UPSC-CMS 2009 Practice Questions

Q: Consider the following statements: 1. The placenta is usually located in the upper uterine segment. 2. The placenta is usually located in the lower uterine segment. 3. The placenta is usually located in the fundus. 4. The placenta is usually located in the anterior uterine wall. Which one of the statements given above are correct ?

1 and 3 only. ***1 and 3 only*** - The placenta typically implants in the **upper uterine segment** and often extends to the **fundus**, providing a robust blood supply and optimal conditions for fetal growth. - An implantation in the **upper uterine segment** or **fundus** ensures that as the uterus grows, the placenta moves away from the cervix, reducing the risk of placenta previa. *1, 3 and 4* - While the placenta can be located in the **anterior uterine wall**, this is not a universal characteristic as it can also be posterior, lateral, or even fundal. - The core locations for healthy placental implantation are the **upper uterine segment** and **fundus**, which are accurately captured in statements 1 and 3. *1, 2 and 3* - The statement that the placenta is usually located in the **lower uterine segment** (statement 2) is incorrect; this location is associated with **placenta previa**, a complication [1]. - Healthy placental implantation avoids the **lower uterine segment** to prevent issues during labour and delivery. *2 and 3 only* - This option incorrectly states that the placenta is usually located in the **lower uterine segment** (statement 2), which is generally considered abnormal. - While location in the **fundus** (statement 3) is correct, combining it with an incorrect primary location makes this option invalid.

Q: Which one of the following investigations is considered to be "Gold standard" technique for diagnosis of arterial occlusive disease ?

Digital Subtraction Angiography (DSA). ***Digital Subtraction Angiography (DSA)*** - **DSA** remains the gold standard for diagnosing arterial occlusive disease as it provides **high-resolution images** of the arterial lumen, accurately depicting stenoses and occlusions [1]. - It allows for precise localization and quantification of arterial lesions, which is crucial for treatment planning, especially for **interventional procedures** [1]. *Duplex imaging* - While useful for screening and follow-up, **duplex ultrasound** is operator-dependent and may not always provide the detailed anatomical information required for definitive diagnosis or pre-procedural planning, especially in complex cases. - It assesses blood flow and vessel patency but can be limited by factors such as patient body habitus, calcification, and bowel gas. *Doppler ultrasound blood flow detection* - **Doppler ultrasound** is an excellent tool for assessing blood flow characteristics and detecting changes indicative of arterial disease, but it provides less anatomical detail compared to angiography. - It is often used for **screening** and monitoring, but it does not offer the precise visualization of the arterial lumen needed to be a gold standard for diagnosis. *Treadmill* - A **treadmill test** (exercise stress test) is used to assess the functional impact of arterial occlusive disease, particularly **intermittent claudication**, by measuring the ankle-brachial index (ABI) after exertion. - It is a physiological test that indicates the presence and severity of flow-limiting lesions, but it does not provide anatomical information about the location or nature of the arterial occlusion.

Q: The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

During labour. ***During labour*** - The **highest risk** of mother-to-child HIV transmission occurs during labor and delivery due to the infant's exposure to maternal blood and genital secretions. - The process of passing through the **birth canal** can lead to inoculation with HIV-infected cells and viral particles. *Third trimester* - While some transmission can occur in the third trimester, the risk is significantly **lower** than during labor. - The placenta generally provides a barrier, though there's a risk of **transplacental passage** if the placental integrity is compromised. *First trimester* - The **lowest risk** of HIV transmission occurs during the first trimester. - The developing fetus is relatively protected by the placenta, and the viral load in maternal blood might be lower compared to later stages without intervention. *During breast feeding* - **Breastfeeding** is a known route of HIV transmission, but its risk is generally **lower per exposure** compared to labor and delivery, especially if the mother is on antiretroviral therapy. - The risk is **cumulative** over the duration of breastfeeding.

Q: What is the most commonly observed fetal effect in women receiving magnesium sulphate therapy for pre-eclampsia/eclampsia ?

Respiratory depression. ***Respiratory depression*** - Magnesium sulfate readily crosses the placenta, leading to elevated magnesium levels in the fetus, which can cause **central nervous system depression** and **respiratory depression** at birth. - This is the **most commonly observed fetal effect**, manifesting as neonatal hypermagnesemia with respiratory compromise, hypotonia, and decreased reflexes. - The effect is due to magnesium's role as a **neuromuscular blocker**, reducing acetylcholine release at the neuromuscular junction. *Intestinal obstruction* - There is no direct link between maternal magnesium sulfate therapy and an increased risk of **fetal intestinal obstruction**. - Intestinal obstruction in neonates is typically associated with **structural anomalies** or conditions like meconium ileus, not magnesium exposure. *Variability in fetal heart rate pattern* - While magnesium sulfate can cause **decreased fetal heart rate variability** as a monitoring finding, this is not the "most commonly observed fetal effect." - Decreased variability is a **transient monitoring change** during therapy, whereas respiratory depression is a direct clinical effect observed at birth. - The question asks for the most common **fetal effect**, and respiratory depression at delivery is more clinically significant and commonly encountered. *Cerebral palsy* - Magnesium sulfate is actually used as a **neuroprotective agent** in preterm births to **reduce the risk of cerebral palsy**. - It does not cause cerebral palsy; rather, it provides fetal neuroprotection when given for preterm labor <32 weeks gestation.

Q: Match List-I with List-II and select the correct answer using the code given below the Lists: (Refer to the image for List-I and List-II)

A→4 B→1 C→2 D→3. ***A→4, B→1, C→2, D→3*** **Correct Matching:** **Tattooing (A) → Foreign particles like dirt, soot (4)** - Tattooing refers to permanent skin discoloration caused by **foreign pigment insertion** into the dermis - Commonly occurs accidentally after trauma with **dirt, soot, gunpowder, or other foreign particles** - The particles become embedded in the skin causing permanent discoloration **Keloid (B) → Outgrows boundaries of original wound (1)** - A keloid is a **prominent raised scar** that extends beyond the margins of the original injury - Results from excessive collagen deposition during abnormal wound healing - **Key feature**: Growth exceeds the boundaries of the original wound area **Dupuytren's contracture (C) → Contractures (2)** - Progressive fibrosis of the **palmar fascia** leading to finger contractures - Causes permanent flexion deformity, typically affecting the ring and little fingers - Results in functional limitation due to **contracture formation** **Basal cell carcinoma (D) → Not familial (3)** - Most common skin malignancy, typically **sporadic** rather than familial - Associated with UV exposure, fair skin, and immunosuppression - Unlike some other cancers, **typically not inherited** in familial patterns *Incorrect Options:* *A→2, B→3, C→4, D→1* - Incorrectly matches tattooing with contractures and Dupuytren's with foreign particles *A→3, B→4, C→1, D→2* - Incorrectly matches tattooing with non-familial trait and keloid with foreign particles *A→1, B→2, C→3, D→4* - Incorrectly matches tattooing with outgrowing boundaries and basal cell carcinoma with foreign particles

Q: Which of the following is the best indicator of prognosis of soft tissue sarcoma?

Tumour grade. ***Tumour grade*** - **Tumor grade** quantifies the degree of cellular differentiation, mitotic activity, and necrosis within the tumor, reflecting its aggressive potential. - A **higher tumor grade** is directly associated with a poorer prognosis, increased risk of local recurrence, and distant metastasis in soft tissue sarcomas. *Tumour size* - While larger tumor size (e.g., >5 cm) is generally associated with a worse prognosis, it is primarily a factor in **staging**, not the most critical prognostic indicator. - **Tumor grade** provides more fundamental information about the biological aggressiveness of the tumor cells regardless of their current size. *Nodal metastasis* - **Nodal metastasis** in soft tissue sarcomas is relatively uncommon (less than 5% of cases) compared to carcinomas, and its presence is a significant negative prognostic factor. - However, because it is rare, it doesn't serve as the *primary* indicator for the majority of sarcoma patients, where tumor grade is more universally applicable. *Histological type* - The **histological type** (e.g., liposarcoma, leiomyosarcoma) helps classify the sarcoma, but different subtypes can have a wide range of biological behavior. - While certain types may have a generally better or worse prognosis, the **grade** *within* that histological type is a more precise predictor of individual patient outcomes.

Q: Lympho-venous anastomosis is done for

Filarial lymphoedema. ***Filarial lymphoedema*** - **Lympho-venous anastomosis (LVA)** is a microsurgical technique used to bypass damaged lymphatic vessels and directly connect lymphatic channels to small veins. This procedure is primarily effective in treating **lymphedema due to lymphatic obstruction**, such as that caused by filarial infection. - In **filarial lymphoedema**, the lymphatic obstruction leads to accumulation of lymph fluid. LVA helps to restore lymphatic drainage, reducing limb swelling and improving symptoms, particularly in the early stages of the disease. *Cystic hygroma* - A **cystic hygroma** is a congenital lymphatic malformation, typically treated by surgical excision, sclerotherapy, or laser ablation. - It involves abnormally dilated lymphatic spaces and doesn't usually benefit from LVA, as the primary issue is malformation rather than obstruction requiring a bypass. *Malignant lymphoedema* - **Malignant lymphoedema** (secondary to cancer or its treatment) is often complicated by active tumor burden, radiation fibrosis, or extensive nodal involvement. - While LVA might be considered in carefully selected cases, its efficacy can be limited due to underlying cancer and the diffuse nature of the lymphatic damage, making it a less common primary indication compared to filarial lymphedema. *Lymphoid cyst* - A **lymphoid cyst** is a localized collection of lymph, often treated by aspiration, sclerotherapy, or surgical excision. - It is not a widespread lymphatic drainage disorder that would necessitate a bypass procedure like lympho-venous anastomosis.

Q: Which one of the following statements is not correct regarding thoracic outlet syndrome?

Radial nerve is involved. ***Radial nerve is involved*** - Thoracic outlet syndrome (TOS) primarily involves compression of the **brachial plexus** (specifically the lower trunk C8-T1), subclavian artery, or subclavian vein. - The **radial nerve** is derived from the posterior cord (C5-T1) of the brachial plexus, but the classic presentation of TOS does not typically involve isolated or predominant radial nerve symptoms. Instead, TOS symptoms more commonly affect the **ulnar nerve distribution** (C8-T1) due to compression of the lower trunk of the brachial plexus. *Resection of First rib is effective treatment* - **First rib resection** is a well-established surgical treatment option for thoracic outlet syndrome, aiming to decompress the neurovascular structures. - This procedure alleviates pressure on the **brachial plexus** and **subclavian vessels**, leading to symptom improvement in many patients. *It is associated with Horner's syndrome* - **Horner's syndrome** can be associated with thoracic outlet pathology, particularly tumors like **Pancoast tumors**, which can compress the sympathetic chain at the thoracic outlet. - While not a direct feature of typical TOS, conditions affecting the thoracic outlet region can impact the **cervical sympathetic ganglion** leading to Horner's syndrome (ptosis, miosis, anhidrosis). *It is a rare condition* - Thoracic outlet syndrome is generally considered a **relatively rare condition**, although its true incidence might be underestimated due to diagnostic challenges. - It is often a diagnosis of exclusion, requiring careful clinical evaluation and imaging to rule out other causes of **neck, shoulder, and arm pain**.

Question 1

Consider the following statements:
1. The placenta is usually located in the upper uterine segment.
2. The placenta is usually located in the lower uterine segment.
3. The placenta is usually located in the fundus.
4. The placenta is usually located in the anterior uterine wall.

Which one of the statements given above are correct ?

Accepted Answer

1 and 3 only

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2 and 3 only

Question 2

Which one of the following investigations is considered to be "Gold standard" technique for diagnosis of arterial occlusive disease ?

Accepted Answer

Digital Subtraction Angiography (DSA)

Answer

Duplex imaging

Answer

Doppler ultrasound blood flow detection

Answer

Treadmill

Question 3

The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

Accepted Answer

During labour

Answer

Third trimester

Answer

First trimester

Answer

During breast feeding

Question 4

Which one of the following statements is not correct about obstetric cholestasis ?

Accepted Answer

Associated with markedly high bilirubin and raised liver enzymes

Answer

It results in pruritus without rash

Answer

It is an indication of termination of pregnancy at 37 weeks

Answer

Risk of recurrence is high in future pregnancies

Question 5

What is the most commonly observed fetal effect in women receiving magnesium sulphate therapy for pre-eclampsia/eclampsia ?

Accepted Answer

Respiratory depression

Answer

Intestinal obstruction

Answer

Variability in fetal heart rate pattern

Answer

Cerebral palsy

Question 6

Spiegelberg's criteria for diagnosis of ovarian pregnancy include the following except

Accepted Answer

Gestational sac is connected with infundibulopelvic ligament

Answer

Gestational sac must occupy the position of ovary

Answer

Ovarian tissue should be present in the wall of gestational sac on histopathology

Answer

Tube on the affected side must be intact

Question 7

Match List-I with List-II and select the correct answer using the code given below the Lists:

(Refer to the image for List-I and List-II)

Accepted Answer

A→4  B→1  C→2  D→3

Answer

A→2  B→3  C→4  D→1

Answer

A→3  B→4  C→1  D→2

Answer

A→1  B→2  C→3  D→4

Question 8

Which of the following is the best indicator of prognosis of soft tissue sarcoma?

Accepted Answer

Tumour grade

Answer

Tumour size

Answer

Nodal metastasis

Answer

Histological type

Question 9

Lympho-venous anastomosis is done for

Accepted Answer

Filarial lymphoedema

Answer

Cystic hygroma

Answer

Malignant lymphoedema

Answer

Lymphoid cyst

Question 10

Which one of the following statements is not correct regarding thoracic outlet syndrome?

Accepted Answer

Radial nerve is involved

Answer

Resection of First rib is effective treatment

Answer

It is associated with Horner's syndrome

Answer

It is a rare condition

UPSC-CMS 2009

Internal Medicine

Obstetrics and Gynecology

Surgery