Community Medicine
4 questionsWhich of the following is/are the measure(s) of dispersion? 1. Mode 2. Median 3. Standard Deviation Select the correct answer using the code given below:
Which among the following is/are the examples of primordial prevention ? 1. Adopting healthy lifestyles from childhood 2. Immunization of infants 3. Screening of cervical cancer Select the correct answer using the code given below:
The appropriate statistical test to find out obesity as a significant risk factor for breast cancer is:
In a case control study, confounding factors can be minimized by the following EXCEPT:
UPSC-CMS 2017 - Community Medicine UPSC-CMS Practice Questions and MCQs
Question 71: Which of the following is/are the measure(s) of dispersion? 1. Mode 2. Median 3. Standard Deviation Select the correct answer using the code given below:
- A. 1, 2 and 3
- B. 2 and 3 only
- C. 1 and 2 only
- D. 3 only (Correct Answer)
Explanation: ***Correct: 3 only*** - **Standard Deviation** is a direct measure of dispersion that quantifies the amount of variation or spread of data values around the mean - It indicates how much individual data points deviate from the average, making it a key statistic for understanding the **spread** within a dataset - Other common measures of dispersion include **range, variance, interquartile range, and coefficient of variation** *Incorrect: 1, 2 and 3* - **Mode** and **Median** are measures of **central tendency**, not dispersion - They describe the center or typical value of a dataset, not the spread or variability - While they provide insight into the data's distribution, they do not quantify how spread out the data points are *Incorrect: 2 and 3 only* - **Median** is a measure of **central tendency** representing the middle value when data is ordered, not a measure of dispersion - Only **Standard Deviation** from this option is a measure of dispersion, making this choice incorrect *Incorrect: 1 and 2 only* - Both **Mode** and **Median** are measures of **central tendency** - Mode indicates the most frequent value and Median represents the middle value - Neither provides information about how **spread out** or dispersed the data points are around the center
Question 72: Which among the following is/are the examples of primordial prevention ? 1. Adopting healthy lifestyles from childhood 2. Immunization of infants 3. Screening of cervical cancer Select the correct answer using the code given below:
- A. 1, 2 and 3
- B. 1 and 3 only
- C. 1 and 2 only
- D. 1 only (Correct Answer)
Explanation: ***1 only*** - **Primordial prevention** aims to prevent the emergence of risk factors in the population, typically through establishing conditions that minimize hazards to health. **Adopting healthy lifestyles from childhood** (such as healthy eating habits, regular physical activity, avoiding smoking and alcohol) prevents the development of risk factors for chronic diseases like obesity, hypertension, and diabetes later in life. - This is the classic example of primordial prevention - intervening before risk factors even develop. *1 and 2 only* - While adopting healthy lifestyles is primordial prevention, **immunization of infants** is actually **primary prevention**, not primordial prevention. - **Primary prevention** prevents disease occurrence in susceptible individuals by interventions like immunization, which protects against specific diseases but does not prevent the emergence of risk factors themselves. - The disease agents already exist in the environment; vaccination simply prevents their effect on the individual. *1, 2 and 3* - **Immunization** is **primary prevention** (not primordial), and **screening for cervical cancer** is **secondary prevention** (early detection and treatment of existing disease). - This option incorrectly classifies both immunization and screening as primordial prevention. *1 and 3 only* - **Screening for cervical cancer** is a form of **secondary prevention** as it aims for early detection and prompt treatment of an existing disease or pre-cancerous condition, not the prevention of risk factors. - This option incorrectly includes secondary prevention and excludes statement 2, which while also incorrect as primordial, makes this combination wrong.
Question 73: The appropriate statistical test to find out obesity as a significant risk factor for breast cancer is:
- A. Chi-square test (Correct Answer)
- B. Wilcoxon’s signed rank test
- C. Student’s paired ‘t’ test
- D. Student’s unpaired ‘t’ test
Explanation: ***Chi-square test*** - The **chi-square test** is used to determine if there is a **significant association** between two **categorical variables**. - In this scenario, both obesity (yes/no) and breast cancer (yes/no) are categorical, making chi-square appropriate to assess if obesity is a risk factor. *Wilcoxon’s signed rank test* - This is a **non-parametric test** used for comparing two related samples or repeated measurements on a single sample, especially when data are not normally distributed. - It is not suitable for assessing the association between two independent categorical variables like obesity and breast cancer. *Student’s paired ‘t’ test* - The **paired t-test** is used to compare the means of two related groups or measurements from the same subject under different conditions (e.g., before and after an intervention). - This test is designed for **continuous data** and would not be appropriate for the categorical variables of obesity and breast cancer. *Student’s unpaired ‘t’ test* - The **unpaired t-test** (also known as independent samples t-test) is used to compare the means of two independent groups for a **continuous outcome variable**. - It is not suitable when both the exposure (obesity) and the outcome (breast cancer) are categorical variables.
Question 74: In a case control study, confounding factors can be minimized by the following EXCEPT:
- A. Matching of variables such as age and sex
- B. Stratification during analysis
- C. Increasing sample size for cases and controls (Correct Answer)
- D. Randomization during selection
Explanation: ***Increasing sample size for cases and controls*** - While increasing sample size improves the **precision** of an estimate and the statistical power of a study, it does **not** address or minimize **confounding factors**. - Confounding occurs when an extraneous variable distorts the observed association between an exposure and an outcome; a larger sample size might make the confounded association appear more statistically significant, but it **cannot remove the confounding itself**. - This is the method that does NOT minimize confounding. *Matching of variables such as age and sex* - **Matching** involves selecting controls that are similar to cases with respect to known confounding variables (e.g., age, sex, socioeconomic status). - This technique helps ensure that the groups being compared are balanced on these potential confounders, thereby **minimizing their influence** on the observed association. - Commonly used in case-control studies. *Stratification during analysis* - **Stratification** involves analyzing the association between exposure and outcome separately within subgroups (strata) defined by different levels of the confounding variable. - This allows researchers to assess if the association holds true within each stratum and estimate the true association **adjusted for the confounder**. - A standard analytical technique to control confounding. *Randomization during selection* - While **randomization** is primarily used in **randomized controlled trials (RCTs)** to distribute confounding factors equally between groups, **random selection of controls** in case-control studies can help ensure representativeness and minimize selection bias. - Although not the primary method for controlling confounding in case-control studies (where matching and stratification are preferred), random selection can contribute to reducing systematic differences between cases and controls. - This differs from "increasing sample size," which fundamentally cannot address confounding.
Obstetrics and Gynecology
5 questionsA 26 year old woman P1L1 reports with High Grade Squamous Intraepithelial Lesion (HGSIL) on Pap smear (Papanicolaou smear). Further management for her is:
With reference to the displacement of uterus, the treatment of choice for genuine stress urinary incontinence is:
Regarding placental separation in III stage of labour, consider the following statements: 1. Separation of placenta occurs at decidua spongiosa 2. In Schultze method, separation of placenta starts at centre 3. In Matthews Duncan's method, separation begins at margin Which of the statements given above is/are correct?
A 16 year old girl presents with primary amenorrhea with absent vagina, cervix and uterus in the presence of normal secondary sexual characteristics. Ovaries are present on USG. The most probable diagnosis is:
A 32 year old woman is noted to have 1200 cc of blood loss following a spontaneous vaginal delivery and delivery of placenta. The uterine fundus is palpated and noted to be firm. Which of the following is the most likely treatment for this patient?
UPSC-CMS 2017 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 71: A 26 year old woman P1L1 reports with High Grade Squamous Intraepithelial Lesion (HGSIL) on Pap smear (Papanicolaou smear). Further management for her is:
- A. Colposcopy and directed biopsy (Correct Answer)
- B. Conisation
- C. VIA, VILI
- D. LEEP
Explanation: ***Colposcopy and directed biopsy*** - A diagnosis of **High-Grade Squamous Intraepithelial Lesion (HGSIL)** from a Pap smear necessitates further investigation with **colposcopy**. - **Colposcopy** allows for direct visualization of the cervix, and **directed biopsies** are taken from suspicious areas to confirm the diagnosis and assess the extent of the lesion. *Conisation* - **Conisation (cone biopsy)** is a surgical procedure to remove a cone-shaped piece of tissue from the cervix. - It is typically performed *after* colposcopy and biopsy have confirmed a high-grade lesion or cervical cancer, not as the initial diagnostic step for HGSIL. *VIA, VILI* - **Visual inspection with acetic acid (VIA)** and **visual inspection with Lugol's iodine (VILI)** are screening methods for cervical cancer, particularly in resource-limited settings. - While useful for screening, they are not appropriate for managing a confirmed HGSIL diagnosis, which requires a more precise evaluation. *LEEP* - **LEEP (Loop Electrosurgical Excision Procedure)** is a common treatment for HGSIL. - Like conisation, LEEP is a therapeutic procedure used *after* a definitive diagnosis has been made through colposcopy and biopsy, not as the initial step for evaluating an HGSIL Pap smear.
Question 72: With reference to the displacement of uterus, the treatment of choice for genuine stress urinary incontinence is:
- A. Periurethral injection of bulking agents
- B. Kegel’s perineal exercises
- C. TVT‐O mid urethral tape (Correct Answer)
- D. Kelly's plication
Explanation: ***TVT‐O mid urethral tape*** - **TVT-O (tension-free vaginal tape-obturator)** is a minimally invasive surgical procedure that provides support to the mid-urethra, effectively treating genuine **stress urinary incontinence (SUI)**. - This procedure aims to restore the anatomical support mechanisms of the urethra, preventing urine leakage during activities that increase abdominal pressure. *Periurethral injection of bulking agents* - This method involves injecting materials around the urethra to increase its bulk and improve coaptation, but it is generally reserved for patients who are not suitable for surgery or as a secondary treatment, and typically has **lower long-term success rates** compared to tape procedures. - While it can improve continence in some cases, it addresses the issue by increasing urethral resistance rather than restoring proper anatomical support. *Kegel’s perineal exercises* - **Kegel exercises** aim to strengthen the **pelvic floor muscles**, which can be effective for mild SUI by improving urethral support and sphincter function. - However, for genuine SUI, which often involves significant anatomical changes or urethral hypermobility, these exercises are typically used as a **first-line conservative treatment** and may not be sufficient on their own. *Kelly’s plication* - **Kelly's plication**, also known as the **Kelly stitch**, is an older surgical procedure that involves plicating (folding and suturing) the periurethral fascia to provide urethral support. - This procedure has largely been replaced by more effective and less invasive mid-urethral tape procedures like TVT-O due to **higher failure rates** and potential complications.
Question 73: Regarding placental separation in III stage of labour, consider the following statements: 1. Separation of placenta occurs at decidua spongiosa 2. In Schultze method, separation of placenta starts at centre 3. In Matthews Duncan's method, separation begins at margin Which of the statements given above is/are correct?
- A. 1, 2 and 3 (Correct Answer)
- B. 1 and 2 only
- C. 2 and 3 only
- D. 1 only
Explanation: ***1, 2 and 3*** - Correctly states that placental separation occurs at the level of the **decidua spongiosa**, which is the physiological cleavage plane permitting placental detachment after birth. - Correctly identifies that in the **Schultze method**, placental separation starts centrally, leading to the fetal surface presenting first. In the **Matthews Duncan method**, separation begins at the margin, causing the maternal surface to present first. *1 and 2 only* - This option is incorrect because while statements 1 and 2 are true, statement 3 is also correct and needs to be included for a complete answer. - It overlooks the accurate description of the **Matthews Duncan method** of placental separation. *2 and 3 only* - This option is incorrect because it fails to acknowledge the fundamental physiological fact that placental separation occurs at the **decidua spongiosa**, which is statement 1. - It omits the correct statement regarding the physiological plane of **placental separation**. *1 only* - This option is incorrect because it only includes statement 1, which is true, but excludes the correct statements 2 and 3 regarding the different methods of placental separation. - It does not account for the accurate descriptions of both the **Schultze** and **Matthews Duncan** methods.
Question 74: A 16 year old girl presents with primary amenorrhea with absent vagina, cervix and uterus in the presence of normal secondary sexual characteristics. Ovaries are present on USG. The most probable diagnosis is:
- A. Klinefelter's syndrome
- B. Mayer Rockitansky Kuster Hauser syndrome (Correct Answer)
- C. Androgen Insensitivity syndrome
- D. Prader-Willi syndrome
Explanation: ***Mayer Rokitansky Küster Hauser syndrome*** - This syndrome is characterized by **agenesis or hypoplasia of the Müllerian ducts**, leading to the absence of the vagina, cervix, and uterus. - The presence of **normal secondary sexual characteristics** and **ovaries** confirms that ovarian function (estrogen production) is intact and the karyotype is typically 46, XX. *Klinefelter's syndrome* - This is a chromosomal disorder in males (47, XXY) characterized by **primary hypogonadism**, small testes, and often infertility. - It would present as a male, not a 16-year-old girl with an absent uterus. *Androgen Insensitivity syndrome* - In this syndrome, individuals are **genetically male (46, XY)** but appear female due to target tissue insensitivity to androgens. - They typically have a short, blind-ending vagina but **lack a uterus, fallopian tubes, and ovaries**, having undescended testes instead. *Prader-Willi syndrome* - This is a genetic disorder characterized by **intellectual disability**, obesity, short stature, and **hypogonadism**. - It does not involve agenesis of the female reproductive organs and is not primarily linked to primary amenorrhea with absent reproductive structures.
Question 75: A 32 year old woman is noted to have 1200 cc of blood loss following a spontaneous vaginal delivery and delivery of placenta. The uterine fundus is palpated and noted to be firm. Which of the following is the most likely treatment for this patient?
- A. Replacement of inverted uterus
- B. Intramuscular prostaglandin
- C. Surgical repair of cervical tear (Correct Answer)
- D. B-Lynch suture
Explanation: **Surgical repair of cervical tear** - The patient presents with **postpartum hemorrhage** (over 1000 mL blood loss) despite a **firm uterine fundus**, which indicates that **uterine atony** is unlikely to be the cause. - A firm uterus in the presence of continuous bleeding suggests a **genital tract laceration**, with a cervical tear being a common site. Surgical repair is necessary to stop the bleeding. *Replacement of inverted uterus* - **Uterine inversion** is characterized by the collapse of the uterine fundus into or through the cervix, which would present as a **soft, non-palpable fundus** or a mass in the vagina. - This patient's fundus is noted to be **firm**, ruling out uterine inversion as the cause of her hemorrhage. *Intramuscular prostaglandin* - **Prostaglandins** (like carboprost tromethamine) are used to treat **uterine atony**, which is characterized by a **soft, boggy uterus**. - The patient's uterus is described as **firm**, indicating that uterine atony is not the primary cause of her hemorrhage. *B-Lynch suture* - The **B-Lynch suture** is a surgical technique primarily used to manage **refractory uterine atony** that has not responded to medical management. - Since the uterus is firm and not atonic, this intervention would not be appropriate for the underlying cause of bleeding in this patient.
Physiology
1 questionsWhich of the following statements is/are correct regarding physiology of menstruation? 1. LH surge precedes ovulation 2. There are two peaks in serum estradiol levels, first in follicular and second in luteal phase 3. Serum progesterone has only one peak i.e., in luteal phase Select the correct answer using the code given below:
UPSC-CMS 2017 - Physiology UPSC-CMS Practice Questions and MCQs
Question 71: Which of the following statements is/are correct regarding physiology of menstruation? 1. LH surge precedes ovulation 2. There are two peaks in serum estradiol levels, first in follicular and second in luteal phase 3. Serum progesterone has only one peak i.e., in luteal phase Select the correct answer using the code given below:
- A. 1, 2 and 3 (Correct Answer)
- B. 2 and 3 only
- C. 1 and 2 only
- D. 1 only
Explanation: ***1, 2 and 3*** - All statements accurately describe key hormonal events during the menstrual cycle. The **LH surge** is indeed the trigger for ovulation, with **estradiol** exhibiting a biphasic pattern, and **progesterone** peaking in the luteal phase. - Understanding the precise timing and interaction of these hormonal events is fundamental to comprehending the entire **physiological process of menstruation**, including follicular development, ovulation, and preparation for potential pregnancy. *2 and 3 only* - This option is incorrect because it omits statement 1, which correctly identifies that the **LH surge precedes ovulation**, a crucial event for ovarian follicle rupture and oocyte release. - The **LH surge** is a direct consequence of rising estrogen levels and is essential for triggering the final maturation of the oocyte and its release from the Graafian follicle. *1 and 2 only* - This option is incorrect because it omits statement 3, which correctly notes that **serum progesterone has only one peak in the luteal phase**, produced by the corpus luteum after ovulation. - The rise in **progesterone** in the luteal phase is vital for preparing the uterine endometrium for implantation and maintaining a potential pregnancy. *1 only* - This option is incorrect as it only acknowledges the **LH surge preceding ovulation** but fails to include the accurate descriptions of the **biphasic estradiol peaks** and the **single progesterone peak** in the luteal phase, both of which are fundamental aspects of the menstrual cycle. - A comprehensive understanding of menstrual physiology requires recognizing the interplay of all these hormonal dynamics throughout the cycle.