UPSC-CMS 2013 Practice Questions

Q: A woman dies from a heart disease six days after delivery. This would come under the category of :

Indirect maternal death. ***Indirect maternal death*** - An **indirect maternal death** is defined as one resulting from a pre-existing disease or a disease that developed during pregnancy, which was not due to direct obstetric causes but was aggravated by the physiological effects of pregnancy. - Heart disease in this context, especially when occurring six days postpartum, is often a pre-existing condition exacerbated by pregnancy-related cardiovascular demands, fitting this definition. *Direct maternal death* - **Direct maternal deaths** are those resulting from obstetric complications of the pregnant state, from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of these. - Examples include severe hemorrhage, pre-eclampsia/eclampsia, or obstructed labor, which are not described in this scenario. *Unclassified death* - An **unclassified death** is assigned when there is insufficient information to determine the cause of death as direct, indirect, or coincidental. - In this case, the cause of death (heart disease) is known, making classification possible. *Medical (non-maternal) death* - This category usually refers to deaths from medical conditions **unrelated to or unaggravated by pregnancy**. - While heart disease is a medical condition, its occurrence six days postpartum strongly suggests that the physiological changes of pregnancy played a significant role in its exacerbation or presentation, thereby classifying it as a maternal death rather than a coincidental non-maternal death.

Q: The amount of previously unrecognized disease that is diagnosed as a result of the screening effort is known as :

Yield. ***Yield*** - The **yield** of a screening program refers to the amount of **previously unrecognized disease** that is identified through the screening effort. - It essentially measures the **productivity** or **effectiveness** of the screening intervention in detecting new cases. *Reliability* - **Reliability** refers to the **consistency** of a measurement or test, meaning it produces the same results under the same conditions. - It does not describe the amount of new disease found but rather the **reproducibility** of the screening process. *Predictive accuracy* - **Predictive accuracy** (positive predictive value or negative predictive value) indicates the probability that a positive or negative test result **truly reflects** the presence or absence of the disease. - While related to screening performance, it's a measure of how accurately the test predicts disease status, not the overall quantity of newly diagnosed disease. *Validity* - **Validity** refers to the extent to which a test measures what it is intended to measure, encompassing both **sensitivity** and **specificity**. - It describes the **accuracy** of the test in correctly identifying diseased and non-diseased individuals, but not the total number of new cases identified in the population.

Q: The National Health Policy 2002 target to be achieved by the year 2010 is :

Reduce infant mortality rate 30/1000 live births. ***Reduce infant mortality rate 30/1000 live births*** - The **National Health Policy 2002** specifically set the target of reducing **Infant Mortality Rate (IMR) to 30 per 1000 live births by the year 2010**. - This was one of the key quantifiable goals with a clear timeline aligned with the question's timeframe. - The policy document explicitly mentioned this as a priority target for improving maternal and child health outcomes in India. *Eradication of polio* - While **polio eradication** was indeed a major objective of the National Health Policy 2002, the target year was **2005, not 2010**. - India achieved polio-free status in 2014 when WHO certified the country as polio-free. - This makes it incorrect for the specific year 2010 mentioned in the question. *Elimination of leprosy* - The **elimination of leprosy** (defined as prevalence of less than 1 case per 10,000 population) was targeted for **2005, not 2010**. - India achieved national level elimination in December 2005, though some districts continued to have higher prevalence. - This target predates the 2010 timeline asked in the question. *Achieve zero level growth of HIV/AIDS* - The National Health Policy 2002 aimed to **halt and reverse the HIV/AIDS epidemic** by 2007. - The specific phrase "zero level growth" and the year 2010 do not accurately reflect the policy's stated objectives. - The focus was on stabilizing prevalence and preventing new infections through NACP (National AIDS Control Programme).

Q: What is the commonest cause of Vulvo-Vaginal Fistula in developing countries ?

Obstructed labour. ***Obstructed labour*** - **Prolonged obstructed labor** causes **ischemic necrosis** of the tissues between the vagina and the bladder or rectum due to continuous pressure from the fetal head, leading to a fistula. - This is the **most common cause** of vulvo-vaginal fistulas in developing countries, often due to limited access to emergency obstetric care like C-sections. *Carcinoma of bladder* - While bladder carcinoma can cause fistulas, they are more typically **vesicovaginal fistulas** and are less common than those resulting from obstructed labor in developing countries. - Fistulas due to malignancy often involve **tissue destruction** and may be associated with prior radiation therapy. *Injury during hysterectomy* - Iatrogenic injury during a **hysterectomy** can lead to a fistula, but this is more common in developed healthcare settings with higher rates of surgical interventions. - This cause is less prevalent globally compared to the widespread issue of obstructed labor in resource-limited regions. *Radiotherapy for treatment of carcinoma cervix* - **Radiotherapy** for cervical carcinoma can cause **radiation-induced necrosis** and lead to fistulas, particularly **rectovaginal** or **vesicovaginal** types. - While a significant cause in cancer patients, it is not the commonest overall cause in developing countries compared to the sheer volume of cases resulting from obstructed labor.

Q: A 28-year old woman comes with infertility. Husband's semen analysis is normal. Endometrial biopsy shows secretory changes with no evidence of tuberculosis. On hysterosalpingography both tubes show tubal blockage. What should be the next step in management?

Diagnostic laparoscopy and chromo-pertubation. ***Diagnostic laparoscopy and chromo-pertubation*** - This procedure directly visualizes the fallopian tubes and surrounding pelvic structures, allowing for definitive confirmation of tubal blockage and identification of potential causes like **endometriosis** or **adhesions**. - **Chromo-pertubation** involves injecting a dye through the cervix to assess tubal patency and identify the exact location and nature of the blockage. *IVF* - While IVF is a viable option for tubal factor infertility, it is generally considered after a more thorough diagnostic workup, especially when the cause of blockage is unknown and potentially treatable. - Proceeding directly to IVF without assessing the possibility of surgical correction might be premature and miss an opportunity for natural conception or a less invasive intervention. *Tuboplasty* - **Tuboplasty** is a surgical procedure to repair or reconstruct damaged fallopian tubes. - However, its success depends on the extent of damage and the specific type of blockage, which can only be determined after a diagnostic evaluation like laparoscopy. *ICSI* - **ICSI (Intracytoplasmic Sperm Injection)** is a specialized form of IVF primarily used for severe male factor infertility, not tubal blockage, especially when the husband's semen analysis is normal. - While ICSI can be part of an IVF cycle, it's not the primary next step for diagnosing or treating tubal blockage in a woman with normal male factor.

Q: Which of the following statements is true for maternal rubella infection?

The primary infection is responsible for birth defects. ***The primary infection is responsible for birth defects*** - **Primary maternal rubella infection** during pregnancy is the primary cause of congenital rubella syndrome, as the virus can cross the placenta and infect the developing fetus. - The risk and severity of **birth defects** are highest when the mother is infected during the first trimester. *24% incidence of congenital infection if acquired during the last month of pregnancy* - While rubella infection late in pregnancy can still lead to fetal infection, the incidence of **congenital rubella syndrome** is significantly lower in the last trimester (typically less than 1%) compared to the first trimester. - The reported incidence of 24% is excessively high for an infection acquired in the **last month of pregnancy**. *It leads to abortions before 16 weeks of gestation* - While **rubella infection** can increase the risk of spontaneous abortion, especially if acquired early in pregnancy, it is not the *only* or *guaranteed* outcome. Many infected pregnancies continue to term with varying degrees of fetal compromise. - The statement suggests a direct and absolute causal link to abortion before 16 weeks, which is too definitive. *It causes blindness with recurrent infection* - **Congenital rubella syndrome** can cause ocular defects such as **cataracts**, **glaucoma**, and **retinopathy**, which can lead to blindness. - However, rubella infection typically confers **lifelong immunity**, making **recurrent infection** extremely rare and thus not a common mechanism for causing blindness.

Q: Contraindications for medical abortions are all except :

Age more than 35 years. ***Age more than 35 years*** - Age alone, including being over 35 years old, is **not a contraindication** for a medical abortion. - The decision for medical abortion is based on health status, gestational age, and patient choice, not primarily on age. *Uncontrolled seizure disorder* - An **uncontrolled seizure disorder** can be a relative contraindication due to the stress and potential risks associated with the abortion process, which could trigger seizures. - Prostaglandins used in medical abortion can sometimes **increase uterine contractions and pain**, which may exacerbate a seizure disorder. *Hemoglobin less than 8 gm%* - A **hemoglobin level less than 8 gm%** indicates significant anemia, which increases the risk of complications from blood loss during a medical abortion. - Patients with severe anemia may require **blood transfusion** if significant bleeding occurs, making medical abortion less safe. *Undiagnosed adnexal mass* - An **undiagnosed adnexal mass** can be a contraindication because it might mask an **ectopic pregnancy**, for which medical abortion drugs are not effective and could be dangerous. - It also raises concerns about potential **complications or rupture** of the mass during the abortion process.

Q: Success of tubal re-canalization is best with :

Laparoscopic ring application. ***Laparoscopic ring application (Falope ring/Tubal clips)*** - Mechanical occlusion methods (clips and rings) cause **minimal tissue destruction**, typically affecting only **2-3 cm** of the fallopian tube. - The tubal segments remain relatively **healthy and undamaged**, with minimal scarring and fibrosis. - Reversal success rates are **highest at 70-90%** due to the preservation of tubal architecture and length. - These methods are considered the **most reversible** form of tubal sterilization. *Pomeroy's technique* - Involves excision of a tubal loop (approximately 3-4 cm) with ligation, causing moderate tissue damage. - The cut ends heal by scarring, and some tubal length is permanently lost. - Reversal success rates are moderate at **60-70%**. - More tissue damage than clip/ring methods but still reasonably reversible. *Uchida's technique* - Involves separating the serosa from the muscularis, ligating and excising a **larger segment** of the tube (4-5 cm). - Creates more extensive tissue damage with greater tubal length loss. - Reversal success rates are lower at **40-50%** due to the complexity and extent of tissue disruption. *Fimbriectomy* - Involves complete removal of the **fimbrial end** of the fallopian tube, which is essential for ovum pickup. - Even if re-anastomosis is technically successful, the **absence of fimbriae** results in extremely poor functional outcomes. - Reversal success rates are very poor at **<20%**, making this the least reversible sterilization method.

Q: The total osmolarity of new oral rehydration solution formulation is:

245 mmol/litre. ***245 mmol/litre*** - The **New Oral Rehydration Solution (ORS)** formulation has a reduced osmolarity of **245 mOsm/L** compared to the original WHO ORS. - This reduced osmolarity aims to minimize stool output and vomiting, making it more effective for treating dehydration in children with acute diarrhea. *210 mmol/litre* - This osmolarity is lower than the recommended new ORS formulation and could potentially lead to a higher risk of **hyponatremia** if not carefully monitored. - While lower osmolarity solutions can reduce stool output, a substantially lower value might compromise adequate rehydration. *300 mmol/litre* - This value is characteristic of the **original WHO ORS** formulation, which had a higher osmolarity. - Higher osmolarity solutions, like the original ORS, can sometimes worsen diarrhea by drawing water into the lumen due to osmotic effects. *255 mmol/litre* - This osmolarity is slightly above the recommended **245 mOsm/L** for the new ORS formulation. - While possibly still effective, the optimal balance between efficacy and minimizing stool volume has been established with the 245 mOsm/L formulation.

Question 1

A woman dies from a heart disease six days after delivery. This would come under the category of :

Accepted Answer

Indirect maternal death

Answer

Direct maternal death

Answer

Unclassified death

Answer

Medical (non-maternal) death

Question 2

The amount of previously unrecognized disease that is diagnosed as a result of the screening effort is known as :

Accepted Answer

Yield

Answer

Reliability

Answer

Predictive accuracy

Answer

Validity

Question 3

The National Health Policy 2002 target to be achieved by the year 2010 is :

Accepted Answer

Reduce infant mortality rate 30/1000 live births

Answer

Elimination of leprosy

Answer

Eradication of polio

Answer

Achieve zero level growth of HIV/AIDS

Question 4

What is the commonest cause of Vulvo-Vaginal Fistula in developing countries ?

Accepted Answer

Obstructed labour

Answer

Carcinoma of bladder

Answer

Injury during hysterectomy

Answer

Radiotherapy for treatment of carcinoma cervix

Question 5

A 28-year old woman comes with infertility. Husband's semen analysis is normal. Endometrial biopsy shows secretory changes with no evidence of tuberculosis. On hysterosalpingography both tubes show tubal blockage. What should be the next step in management?

Accepted Answer

Diagnostic laparoscopy and chromo-pertubation

Answer

IVF

Answer

Tuboplasty

Answer

ICSI

Question 6

Which of the following statements is true for maternal rubella infection?

Accepted Answer

The primary infection is responsible for birth defects

Answer

24% incidence of congenital infection if acquired during the last month of pregnancy

Answer

It leads to abortions before 16 weeks of gestation

Answer

It causes blindness with recurrent infection

Question 7

Contraindications for medical abortions are all except :

Accepted Answer

Age more than 35 years

Answer

Uncontrolled seizure disorder

Answer

Hemoglobin less than 8 gm%

Answer

Undiagnosed adnexal mass

Question 8

In a woman using an intrauterine contraceptive device (IUCD) an unexpected pregnancy occurs and the IUCD threads are visible. What is the reason to recommend removal of the device ?

Accepted Answer

To prevent the risk of subsequent septic abortion and preterm labour

Answer

To prevent post partum haemorrhage

Answer

To prevent congenital abnormality of the newborn

Answer

To prevent perforation

Question 9

Success of tubal re-canalization is best with :

Accepted Answer

Laparoscopic ring application

Answer

Uchida's technique

Answer

Fimbriectomy

Answer

Pomeroy's technique

Question 10

The total osmolarity of new oral rehydration solution formulation is:

Accepted Answer

245 mmol/litre

Answer

210 mmol/litre

Answer

300 mmol/litre

Answer

255 mmol/litre

UPSC-CMS 2013

Community Medicine

Obstetrics and Gynecology

Pharmacology