UPSC-CMS 2019 Practice Questions

Q: Consider the following statements regarding infertility: 1. Endometrial biopsy provides information regarding ovulatory factor 2. Both tubal and peritoneal factors can be assessed at laparoscopy 3. Unexplained infertility may be due to luteal phase defect Which of the statements given above is/are correct?

1, 2 and 3. ***Correct: 1, 2 and 3*** - **Statement 1** - **Endometrial biopsy** was historically used to assess the histological changes in the endometrium that correlate with the hormonal environment (progesterone effect), indirectly confirming **ovulation** and luteal phase adequacy. *Note: Current guidelines (ASRM) no longer recommend routine endometrial biopsy for infertility evaluation, as serum progesterone and ultrasound monitoring are preferred.* - **Statement 2** - **Laparoscopy with chromopertubation** is the gold standard for direct visualization of the fallopian tubes (assessing patency, hydrosalpinx, adhesions) and peritoneal factors such as **endometriosis**, pelvic adhesions, or sequelae of pelvic inflammatory disease. This statement is definitively correct. - **Statement 3** - **Unexplained infertility** may be attributed to subtle factors including **luteal phase defect** (LPD). *Note: The concept of LPD is controversial in modern reproductive medicine, with current evidence not strongly supporting it as a distinct diagnosis. Unexplained infertility is more commonly attributed to subtle sperm dysfunction, oocyte quality issues, or immunological factors.* *Incorrect: 1 and 3 only* - This option incorrectly excludes statement 2, which is clearly correct. **Laparoscopy** is a fundamental diagnostic tool for evaluating both tubal patency and peritoneal factors in the infertility workup. *Incorrect: 2 and 3 only* - This option incorrectly excludes statement 1. While endometrial biopsy is not routinely recommended in current practice, it was a recognized method for assessing ovulatory function and luteal phase adequacy at the time of this examination (2019). *Incorrect: 1 and 2 only* - This option incorrectly excludes statement 3. In the context of this 2019 examination, luteal phase defect was considered a potential cause of unexplained infertility, even though this concept is now controversial in modern reproductive medicine.

Q: Which one of the following about primary dysmenorrhea is NOT true?

Pain increases following pregnancy and delivery. ***Pain increases following pregnancy and delivery*** - It is a common clinical observation that primary dysmenorrhea often **improves or resolves** after pregnancy and childbirth, likely due to cervical dilatation, changes in uterine structure, or altered innervation. - Therefore, the statement that pain *increases* following pregnancy and delivery is **NOT true** and is the correct answer. *Most commonly seen in adolescents and young women* - This statement is **TRUE**. Primary dysmenorrhea typically begins within **6-12 months** after menarche once ovulatory cycles are established. - It is **most prevalent in adolescents and women in their 20s**, though it can persist into later reproductive years. - Incidence decreases with age and often improves after childbirth. *Pain is related to uterine hypoxia* - This statement is **TRUE**. The pain in primary dysmenorrhea is primarily caused by **excessive prostaglandin F2α production** during endometrial breakdown. - Prostaglandins cause **intense uterine contractions** leading to **ischemia** and reduced blood flow (hypoxia) to the myometrium. - This **uterine hypoxia** and ischemia are significant contributors to the painful cramps experienced. *Always confined to ovulatory cycles* - This statement is **TRUE**. Primary dysmenorrhea is intrinsically linked to **ovulatory menstrual cycles**. - It involves prostaglandin production in response to progesterone withdrawal and endometrial breakdown, which **only occurs in ovulatory cycles**. - Anovulatory cycles (common immediately after menarche) are typically **painless**.

Q: Consider the following statements regarding diameters of a normal female pelvis: 1. AP diameter is the shortest diameter at brim 2. Oblique diameter is the largest diameter of inlet 3. Diagonal conjugate cannot be directly measured Which of the statements given above is/are correct?

1 only. ***1 only*** - The **anteroposterior (AP) diameter** (true conjugate/obstetric conjugate) is indeed the **shortest diameter at the brim** of the normal female pelvis, measuring approximately **11 cm**. - At the pelvic inlet, the **transverse diameter is the longest (13 cm)**, followed by the **oblique diameter (12 cm)**, and the **AP diameter is the shortest (11 cm)**. - This is the correct answer as only Statement 1 is accurate. *1 and 2 only* - While Statement 1 is correct, Statement 2 is **incorrect**. - The **oblique diameter (12 cm)** is NOT the largest diameter of the inlet. The **transverse diameter (13-13.5 cm)** is the largest diameter at the pelvic inlet. - This is a common misconception that must be clarified. *2 only* - Statement 2 is **incorrect**. The **transverse diameter**, not the oblique diameter, is the largest diameter of the pelvic inlet. - In a normal gynecoid pelvis: Transverse (13 cm) > Oblique (12 cm) > AP diameter (11 cm). *1, 2 and 3* - Statement 1 is correct, but Statements 2 and 3 are **incorrect**. - Statement 2: The oblique diameter is not the largest; the **transverse diameter** is. - Statement 3: The **diagonal conjugate CAN be measured clinically** during vaginal examination (from lower border of symphysis pubis to sacral promontory) and typically measures 12.5 cm.

Q: Consider the following statements regarding Carcinoma Cervix: 1. Clinical staging is done 2. Treatment if provided in stage I leads to survival rate of 80–90 % 3. Surgery is preferred in young women with stage III disease 4. HPV is considered to be the causative agent Which of the statements given above are correct?

1, 2 and 4 only. ***1, 2 and 4 only*** - **Clinical staging** is the primary method for staging cervical cancer using the FIGO system, as opposed to surgical staging used for other gynecological cancers. - Early detection and treatment in **Stage I** cervical cancer offer excellent prognoses, with survival rates often reported between **80-90%**. - **Human Papillomavirus (HPV)** is the established causative agent for nearly all cases of cervical cancer, particularly high-risk subtypes like HPV-16 and HPV-18. *1, 2, 3 and 4* - This option is incorrect because it includes statement 3, which is false. - **Stage III** cervical cancer represents locally advanced disease with parametrial involvement or pelvic wall extension, making it unsuitable for primary surgical management. - Stage III disease is managed with **concurrent chemoradiation** (cisplatin-based chemotherapy with external beam radiation and brachytherapy), not surgery, regardless of patient age. *3 and 4 only* - This option is incorrect as it includes the false statement 3 about surgery in Stage III disease. - It also omits the correct statements regarding **clinical staging** (statement 1) and the excellent **survival rates** in Stage I (statement 2). *1 and 2 only* - This option is incomplete as it correctly identifies that **clinical staging** is used and that **Stage I treatment offers good survival**. - However, it fails to include statement 4, which correctly identifies **HPV as the causative agent** of cervical cancer—a fundamental fact in cervical cancer etiology.

Q: Which one of the following is NOT a mandatory procedure for FIGO staging of Carcinoma cervix?

Ultrasound abdomen. ***Ultrasound abdomen*** - **Ultrasound abdomen** is **not a mandatory procedure** for the standard FIGO staging of cervical carcinoma. - FIGO staging is primarily a **clinical staging system** based on physical examination, inspection, palpation, and biopsy. - While imaging studies (CT, MRI, ultrasound) are valuable for **treatment planning**, they are not part of the official FIGO staging criteria. - Optional procedures allowed include cystoscopy, proctoscopy, and IVP, but not routine abdominal ultrasound. *Biopsy* - A **tissue biopsy** with histological confirmation is **mandatory** for the diagnosis and staging of cervical carcinoma. - It establishes the presence of malignancy and determines the histological type (squamous cell carcinoma, adenocarcinoma, etc.). - Without biopsy confirmation, no staging can be performed. *Pelvic examination* - A thorough **pelvic examination** (including inspection, palpation, and speculum examination) is **mandatory** and forms the cornerstone of FIGO staging. - Clinical assessment determines tumor size, vaginal involvement, parametrial extension, and pelvic wall involvement. - FIGO staging is primarily a **clinical staging system**, making pelvic examination essential. *Endocervical curettage* - **Endocervical curettage (ECC)** is **not mandatory** for FIGO staging of invasive cervical carcinoma. - ECC is primarily used in the evaluation of **cervical dysplasia/CIN** to rule out occult endocervical involvement. - Once invasive carcinoma is confirmed by biopsy, ECC does not contribute to staging and is not part of standard FIGO protocols. - However, it may be performed in specific clinical scenarios at the physician's discretion, but it remains optional.

Q: Consider the following statements regarding Uterine Leiomyoma: 1. Prevalence is highest between 35 and 45 years 2. More common in nulliparous women 3. Display reversible shrinkage after treatment with GnRH 4. Requires to be treated only if symptomatic Which of the statements given above are correct?

1, 2, 3 and 4. ***1, 2, 3 and 4*** - **Statement 1 is correct**: The prevalence of uterine leiomyomas is highest between **35 and 45 years of age**, as these are estrogen-dependent tumors that grow during reproductive years and peak in the 4th-5th decades. - **Statement 2 is correct**: Leiomyomas are **more common in nulliparous women**. Nulliparity is a well-established risk factor for fibroids. Each full-term pregnancy is associated with a reduced risk of developing fibroids, likely due to hormonal changes and uterine remodeling during pregnancy. - **Statement 3 is correct**: GnRH agonists cause **reversible shrinkage** of leiomyomas (typically 30-60% volume reduction). The term "reversible" accurately describes that fibroids regrow after treatment cessation. This makes GnRH agonists useful for preoperative shrinkage or temporary symptom relief, but not a permanent solution. - **Statement 4 is correct**: Leiomyomas **require treatment only if symptomatic**. Asymptomatic fibroids are managed with observation. Treatment is indicated for symptoms like menorrhagia, pelvic pain, pressure symptoms, or reproductive issues. *1 and 4 only* - Incorrect because statements 2 and 3 are also correct. *2 and 3 only* - Incorrect because statements 1 and 4 are also correct. *1, 2 and 3 only* - Incorrect because statement 4 is also correct.

Q: A 58 year old woman with suspected ovarian cancer was operated for surgical staging. On laparotomy and subsequent histopathological examination of the specimen it was found that both ovaries were involved, capsule was ruptured, ascites was present containing malignant cells. Uterus and tubes were normal and there were no peritoneal implants. The FIGO stage for this patient would be:

Stage I. ***Stage I*** - This case represents **Stage IC** (specifically IC3) according to FIGO ovarian cancer staging criteria. - **Stage IC3** is defined as ovarian tumor with **capsule rupture and/or positive peritoneal washings/ascites with malignant cells**. - Key features present: both ovaries involved, **capsule ruptured**, **ascites with malignant cells**, but **no peritoneal implants**. - The absence of peritoneal implants outside the pelvis means this cannot be Stage III, making Stage IC the correct classification. *Stage II* - Stage II requires **pelvic extension** with involvement of uterus, fallopian tubes, or other pelvic structures. - In this case, the uterus and tubes are explicitly **normal**, ruling out Stage II. - Stage II does not involve malignant ascites as the primary criterion. *Stage III* - Stage III requires **peritoneal implants outside the pelvis** and/or **retroperitoneal/inguinal lymph node involvement**. - This case explicitly states there are **no peritoneal implants**, which excludes Stage III classification. - Common misconception: malignant ascites alone does NOT constitute Stage III; visible implants or lymph node involvement are required. *Stage IV* - Stage IV involves **distant metastasis** to organs such as liver parenchyma, lungs, or extra-abdominal sites, or **pleural effusion with malignant cells**. - No evidence of distant organ involvement is present in this case. - This is clearly not Stage IV disease.

Q: Which one of the following is the serum marker in epithelial ovarian cancer?

CA–125. ***CA–125*** - **CA-125** (**Cancer Antigen 125**) is the most widely used serum tumor marker for **epithelial ovarian cancer**. - Its levels are often **elevated** in women with epithelial ovarian cancer, particularly in advanced stages, and it is used for **monitoring treatment response** and **detecting recurrence**. *HCG* - **Human Chorionic Gonadotropin (HCG)** is primarily associated with **pregnancy** and **gestational trophoblastic disease**. - It may also be elevated in some **germ cell tumors**, but not typically in epithelial ovarian cancer. *CEA* - **Carcinoembryonic Antigen (CEA)** is a tumor marker commonly associated with **colorectal cancer**. - While it can be elevated in other adenocarcinomas, it is **not the primary marker** for epithelial ovarian cancer. *AFP* - **Alpha-fetoprotein (AFP)** is a marker primarily associated with **hepatocellular carcinoma** and **germ cell tumors**, particularly **yolk sac tumors**. - It is not a significant marker for common **epithelial ovarian cancers**.

Q: Which of the following is NOT an ideally suited condition for use of ring pessary in case of uterine prolapse?

Late pregnancy. ***Late pregnancy*** - A ring pessary is generally **contraindicated** in late pregnancy due to the risk of inducing uterine contractions, premature rupture of membranes, or infection, and it is not an appropriate long-term solution for prolapse during this period. - The gravid uterus itself acts as a natural support for prolapsed organs, making a pessary less necessary and potentially harmful. *Puerperium* - The **puerperium** can be an ideal time for pessary use, especially if prolapse is noted shortly after delivery. - Tissues are still lax and remodeling, and a pessary can help support the uterus and vagina during this healing phase, potentially preventing more severe prolapse later on. *Patient's unwillingness for surgery* - For patients who **decline surgical intervention**, a ring pessary offers a non-surgical management option for uterine prolapse, providing relief from symptoms. - It allows patients to manage their condition conservatively and is a practical choice given their personal preference. *Patient unfit for surgery* - In cases where a patient has significant comorbidities that make them **unsuitable for surgery** (e.g., severe cardiac disease, advanced age), a ring pessary is a safe and effective alternative. - It provides symptomatic relief without the risks associated with general anesthesia and surgical recovery.

Q: Which of the following are the vaccines for prevention of cervical cancer? 1. Cervarix 2. Gardasil 3. T-dap 4. Influenza Select the correct answer using the code given below:

1 and 2. ***Option A: 1 and 2 (Cervarix and Gardasil)*** - Both are **HPV vaccines** that prevent cervical cancer by targeting oncogenic human papillomavirus types - **Cervarix**: Bivalent vaccine protecting against HPV-16 and HPV-18 (responsible for ~70% of cervical cancers) - **Gardasil**: Quadrivalent vaccine (Gardasil-4) protecting against HPV-6, 11, 16, and 18; Nonavalent version (Gardasil-9) covers additional high-risk HPV types (31, 33, 45, 52, 58) - **Clinical significance**: Persistent HPV infection is the primary cause of cervical cancer; vaccination is primary prevention *Option B: 1 and 3* - While Cervarix is correct, **T-dap vaccine** (tetanus, diphtheria, acellular pertussis) is a bacterial vaccine with no role in cervical cancer prevention - T-dap targets entirely different pathogens and has no effect on HPV infection *Option C: 2 and 3* - Gardasil is correct for cervical cancer prevention, but **T-dap** is unrelated to HPV or cervical cancer - Mixing a correct HPV vaccine with an unrelated bacterial vaccine makes this option incorrect *Option D: 2 and 4* - Gardasil is correct, but **influenza vaccine** targets influenza virus to prevent seasonal flu, not HPV-related malignancies - Influenza vaccine has no protective effect against cervical cancer

Question 1

Consider the following statements regarding infertility:

1. Endometrial biopsy provides information regarding ovulatory factor
2. Both tubal and peritoneal factors can be assessed at laparoscopy
3. Unexplained infertility may be due to luteal phase defect Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Question 2

Which one of the following about primary dysmenorrhea is NOT true?

Accepted Answer

Pain increases following pregnancy and delivery

Answer

Most commonly seen in adolescents and young women

Answer

Pain is related to uterine hypoxia

Answer

Always confined to ovulatory cycles

Question 3

Consider the following statements regarding diameters of a normal female pelvis:

1. AP diameter is the shortest diameter at brim
2. Oblique diameter is the largest diameter of inlet
3. Diagonal conjugate cannot be directly measured Which of the statements given above is/are correct?

Accepted Answer

1 only

Answer

1 and 2 only

Answer

1, 2 and 3

Answer

2 only

Question 4

Consider the following statements regarding Carcinoma Cervix:

1. Clinical staging is done
2. Treatment if provided in stage I leads to survival rate of 80–90 %
3. Surgery is preferred in young women with stage III disease
4. HPV is considered to be the causative agent Which of the statements given above are correct?

Accepted Answer

1, 2 and 4 only

Answer

1, 2, 3 and 4

Answer

3 and 4 only

Answer

1 and 2 only

Question 5

Which one of the following is NOT a mandatory procedure for FIGO staging of Carcinoma cervix?

Accepted Answer

Ultrasound abdomen

Answer

Biopsy

Answer

Pelvic examination

Answer

Endocervical curettage

Question 6

Consider the following statements regarding Uterine Leiomyoma:

1. Prevalence is highest between 35 and 45 years
2. More common in nulliparous women
3. Display reversible shrinkage after treatment with GnRH
4. Requires to be treated only if symptomatic
Which of the statements given above are correct?

Accepted Answer

1, 2, 3 and 4

Answer

2 and 3 only

Answer

1 and 4 only

Answer

1, 2 and 3 only

Question 7

A 58 year old woman with suspected ovarian cancer was operated for surgical staging. On laparotomy and subsequent histopathological examination of the specimen it was found that both ovaries were involved, capsule was ruptured, ascites was present containing malignant cells. Uterus and tubes were normal and there were no peritoneal implants. The FIGO stage for this patient would be:

Accepted Answer

Stage I

Answer

Stage III

Answer

Stage II

Answer

Stage IV

Question 8

Which one of the following is the serum marker in epithelial ovarian cancer?

Accepted Answer

CA–125

Answer

HCG

Answer

CEA

Answer

AFP

Question 9

Which of the following is NOT an ideally suited condition for use of ring pessary in case of uterine prolapse?

Accepted Answer

Late pregnancy

Answer

Puerperium

Answer

Patient's unwillingness for surgery

Answer

Patient unfit for surgery

Question 10

Which of the following are the vaccines for prevention of cervical cancer?

1. Cervarix
2. Gardasil
3. T-dap
4. Influenza

Select the correct answer using the code given below:

Accepted Answer

1 and 2

Answer

1 and 3

Answer

2 and 3

Answer

2 and 4

UPSC-CMS 2019

Obstetrics and Gynecology

Pharmacology