Anatomy
2 questionsThe blood supply of uterus is from: 1. Uterine artery 2. Ovarian artery 3. Pudendal artery 4. Superior vesical artery Select the correct answer using the code given below:
Which one of the following statements regarding anatomy of fetal head is NOT true?
UPSC-CMS 2018 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 61: The blood supply of uterus is from: 1. Uterine artery 2. Ovarian artery 3. Pudendal artery 4. Superior vesical artery Select the correct answer using the code given below:
- A. 1 and 2 (Correct Answer)
- B. 1 and 3
- C. 2 and 4
- D. 3 and 4
Explanation: Option A: 1 and 2 - The uterine artery, a branch of the internal iliac artery, is the primary blood supply to the uterus [1]. - The ovarian artery, a direct branch from the abdominal aorta, also contributes to uterine blood supply by anastomosing with the uterine artery [1]. Option B: 1 and 3 - While the uterine artery is a primary source, the pudendal artery supplies the external genitalia and perineum, not the uterus directly. - The pudendal artery's territory is distinct from the uterine circulation. Option C: 2 and 4 - The ovarian artery does supply the uterus [1], but the superior vesical artery primarily supplies the superior portion of the urinary bladder. - The superior vesical artery does not significantly contribute to uterine vascularization. Option D: 3 and 4 - Neither the pudendal artery nor the superior vesical artery are direct or significant suppliers of blood to the uterus. - Their primary supply territories are the perineum/external genitalia and the bladder, respectively.
Question 62: Which one of the following statements regarding anatomy of fetal head is NOT true?
- A. Frontal suture separates the two frontal bones
- B. Bregma is a diamond shaped space at junction of coronal and sagittal sutures
- C. Coronal suture separates frontal bones from parietal bones
- D. Lambdoid suture separates the two parietal bones (Correct Answer)
Explanation: The lambdoid suture separates the two parietal bones - This statement is **incorrect**. The **sagittal suture** separates the two parietal bones [1]. - The **lambdoid suture** separates the parietal bones from the occipital bone [1]. *Frontal suture separates the two frontal bones* - This statement is **true**. The frontal suture (also called the metopic suture) divides the two halves of the **frontal bone** in the fetal skull [1]. - While it usually fuses after birth, it is prominent in the fetal head. *Bregma is a diamond shaped space at junction of coronal and sagittal sutures* - This statement is **true**. The **bregma** is the anterior fontanelle, a significant landmark in the fetal skull, formed by the junction of the coronal and sagittal sutures. - Its diamond shape and location are crucial for assessing fetal head position and molding during labor [2]. *Coronal suture separates frontal bones from parietal bones* - This statement is **true**. The **coronal suture** runs bilaterally across the top of the skull, separating the **frontal bone** anteriorly from the two **parietal bones** posteriorly [1]. - This anatomical arrangement allows for molding of the fetal head during passage through the birth canal [1].
Obstetrics and Gynecology
7 questionsPregnancy can be terminated at any gestation if the fetus is diagnosed to have:
Which one of the following is NOT a cause of recurrent spontaneous abortion?
For vaginal breech delivery, ideal selection criteria would include: 1. Fetus not compromised 2. Adequate pelvis 3. Flexed breech presentation 4. Estimated fetal weight < 3.5 kg Select the correct answer using the code given below:
Consider the following presentations: 1. Brow presentation 2. Left mento anterior position 3. Occipito posterior position 4. Breech presentation In which of the above Vaginal delivery is NOT possible?
Which one of the following regarding amniotic fluid is true?
Consider the following statements regarding changes in pregnancy: 1. Plasma volume increases up to 30–50% 2. Pregnancy is a hypercoagulable state 3. Hematocrit is decreased 4. Total plasma protein concentration increases Which of the statements given above is/are correct?
A 30 year old lady, mother of 3 children presents with mass descending per vaginum. On examination it is found to have stage 3 prolapse, moderate cystocele, no posterior vaginal wall prolapse. The recommended surgery would be:
UPSC-CMS 2018 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 61: Pregnancy can be terminated at any gestation if the fetus is diagnosed to have:
- A. Anencephaly (Correct Answer)
- B. Duodenal atresia
- C. Bilateral talipes
- D. Hydrocephalus
Explanation: ***Anencephaly*** - Anencephaly is a **lethal congenital anomaly** where the brain and skull do not develop properly. - Due to the **incompatible-with-life prognosis**, termination of pregnancy at any gestation is medically justified and often offered. *Duodenal atresia* - **Duodenal atresia** is a treatable condition where the duodenum is blocked. - It is **surgically correctable** after birth and does not warrant termination of pregnancy at any stage. *Bilateral talipes* - **Bilateral talipes** (clubfoot) is a common musculoskeletal birth defect that can be corrected with conservative management (e.g., Ponseti method) or surgery. - It is **not life-threatening** and does not justify termination of pregnancy. *Hydrocephalus* - While hydrocephalus can be severe, its prognosis is variable and often depends on the underlying cause and severity. - Many cases of **hydrocephalus are manageable** with shunting procedures, and it is not universally considered a condition that warrants termination at any gestation.
Question 62: Which one of the following is NOT a cause of recurrent spontaneous abortion?
- A. Antiphospholipid syndrome
- B. Inherited thrombophilia
- C. Rubella infection (Correct Answer)
- D. Chromosomal abnormality
Explanation: ***Rubella infection*** - While rubella infection during pregnancy can lead to serious **congenital anomalies** (congenital rubella syndrome) and fetal death, it is **NOT a typical cause of recurrent spontaneous abortions** - Rubella primarily causes **single pregnancy loss** or teratogenic effects in ongoing pregnancies, rather than the pattern of repeated losses seen in recurrent abortion - The infection does not create the persistent maternal factors (immunological, thrombophilic, or anatomical) that characterize causes of recurrent pregnancy loss *Antiphospholipid syndrome* - This autoimmune disorder is a **well-established cause of recurrent pregnancy loss** (accounts for 10-15% of cases) - Antiphospholipid antibodies cause **thrombosis in placental vasculature**, leading to placental insufficiency and infarction - Results in repeated pregnancy losses, typically in the second trimester *Inherited thrombophilia* - Conditions like **Factor V Leiden mutation** and **prothrombin gene mutation** increase thrombotic risk - Cause **placental microthrombi** that compromise fetal blood supply - Recognized as a cause of recurrent spontaneous abortion, though the association is stronger for late pregnancy loss *Chromosomal abnormality* - **Parental balanced translocations** are an important cause of recurrent spontaneous abortion (3-5% of couples) - While random fetal aneuploidy is the most common cause of sporadic abortion, parental chromosomal rearrangements lead to **recurrent unbalanced offspring** and repeated losses - Karyotyping of both partners is recommended after recurrent pregnancy loss
Question 63: For vaginal breech delivery, ideal selection criteria would include: 1. Fetus not compromised 2. Adequate pelvis 3. Flexed breech presentation 4. Estimated fetal weight < 3.5 kg Select the correct answer using the code given below:
- A. 2 and 4 only
- B. 1, 3 and 4 only
- C. 1, 2, 3 and 4 (Correct Answer)
- D. 1, 2 and 3 only
Explanation: ***1, 2, 3 and 4*** - All listed criteria (fetus not compromised, adequate pelvis, **flexed breech presentation**, and estimated fetal weight < 3.5 kg) are considered **ideal selection criteria** for a safe vaginal breech delivery. - **Flexed (frank) breech** with hips flexed and knees extended is the **most favorable type** for vaginal delivery, as it presents the smallest diameter and has the lowest risk of cord prolapse. - While many institutions now favor elective cesarean section for breech presentations, these criteria represent conditions under which a **vaginal delivery can be safely attempted** with minimal risk. *2 and 4 only* - This option is incomplete as it correctly identifies adequate pelvis and estimated fetal weight < 3.5 kg but omits other crucial factors like **fetal well-being** and the **type of breech presentation**. - A successful vaginal breech delivery also requires the fetus to be **uncompromised** and ideally in a **flexed (frank) breech** presentation. *1, 3 and 4 only* - This option overlooks the critical importance of an **adequate maternal pelvis**, which is fundamental for allowing the passage of the fetus during vaginal delivery regardless of fetal presentation. - While fetal status, presentation, and weight are important, a **contracted or inadequate pelvis** would contraindicate vaginal delivery. *1, 2 and 3 only* - This option excludes the **estimated fetal weight** being less than 3.5 kg, which is a significant factor in assessing the feasibility of vaginal breech delivery. - Larger fetuses (typically >3.5-4 kg) have a **higher risk of birth trauma** and **head entrapment** during vaginal breech delivery, even with an adequate pelvis and favorable presentation.
Question 64: Consider the following presentations: 1. Brow presentation 2. Left mento anterior position 3. Occipito posterior position 4. Breech presentation In which of the above Vaginal delivery is NOT possible?
- A. 1, 2 and 3
- B. 4 only
- C. 1 only (Correct Answer)
- D. 1 and 3 only
Explanation: ***1 only*** - A **brow presentation** presents the fetal head at an unfavorable diameter (**mentovertical diameter**), making vaginal delivery impossible due to **mechanical obstruction**. - With the brow presenting, the head cannot adequately mold or engage in the maternal pelvis, necessitating a **cesarean section** for safe delivery. *1, 2 and 3* - While **brow presentation** (1) is not amenable to vaginal delivery, **left mento anterior position** (2) generally allows for successful vaginal delivery. - **Occipito posterior position** (3) can often be delivered vaginally, sometimes requiring rotation, making this option incorrect. *4 only* - **Breech presentation** (4) can sometimes be delivered vaginally, although it carries higher risks and often warrants a **cesarean section**, but it is not universally impossible. - This option incorrectly suggests that only breech presentation is impossible for vaginal delivery, while brow presentation is a definitive contraindication. *1 and 3 only* - **Brow presentation** (1) is indeed a contraindication for vaginal delivery. - However, **occipito posterior position** (3) does not inherently preclude vaginal delivery, as many cases can be delivered vaginally, making this option incorrect.
Question 65: Which one of the following regarding amniotic fluid is true?
- A. It is decreased in gestational diabetes
- B. The volume is highest at 28 weeks
- C. It reveals information about fetal lung maturity and wellbeing (Correct Answer)
- D. It is decreased in duodenal atresia in baby
Explanation: **_It reveals information about fetal lung maturity and wellbeing_** - Amniotic fluid analysis, specifically looking at the **lecithin-to-sphingomyelin (L/S) ratio** and the presence of **phosphatidylglycerol**, helps assess fetal lung maturity. - It also provides genetic information through **amniocentesis**, which can indicate fetal wellbeing by detecting chromosomal abnormalities or infections. *It is decreased in gestational diabetes* - **Gestational diabetes** is typically associated with **polyhydramnios** (excessive amniotic fluid volume) due to fetal hyperglycemia leading to increased fetal urination. - Oligohydramnios (decreased amniotic fluid) can occur in cases of uncontrolled diabetes with associated fetal renal anomalies or placental insufficiency, but it is not the primary association with gestational diabetes. *The volume is highest at 28 weeks* - The **amniotic fluid volume** typically peaks around **32-34 weeks of gestation**, not 28 weeks. - After this peak, the volume gradually decreases until term due to changes in production and reabsorption. *It is decreased in duodenal atresia in baby* - **Duodenal atresia** and other high gastrointestinal obstructions prevent the fetus from swallowing and absorbing amniotic fluid, leading to an **increase in amniotic fluid volume (polyhydramnios)**. - Oligohydramnios is more commonly associated with conditions like renal agenesis or chronic uteroplacental insufficiency.
Question 66: Consider the following statements regarding changes in pregnancy: 1. Plasma volume increases up to 30–50% 2. Pregnancy is a hypercoagulable state 3. Hematocrit is decreased 4. Total plasma protein concentration increases Which of the statements given above is/are correct?
- A. 1 and 2 only
- B. 1 only
- C. 1, 2, 3 and 4
- D. 3 and 4 only
- E. 1, 2 and 3 only (Correct Answer)
Explanation: ***1, 2 and 3 only*** - **Statement 1 is correct**: Plasma volume increases significantly by **30-50%** during pregnancy, representing a key physiological adaptation. - **Statement 2 is correct**: Pregnancy is inherently a **hypercoagulable state** due to increased clotting factors (I, VII, VIII, IX, X, fibrinogen), decreased protein S, and reduced fibrinolysis—an adaptive mechanism to prevent excessive bleeding during delivery. - **Statement 3 is correct**: Hematocrit **decreases** due to physiological hemodilution; plasma volume increases proportionally more (40-50%) than red blood cell mass (20-30%), resulting in physiological anemia of pregnancy. - **Statement 4 is incorrect**: Total plasma protein concentration actually **decreases** during pregnancy (not increases) due to the hemodilution effect; albumin typically decreases from ~4.0 to ~3.0 g/dL. *1 and 2 only* - While statements 1 and 2 are correct, this option incorrectly excludes **statement 3 (decreased hematocrit)**, which is a well-established physiological change during pregnancy caused by hemodilution. *1 only* - Statement 1 is correct, but this option excludes both the **hypercoagulable state (statement 2)** and **decreased hematocrit (statement 3)**, which are both fundamental pregnancy-related changes. *1, 2, 3 and 4* - Statements 1, 2, and 3 are all correct. However, **statement 4 is incorrect** because total plasma protein concentration **decreases** (not increases) during pregnancy due to the disproportionate increase in plasma volume compared to protein synthesis. *3 and 4 only* - Statement 3 is correct, but **statement 4 is incorrect** (plasma protein concentration decreases, not increases). Additionally, this option incorrectly excludes statements 1 and 2, which are both correct and represent important physiological adaptations in pregnancy.
Question 67: A 30 year old lady, mother of 3 children presents with mass descending per vaginum. On examination it is found to have stage 3 prolapse, moderate cystocele, no posterior vaginal wall prolapse. The recommended surgery would be:
- A. Vaginal hysterectomy
- B. Rectocele repair
- C. Cystocele repair
- D. Manchester operation (Correct Answer)
Explanation: ***Manchester operation*** - This procedure (also called **Fothergill's operation**) involves **cervical amputation with cardinal ligament plication** and **anterior colporrhaphy** to address uterine prolapse with cervical elongation and cystocele. - The answer assumes **cervical elongation** is present in this stage 3 prolapse case, which is a common component of uterine descent, even when not explicitly stated. - Manchester operation is particularly suitable for **younger women desiring uterine preservation** (patient is 30 years old) who have completed their family but want to avoid hysterectomy. - It directly addresses both the **uterine prolapse** (via cervical amputation and ligament support) and the **moderate cystocele** (via anterior colporrhaphy). - The absence of posterior wall prolapse means no posterior repair is needed, making this a suitable choice. *Vaginal hysterectomy* - This is the **gold standard definitive treatment** for stage 3 uterine prolapse with cystocele in multiparous women when family is complete. - However, in a **30-year-old patient**, uterine preservation may be preferred for hormonal, sexual, or psychological reasons, even if fertility is not a concern. - While highly effective, Manchester operation offers an alternative that preserves the uterus with comparable anatomical outcomes for appropriately selected cases. *Rectocele repair* - This addresses **posterior vaginal wall prolapse** (descent of rectum), which is explicitly **absent** in this patient's examination. - Performing this procedure would be unnecessary given there is no posterior compartment defect. *Cystocele repair* - Anterior colporrhaphy alone only corrects the **bladder prolapse** and does not address the primary problem of **stage 3 uterine prolapse**. - The main complaint is a "mass descending per vaginum" due to **uterine descent**, which requires addressing the apical support defect. - This would be **inadequate as monotherapy** and would leave the uterine prolapse uncorrected.
Pediatrics
1 questionsThe congenital abnormality which is invariably lethal is:
UPSC-CMS 2018 - Pediatrics UPSC-CMS Practice Questions and MCQs
Question 61: The congenital abnormality which is invariably lethal is:
- A. Transposition of great vessels
- B. Anencephaly (Correct Answer)
- C. Cleft lip
- D. Down Syndrome
Explanation: ***Anencephaly*** - **Anencephaly** is a severe form of **neural tube defect** where the brain and skull do not develop properly, resulting in the absence of a major part of the brain and skull. - Infants born with anencephaly are either stillborn or die shortly after birth due to the lack of vital brain structures, making it an **invariably lethal** condition. *Transposition of great vessel* - **Transposition of the great arteries (TGA)** is a serious congenital heart defect where the two main arteries leaving the heart (aorta and pulmonary artery) are connected to the wrong ventricles. - While TGA is a life-threatening condition requiring immediate medical intervention, including surgery, it is **not invariably lethal** with modern treatment and advances in pediatric cardiology. *Cleft lip* - A **cleft lip** is a birth defect characterized by a split or opening in the upper lip, which may extend into the nose. - While it requires surgical correction and can cause feeding difficulties or speech problems if untreated, it is **not life-threatening** and has no direct impact on infant mortality. *Down Syndrome* - **Down syndrome** (Trisomy 21) is a chromosomal disorder characterized by intellectual disability, distinctive facial features, and often associated with other medical conditions like heart defects or gastrointestinal abnormalities. - Individuals with Down syndrome have a **reduced life expectancy** compared to the general population; however, advancements in medical care have significantly improved their lifespan, and it is **not an invariably lethal** condition.