Anatomy
1 questionsUterus is supported by which of the following ligaments? 1. Pubocervical ligament 2. Cardinal ligament 3. Uterosacral ligament 4. Ovarian ligament.
UPSC-CMS 2022 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 41: Uterus is supported by which of the following ligaments? 1. Pubocervical ligament 2. Cardinal ligament 3. Uterosacral ligament 4. Ovarian ligament.
- A. 2, 3 and 4
- B. 1, 2 and 3 (Correct Answer)
- C. 1, 2 and 4
- D. 1, 3 and 4
Explanation: ***1, 2 and 3*** - The **Pubocervical**, **Cardinal**, and **Uterosacral ligaments** are collectively known as the **endopelvic fascia** or **true ligaments** of the uterus, providing primary support [1]. - These ligaments attach the cervix and uterus to the pelvic walls, preventing uterine prolapse [1]. *2, 3 and 4* - This option incorrectly includes the **ovarian ligament** as a primary uterine support, while excluding the critical **pubocervical ligament**. - The ovarian ligament mainly connects the ovary to the uterus and does not offer significant structural support for the uterus itself. *1, 2 and 4* - This choice incorrectly excludes the **uterosacral ligament**, which is a key component of the primary uterine support system [1]. - The uterosacral ligaments contribute to posterior uterine support and help maintain its anteverted position [1]. *1, 3 and 4* - This option omits the **cardinal ligament** (also known as Mackenrodt's ligament), which is one of the most crucial supports for the uterus, stabilizing the cervix laterally [1]. - The cardinal ligaments are rich in connective tissue and provide significant lateral structural support [1].
Community Medicine
1 questionsAmongst the following, the Pearl Index is highest with
UPSC-CMS 2022 - Community Medicine UPSC-CMS Practice Questions and MCQs
Question 41: Amongst the following, the Pearl Index is highest with
- A. combined oral contraceptives
- B. calendar rhythm method (Correct Answer)
- C. barrier contraceptives
- D. intrauterine contraceptive devices
Explanation: ***calendar rhythm method*** - The **Pearl Index** measures the number of unintended pregnancies per 100 women-years of exposure. A higher Pearl Index signifies a **less effective** contraceptive method. - The calendar rhythm method, due to its reliance on estimations and user adherence, has a significantly higher failure rate compared to other methods, leading to the **highest Pearl Index**. *combined oral contraceptives* - **Combined oral contraceptives** have a relatively low Pearl Index, especially with perfect use, as they are highly effective in preventing ovulation. - Their effectiveness can be reduced by **missed pills** or interactions with certain medications. *barrier contraceptives* - **Barrier methods** like condoms or diaphragms have a moderate Pearl Index, as their effectiveness depends on consistent and correct use. - Breakage or incorrect application can lead to **method failure**. *intrauterine contraceptive devices* - **Intrauterine contraceptive devices (IUCDs)**, both hormonal and copper, are among the most effective long-acting reversible contraceptives, resulting in a very low Pearl Index. - Once inserted, they require no daily user action, contributing to their **high efficacy**.
Internal Medicine
1 questionsHeavy menstrual bleeding is a common presentation in which of the following? 1. Clotting factor deficiency 2. Fibroid uterus 3. Adenomyosis 4. Prolactinoma.
UPSC-CMS 2022 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 41: Heavy menstrual bleeding is a common presentation in which of the following? 1. Clotting factor deficiency 2. Fibroid uterus 3. Adenomyosis 4. Prolactinoma.
- A. 1, 2 and 3 (Correct Answer)
- B. 2, 3 and 4
- C. 1, 2 and 4
- D. 1, 3 and 4
Explanation: ***1, 2 and 3*** - **Clotting factor deficiencies** (e.g., von Willebrand disease, factor XI deficiency) impair normal hemostasis, leading to prolonged and heavy menstrual bleeding. - **Fibroid uterus** causes heavy menstrual bleeding due to increased endometrial surface area, impaired uterine contractility, and dilated underlying vessels. - **Adenomyosis**, characterized by endometrial tissue within the myometrium, leads to an enlarged, boggy uterus and causes heavy and painful menstruation. *2, 3 and 4* - This option correctly identifies fibroid uterus and adenomyosis, which are common causes of heavy menstrual bleeding. - However, **prolactinoma** typically causes **amenorrhea** or oligomenorrhea, not heavy menstrual bleeding, due to its inhibitory effect on gonadotropin-releasing hormone (GnRH). *1, 2 and 4* - While clotting factor deficiency and fibroid uterus are valid causes of heavy menstrual bleeding, **prolactinoma** is an incorrect inclusion. - Prolactinoma often leads to **hypogonadism** and anovulation, resulting in irregular or absent menstrual periods. *1, 3 and 4* - This option includes clotting factor deficiency and adenomyosis, which are causes of heavy menstrual bleeding. - However, **prolactinoma** is not associated with heavy menstrual bleeding; instead, it is known to cause **menstrual irregularities** including amenorrhea.
Obstetrics and Gynecology
7 questionsDuring the first stage of labour, the intrauterine pressure is increased up to
Which of the following is the most widely used screening test for cervical cancer?
Serum level of CA 125 is raised in which of the following conditions?
Following vaginal delivery, uterus becomes non-pregnant size by
Indications and prerequisites for delivery with the ventouse include which of the following? 1. Delay in the second stage of labour 2. Non-reassuring fetal heart rate 3. Gestation age less than 34 weeks of pregnancy 4. Vertex presentation.
Which of the following fetal infections is MOST commonly associated with significant intrauterine growth restriction?
Missed abortion is not diagnosed if
UPSC-CMS 2022 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 41: During the first stage of labour, the intrauterine pressure is increased up to
- A. 40–50 mm of Hg (Correct Answer)
- B. 100–120 mm of Hg
- C. 8–10 mm of Hg
- D. 2–3 mm of Hg
Explanation: ***40–50 mm of Hg*** - This pressure range is typical during **uterine contractions** in the first stage of labor, effectively causing cervical effacement and dilation. - These pressures provide sufficient force to facilitate the progression of labor while maintaining adequate **uteroplacental blood flow** between contractions. *100–120 mm of Hg* - This pressure range is generally too high for the first stage of labor and is more commonly seen in the **second stage** or during prolonged, abnormal contractions. - Such elevated pressures could potentially compromise **fetal well-being** due to reduced uteroplacental perfusion. *8–10 mm of Hg* - This pressure range represents the **resting tone** of the uterus between contractions, not the peak pressure during a contraction. - It is too low to cause significant cervical changes or *advance labor*. *2–3 mm of Hg* - This pressure is significantly below the normal resting tone of the uterus and is not associated with any stage of active labor. - Such low pressures would indicate **uterine inactivity** or atony, not active contractions.
Question 42: Which of the following is the most widely used screening test for cervical cancer?
- A. Pap test (Correct Answer)
- B. Visual inspections with acetic acid
- C. HPV DNA test
- D. Endocervical curettage
Explanation: ***Pap test*** - The **Pap test** (Papanicolaou test) is the most widely used and effective screening test for cervical cancer globally. - It involves collecting cells from the **cervix** to detect **precancerous** and cancerous changes early. *Endocervical curettage* - **Endocervical curettage** is a diagnostic procedure used to obtain tissue samples from the endocervical canal, typically performed after an abnormal Pap test. - It is a **biopsy procedure**, not a primary screening test for general populations. *Visual inspections with acetic acid* - **Visual inspection with acetic acid (VIA)** is a lower-cost screening method used in resource-limited settings. - It involves applying acetic acid to the cervix and observing for **acetowhite changes**, but its sensitivity and specificity are not as high as the Pap test. *HPV DNA test* - The **HPV DNA test** detects high-risk types of human papillomavirus, which are responsible for most cervical cancers. - While it's increasingly used, especially in conjunction with the Pap test (co-testing) or as primary screening in some settings, the **Pap test** remains the most **widely established** and utilized primary screening method.
Question 43: Serum level of CA 125 is raised in which of the following conditions?
- A. Epithelial ovarian cancer
- B. Pelvic inflammatory disease
- C. Endometriosis
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **CA 125** levels can be elevated in various gynecological conditions, both malignant and benign. - While most recognized for its role in **epithelial ovarian cancer**, it is not exclusively specific to this condition. *Epithelial ovarian cancer* - **CA 125** is a commonly used tumor marker for **epithelial ovarian cancer**, playing a role in its diagnosis, monitoring, and recurrence detection. - While elevated in a high percentage of advanced ovarian cancers, it can also be normal in early-stage disease. *Pelvic inflammatory disease* - **Inflammation** of the pelvic organs, such as in **Pelvic Inflammatory Disease (PID)**, can cause an increase in **CA 125** levels. - The elevation is typically due to the irritation of the peritoneal surface or the presence of inflammatory exudates. *Endometriosis* - **Endometriosis**, a condition where endometrial-like tissue grows outside the uterus, is a well-known cause of elevated **CA 125**. - The level of **CA 125** often correlates with the severity and extent of the endometrial implants.
Question 44: Following vaginal delivery, uterus becomes non-pregnant size by
- A. 9 weeks postpartum
- B. 8 weeks postpartum
- C. 6 weeks postpartum (Correct Answer)
- D. 4 weeks postpartum
Explanation: ***6 weeks postpartum*** - This period allows for sufficient **myometrial contraction** and involution to return the uterus to its pre-pregnancy size through the process of **autolysis** and fundal descent. - The uterine weight decreases significantly from about 1000g immediately after delivery to approximately 50-70g by 6 weeks. - By the end of the puerperium (6 weeks), complete uterine involution is achieved. *9 weeks postpartum* - By 9 weeks, uterine involution would have been completed much earlier, and the uterus would have attained its **non-pregnant size** several weeks prior. - This timeframe is typically beyond the normal window for the completion of uterine regression. *8 weeks postpartum* - Similar to 9 weeks, by 8 weeks postpartum, the uterus would have already returned to its **non-pregnant state**. - The process of **involution** is usually completed well before this mark. *4 weeks postpartum* - While significant **uterine involution** occurs by 4 weeks, the uterus may still be slightly larger and heavier than its pre-pregnancy size. - Complete return to the **non-pregnant state** typically requires an additional two weeks.
Question 45: Indications and prerequisites for delivery with the ventouse include which of the following? 1. Delay in the second stage of labour 2. Non-reassuring fetal heart rate 3. Gestation age less than 34 weeks of pregnancy 4. Vertex presentation.
- A. 1, 2 and 4 (Correct Answer)
- B. 2, 3 and 4
- C. 1, 2 and 3
- D. 1, 3 and 4
Explanation: ***1, 2 and 4*** - **Ventouse delivery** is indicated for **delay in the second stage of labor** and **non-reassuring fetal heart rate**, when expeditious delivery is required. - A crucial prerequisite is **vertex presentation**, ensuring proper application of the vacuum cup to the fetal head. *2, 3 and 4* - **Gestation age less than 34 weeks of pregnancy** is a contraindication for ventouse delivery due to the increased risk of **fetal scalp trauma** and **intracranial hemorrhage** in premature infants. - While **non-reassuring fetal heart rate** and **vertex presentation** are valid points, the inclusion of premature gestation makes this option incorrect. *1, 2 and 3* - Again, **gestation age less than 34 weeks of pregnancy** is a contraindication, not an indication or prerequisite, for ventouse delivery. - Although **delay in the second stage** and **non-reassuring fetal heart rate** are correct factors, the inclusion of prematurity renders this option incorrect. *1, 3 and 4* - This option incorrectly lists **gestation age less than 34 weeks of pregnancy** as a prerequisite. - While **delay in the second stage** and **vertex presentation** are appropriate, the prematurity contraindication makes this an unsuitable choice.
Question 46: Which of the following fetal infections is MOST commonly associated with significant intrauterine growth restriction?
- A. Human papillomavirus infection
- B. Rubella infection
- C. Toxoplasmosis
- D. Cytomegalovirus infection (Correct Answer)
Explanation: ***Cytomegalovirus infection*** - **Cytomegalovirus (CMV)** is the **most common congenital infection** and the **leading cause of intrauterine growth restriction (IUGR)** among the TORCH infections. - CMV has a direct cytopathic effect on fetal tissues and significantly impairs placental function, leading to severe and consistent growth restriction. - Congenital CMV infection affects approximately **0.5-1% of all live births**, with **IUGR being one of the most prominent features** in symptomatic cases. - Other manifestations include microcephaly, intracranial calcifications, hepatosplenomegaly, sensorineural hearing loss, and neurodevelopmental impairment. *Human papillomavirus infection* - **Human papillomavirus (HPV)** is primarily associated with genital warts and cervical dysplasia in mothers. - While vertical transmission can occur (causing juvenile-onset recurrent respiratory papillomatosis), HPV **does not cause IUGR**. - HPV is **not part of the TORCH infections** and has no association with fetal growth restriction. *Rubella infection* - **Congenital rubella syndrome** is characterized by the classic triad: cataracts, cardiac defects (patent ductus arteriosus), and sensorineural hearing loss. - While rubella **can cause IUGR**, it is far less common in modern practice due to widespread **MMR vaccination**. - The incidence of congenital rubella has dramatically decreased, making it a less frequent cause of IUGR compared to CMV. *Toxoplasmosis* - **Congenital toxoplasmosis** presents with the classic triad: hydrocephalus, intracranial calcifications, and chorioretinitis. - While toxoplasmosis **can contribute to growth restriction**, IUGR is not its most prominent or consistent feature. - **CMV remains the most common and most consistently associated** TORCH infection with significant IUGR in clinical practice.
Question 47: Missed abortion is not diagnosed if
- A. USG shows fetus with cardiac activity (Correct Answer)
- B. uterus is smaller than gestational age
- C. external os is closed
- D. vaginal bleed is brownish in colour
Explanation: ***USG shows fetus with cardiac activity*** - The presence of **fetal cardiac activity** on ultrasound is the definitive sign of a viable pregnancy, ruling out missed abortion. - Missed abortion is characterized by a **non-viable intrauterine pregnancy** (no cardiac activity) with a closed cervix, and would not be diagnosed if cardiac activity is detected. *uterus is smaller than gestational age* - A uterus consistently smaller than expected for gestational age can be a sign of a **non-viable pregnancy** or **intrauterine growth restriction**, both of which could be associated with missed abortion. - However, this finding alone is not diagnostic and needs confirmation with ultrasound to assess fetal viability. *external os is closed* - A **closed external os** is characteristic of a missed abortion, where the products of conception are retained within the uterus. - In a missed abortion, the cervix often remains closed, preventing the expulsion of the non-viable pregnancy. *vaginal bleed is brownish in colour* - **Brownish vaginal bleeding** indicates old or deoxygenated blood, which is a common symptom of a threatened abortion or missed abortion. - This type of bleeding suggests that the pregnancy may not be progressing normally and often prompts further investigation to assess fetal viability.