium requirement for **pregnant women aged 19 years and above** according to **ACOG** and many international guidelines. - Some guidelines, including **ICMR (2020)**, recommend **1200 mg/day** for all pregnant women, making both 1000-1200 mg acceptable ranges. - Adequate calcium intake supports **fetal skeletal development** and helps prevent complications such as **gestational hypertension** and **preeclampsia**. - This answer is accepted as the standard recommendation for normal pregnancy in most textbooks. *500 mg* - This amount is the recommended daily intake for **pre-school children**, not pregnant women. - Grossly insufficient during pregnancy, as the **fetus requires approximately 200-300 mg/day** for skeletal development, primarily drawn from maternal calcium stores. - Would lead to **maternal bone demineralization** and increased risk of pregnancy complications. *2000 mg* - This represents the **tolerable upper intake level (UL)** for calcium during pregnancy. - While not harmful in most cases, this higher dose is **unnecessarily excessive** for routine supplementation. - May cause side effects including **constipation, kidney stones**, and interference with absorption of other minerals like iron and zinc. *250 mg* - This is **significantly below the requirement** for both pregnant and non-pregnant adults (who need ~600-800 mg/day). - Such severe deficiency would result in **mobilization of maternal bone calcium** to meet fetal demands. - Would increase risk of **osteoporosis, pre-eclampsia**, and impaired fetal bone development. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 35-year-old woman who has completed her family shows a positive Pap smear (Cervical intraepithelial neoplasia III (CIN III)). What is to be done next?

Simple hysterectomy. ***Simple hysterectomy*** - **Simple (total) hysterectomy** is the **definitive treatment of choice** for **CIN III** in a woman who has **completed her family**. - It removes the **entire uterus and cervix**, eliminating the risk of **recurrence or progression** to invasive cancer. - This provides a **permanent cure** without the need for long-term surveillance required after excisional procedures. - Preferred over conisation in this scenario as **fertility preservation is not needed**. *Conisation* - **Conisation** (cone biopsy) is an excisional procedure that removes a cone-shaped piece of cervical tissue and is the **treatment of choice for CIN III when fertility preservation is desired**. - While it can be both diagnostic and therapeutic, it has a **10-15% recurrence rate** and requires **lifelong cervical surveillance**. - In a patient who has **completed her family**, a more definitive treatment (hysterectomy) is preferred over conisation. *Wertheim's hysterectomy* - **Wertheim's hysterectomy** (radical hysterectomy with pelvic lymphadenectomy) is indicated for **invasive cervical cancer** (Stage IA2-IIA). - **CIN III is a pre-invasive lesion**, not invasive cancer, making this procedure unnecessarily radical and associated with significant morbidity. - This would only be considered if invasion is confirmed on histopathology. *Cryotherapy* - **Cryotherapy** is an **ablative treatment** that destroys abnormal cervical tissue by freezing. - It is suitable for **CIN I or CIN II** with small lesions but is **inadequate for CIN III** due to: - Higher risk of **residual disease** (cannot assess depth of involvement) - **No histological specimen** obtained for margin assessment - Higher recurrence rates compared to excisional procedures [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: While making a pelvic assessment in a gravid woman, the obstetrician can measure with examining finger the following diameter:

Diagonal conjugate. ***Diagonal conjugate*** - This is the only pelvic inlet diameter that can be directly measured clinically by the **examining finger**. - It extends from the **lower border of the pubic symphysis** to the **sacral promontory**. *True conjugate* - The true conjugate extends from the **upper border of the pubic symphysis** to the sacral promontory and cannot be directly measured due to the bladder. - It is an **estimated measurement**, usually derived by subtracting 1.5 to 2 cm from the diagonal conjugate. *Diameter of pelvic inlet* - This is a general term referring to various diameters of the pelvic inlet, some of which are not clinically measurable. - While one of its components, the diagonal conjugate, is measurable, the phrase "diameter of pelvic inlet" is too broad, and specific diameters are not directly accessible. *Obstetric conjugate* - This diameter is taken from the **innermost aspect of the pubic symphysis** to the sacral promontory, representing the shortest anteroposterior diameter the fetal head must pass. - Like the true conjugate, it cannot be directly measured clinically and is also estimated from the diagonal conjugate (approximately 0.5 cm less than the true conjugate). [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

Which of the following hormones is the best indicator of maternal-fetal placental unit?

Accepted Answer

Estriol

Answer

Progesterone

Answer

Human placental lactogen

Answer

Prolactin

Question 2

During a normal pregnancy, the changes occurring in the urinary tract include the following except

Accepted Answer

Hypertonicity of the ureteric smooth muscle

Answer

Dilatation of the ureters

Answer

Elevation and thickening of the trigone

Answer

Increase in the Glomerular filtration rate

Question 3

The daily requirement of calcium during normal pregnancy is

Accepted Answer

1000 mg

Answer

500 mg

Answer

2000 mg

Answer

250 mg

Question 4

A 35-year-old woman who has completed her family shows a positive Pap smear (Cervical intraepithelial neoplasia III (CIN III)). What is to be done next?

Accepted Answer

Simple hysterectomy

Answer

Wertheim's hysterectomy

Answer

Cryotherapy

Answer

Conisation

Question 5

While making a pelvic assessment in a gravid woman, the obstetrician can measure with examining finger the following diameter:

Accepted Answer

Diagonal conjugate

Answer

True conjugate

Answer

Diameter of pelvic inlet

Answer

Obstetric conjugate

Question 6

The perinatal complications of a diabetic pregnancy include :

1. Small for Gestational Age baby
2. Stillbirth
3. Hypoglycaemia
4. Respiratory distress syndrome

Select the correct answer from the code given below :

Accepted Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 and 4 only

Answer

1 and 3 only

Question 7

Antimicrobial prophylaxis is essential for a woman in labour who has

Accepted Answer

Heart disease

Answer

Hypertension

Answer

Diabetes mellitus

Answer

Renal disease

Question 8

A nulliparous woman presents with acute lower abdominal pain. She has a history of missed periods. The ultrasound examination shows an empty uterus. The cervical movements are very tender. The vital signs are stable. How will you manage her?

Accepted Answer

Admit her for observation

Answer

Start a pitocin drip

Answer

Treat her as a case of Pelvic Inflammatory Disease.

Answer

Perform a laparotomy

Question 9

In a pregnancy complicated by heart disease, which of the following is/are contraindicated?
1. External cephalic version
2. LSCS
3. Corrective surgery of the heart lesion
4. Prophylactic intravenous meth-ergine at the birth of anterior shoulder
Select the correct answer from the code given below :

Accepted Answer

1 and 4 only

Answer

1 only

Answer

1 and 3 only

Answer

1, 2, 3 and 4

Question 10

During a routine prenatal visit, a 22-week gravid woman is found to be affected with ankle oedema and new onset hypertension. The urine analysis reveals marked proteinuria. Which of the following, if it were to occur, would substantiate the diagnosis of eclampsia?

Accepted Answer

Seizures

Answer

Molar pregnancy

Answer

Thrombocytopenia

Answer

Hyperuricaemia

UPSC-CMS 2023 — Obstetrics and Gynecology