Anatomy
1 questionsWhich one of the following is NOT a support of uterus, preventing its descent?
UPSC-CMS 2020 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 51: Which one of the following is NOT a support of uterus, preventing its descent?
- A. Endopelvic fascia
- B. Mackenrodt's ligament
- C. Pubocervical ligament
- D. Inguinal ligament (Correct Answer)
Explanation: ***Inguinal ligament*** - The **inguinal ligament** is a fibrous band extending from the **anterior superior iliac spine** to the **pubic tubercle**, forming the inferior border of the anterior abdominal wall [2]. - It plays no direct role in supporting the uterus; its primary function is to serve as an attachment site for muscles and define the **inguinal canal** [2]. *Endopelvic fascia* - The **endopelvic fascia** is a connective tissue layer that surrounds pelvic organs and contributes significantly to their support [1]. - It forms condensations such as the **uterosacral** and **cardinal (Mackenrodt's) ligaments**, which directly stabilize the uterus [1]. *Mackenrodt's ligament* - Also known as the **cardinal ligament** or **transverse cervical ligament**, it extends from the cervix and lateral vaginal fornix to the lateral pelvic walls [1]. - This ligament is a primary support of the uterus, preventing its descent and maintaining its position [1]. *Pubocervical ligament* - The **pubocervical ligament** extends from the anterior aspect of the cervix to the posterior surface of the pubic symphysis. - It is a condensation of the **endopelvic fascia** and provides anterior support to the uterus and bladder [1].
Forensic Medicine
1 questionsFrom medicolegal point of view which one of the following is NOT a sign of previous child birth?
UPSC-CMS 2020 - Forensic Medicine UPSC-CMS Practice Questions and MCQs
Question 51: From medicolegal point of view which one of the following is NOT a sign of previous child birth?
- A. Introitus is gaping and there is presence of carunculae myrtiformis
- B. Conical cervix with round external os (Correct Answer)
- C. Perineum is lax and there is evidence of scarring
- D. Abdomen is lax and loose with striae and linea nigra
Explanation: ***Conical cervix with round external os*** - A **conical cervix with a round external os** is characteristic of a **nulliparous woman** (never given birth). - After childbirth, the cervix typically becomes **transversely slit-like** due to the dilation during labor. *Introitus is gaping and there is presence of carunculae myrtiformis* - A **gaping introitus** is a common finding after childbirth due to the stretching and relaxation of the **vaginal outlet**. - **Carunculae myrtiformes** are remnants of the hymen that are usually fragmented during vaginal delivery. *Abdomen is lax and loose with striae and linea nigra* - **Lax and loose abdominal skin**, along with the presence of **striae gravidarum** (stretch marks) and a prominent **linea nigra** (hyperpigmented line), are classic signs of a previous pregnancy and childbirth. - These changes result from the significant stretching of the abdominal wall during uterine enlargement. *Perineum is lax and there is evidence of scarring* - A **lax perineum** indicates loss of tone in the pelvic floor muscles, which commonly occurs after vaginal delivery. - **Perineal scarring** can be a result of episiotomy or perineal tears sustained during childbirth.
Obstetrics and Gynecology
7 questionsAs per ICMR guidelines, which one of the following statements is true regarding effects of COVID-19 on fetus according to current evidence?
As per ICMR guidelines, which one of the following statements is true regarding COVID-19 infection in pregnancy?
Which one of the following is NOT a method of management of Deep Transverse Arrest with the living fetus?
Successful external cephalic version of breech presentation is likely in case all of the following EXCEPT:
Implantation of a fertilised ovum occurs on which day following fertilisation?
The net effect of antenatal care has been the following EXCEPT:
Which one of the following is NOT a component of active phase in the partograph?
UPSC-CMS 2020 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 51: As per ICMR guidelines, which one of the following statements is true regarding effects of COVID-19 on fetus according to current evidence?
- A. COVID-19 virus infection is an indication of MTP
- B. COVID-19 virus is not teratogenic (Correct Answer)
- C. There is increased risk of fetal growth restriction
- D. There is increased risk of early pregnancy loss
Explanation: ***COVID-19 virus is not teratogenic*** - Current evidence, including ICMR guidelines, indicates that the COVID-19 virus itself does not cause **congenital malformations** or developmental abnormalities in the fetus, distinguishing it from truly **teratogenic agents**. - While maternal infection can have adverse outcomes, these are generally not due to direct fetal malformation from the virus. *COVID-19 virus infection is an indication of MTP* - **MTP (Medical Termination of Pregnancy)** is not indicated solely based on maternal COVID-19 infection, as the virus is not considered teratogenic and typically does not cause severe direct fetal harm requiring termination. - Ethical and medical guidelines do not support routine termination for uncomplicated maternal COVID-19. *There is increased risk of fetal growth restriction* - While severe maternal COVID-19 can rarely be associated with *some* adverse pregnancy outcomes, a consistently and significantly increased risk of **fetal growth restriction (FGR)** is not definitively established as a direct effect of the virus itself, especially in mild to moderate cases. - Other factors, such as severe maternal illness, hypoxia, or comorbidities, are more strongly linked to FGR. *There is increased risk of early pregnancy loss* - Data from various studies has not consistently shown a significant or direct increase in the risk of **early pregnancy loss** (miscarriage) specifically due to COVID-19 infection in early pregnancy. - While any maternal infection can theoretically increase risk, COVID-19 is not classified as a primary cause of increased early pregnancy loss based on current evidence.
Question 52: As per ICMR guidelines, which one of the following statements is true regarding COVID-19 infection in pregnancy?
- A. Pregnant women with heart disease are at higher risk (Correct Answer)
- B. COVID-19 pneumonia in pregnancy is more severe with poor recovery
- C. COVID-19 virus is secreted in breast milk
- D. Vaginal secretions always test positive for COVID-19 in pregnancy
Explanation: ***Pregnant women with heart disease are at higher risk*** - Pre-existing **heart disease** is a significant risk factor for severe COVID-19 outcomes in pregnant women due to the increased physiological cardiac demands of both pregnancy and infection. - According to ICMR guidelines and global data, comorbidities like **cardiovascular disease** place pregnant individuals in a higher-risk category for severe illness. *COVID-19 pneumonia in pregnancy is more severe with poor recovery* - While pregnant women *can* develop severe COVID-19 pneumonia, the general consensus, including ICMR guidelines, states that most pregnant women experience **mild to moderate illness** and have a **good recovery**. - Pooled data indicates that the majority of pregnant women with COVID-19 will not develop severe pneumonia or experience poorer recovery *solely* due to pregnancy. *COVID-19 virus is secreted in breast milk* - Current evidence suggests that the **COVID-19 virus is generally not detectable** in breast milk. - ICMR and other major health organizations recommend that **mothers with COVID-19 continue breastfeeding**, as the benefits outweigh potential risks, and antibodies may be transferred. *Vaginal secretions always test positive for COVID-19 in pregnancy* - The primary transmission route for COVID-19 is through **respiratory droplets**, not vaginal secretions. - While some studies have detected viral RNA in vaginal secretions in a small percentage of cases, it is **not always positive** and is not considered a primary source of transmission.
Question 53: Which one of the following is NOT a method of management of Deep Transverse Arrest with the living fetus?
- A. Caesarean section
- B. Manual rotation and application of forceps
- C. Delivery by application of forceps to the unrotated head
- D. Delivery by ventouse (Correct Answer)
Explanation: ***Delivery by ventouse*** - **Vacuum extraction (ventouse)** requires the fetal head to be engaged and the leading part to be no higher than 1/5th above the symphysis pubis, and it does not allow for rotation once applied. - In a **deep transverse arrest**, the fetal head is unrotated, and direct application of a ventouse without prior rotation is unsafe and ineffective, as it would apply traction in an improper direction, risking scalp injury without resolving the arrest. *Caesarean section* - **Caesarean section** is a viable and often necessary option for deep transverse arrest, especially when other rotational or instrumental delivery methods are contraindicated or unsuccessful. - It ensures safe delivery for both mother and fetus in cases of **cephalopelvic disproportion** or failed operative vaginal delivery. *Manual rotation and application of forceps* - **Manual rotation** involves an obstetrician manually turning the fetal head from the transverse to the occipito-anterior or posterior position. - After successful manual rotation, **forceps** can then be applied to facilitate vaginal delivery, provided there are no other contraindications. *Delivery by application of forceps to the unrotated head* - **Kielland's forceps** are specifically designed for rotation and delivery in cases of **deep transverse arrest** and can be applied to an unrotated head to achieve rotation without prior manual intervention. - While other types of forceps typically require the head to be in an occipito-anterior position, Kielland's forceps allow for the necessary rotation before traction is applied, making it a suitable method for managing deep transverse arrest.
Question 54: Successful external cephalic version of breech presentation is likely in case all of the following EXCEPT:
- A. Non engaged breech
- B. Adequate amniotic fluid
- C. Breech with extended legs (Correct Answer)
- D. Complete breech with sacroanterior position
Explanation: ***Breech with extended legs*** - An extended leg presentation (frank breech) makes successful external cephalic version **less likely** because the **fetal legs splint the fetus**, creating a rigid, elongated configuration that resists rotation. - The extended posture restricts fetal mobility necessary for successful manipulation. - Frank breech is the **least favorable type** for ECV success. *Non engaged breech* - A **non-engaged breech** presentation indicates the fetal buttocks or feet are not yet fixed in the maternal pelvis, allowing **greater mobility** and making successful external cephalic version **more likely**. - Lack of engagement means there is ample space for the fetus to turn. *Adequate amniotic fluid* - **Adequate amniotic fluid** provides essential space and cushioning for the fetus to move, which is crucial for a successful external cephalic version. - It reduces friction and allows for easier manipulation of the fetus during the procedure. - Oligohydramnios is a relative contraindication to ECV. *Complete breech with sacroanterior position* - A **complete breech** (with flexed hips and knees) is generally **more favorable** for external cephalic version compared to frank breech, as the flexed posture creates a more compact, mobile configuration. - The fetal position (sacroanterior, sacrotransverse, or sacroposterior) has less impact on ECV success than the **type of breech presentation** (complete vs. frank). - Complete breech allows easier manipulation than the rigid frank breech configuration.
Question 55: Implantation of a fertilised ovum occurs on which day following fertilisation?
- A. Day 6 (Correct Answer)
- B. Day 14
- C. Day 20
- D. Day 10
Explanation: ***Day 6*** * Fertilization occurs in the **ampulla** of the fallopian tube, and the zygote undergoes cleavage as it travels towards the uterus. * By day 5-6, the embryo develops into a **blastocyst** with an outer trophoblast layer and inner cell mass. * **Implantation begins on day 6-7** post-fertilization when the blastocyst attaches to the endometrium, making day 6 the correct answer for when implantation occurs. * The process continues and is complete by day 10-12, but the initial attachment (implantation) starts on day 6. *Incorrect: Day 14* * Day 14 marks the time of **ovulation** in a typical 28-day menstrual cycle, not implantation. * By day 14 post-fertilization, the embryo would have been implanted for approximately one week. *Incorrect: Day 20* * Implantation occurs much earlier, around day 6-12 post-fertilization. * By day 20 post-fertilization, the implanted embryo would be well into **gastrulation and organogenesis**. *Incorrect: Day 10* * While the implantation process may continue until day 10-12, it **begins on day 6**, not day 10. * Day 10 represents a later stage when implantation is nearly complete, but the question asks when implantation occurs (i.e., begins).
Question 56: The net effect of antenatal care has been the following EXCEPT:
- A. Reduction in maternal morbidity
- B. Reduction in perinatal mortality
- C. Reduction in the incidence of institutional delivery (Correct Answer)
- D. Reduction in maternal mortality
Explanation: ***Reduction in the incidence of institutional delivery*** - Antenatal care aims to increase awareness of safe delivery practices and encourage women to deliver in health facilities, thereby **increasing institutional deliveries**, not reducing them. - Improved access to and understanding of obstetric care through ANC promotes safer childbirth environments. *Reduction in maternal morbidity* - Antenatal care plays a crucial role in the early detection and management of **pregnancy-related complications** such as pre-eclampsia, gestational diabetes, and infections. - This proactive management minimizes the severity and impact of these conditions on maternal health. *Reduction in perinatal mortality* - Regular antenatal visits allow for monitoring of fetal growth and well-being, identification of **fetal distress**, and intervention for conditions like intrauterine growth restriction. - Early detection and management of issues affecting the fetus significantly improve perinatal outcomes and reduce **stillbirths** and **neonatal deaths**. *Reduction in maternal mortality* - ANC provides essential health education, nutritional advice, and timely vaccinations, which are vital for a healthy pregnancy. - It also facilitates preparedness for childbirth and potential complications, thereby **reducing the risk of maternal death** from preventable causes.
Question 57: Which one of the following is NOT a component of active phase in the partograph?
- A. Acceleration phase
- B. Phase of deceleration
- C. Phase of maximum slope
- D. Phase of expulsion (Correct Answer)
Explanation: ***Phase of expulsion*** - The **phase of expulsion** (or the second stage of labor) begins after the cervix is fully dilated and ends with the birth of the baby. - While it immediately follows the active phase, it is not considered a component of the **active phase** itself, which primarily focuses on cervical dilation progress. *Acceleration phase* - The **acceleration phase** is an early part of the active phase of labor where the rate of cervical dilation begins to increase. - It marks the transition from the latent phase to the more rapid dilation characteristic of active labor. *Phase of deceleration* - The **phase of deceleration** occurs towards the end of the active phase, just before full cervical dilation, where the rate of dilation slows down. - This phase is typically associated with the advancing fetal head encountering the pelvic floor. *Phase of maximum slope* - The **phase of maximum slope** (or maximum ascent) is the steepest part of the active phase, where cervical dilation occurs at its fastest rate. - This is the most efficient period of cervical change during labor.
Surgery
1 questionsDuring total abdominal hysterectomy the ureter is likely to undergo injury or ligation during the following steps EXCEPT:
UPSC-CMS 2020 - Surgery UPSC-CMS Practice Questions and MCQs
Question 51: During total abdominal hysterectomy the ureter is likely to undergo injury or ligation during the following steps EXCEPT:
- A. During division and ligation of the round ligaments (Correct Answer)
- B. During division and ligation of infundibulopelvic ligaments
- C. During division and ligation of mackenrodt's and uterosacral ligaments
- D. At the vaginal angles while incising the vagina to remove the cervix with the uterus
Explanation: ***During division and ligation of the round ligaments*** - The round ligaments are located **far from the ureters**, passing through the **inguinal canal** anteriorly. - They are **anterior and lateral** to the broad ligament and do not cross the ureteral path. - **Ureteral injury is highly unlikely** during their division and ligation, making this the correct answer to the EXCEPT question. *During division and ligation of mackenrodt's and uterosacral ligaments* - The **ureter passes about 1-2 cm lateral to the cervix** at the level of the internal os, in close proximity to the **cardinal (Mackenrodt's) and uterosacral ligaments**. - These ligaments provide significant support to the uterus and are one of the **most common sites of ureteral injury** during hysterectomy. - The ureter is particularly vulnerable during clamping and ligating these structures. *At the vaginal angles while incising the vagina to remove the cervix with the uterus* - The **ureters are at the level of the vaginal fornices** as they course toward the bladder base. - This is a well-recognized **high-risk area** for ureteral injury during vaginal cuff clamping and incision. - The ureter can be inadvertently caught in the clamps applied to control bleeding from the vaginal angles. *During division and ligation of infundibulopelvic ligaments* - The **infundibulopelvic ligament** (IP ligament or suspensory ligament of the ovary) contains the **ovarian vessels**. - The ureter runs along the **pelvic sidewall immediately medial and posterior** to the IP ligament. - This is another **high-risk area** for ureteral injury, especially if the ligament is not elevated adequately away from the pelvic sidewall during clamping.