Obstetrics and Gynecology
3 questionsFollowing statements are correct about levonorgestrel containing intra-uterine contraceptive device (Mirena) except
What is the most common cause of vault prolapse following hysterectomy ?
Following which of the tubectomy procedures listed below, best result is achieved for reversal sterilization (recanalization procedure) ?
UPSC-CMS 2009 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 61: Following statements are correct about levonorgestrel containing intra-uterine contraceptive device (Mirena) except
- A. It increases the risk of ectopic pregnancy (Correct Answer)
- B. It reduces the risk of pelvic inflammatory disease
- C. It releases 20 µg/day of levonorgestrel
- D. It increases the risk of ovarian cyst formation
Explanation: ***It increases the risk of ectopic pregnancy*** - This statement is **INCORRECT**. The **levonorgestrel-releasing IUD (Mirena)** does NOT increase the absolute risk of ectopic pregnancy compared to women not using contraception. - In fact, it **significantly reduces** the risk of ectopic pregnancy by preventing pregnancy altogether. The absolute risk of ectopic pregnancy is much lower in IUD users than in non-contraceptive users. *It reduces the risk of pelvic inflammatory disease* - The **levonorgestrel-releasing IUD (Mirena)** actually reduces the risk of PID. This is because **progestin thickens cervical mucus**, creating a barrier that can prevent ascending infection. - Unlike older copper IUDs, newer IUDs (both copper and hormonal) are generally not associated with an increased risk of PID after the first month following insertion. *It releases 20 µg/day of levonorgestrel* - The **Mirena IUD** is designed to release approximately **20 micrograms of levonorgestrel per day** initially, which then gradually decreases over its lifespan. - This consistent low-dose release is crucial for its contraceptive and therapeutic effects. *It increases the risk of ovarian cyst formation* - **Levonorgestrel-releasing IUDs** can increase the incidence of **functional ovarian cysts**. This is because the hormonal action can interfere with the normal follicular development and ovulation cycle. - These cysts are usually benign, asymptomatic, and resolve spontaneously.
Question 62: What is the most common cause of vault prolapse following hysterectomy ?
- A. Obesity
- B. Failure to identify and repair enterocele (Correct Answer)
- C. Chronic cough
- D. Diabetes mellitus
Explanation: ***Failure to identify and repair enterocele*** - An **enterocele** is a type of **hernia** in which the peritoneum and small bowel descend into the space between the vagina and rectum. - If an existing **enterocele** is not identified and repaired during hysterectomy, it can **worsen over time** and contribute significantly to **vaginal vault prolapse**. *Obesity* - While **obesity** is a risk factor for pelvic organ prolapse in general due to increased intra-abdominal pressure, it is not considered the most common direct cause of **vault prolapse specifically after hysterectomy**. - It contributes to general weakening of pelvic floor support but is less direct in causing vault collapse than a missed enterocele. *Chronic cough* - **Chronic cough** increases intra-abdominal pressure and is a risk factor for the development or worsening of pelvic organ prolapse. - However, similar to obesity, it's a general contributor to prolapse and not typically the most common direct cause of **vault prolapse** as compared to surgical factors. *Diabetes mellitus* - **Diabetes mellitus** can contribute to overall tissue weakness and neuropathy, potentially affecting pelvic floor support over time. - It is not considered a primary or frequent direct cause of **vaginal vault prolapse** following hysterectomy.
Question 63: Following which of the tubectomy procedures listed below, best result is achieved for reversal sterilization (recanalization procedure) ?
- A. Fallopian ring occlusion (Correct Answer)
- B. Electrocoagulation
- C. Irving method
- D. Pomeroy ligation
Explanation: ***Fallopian ring occlusion*** - This method uses a **silicone band** to occlude the fallopian tube, causing minimal damage to the surrounding tissue. - The small segment of the tube affected allows for a **higher success rate** in re-anastomosis during reversal sterilization due to preserved tubal length and integrity. *Electrocoagulation* - This method involves **burning and destroying** a significant segment of the fallopian tube with an electric current. - The extensive tissue damage and scarring make **recanalization difficult** and significantly reduce the success of reversal. *Irving method* - This procedure involves **ligating and dissecting** the fallopian tube, then burying the proximal end into the broad ligament. - The complex anatomical alteration and potential for **significant scarring** make reversal challenging and less successful. *Pomeroy ligation* - This technique involves **ligating and excising a loop** of the fallopian tube, which causes moderate tissue damage and segment removal. - While reversal is possible, the **removal of a tubal segment** can result in a shorter tube and a lower success rate compared to tubal ring occlusion.
Pathology
1 questionsFolic acid deficiency is characterized by the following features except
UPSC-CMS 2009 - Pathology UPSC-CMS Practice Questions and MCQs
Question 61: Folic acid deficiency is characterized by the following features except
- A. Macrocytes
- B. Howell-Jolly bodies
- C. Hypersegmented neutrophils
- D. Microcytes (Correct Answer)
Explanation: ***Microcytes*** - **Folic acid deficiency** causes **macrocytic anemia** [1][2], meaning red blood cells are larger than normal, not microcytic (smaller than normal). - **Microcytes** are characteristic of **iron deficiency anemia** or thalassemia. *Macrocytes* - **Folic acid deficiency** leads to defective DNA synthesis, resulting in larger, immature red blood cells known as **macrocytes** [2]. - This is a hallmark of **megaloblastic anemia**, which includes both folic acid and vitamin B12 deficiencies [4]. *Howell-Jolly bodies* - These are **nuclear remnants** found in red blood cells that indicate impaired splenic function or accelerated red blood cell production. - While not exclusive to folic acid deficiency, they can be seen due to the **dyserythropoiesis** (abnormal red blood cell development) associated with it. *Hypersegmented neutrophils* - **Hypersegmented neutrophils** are a classic morphological finding in peripheral blood smears of patients with **folic acid deficiency** (and vitamin B12 deficiency) [2][3]. - This occurs due to abnormal maturation of neutrophils in the bone marrow, where the nucleus divides into a higher number of lobes (typically 5 or more) [3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 594-595. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 593-594. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 654. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 130-131.
Pharmacology
5 questionsWhat is the drug of choice for emergency contraception ?
Which one of the following is not a third generation progestogen used in combined oral contraceptive pills ?
Minipill containing 75 µg of desogestrel is used for contraception. Which of the following is its schedule of administration ?
Consider the following list of cancers: 1. Ovarian cancer 2. Colon cancer 3. Endometrial cancer 4. Breast cancer What is the effect of combined oral contraceptive pills on the above?
What is the content of ethinyl estradiol in very low dose oral contraceptives ?
UPSC-CMS 2009 - Pharmacology UPSC-CMS Practice Questions and MCQs
Question 61: What is the drug of choice for emergency contraception ?
- A. High dose oestrogen alone
- B. Danazol
- C. Levonorgestrel only pill (Correct Answer)
- D. Yuzpe regimen (combined oral pill)
Explanation: ***Levonorgestrel only pill*** - **Levonorgestrel-only pills (LNG-EC)** are the most common and effective form of emergency contraception globally, available over-the-counter in many regions. - It works primarily by **inhibiting or delaying ovulation** and is most effective when taken as soon as possible after unprotected intercourse. *High dose oestrogen alone* - High-dose estrogen alone is **not used** for emergency contraception due to its high incidence of side effects like severe nausea and vomiting. - While estrogens can affect implantation, their use without progestin for EC is **ineffective and unsafe** compared to other methods. *Danazol* - **Danazol** is an attenuated androgen that was explored for emergency contraception but has been largely **abandoned** due to variable efficacy and a high incidence of side effects like androgenic effects. - It works by suppressing ovulation and endometrial development but is **inferior** to levonorgestrel or ulipristal acetate. *Yuzpe regimen (combined oral pill)* - The **Yuzpe regimen** uses a combination of estrogen and progestin from regular oral contraceptive pills, which is **less effective** and has more side effects (nausea, vomiting) than levonorgestrel-only pills. - This method requires taking **two doses 12 hours apart**, making it less convenient than single-dose levonorgestrel.
Question 62: Which one of the following is not a third generation progestogen used in combined oral contraceptive pills ?
- A. Norgestimate
- B. Levonorgestrel (Correct Answer)
- C. Gestodene
- D. Desogestrel
Explanation: ***Levonorgestrel*** - **Levonorgestrel** is a **second-generation progestogen** commonly used in combined oral contraceptive pills and emergency contraception. - While effective, it tends to have higher androgenic activity compared to third-generation progestogens. *Norgestimate* - **Norgestimate** is a **third-generation progestogen** known for its lower androgenic activity. - It is often favored in combined oral contraceptives to minimize androgenic side effects like acne and hirsutism. *Gestodene* - **Gestodene** is a **third-generation progestogen** that has minimal androgenic activity and high progestational potency. - It is frequently included in modern combined oral contraceptives to improve cycle control and reduce side effects. *Desogestrel* - **Desogestrel** is also a **third-generation progestogen** and is an active metabolite of etonogestrel. - It is characterized by its low androgenic effects and is used in various combined oral contraceptive formulations.
Question 63: Minipill containing 75 µg of desogestrel is used for contraception. Which of the following is its schedule of administration ?
- A. Taken continuously without pill-free intervals (Correct Answer)
- B. Taken once a day pill for 3 months with 7 days pill free interval
- C. Taken for 21 days with 7 days pill free interval
- D. Taken once a day pill for 2 months with 7 days pill free interval
Explanation: **Taken continuously without pill-free intervals** - **Minipills**, containing only progestin such as desogestrel, are designed for continuous daily administration to maintain consistent progestin levels and contraceptive efficacy. - Unlike combined oral contraceptive pills, minipills do not include a **pill-free interval** as there is no estrogen component to initiate a withdrawal bleed. *Taken once a day pill for 3 months with 7 days pill free interval* - This regimen is more characteristic of **extended-cycle combined oral contraceptives** or specific progestin-only regimens not typically applied to standard minipills like desogestrel. - A 7-day pill-free interval is usually for combined oral contraceptives to allow for a **withdrawal bleed**. *Taken for 21 days with 7 days pill free interval* - This is the standard regimen for **combined oral contraceptive pills**, which contain both estrogen and progestin. - The 7-day pill-free interval allows for a **hormone withdrawal bleed**, which is not part of minipill administration. *Taken once a day pill for 2 months with 7 days pill free interval* - This schedule is not a standard administration for either **minipills** or typical combined oral contraceptives. - **Continuous use** is crucial for minipills to maintain their contraceptive effect.
Question 64: Consider the following list of cancers: 1. Ovarian cancer 2. Colon cancer 3. Endometrial cancer 4. Breast cancer What is the effect of combined oral contraceptive pills on the above?
- A. Increased risk of 3 and 4 only
- B. Protection against 1, 2 and 3 (Correct Answer)
- C. Decreased risk of 1 and 2 only
- D. Increased risk of 2 and 3 only
Explanation: **Protection against 1, 2, and 3** - Combined oral contraceptive (COC) pills are known to **reduce the risk of ovarian and endometrial cancer**, effects that can persist for decades after discontinuation. This is primarily due to the suppression of ovulation and the direct effect of progestin on the endometrium. - COC use also offers some **protection against colorectal cancer**, with studies showing a modest reduction in risk, potentially related to changes in bile acid metabolism or other hormonal effects. *Increased risk of 3 and 4 only* - While COCs **decrease the risk of endometrial cancer (3)**, they are associated with a **modest, temporary increase in the risk of breast cancer (4)**, which typically returns to baseline 10 years after cessation. - This option incorrectly states an increased risk for endometrial cancer and doesn't account for the protective effects on ovarian and colon cancer. *Decreased risk of 1 and 2 only* - COCs do **decrease the risk of ovarian cancer (1) and colon cancer (2)**. - However, this option is incomplete as it overlooks the significant protective effect on **endometrial cancer (3)**. *Increased risk of 2 and 3 only* - COCs actually **decrease the risk of both colon cancer (2) and endometrial cancer (3)**. - This statement directly contradicts the established protective effects of COCs on these cancer types.
Question 65: What is the content of ethinyl estradiol in very low dose oral contraceptives ?
- A. 20 µg (Correct Answer)
- B. 15 µg
- C. 25 µg
- D. 30 µg
Explanation: ***20 µg*** - Very low-dose oral contraceptives typically contain **20 µg of ethinyl estradiol**. This dosage is chosen to minimize estrogen-related side effects while maintaining contraceptive efficacy. - While it offers fewer side effects, its **contraceptive reliability** might be slightly lower than standard doses, and it could lead to more **breakthrough bleeding**. *15 µg* - Oral contraceptives with **15 µg of ethinyl estradiol** are considered ultra-low dose and are less common. - This dosage carries a higher risk of **breakthrough bleeding** and potentially reduced efficacy compared to 20 µg. *25 µg* - An oral contraceptive containing **25 µg of ethinyl estradiol** falls within the low-dose range, but it is not classified as "very low dose" given that 20 µg is the typical threshold for that designation. - While still generally well-tolerated, it contains slightly more estrogen than the very low-dose options. *30 µg* - This concentration of ethinyl estradiol is characteristic of **low-dose oral contraceptives**, but not "very low dose." - It offers good contraceptive efficacy with a relatively low incidence of estrogen-related side effects.
Physiology
1 questionsAfter how many hours of LH surge does the ovulation occur?
UPSC-CMS 2009 - Physiology UPSC-CMS Practice Questions and MCQs
Question 61: After how many hours of LH surge does the ovulation occur?
- A. 24-48 hours
- B. 12-24 hours
- C. 12-36 hours
- D. 24-36 hours (Correct Answer)
Explanation: ***24-36 hours*** - The **luteinizing hormone (LH) surge** triggers the final maturation of the oocyte and rupture of the dominant follicle. - Ovulation typically occurs **24-36 hours after the onset of the LH surge**, or approximately **10-18 hours after the LH peak**. - This is the **standard timeframe** taught in reproductive physiology and corresponds to the physiological cascade required for follicular rupture. *12-24 hours* - This timeframe is **too early** for ovulation to occur after the LH surge onset. - While some follicular changes begin during this period, the complete maturation and rupture process typically requires more time. - This might represent the interval from LH peak in some cases, but not from surge onset. *12-36 hours* - This range is **too broad** and includes both early (12h) and appropriate (24-36h) timeframes. - While the upper range is correct, the lower bound extends into a period when ovulation has typically not yet occurred. - Less precise than the 24-36 hour window. *24-48 hours* - While ovulation can occasionally occur up to 48 hours post-surge, this is **less common**. - The upper limit (48h) extends beyond the typical ovulation window. - Most ovulations are completed by 36 hours after the LH surge onset.