Community Medicine
1 questionsGlobal hunger index combines four indicators EXCEPT:
UPSC-CMS 2019 - Community Medicine UPSC-CMS Practice Questions and MCQs
Question 71: Global hunger index combines four indicators EXCEPT:
- A. Child stunting
- B. Child mortality
- C. Undernourishment
- D. Child morbidity (Correct Answer)
Explanation: ***Child morbidity*** - **Child morbidity** is not used as an indicator in the Global Hunger Index. While related to health outcomes, the GHI focuses on specific measures of **undernutrition** and **child mortality**. - Morbidity refers to the prevalence of disease, which is a broader health measure and not specific to hunger assessment within the GHI framework. *Child stunting* - **Child stunting** is a key indicator in the GHI, measuring the proportion of children under the age of five who have low **height-for-age**. - This indicator reflects **chronic undernutrition** and its long-term impact on children's growth and development. - Stunting indicates inadequate nutrition over an extended period. *Child mortality* - **Child mortality** is included in the GHI and represents the mortality rate of children under the age of five. - This indicator reflects the fatal synergy between **inadequate nutrition** and unhealthy environments on young children. - It captures the ultimate consequence of food insecurity and undernutrition. *Undernourishment* - **Undernourishment** is one of the primary indicators in the GHI, measuring the proportion of the population whose **caloric intake is insufficient** to meet dietary energy requirements. - This indicator directly reflects the **food supply situation** and adequacy of dietary energy consumption at the population level.
Obstetrics and Gynecology
7 questionsA 22 year old woman comes with complaints of pain and discomfort in vaginal region. On examination there is unilateral tender swelling in the posterior half of labium majus, overlying skin is red and edematous. What is the most probable diagnosis?
A 29 year old woman is noted to have three consecutive first trimester spontaneous abortions. Examination reveals fibroid uterus. Which of the following types of uterine fibroids would most likely lead to recurrent abortions?
A 25 year old infertile woman is noted to have blocked fallopian tubes on Hysterosalpingography. Which of the following is the best next step for this woman?
The contraceptive choice for a 38 year old woman with chronic hypertension and history of dysmenorrhea and menorrhagia (malignancy ruled out) is:
Tubectomy is commonly performed at which site of fallopian tube?
A 60 year old woman presents with postmenopausal bleeding. On endometrial curettage she is diagnosed as endometrial carcinoma. Which one of the following is a risk factor for endometrial cancer?
A 29 year old woman presents in emergency ward with amenorrhea of 6 weeks and pain. Urine pregnancy test shows positive. Examination shows diffuse significant lower abdomen tenderness. The pelvic examination is difficult to accomplish due to guarding. Her Beta-hCG level is 4000 mIU/ml. Transvaginal ultrasound shows no pregnancy in the uterus and no adnexal mass but moderate fluid in abdomen. Which of the following is the next best step?
UPSC-CMS 2019 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 71: A 22 year old woman comes with complaints of pain and discomfort in vaginal region. On examination there is unilateral tender swelling in the posterior half of labium majus, overlying skin is red and edematous. What is the most probable diagnosis?
- A. Bartholin's abscess (Correct Answer)
- B. Trichomoniasis
- C. Utero vaginal prolapse
- D. Inversion of uterus
Explanation: ***Bartholin's abscess*** - The presentation of a **unilateral, tender swelling** in the **posterior half of the labium majus (not minus)**, with overlying **red and edematous skin**, is highly characteristic of a **Bartholin's abscess**. - This occurs when the **Bartholin's gland duct** becomes obstructed and infected, leading to pus accumulation and inflammation. *Trichomoniasis* - This is a **sexually transmitted infection** that causes **vaginitis**, characterized by a **frothy, foul-smelling discharge**, itching, and dysuria. - It does not present as a **localized, tender swelling** in the labia. *Utero vaginal prolapse* - This condition involves the **descent of the uterus and/or vagina** from their normal position, often causing a **feeling of pressure or a bulge** in the vagina. - It does not manifest as an acute, **unilateral, tender inflammatory swelling** of the labia. *Inversion of uterus* - **Uterine inversion** is a rare and life-threatening obstetric emergency, typically occurring **postpartum**, where the uterus turns inside out. - Its symptoms include **severe pain, hemorrhage, and shock**, and it is not related to a localized labial swelling.
Question 72: A 29 year old woman is noted to have three consecutive first trimester spontaneous abortions. Examination reveals fibroid uterus. Which of the following types of uterine fibroids would most likely lead to recurrent abortions?
- A. Submucosal (Correct Answer)
- B. Cervical
- C. Intramural
- D. Subserosal
Explanation: ***Submucosal*** - **Submucosal fibroids** are located directly beneath the **endometrium** and can protrude into the uterine cavity, disrupting the normal implantation site and early fetal development. - Their presence significantly increases the risk of **implantation failure** and **recurrent first-trimester spontaneous abortions** due to mechanical distortion and altered uterine blood flow. *Cervical* - **Cervical fibroids** are rare and located in the uterine cervix; while they can cause symptoms like bleeding or difficulty with delivery, they are less likely to directly impact **early implantation** or cause **recurrent first-trimester abortions**. - Their primary impact is often related to labor and delivery complications rather than early pregnancy loss. *Intramural* - **Intramural fibroids** are located within the muscular wall of the uterus and are the most common type. While large or numerous intramural fibroids can sometimes contribute to pregnancy complications, their direct impact on **recurrent first-trimester abortions** is generally less significant compared to submucosal fibroids. - Their effect on fertility often depends on their size, number, and proximity to the **endometrial cavity**. *Subserosal* - **Subserosal fibroids** are located on the outer surface of the uterus, beneath the serosa, and typically grow outwards. - They usually have **minimal to no impact** on implantation or early pregnancy development, thus they are unlikely to be a cause of **recurrent first-trimester abortions**.
Question 73: A 25 year old infertile woman is noted to have blocked fallopian tubes on Hysterosalpingography. Which of the following is the best next step for this woman?
- A. Clomiphene citrate therapy
- B. Laparoscopy (Correct Answer)
- C. Intrauterine insemination
- D. Gonadotropin therapy
Explanation: ***Laparoscopy*** - A **blocked fallopian tube** identified on hysterosalpingography (HSG) requires direct visualization to confirm the diagnosis, assess the extent of the blockage, identify any associated pelvic pathology (adhesions, endometriosis), and potentially perform surgical correction (e.g., salpingostomy, fimbrioplasty, adhesiolysis). - Laparoscopy allows for **definitive diagnosis** of tubal pathology and can be therapeutic. It is particularly indicated when there is suspicion of correctable pathology or when the patient prefers attempting natural conception. - **Note**: In modern practice, IVF is increasingly considered as first-line for bilateral tubal disease, but laparoscopy remains important for diagnostic purposes and when surgical correction is feasible. *Clomiphene citrate therapy* - This therapy is primarily used to induce **ovulation** in anovulatory infertility, which is not the primary issue when blocked fallopian tubes are identified. - It would be ineffective in overcoming a physical **tubal obstruction**, as sperm and egg cannot meet regardless of ovulation status. *Intrauterine insemination* - IUI involves placing sperm directly into the uterus, bypassing cervical factors, but it still requires at least one **patent fallopian tube** for fertilization to occur. - With blocked fallopian tubes, IUI would not address the problem of the egg and sperm being unable to meet, making it an inappropriate choice. *Gonadotropin therapy* - Gonadotropins (FSH and LH) are used to stimulate **follicle development** and ovulation, similar to clomiphene but often for more resistant cases or controlled ovarian hyperstimulation. - This therapy does not resolve **tubal blockages** and would not be effective in achieving pregnancy in the presence of blocked fallopian tubes without patent tubes for fertilization.
Question 74: The contraceptive choice for a 38 year old woman with chronic hypertension and history of dysmenorrhea and menorrhagia (malignancy ruled out) is:
- A. Copper intrauterine device
- B. Sterilization
- C. Combined oral contraceptive pills
- D. Levonorgestrel intrauterine device (Correct Answer)
Explanation: ***Levonorgestrel intrauterine device*** - The **Levonorgestrel IUD** is an excellent choice as it provides effective contraception while also treating menorrhagia and dysmenorrhea due to its local progesterone release. - It is safe for women with **hypertension** as it is a **non-estrogen-containing method**, avoiding the increased risk of thrombotic events associated with estrogen. *Copper intrauterine device* - While an effective non-hormonal contraceptive, the **copper IUD** can worsen **dysmenorrhea** and **menorrhagia**, which are existing concerns for the patient. - It does not offer any therapeutic benefits for her heavy and painful periods. *Sterilization* - Although it provides permanent and highly effective contraception, **sterilization** does not address the patient's symptoms of **dysmenorrhea** and **menorrhagia**. - It is an irreversible procedure and typically considered when no further childbearing is desired and symptomatic relief is not a primary concern for the contraceptive method itself. *Combined oral contraceptive pills* - **Combined oral contraceptive pills (COCs)** are generally contraindicated or used with caution in women with uncontrolled **hypertension** due to the estrogen component, which can increase the risk of cardiovascular events, including thrombosis. - While COCs can improve dysmenorrhea and menorrhagia, the cardiovascular risks in a 38-year-old with chronic hypertension outweigh these benefits.
Question 75: Tubectomy is commonly performed at which site of fallopian tube?
- A. Infundibulum
- B. Ampulla
- C. Cornua
- D. Isthmus (Correct Answer)
Explanation: ***Isthmus*** - The **isthmus** is the **most common site** for tubectomy (tubal ligation) procedures. - It is the preferred location because it is **narrow, straight, and easily accessible** during surgery, making ligation technically simpler. - The isthmus has **relatively less blood supply** compared to other parts of the tube, reducing the risk of bleeding. - Common techniques like the **Pomeroy method** and **Parkland technique** are typically performed at the isthmus. - The narrow diameter ensures **complete occlusion** and reduces the risk of recanalization. *Ampulla* - The **ampulla** is the widest and longest portion of the fallopian tube, located between the isthmus and infundibulum. - It is **rarely chosen** for tubectomy because its wider lumen makes complete occlusion more difficult. - The ampulla has **higher vascularity**, increasing the risk of bleeding during surgery. - Greater risk of **incomplete blockage** and potential for recanalization. *Infundibulum* - The **infundibulum** is the funnel-shaped distal end with fimbriae that opens into the peritoneal cavity. - This site is **almost never used** for tubectomy due to its proximity to the ovary and technical difficulty. - Risk of damage to the fimbriae and ovarian blood supply. *Cornua* - The **cornua** (interstitial portion) passes through the uterine wall. - While sometimes used, it is **less common** than the isthmus due to increased technical difficulty. - Cornual resection carries higher risk of **uterine perforation** and **bleeding** from the uterine vessels. - May be chosen in specific clinical scenarios but not the standard first choice.
Question 76: A 60 year old woman presents with postmenopausal bleeding. On endometrial curettage she is diagnosed as endometrial carcinoma. Which one of the following is a risk factor for endometrial cancer?
- A. Oral contraceptive use
- B. Multiparity
- C. Diabetes mellitus (Correct Answer)
- D. Smoking
Explanation: ***Diabetes mellitus*** - Diabetes is a significant risk factor for endometrial cancer, particularly due to its association with **obesity** and resulting increased **estrogen levels**. - **Insulin resistance** and elevated insulin-like growth factors can directly promote endometrial cell proliferation. *Oral contraceptive use* - Combined oral contraceptives (OCPs) are actually **protective** against endometrial cancer. - The progestin component in OCPs counteracts the unopposed estrogen effect that is a major driver of endometrial cancer. *Multiparity* - **Multiparity** (having had multiple pregnancies) is generally considered to be protective against endometrial cancer. - This protective effect is thought to be related to the hormonal changes during pregnancy, which involve a higher proportion of **progesterone**. *Smoking* - Smoking is generally associated with an **increased risk of certain cancers,** but it is **not considered a risk factor** for endometrial cancer. - Some studies suggest it might even slightly decrease risk due to anti-estrogenic effects, though this benefit is far outweighed by its many harms.
Question 77: A 29 year old woman presents in emergency ward with amenorrhea of 6 weeks and pain. Urine pregnancy test shows positive. Examination shows diffuse significant lower abdomen tenderness. The pelvic examination is difficult to accomplish due to guarding. Her Beta-hCG level is 4000 mIU/ml. Transvaginal ultrasound shows no pregnancy in the uterus and no adnexal mass but moderate fluid in abdomen. Which of the following is the next best step?
- A. Repeat Beta-hCG level in 48 hours
- B. Institution of methotrexate
- C. Wait and watch
- D. Emergency laparotomy (Correct Answer)
Explanation: ***Emergency laparotomy*** - The patient presents with **amenorrhea**, **positive pregnancy test**, significant lower **abdominal tenderness**, and **free fluid in the abdomen** without an intrauterine pregnancy on ultrasound, strongly suggesting a **ruptured ectopic pregnancy**, which is a life-threatening emergency requiring immediate surgical intervention. - The high **Beta-hCG level of 4000 mIU/ml** with no intrauterine pregnancy on ultrasound, combined with acute abdominal pain and tenderness, points to a rapidly progressing ectopic pregnancy that may have already ruptured, necessitating **emergency laparotomy** for hemorrhage control and removal of the ectopic gestation. *Repeat Beta-hCG level in 48 hours* - While serial Beta-hCG measurements are used to monitor early pregnancies, this patient's acute symptoms of severe abdominal pain, tenderness, and fluid in the abdomen, along with a high Beta-hCG and no intrauterine pregnancy, indicate an **urgent condition** that cannot wait 48 hours. - Waiting for repeat hCG levels would delay critical intervention for a potentially ruptured ectopic pregnancy, which could lead to **hemorrhagic shock** and death. *Institution of methotrexate* - **Methotrexate** is typically considered for **unruptured, stable ectopic pregnancies** with lower Beta-hCG levels and no signs of acute abdominal distress or rupture. - This patient's presentation with acute pain, tenderness, and free fluid strongly suggests rupture, making **methotrexate inappropriate** and dangerous as it would not address the active bleeding and could worsen her condition. *Wait and watch* - A "wait and watch" approach is inappropriate and extremely dangerous given the patient's acute abdominal pain, tenderness, and evidence of free fluid in the abdomen, which are all signs of a **ruptured ectopic pregnancy**. - Delaying intervention in cases of potential ruptured ectopic pregnancy can lead to **massive hemorrhage**, shock, and maternal death.
Pharmacology
2 questionsWhich one of the following drugs does NOT interfere with efficacy of oral contraceptive pills and increase the failure rates?
Which one of the following antihypertensive drugs is NOT safe during pregnancy?
UPSC-CMS 2019 - Pharmacology UPSC-CMS Practice Questions and MCQs
Question 71: Which one of the following drugs does NOT interfere with efficacy of oral contraceptive pills and increase the failure rates?
- A. Barbiturates
- B. Rifampicin
- C. Ranitidine (Correct Answer)
- D. Ampicillin
Explanation: ***Ranitidine*** - **Ranitidine** is an H2 receptor antagonist that reduces stomach acid and does not interact with the **cytochrome P450 enzyme system**, which metabolizes oral contraceptives. - This means it does not significantly alter the **pharmacokinetics** of oral contraceptive pills, ensuring their efficacy is maintained. *Barbiturates* - **Barbiturates** are potent inducers of the **hepatic cytochrome P450 enzyme system**, specifically CYP3A4. - This induction accelerates the metabolism of estrogen and progestin components of oral contraceptives, leading to **lower serum levels** and reduced contraceptive efficacy. *Rifampicin* - **Rifampicin** is a strong inducer of the **hepatic cytochrome P450 enzyme system**, particularly CYP3A4, which is responsible for metabolizing steroid hormones. - This accelerated metabolism significantly reduces the serum concentrations of oral contraceptive hormones, thereby **decreasing their effectiveness** and increasing the risk of unintended pregnancy. *Ampicillin* - **Ampicillin**, and other broad-spectrum antibiotics, can theoretically interfere with oral contraceptive efficacy by disrupting the **enterohepatic recirculation** of estrogens. - This disruption leads to a decrease in the reabsorption of estrogen metabolites from the gut, resulting in **lower circulating estrogen levels** and potentially reduced contraceptive protection.
Question 72: Which one of the following antihypertensive drugs is NOT safe during pregnancy?
- A. Labetalol
- B. ACE-inhibitors (Correct Answer)
- C. Nifedipine
- D. Alpha-methyl dopa
Explanation: ***ACE-inhibitors*** - **ACE inhibitors** (e.g., enalapril, lisinopril) are **contraindicated** in pregnancy due to their association with severe fetal abnormalities, including **renal agenesis**, **oligohydramnios**, and **fetal death** [1], [2]. - They should be discontinued as soon as pregnancy is confirmed or suspected due to their known **teratogenic effects** [1], [2].*Labetalol* - **Labetalol**, a combined alpha- and beta-blocker, is considered one of the **first-line agents** for managing hypertension in pregnancy. - It has a good safety profile for both the mother and the fetus and is commonly used in conditions like **preeclampsia**.*Nifedipine* - **Nifedipine**, a calcium channel blocker, is also a **safe and effective** option for treating hypertension during pregnancy. - It is frequently used for managing **chronic hypertension** and **preeclampsia** due to its rapid onset of action and tolerability.*Alpha-methyl dopa* - **Alpha-methyl dopa** (methyldopa) is considered one of the **safest and most extensively studied** antihypertensive medications for use in pregnancy. - It is often the **first-choice agent** for chronic hypertension during pregnancy due to its long-standing track record of safety for the fetus.