Forensic Medicine
1 questionsA 15 year old girl comes to the gynae casualty with a relative with complaints of amenorrhoea 2 months. The urine pregnancy test is positive, ultrasound confirms 8 weeks pregnancy. The attendants are not willing to file a police case. What should the treating doctor do?
UPSC-CMS 2018 - Forensic Medicine UPSC-CMS Practice Questions and MCQs
Question 51: A 15 year old girl comes to the gynae casualty with a relative with complaints of amenorrhoea 2 months. The urine pregnancy test is positive, ultrasound confirms 8 weeks pregnancy. The attendants are not willing to file a police case. What should the treating doctor do?
- A. None of the options
- B. Inform the police and make MLC (Correct Answer)
- C. Take consent for abortion and proceed
- D. Take parents consent for MTP
Explanation: ***Inform the police and make MLC*** - A 15-year-old girl is a minor, and pregnancy in a minor is considered a **cognizable offense** under the **Protection of Children from Sexual Offences (POCSO) Act, 2012**. - Under POCSO Act, **sexual intercourse with a person below 18 years is statutory rape**, regardless of consent. - Reporting to the police and making a **medico-legal case (MLC)** is **mandatory** for healthcare providers to ensure legal protection for the minor and initiate investigation into sexual abuse. - This reporting is required **irrespective of the family's wishes** or unwillingness to file a case. *None of the options* - This is incorrect because there is a clear legal and ethical obligation to report the case due to the patient's age and the implications of the POCSO Act. - Failing to act would constitute a **breach of duty** under Section 19 of POCSO Act and could have serious legal consequences for the doctor. *Take consent for abortion and proceed* - While **Medical Termination of Pregnancy (MTP)** might be medically indicated, a doctor cannot proceed based on consent alone without addressing the **legal ramifications** of pregnancy in a minor. - Performing abortion without reporting the case would mean **bypassing mandatory POCSO Act provisions**, which has serious legal implications for the treating doctor. *Take parents consent for MTP* - While parental consent for MTP is necessary for a minor under the MTP Act, it does **not supersede the requirement** to report pregnancy in a minor under the **POCSO Act**. - The primary concern here is the **protection of the minor** from potential sexual abuse, which mandates police involvement before any other intervention.
Obstetrics and Gynecology
8 questionsWhich one of the following statements is NOT true regarding general physiological changes after delivery?
Consider following statements regarding Beta Thalassemia in pregnancy: 1. There is low MCH and MCV 2. Total Iron binding capacity may be elevated or normal 3. HbA2 more than 3.5% is seen in Haemoglobin Electrophoresis Which of the statements given above is/are correct?
A 20 year old Primigravida, comes at 35 weeks of gestation with complaints of swelling of feet. On examination her blood pressure is 170/110 mm Hg on 2 occasions; urine examination shows proteinuria. Which one of the following statements regarding her management is NOT true?
A 25 year old, G2P1L1 came with amenorrhoea of two and half months followed by bleeding PV and pain abdomen. On examination cervical OS is open with slight bleeding. The uterus is 10 weeks size with no tenderness in the fornices. The probable clinical diagnosis is:
Which one of the following statements regarding intrauterine growth restriction is NOT correct?
Which of the following is an absolute contraindication for use of oral contraceptive pills?
Which one of the following clinical situations is NOT ideal to perform female sterilization procedure?
Cardiac diseases in pregnancy which have major risk of maternal mortality are: 1. Pulmonary hypertension 2. Aortic coarctation with valvular involvement 3. Atrial septal defect 4. Mitral stenosis Select the correct answer using the code given below:
UPSC-CMS 2018 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 51: Which one of the following statements is NOT true regarding general physiological changes after delivery?
- A. Blood volume returns to normal by second week
- B. Pulse may be raised on first day
- C. Temperature should not be above 99°F
- D. Cardiac output remains unchanged after delivery (Correct Answer)
Explanation: ***Cardiac output remains unchanged after delivery*** - This statement is incorrect because **cardiac output** actually undergoes significant changes postpartum. It **increases immediately after delivery** due to autotransfusion from the now-empty uterus and removal of uteroplacental shunt, peaking within the first hours, before gradually declining to pre-pregnancy levels over several weeks. - The drop in cardiac output after delivery is not immediate or complete, with initial increases followed by a gradual decrease, which refutes the idea of it remaining unchanged. *Blood volume returns to normal by second week* - This statement is generally true; after an initial increase immediately postpartum due to the relief of vena caval compression and autotransfusion, **blood volume progressively decreases** and typically returns to pre-pregnancy levels within the **first few weeks** following delivery. - The excess plasma volume accumulated during pregnancy is lost through diuresis and diaphoresis, bringing total blood volume back to normal. *Pulse may be raised on first day* - This statement is also true; many women experience a **transient increase in heart rate (tachycardia)** during the first 24-48 hours postpartum. - This can be attributed to several factors including **pain**, excitement, **blood loss**, and the rapid physiological changes occurring as the body adjusts after delivery. *Temperature should not be above 99°F* - This statement is largely true, as a **postpartum temperature** above 100.4°F (38°C) on two successive occasions and remaining elevated for more than 24 hours is typically considered a sign of **puerperal fever** and warrants investigation. - A transient rise to 100.4°F (38°C) within the first 24 hours can occur due to **dehydration** or the stress of labor, but sustained elevation above 99°F without a clear explanation should prompt further assessment for infection.
Question 52: Consider following statements regarding Beta Thalassemia in pregnancy: 1. There is low MCH and MCV 2. Total Iron binding capacity may be elevated or normal 3. HbA2 more than 3.5% is seen in Haemoglobin Electrophoresis Which of the statements given above is/are correct?
- A. 2 and 3 only
- B. 1 and 2 only
- C. 1 only
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - Statement 1 is correct: Patients with **beta thalassemia** typically exhibit **microcytic (low MCV)** and **hypochromic (low MCH)** anemia due to reduced beta-globin chain synthesis. - Statement 2 is correct: **Total iron binding capacity (TIBC)** in beta thalassemia trait is typically **normal or slightly elevated**. Unlike iron deficiency anemia where TIBC is markedly elevated, in thalassemia trait the TIBC remains in the normal range or may be mildly elevated. Importantly, serum ferritin is normal or elevated (unlike iron deficiency where it's low). - Statement 3 is correct: **Hemoglobin electrophoresis** in beta thalassemia trait characteristically shows **HbA2 > 3.5%** (usually 4-6%), which is the key diagnostic criterion that differentiates it from iron deficiency anemia. *2 and 3 only* - This option is incorrect because statement 1 (low MCH and MCV) is a fundamental hematological characteristic of beta thalassemia and is therefore correct. *1 and 2 only* - This option is incorrect because statement 3 (HbA2 > 3.5%) is the definitive diagnostic criterion for beta thalassemia trait and is essential for diagnosis. *1 only* - This option is incorrect because statements 2 and 3 are also accurate. Low MCV and MCH alone cannot distinguish beta thalassemia from iron deficiency anemia; elevated HbA2 and normal/elevated ferritin with normal/slightly elevated TIBC are key differentiating features.
Question 53: A 20 year old Primigravida, comes at 35 weeks of gestation with complaints of swelling of feet. On examination her blood pressure is 170/110 mm Hg on 2 occasions; urine examination shows proteinuria. Which one of the following statements regarding her management is NOT true?
- A. Injection Dexamethasone is to be given for fetal lung maturity (Correct Answer)
- B. Can be labelled as Preeclampsia
- C. Both maternal and fetal monitoring are required
- D. Requires urgent admission
Explanation: ***Injection Dexamethasone is to be given for fetal lung maturity*** - At **35 weeks of gestation**, corticosteroids for fetal lung maturity are **traditionally NOT routinely indicated** according to classical obstetric teaching. - The primary indication for antenatal corticosteroids is between **24 and 34 weeks of gestation**, when the risk of respiratory distress syndrome is highest. - At 35 weeks, fetal lungs are generally considered sufficiently mature, and the risk-benefit ratio of routine steroid administration changes. - **Note**: Evolving evidence (post-2016) suggests potential benefits of late preterm steroids (34-36+6 weeks) in certain scenarios, but this was not standard practice at the time of this examination. - In the context of this question and examination year, this statement is **NOT true** as routine practice. *Can be labelled as Preeclampsia* - The patient presents with **severe hypertension** (BP 170/110 mmHg on two occasions) and **proteinuria**, which are the hallmark diagnostic criteria for **severe preeclampsia**. - BP ≥160/110 mmHg meets the criteria for severe features. - Swelling of the feet (**edema**) is a common, though not diagnostic, associated symptom. *Both maternal and fetal monitoring are required* - In severe preeclampsia, **close maternal monitoring** for signs of worsening disease is crucial: - Severe hypertension, headaches, visual disturbances, epigastric pain - Laboratory monitoring: liver enzymes, platelets, creatinine, LDH - **Fetal monitoring** is essential to assess fetal well-being: - Non-stress tests, biophysical profiles - Doppler velocimetry to assess placental insufficiency - Monitoring for IUGR or fetal distress *Requires urgent admission* - With BP 170/110 mmHg and proteinuria at 35 weeks, this is **severe preeclampsia** - a medical emergency. - **Urgent admission** is necessary for: - Continuous maternal and fetal monitoring - Blood pressure control with antihypertensives - Magnesium sulfate for seizure prophylaxis - Planning for timely delivery (delivery is the definitive treatment)
Question 54: A 25 year old, G2P1L1 came with amenorrhoea of two and half months followed by bleeding PV and pain abdomen. On examination cervical OS is open with slight bleeding. The uterus is 10 weeks size with no tenderness in the fornices. The probable clinical diagnosis is:
- A. Inevitable abortion (Correct Answer)
- B. Incomplete abortion
- C. Missed abortion
- D. Ectopic pregnancy
Explanation: ***Inevitable abortion*** - The presence of **amenorrhea** followed by **vaginal bleeding** and **abdominal pain**, with an **open cervical os**, indicates that the abortion process cannot be halted. - Critically, there is **no history of passage of products of conception**, which means the abortion is inevitable but has not yet occurred. - The uterus size being consistent with **10 weeks of gestation** confirms an intrauterine pregnancy in the process of being expelled. *Incomplete abortion* - This diagnosis also involves vaginal bleeding and an open cervical os, but it is characterized by the **partial expulsion of products of conception**. - The key differentiator is that incomplete abortion requires **history or evidence of tissue passage**, which is not mentioned in this clinical scenario. - In inevitable abortion, the os is open and bleeding is present, but expulsion has not yet begun. *Missed abortion* - A missed abortion involves fetal demise without symptoms like bleeding or pain, and a **closed cervical os**. - This patient presents with active bleeding and pain, and an open cervical os, which contradicts the features of a missed abortion. - The uterus may be smaller than expected for dates in missed abortion. *Ectopic pregnancy* - Although an ectopic pregnancy can cause amenorrhea, vaginal bleeding, and abdominal pain, the uterus in an ectopic pregnancy is typically **smaller than expected for gestational age** or normal in size, and there is often **significant adnexal tenderness or mass**. - The finding of a **10-week sized uterus** strongly suggests an intrauterine pregnancy rather than ectopic, and the absence of adnexal tenderness makes ectopic pregnancy unlikely.
Question 55: Which one of the following statements regarding intrauterine growth restriction is NOT correct?
- A. There is danger of fetal asphyxia during delivery
- B. Generally not seen in women with gestational diabetes
- C. Doppler studies are indicated
- D. Defined according to biparietal diameter (Correct Answer)
Explanation: ***Defined according to biparietal diameter*** - **Intrauterine growth restriction (IUGR)** is primarily defined by estimated fetal weight falling below the **10th percentile** for gestational age, not solely by biparietal diameter (BPD). - While BPD is one of several biometric measurements used to estimate fetal weight, it alone is insufficient to diagnose or define IUGR. Other factors like umbilical artery **Doppler studies** and maternal-fetal risk factors are also considered. *There is danger of fetal asphyxia during delivery* - Fetuses with IUGR are at increased risk of **fetal compromise** due to altered placental function and reduced reserve, making them more susceptible to **asphyxia** during the stress of labor. - This increased risk often necessitates careful monitoring during labor and sometimes leads to earlier intervention such as **cesarean section**. *Generally not seen in women with gestational diabetes* - This statement is correct. While gestational diabetes can lead to various complications, the primary fetal concern is **macrosomia** (large-for-gestational-age infants), rather than IUGR. - IUGR is more commonly associated with conditions causing **placental insufficiency**, while maternal hyperglycemia in gestational diabetes tends to cause excessive fetal growth. *Doppler studies are indicated* - **Doppler velocimetry** of the umbilical artery and other fetal vessels is crucial for monitoring fetuses with IUGR. - These studies assess **placental function** and fetal hemodynamics, helping to determine the severity of IUGR and guide the timing of delivery.
Question 56: Which of the following is an absolute contraindication for use of oral contraceptive pills?
- A. Epilepsy
- B. Focal Migraine (Correct Answer)
- C. Bronchial Asthma
- D. Smoking
Explanation: ***Focal Migraine*** - A **focal migraine**, especially with aura, significantly increases the risk of **ischemic stroke** in women using combined oral contraceptives. - Due to the heightened risk of **thrombosis** associated with oral contraceptives, a history of focal migraine is considered an **absolute contraindication** (WHO MEC Category 4). *Epilepsy* - Epilepsy is generally not an absolute contraindication for oral contraceptive pills, though some **antiepileptic drugs** can reduce contraceptive efficacy due to **enzyme induction**. - Adjustments in contraceptive methods may be needed, but the condition itself does not make OCPs absolutely unsafe. *Bronchial Asthma* - Bronchial asthma is **not a contraindication** to the use of oral contraceptive pills. - There is no known interaction or increased risk of adverse events between OCPs and asthma. *Smoking* - **Smoking** in women **aged ≥35 years who smoke ≥15 cigarettes/day** is an **absolute contraindication** (WHO MEC Category 4) due to significantly increased risk of **cardiovascular events** including myocardial infarction and stroke. - In younger women or lighter smokers, it represents a **relative contraindication** (WHO MEC Category 2-3). - In the context of this question, **focal migraine** is the correct answer as it is an absolute contraindication regardless of age or severity, whereas smoking becomes absolute only in specific circumstances.
Question 57: Which one of the following clinical situations is NOT ideal to perform female sterilization procedure?
- A. Postmenstrual period
- B. Concurrent with MTP
- C. 7 days postpartum
- D. During active pelvic inflammatory disease (Correct Answer)
Explanation: ***During active pelvic inflammatory disease*** - **Active infection** increases surgical risks, complications, and may worsen the existing **pelvic inflammatory disease**. - Standard medical practice requires **treating the infection first** before performing elective procedures like sterilization. *Postmenstrual period* - This is an **ideal time** for sterilization as the uterus is **atrophic** and there is high certainty that the woman is not pregnant. - The **risk of pregnancy** is minimal, and the procedure can be performed with greater safety and efficacy. *Concurrent with MTP* - Performing sterilization concurrently with **medical termination of pregnancy (MTP)** is **standard practice** and often advisable. - This approach ensures the woman is not pregnant and provides convenient **permanent contraception** without requiring an additional surgical procedure. *7 days postpartum* - The **immediate postpartum period** is an excellent time for female sterilization due to the enlarged uterus being easily palpated and **fallopian tubes** being readily accessible. - The woman is usually secure in her decision, and this timing allows for **one hospital stay** for both delivery and sterilization.
Question 58: Cardiac diseases in pregnancy which have major risk of maternal mortality are: 1. Pulmonary hypertension 2. Aortic coarctation with valvular involvement 3. Atrial septal defect 4. Mitral stenosis Select the correct answer using the code given below:
- A. 1 and 4
- B. 2 and 3
- C. 1 and 2 (Correct Answer)
- D. 3 and 4
Explanation: ***1 and 2*** - **Pulmonary hypertension** is classified as WHO Class IV (highest risk) with maternal mortality rates of 30-50%. It represents a contraindication to pregnancy due to the inability to accommodate increased cardiac output and hemodynamic changes. - **Aortic coarctation with valvular involvement** is also high-risk (WHO Class III-IV) due to increased risk of aortic dissection, rupture, heart failure, and stroke from the hemodynamic stress of pregnancy, particularly when complicated by valvular disease. - This combination represents the two conditions with the **highest and most consistently documented maternal mortality risk**. *1 and 4* - **Pulmonary hypertension** carries extremely high risk as noted above. - **Mitral stenosis** risk is severity-dependent: severe MS (valve area <1.0 cm²) is WHO Class III-IV with significant mortality risk (5-15%), while mild-moderate MS is lower risk with proper management. - While this combination includes high-risk conditions, **aortic coarctation with valvular involvement** (option 2) generally carries higher and more consistent risk than mitral stenosis, particularly compared to non-severe MS cases. *2 and 3* - **Aortic coarctation with valvular involvement** is high-risk as described above. - **Atrial septal defect (ASD)** is typically WHO Class II (low risk) and well-tolerated during pregnancy unless complicated by Eisenmenger syndrome or pulmonary hypertension. - This pairing incorrectly combines a high-risk condition with a generally low-risk condition. *3 and 4* - **Atrial septal defect (ASD)** is generally low-risk (WHO Class II) in uncomplicated cases. - **Mitral stenosis** varies by severity, but even severe MS carries lower mortality risk than pulmonary hypertension or complicated aortic coarctation. - This option incorrectly identifies conditions that do not consistently represent the **major/highest** maternal mortality risk compared to pulmonary hypertension and aortic coarctation with valvular involvement.
Pharmacology
1 questionsThe amount of Ethinyl Estradiol in third generation combined oral contraceptive pills is:
UPSC-CMS 2018 - Pharmacology UPSC-CMS Practice Questions and MCQs
Question 51: The amount of Ethinyl Estradiol in third generation combined oral contraceptive pills is:
- A. 35–50 mcg
- B. 10–20 mcg
- C. 20–30 mcg
- D. 30–35 mcg (Correct Answer)
Explanation: ***30–35 mcg*** - **Third-generation combined oral contraceptive pills (COCs)** typically contain **30-35 mcg of Ethinyl Estradiol**. - Third generation is defined by the type of **progestin used** (desogestrel, gestodene, or norgestimate), not the estrogen dose. - This dosage provides effective contraception while minimizing estrogen-related side effects compared to first-generation pills. - Common formulations include **30 mcg or 35 mcg** of ethinyl estradiol. *20–30 mcg* - While some third-generation formulations may contain doses at the lower end (20 mcg), this range overlaps with **ultra-low dose formulations**. - The typical and most common dosage for third-generation COCs is **30-35 mcg**, not this lower range. *10–20 mcg* - This represents **ultra-low dose COCs**, which aim to further reduce estrogen exposure. - These formulations may be associated with **breakthrough bleeding** and reduced cycle control. - Not the standard dose for third-generation COCs. *35–50 mcg* - These higher doses are characteristic of **first-generation COCs** from the 1960s-1970s. - Associated with higher rates of **thromboembolic events** and estrogen-related side effects. - Modern COCs use lower doses for improved safety profiles.