Community Medicine
1 questionsPearl index for contraceptive effectiveness is calculated in terms of which of the following? 1. Pregnancy rate 2. Abortion rate 3. Hundred woman years 4. Thousand woman years Select the correct answer using the code given below:
UPSC-CMS 2020 - Community Medicine UPSC-CMS Practice Questions and MCQs
Question 41: Pearl index for contraceptive effectiveness is calculated in terms of which of the following? 1. Pregnancy rate 2. Abortion rate 3. Hundred woman years 4. Thousand woman years Select the correct answer using the code given below:
- A. 2 and 3
- B. 1 only
- C. 1 and 3 (Correct Answer)
- D. 1, 2 and 4
Explanation: ***1 and 3*** - The **Pearl Index** is a common method for measuring the **effectiveness of contraception**. - It calculates the number of pregnancies per **100 women-years** of exposure to a particular contraceptive method. *2 and 3* - While abortions can occur in cases of contraceptive failure, the **Pearl Index** specifically focuses on the **pregnancy rate**, not the abortion rate. - The denominator of **hundred woman-years** is correct, but abortion rate is not a direct component of the Pearl Index calculation. *1 only* - The **pregnancy rate** is indeed a key component of the Pearl Index, but it must be expressed in a standardized unit, which is typically **hundred woman-years**. - Simply stating "pregnancy rate" without the context of exposure time is insufficient for the Pearl Index. *1, 2 and 4* - The **Pearl Index** does not directly incorporate the **abortion rate**. - Its standard denomination is **hundred woman-years**, not thousand woman-years.
Obstetrics and Gynecology
9 questionsWhich one of the following statements regarding pre-conceptional counseling is NOT correct?
Consider the following statements regarding Non Stress Test (NST): 1. Reactive NST indicates a healthy fetus 2. NST is an observed association of fetal breathing with fetal movements 3. NST has a low false negative rate (< 1%) but high false positive rate (>50%) 4. Testing should be started at 20 weeks Which of the statement(s) given above is/are correct?
Which one of the following is a protective factor for endometrial hyperplasia?
A woman who is not breast feeding her newborn child is advised to use a contraceptive method by:
Indications for removal of IUDs are all EXCEPT:
Contraindications for insertion of IUDs are all EXCEPT:
Which one of the following is NOT a contraindication for use of Mini pill?
Which one of the following is the most commonly used surgical method/technique of female sterilization as recommended by Government of India?
Which of the following is/are required for a registered medical practitioner to qualify for performing Medical Termination of Pregnancy (MTP), as per revised rules of MTP Act? 1. Certified for assisting at least 25 MTP in an authorized centre 2. Diploma or degree in Obstetrics and Gynaecology 3. House surgeon training for 6 months in Obstetrics and Gynaecology 4. Certified training for 6 months in laparoscopic surgeries Select the correct answer using the code given below:
UPSC-CMS 2020 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 41: Which one of the following statements regarding pre-conceptional counseling is NOT correct?
- A. It helps in early detection of risk factors
- B. It is needed only in selected complicated pregnancies (Correct Answer)
- C. It is a part of preventive medicine
- D. It helps in reducing maternal morbidity and mortality
Explanation: ***It is needed only in selected complicated pregnancies*** - Pre-conceptional counseling is important for **all women of reproductive age**, especially those planning a pregnancy, not just for complicated cases. - Its purpose is to **optimize maternal health before conception** to prevent adverse outcomes, regardless of initial perceived risk. *It helps in early detection of risk factors* - Pre-conceptional counseling identifies **maternal and fetal risk factors** such as chronic medical conditions, genetic predisposition, and lifestyle choices before pregnancy. - Early detection allows for ** timely interventions** to mitigate these risks. *It is a part of preventive medicine* - Counseling before pregnancy focuses on **prevention of adverse pregnancy outcomes** by optimizing health and addressing potential issues. - This proactive approach aligns directly with the principles of **preventive healthcare**. *It helps in reducing maternal morbidity and mortality* - By addressing risk factors, optimizing health, and educating women about healthy behaviors, pre-conceptional counseling can significantly **lower the incidence of complications** during pregnancy. - This ultimately contributes to a **reduction in maternal illness and death**.
Question 42: Consider the following statements regarding Non Stress Test (NST): 1. Reactive NST indicates a healthy fetus 2. NST is an observed association of fetal breathing with fetal movements 3. NST has a low false negative rate (< 1%) but high false positive rate (>50%) 4. Testing should be started at 20 weeks Which of the statement(s) given above is/are correct?
- A. 1 and 4
- B. 2 only
- C. 3 only
- D. 1 and 3 (Correct Answer)
Explanation: ***1 and 3*** - A **reactive NST** indicates adequate fetal oxygenation and an intact autonomic nervous system, strongly suggesting a **healthy fetus**. - NST has excellent **sensitivity** for detecting fetal well-being, leading to a very **low false-negative rate** (less than 1%), but its relatively high rate of non-reactive results in healthy fetuses contributes to a **high false-positive rate** (over 50%). *1 and 4* - While statement 1 is correct, statement 4 is incorrect because NST testing is typically initiated at **28-32 weeks of gestation**, not 20 weeks, as fetal autonomic nervous system maturation is required. - At 20 weeks, the fetus often lacks the mature neurological responses necessary for a reliable NST. *2 only* - Statement 2 incorrectly describes NST; the NST observes the association of **fetal heart rate accelerations** with **fetal movements**, not fetal breathing. - Fetal breathing movements are typically assessed during a **biophysical profile**, not solely by NST. *3 only* - While statement 3 correctly describes the false negative and positive rates of NST, statement 1 is also correct, as a reactive NST is indeed a strong indicator of a healthy fetus. - This option is incomplete as it misses another correct statement.
Question 43: Which one of the following is a protective factor for endometrial hyperplasia?
- A. Tamoxifen therapy
- B. Multiparity (Correct Answer)
- C. Diabetes
- D. Delayed menopause
Explanation: ***Multiparity*** - **Multiparity** is a protective factor against endometrial hyperplasia due to **periods of anovulation and progesterone dominance** during pregnancy. - Each pregnancy provides prolonged exposure to high levels of **progesterone**, which counteracts unopposed estrogenic effects on the endometrium and prevents hyperplasia. - Multiple pregnancies reduce the total number of **ovulatory cycles** in a woman's lifetime, thereby decreasing cumulative exposure to unopposed estrogen. *Tamoxifen therapy* - **Tamoxifen**, while an anti-estrogen in breast tissue, acts as a **partial estrogen agonist** on the endometrium, increasing the risk of endometrial hyperplasia and cancer. - It can lead to changes in the endometrial lining, including **polyps** and hyperplasia, due to its estrogenic effects in the uterus. *Diabetes* - **Diabetes**, particularly type 2, is a risk factor for endometrial hyperplasia and cancer, not a protective factor. - It is associated with **increased insulin levels** and insulin-like growth factors, which can promote endometrial cell proliferation. *Delayed menopause* - **Delayed menopause** means a longer lifetime exposure to estrogen during the reproductive years. - Prolonged exposure to **unopposed estrogen** is a significant risk factor for endometrial hyperplasia, as it promotes endometrial proliferation.
Question 44: A woman who is not breast feeding her newborn child is advised to use a contraceptive method by:
- A. 3rd postpartum month
- B. 3rd postpartum week
- C. 6th postpartum month
- D. 6th postpartum week (Correct Answer)
Explanation: ***6th postpartum week*** - For non-breastfeeding women, the **uterus typically involutes** by 6 weeks, and ovulatory cycles can resume as early as 4-6 weeks postpartum. - Due to the rapid return to fertility and the completion of immediate postpartum healing, contraceptive methods are generally recommended around the **6-week postpartum check-up**. *3rd postpartum month* - This is generally considered **too late** for initiating contraception in non-breastfeeding women as fertility can return much earlier. - Waiting until 3 months significantly increases the risk of **unintended pregnancy** because ovulation often occurs before the first postpartum menses. *3rd postpartum week* - While some women may ovulate early, it's generally **too soon** to initiate most contraceptive methods due to ongoing uterine involution and the risk of postpartum complications. - The risk of **thrombosis** is still elevated in the immediate postpartum period, making certain hormonal contraceptives (e.g., estrogen-containing methods) contraindicated. *6th postpartum month* - Similar to the 3rd postpartum month, this is generally **too late** to initiate contraception for non-breastfeeding women. - Prolonged delay significantly increases the likelihood of **unintended conception** during this period.
Question 45: Indications for removal of IUDs are all EXCEPT:
- A. Pregnancy with IUD
- B. Flaring up of salpingitis
- C. Perforation of uterus
- D. Cyclical menstrual bleeding (Correct Answer)
Explanation: ***Cyclical menstrual bleeding*** - **Normal cyclical menstrual bleeding** is an expected physiological event and not an indication for IUD removal. - While IUDs can alter menstrual patterns (e.g., heavier or lighter bleeding), typical cyclical bleeding that is not excessively heavy, painful, or prolonged usually does not warrant removal. *Pregnancy with IUD* - If a **pregnancy occurs with an IUD in situ**, especially in the first trimester, the IUD should ideally be removed to reduce the risk of spontaneous abortion, preterm labor, or infection. - Removal is especially crucial if the strings are visible and accessible; if not, close monitoring is necessary. *Flaring up of salpingitis* - **Salpingitis (pelvic inflammatory disease - PID)** is a serious infection that can be exacerbated or initiated by the presence of an IUD, particularly during insertion or in individuals with pre-existing infections. - A confirmed or suspected flare-up of salpingitis necessitates IUD removal to control the infection and prevent further complications like infertility or ectopic pregnancy. *Perforation of uterus* - **Uterine perforation** is a serious complication that can occur during IUD insertion and requires immediate removal of the device. - Depending on the extent of perforation, it may lead to pain, hemorrhage, infection, or damage to surrounding organs.
Question 46: Contraindications for insertion of IUDs are all EXCEPT:
- A. During cesarean section (Correct Answer)
- B. Trophoblastic disease
- C. Suspected pregnancy
- D. Severe dysmenorrhea
Explanation: ***During cesarean section*** - Immediate post-placental IUD insertion during cesarean section is **safe and effective** with proper technique and uterine assessment - This timing improves continuation rates by avoiding a separate office visit - WHO and ACOG guidelines support this practice, making it **NOT a contraindication** *Trophoblastic disease* - Gestational trophoblastic disease is a **contraindication** due to increased risk of uterine perforation - IUD insertion can mask disease recurrence and interfere with hCG monitoring - Must wait until complete resolution and hCG normalization *Suspected pregnancy* - IUD insertion in a pregnant uterus can cause **miscarriage, infection, or perforation** - Pregnancy must be **ruled out** before insertion - This is an **absolute contraindication** *Severe dysmenorrhea* - **Copper IUDs** are relatively contraindicated as they can worsen menstrual cramps and bleeding - However, **levonorgestrel-releasing IUDs (LNG-IUS)** are actually therapeutic for dysmenorrhea - As a general contraindication listing (without specifying IUD type), severe dysmenorrhea is traditionally considered a contraindication primarily for copper IUDs
Question 47: Which one of the following is NOT a contraindication for use of Mini pill?
- A. Breast feeding (Correct Answer)
- B. Pregnancy
- C. Thromboembolic disease
- D. History of breast cancer
Explanation: ***Breastfeeding*** - **Mini-pills**, which contain only progestin, are **safe for use during breastfeeding** as they do not significantly affect milk production or infant health. - They are often the **preferred hormonal contraceptive** for nursing mothers. - WHO Category 1 (no restriction) for breastfeeding women. *Pregnancy* - **Pregnancy** is a **contraindication** for any hormonal contraceptive, including the mini-pill. - The purpose of contraception is to **prevent pregnancy**, making its presence a clear reason not to start or continue the method. - WHO Category 4 (unacceptable health risk). *Thromboembolic disease* - **History of thromboembolic disease is NOT an absolute contraindication** for progestin-only pills (mini-pills). - Unlike combined oral contraceptives that contain estrogen, **mini-pills do not significantly increase the risk of thrombosis** as they lack the estrogen component responsible for clotting effects. - WHO Category 2 (advantages generally outweigh risks) for history of VTE. - This makes mini-pills a **safer alternative** for women with previous thromboembolism who need hormonal contraception. *History of breast cancer* - A **history of breast cancer** is a **contraindication** for hormonal contraceptives, including mini-pills, because steroid hormones can promote the growth of hormone-sensitive cancers. - Current breast cancer: WHO Category 4; past breast cancer with no evidence of disease for 5 years: WHO Category 3. - Alternative non-hormonal contraception methods are recommended in such cases.
Question 48: Which one of the following is the most commonly used surgical method/technique of female sterilization as recommended by Government of India?
- A. Madlener technique
- B. Uchida technique
- C. Irving method
- D. Pomeroy's method (Correct Answer)
Explanation: ***Pomeroy's method*** - **Pomeroy's method** involves creating a loop of the fallopian tube, ligating its base, and excising the looped segment, which is a highly effective and widely used surgical sterilization technique. - This method is the **most commonly recommended by the Government of India** for female sterilization under the national family planning program, typically performed via minilaparotomy (minilap) approach. - It is preferred due to its **simplicity, high efficacy, and low complication rates**, making it particularly suitable for resource-constrained settings and large-scale implementation in India. *Madlener technique* - The **Madlener technique** involves crushing and ligating a loop of the fallopian tube without excising any segment, making it less robust and potentially leading to higher recanalization rates. - This method is generally considered less effective compared to techniques that involve segment excision or destruction, hence it is not the most commonly recommended. *Uchida technique* - The **Uchida technique** involves injecting a sclerosing solution into the fallopian tube and then excising a portion of the tube, aiming to induce extensive fibrosis and prevent recanalization. - While effective, it is a more complex procedure than Pomeroy's method, requiring specialized training and materials, making it less suitable for widespread adoption as a primary method in national programs. *Irving method* - The **Irving method** involves ligating and transecting the fallopian tube, then burying the proximal stump into the broad ligament and the distal stump under the serosa, creating multiple barriers to recanalization. - This technique is highly effective but is considered more technically demanding and time-consuming than Pomeroy's method, which limits its widespread use as the go-to sterilization method in public health programs.
Question 49: Which of the following is/are required for a registered medical practitioner to qualify for performing Medical Termination of Pregnancy (MTP), as per revised rules of MTP Act? 1. Certified for assisting at least 25 MTP in an authorized centre 2. Diploma or degree in Obstetrics and Gynaecology 3. House surgeon training for 6 months in Obstetrics and Gynaecology 4. Certified training for 6 months in laparoscopic surgeries Select the correct answer using the code given below:
- A. 2 only
- B. 1 only
- C. 1, 2 and 3 (Correct Answer)
- D. 1, 2 and 4
Explanation: ***1, 2 and 3*** - As per the **MTP (Amendment) Act 2021 and Rules**, a registered medical practitioner (RMP) can perform MTP if they meet **any one** of the following qualifications: - Assisted at least **25 MTPs** in an authorized center - Hold a **diploma or degree in Obstetrics and Gynaecology** - Completed **house surgeon training for 6 months** in Obstetrics and Gynaecology in a recognized institution - All three statements (1, 2, and 3) represent valid pathways for qualification under the MTP Act, making this the correct answer. *2 only* - While a **diploma or degree in Obstetrics and Gynaecology** is indeed a valid qualification, it is not the *only* pathway recognized by the MTP Act. - Other pathways including practical experience (25 MTPs) and house surgeon training are equally valid qualifications. *1 only* - Assisting at least **25 MTPs** in an authorized center is a valid standalone qualification under the MTP Act. - However, this option is incorrect because statements 2 and 3 are also valid qualifications, not just statement 1 alone. *1, 2 and 4* - **Certified training for 6 months in laparoscopic surgeries** is **not a requirement** for performing MTP under the MTP Act. - While surgical skills are valuable, laparoscopic surgery training is not specifically mandated for MTP qualification, which primarily involves medical and surgical abortion procedures that don't necessarily require laparoscopic techniques.