Community Medicine
1 questionsAs per the PC & PNDT Act, permission will be given to perform the tests for detection of which of the following?
UPSC-CMS 2022 - Community Medicine UPSC-CMS Practice Questions and MCQs
Question 51: As per the PC & PNDT Act, permission will be given to perform the tests for detection of which of the following?
- A. Sex-linked genetic diseases
- B. Chromosomal abnormalities
- C. Haemoglobinopathies
- D. All of the above (Correct Answer)
Explanation: ***All of the above*** - The **PC & PNDT Act** (Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994) permits prenatal diagnostic procedures specifically for detection of **chromosomal abnormalities**, **genetic metabolic diseases**, **haemoglobinopathies**, **sex-linked genetic diseases**, and **congenital anomalies** when there are medical indications. - All three conditions listed in the options (**sex-linked genetic diseases**, **chromosomal abnormalities**, and **haemoglobinopathies**) are explicitly mentioned in the Act as permissible reasons for prenatal testing. - The key principle is that these tests must be conducted only for detection of genetic/congenital abnormalities and **not for sex determination**, which is the primary prohibition under the Act. - Therefore, permission will be given for detection of all the conditions mentioned. *Why each individual option alone would be incomplete* - While each of the three conditions (**sex-linked genetic diseases**, **chromosomal abnormalities**, **haemoglobinopathies**) is individually permitted under the Act, selecting any single option would be incomplete. - The Act permits testing for all these categories of genetic disorders, not just one specific type. - This makes "All of the above" the most comprehensive and accurate answer.
Obstetrics and Gynecology
8 questionsIn which of the following situations might delayed cord clamping be contraindicated?
Which of the following best defines gestational hypertension?
A 27-year-old female is complaining of grayish white discharge with fishy odour. There is no history of itching associated with discharge. Which one of the following is the most likely diagnosis?
Which of the following is a contraindication for insertion of Intrauterine Contraceptive Device (IUCD)?
Regarding the phenomenon of ‘lightening’ in primigravida at term pregnancy, which one of the following statements is correct?
The first-line drug for intrapartum prophylaxis against Group β Streptococcal (GBS) infection in pregnancy is
Which of the following is NOT a component of the combined prenatal screening test in the first trimester?
Which of the following are correct regarding Placental Site Trophoblastic Tumour (PSTT)? 1. Low serum β-hCG 2. Composed mainly of cytotrophoblast 3. Highly responsive to chemo radiation 4. Confined to endometrium without myometrial invasion
UPSC-CMS 2022 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 51: In which of the following situations might delayed cord clamping be contraindicated?
- A. Placental abruption with maternal compromise
- B. Need for immediate neonatal resuscitation where delayed clamping interferes (Correct Answer)
- C. Severe maternal hemorrhage requiring immediate resuscitation
- D. Cord prolapse requiring immediate delivery
Explanation: ***Need for immediate neonatal resuscitation where delayed clamping interferes*** - If a neonate requires **immediate resuscitation** (e.g., due to severe birth asphyxia), delaying cord clamping would delay essential life-saving interventions - The priority is to establish effective **ventilation and circulation** in the newborn, which necessitates prompt cutting of the cord for transfer to a resuscitation area - **Current guidelines** recommend immediate cord clamping when the baby requires immediate positive pressure ventilation or other advanced resuscitation measures *Severe maternal hemorrhage requiring immediate resuscitation* - Severe maternal hemorrhage primarily affects the mother and necessitates rapid maternal resuscitation - This does **not inherently contraindicate** delayed cord clamping for the stable neonate - If the infant is healthy and does not require immediate intervention, delayed clamping can still be practiced while the maternal emergency is managed *Placental abruption with maternal compromise* - Placental abruption with maternal compromise is a severe obstetric emergency for the mother - Similar to severe maternal hemorrhage, it does **not automatically contraindicate** delayed cord clamping if the infant is stable - However, if abruption has led to fetal compromise requiring immediate neonatal resuscitation, then delayed cord clamping would be contraindicated due to the need for immediate neonatal intervention *Cord prolapse requiring immediate delivery* - While cord prolapse is an obstetric emergency requiring immediate delivery, delayed cord clamping is **not directly contraindicated** by the prolapse once delivery has occurred - The contraindication arises only if there's an urgent need to intervene in the neonate that would be delayed by waiting - The prolapse primarily dictates delivery timing, not cord clamping timing
Question 52: Which of the following best defines gestational hypertension?
- A. Sustained rise of blood pressure to 140/90 mmHg or more on two occasions 4-6 hours apart with proteinuria after 20 weeks of gestation
- B. Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 12 weeks of gestation
- C. Sustained rise of blood pressure to 150/100 mmHg or more on at least two occasions 2 hours apart after 20 weeks of gestation
- D. Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 20 weeks of gestation in a previously normotensive woman (Correct Answer)
Explanation: **Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 20 weeks of gestation in a previously normotensive woman** - **Gestational hypertension** is defined by a new onset of **hypertension** (≥140/90 mmHg) occurring for the first time **after 20 weeks of gestation**, without accompanying **proteinuria** or other systemic signs of preeclampsia. - The elevated blood pressure must be recorded on at least **two occasions 4-6 hours apart** to ensure it's a sustained elevation and not a transient spike. - The woman must be **previously normotensive** (normal blood pressure before pregnancy). *Sustained rise of blood pressure to 140/90 mmHg or more on two occasions 4-6 hours apart with proteinuria after 20 weeks of gestation* - The presence of **proteinuria** along with hypertension after 20 weeks of gestation defines **preeclampsia**, not gestational hypertension. - Gestational hypertension specifically excludes proteinuria or other signs of end-organ damage. *Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 12 weeks of gestation* - The onset of hypertension defining gestational hypertension must occur **after 20 weeks of gestation**. Hypertension before this period is typically considered **chronic hypertension**. - While the blood pressure criteria and timing are otherwise correct, the gestational age onset is incorrect for gestational hypertension. *Sustained rise of blood pressure to 150/100 mmHg or more on at least two occasions 2 hours apart after 20 weeks of gestation* - The threshold for hypertension in pregnancy is **140/90 mmHg**, not 150/100 mmHg; blood pressure at or above 160/110 mmHg indicates **severe hypertension**. - While recordings 2 hours apart might be relevant in some contexts, the standard for diagnosis of gestational hypertension usually specifies **4-6 hours apart** to confirm sustained elevation.
Question 53: A 27-year-old female is complaining of grayish white discharge with fishy odour. There is no history of itching associated with discharge. Which one of the following is the most likely diagnosis?
- A. Trichomoniasis
- B. Urinary tract infection
- C. Bacterial vaginosis (Correct Answer)
- D. Candidiasis
Explanation: ***Bacterial vaginosis*** - The classic presentation includes **grayish-white vaginal discharge** with a **fishy odor**, especially after intercourse, and **absence of itching**. - This clinical picture aligns perfectly with **Amsel's criteria** for bacterial vaginosis, which include vaginal pH >4.5, clue cells on microscopy, and a positive whiff test. *Trichomoniasis* - Characteristically presents with a **frothy, greenish-yellow discharge** and often causes **vulvovaginal itching and irritation**, which are not reported here. - While it can cause a foamy discharge and sometimes a foul odor, the specific symptom profile given is less typical for trichomoniasis. *Urinary tract infection* - Primarily involves symptoms such as **dysuria (painful urination)**, frequent urination, and urgency, rather than vaginal discharge. - A UTI does not typically present with a "fishy-smelling grayish-white discharge" as its primary symptom. *Candidiasis* - Typically presents with a **thick, white, "cottage cheese-like" discharge** and is almost always associated with significant **vulvovaginal itching and burning**. - The absence of itching and the description of a grayish, fishy-smelling discharge make candidiasis highly unlikely.
Question 54: Which of the following is a contraindication for insertion of Intrauterine Contraceptive Device (IUCD)?
- A. Suspected pregnancy (Correct Answer)
- B. Age > 35 years
- C. Severe dysmenorrhea
- D. Multiple sexual partners
Explanation: ***Suspected pregnancy*** - Insertion of an IUCD into a pregnant uterus is an **absolute contraindication** (WHO MEC Category 4). - Can lead to **septic abortion**, **miscarriage**, **uterine perforation**, or **ectopic pregnancy complications**. - **Pregnancy must be ruled out** before IUCD insertion through history, examination, and urine pregnancy test if indicated. *Age > 35 years* - Age alone is **not a contraindication** for IUCD insertion. - IUCDs are safe and highly effective for women over 35 years. - In fact, IUCDs are often preferred for older reproductive-age women due to high efficacy and non-hormonal options. *Severe dysmenorrhea* - **Not an absolute contraindication** for IUCD insertion. - **Copper IUCDs** may worsen dysmenorrhea and should be used with caution. - **Levonorgestrel-releasing IUCDs (LNG-IUS)** are actually **therapeutic** for severe dysmenorrhea and reduce menstrual blood loss. - The type of IUCD can be selected based on the clinical scenario. *Multiple sexual partners* - **Not a contraindication** for IUCD insertion per WHO Medical Eligibility Criteria. - While multiple partners increase STI risk, this can be addressed through **STI screening** and **barrier contraception counseling**. - IUCDs do not increase risk of PID in women without current cervical infection. - The outdated concern about PID risk has been refuted by modern evidence.
Question 55: Regarding the phenomenon of ‘lightening’ in primigravida at term pregnancy, which one of the following statements is correct?
- A. It occurs earlier in primigravida compared to multigravida.
- B. There are no bladder or bowel symptoms associated with this phenomenon.
- C. It is a welcome sign since it indicates descent fetal head into pelvis. (Correct Answer)
- D. It is associated with worsening cardiorespiratory embarrassment in mother.
Explanation: ***It is a welcome sign since it indicates descent fetal head into pelvis.*** - **Lightening** (also known as "dropping") is the descent of the fetal head into the **pelvic inlet** before labor begins. This is a **positive sign** as it suggests the fetus is preparing for birth. - The descent of the fetal head often relieves pressure on the mother's diaphragm, making breathing easier. *It occurs earlier in primigravida compared to multigravida.* - In **primigravidae**, lightening typically occurs around **2-4 weeks before labor**, as the fetal head engages into the pelvis. - In **multigravidae**, lightening often occurs **later**, sometimes not until the onset of labor or during labor, because their pelvic muscles are more lax and the fetal head may not engage until labor begins. - This statement is **incorrect** as it would reverse the actual timing. *There are no bladder or bowel symptoms associated with this phenomenon.* - As the fetus descends into the pelvis, it places **increased pressure on the bladder** and rectum. - This often leads to symptoms such as **increased urinary frequency** and a feeling of **pelvic pressure** or discomfort. *It is associated with worsening cardiorespiratory embarrassment in mother.* - **Lightening** actually **alleviates** cardiorespiratory embarrassment because the uterus drops, reducing pressure on the diaphragm and thus making breathing **easier** for the mother. - Before lightening, the high fundal height can lead to **shortness of breath** and discomfort.
Question 56: The first-line drug for intrapartum prophylaxis against Group β Streptococcal (GBS) infection in pregnancy is
- A. penicillin (Correct Answer)
- B. doxycycline
- C. vancomycin
- D. azithromycin
Explanation: ***penicillin*** - **Penicillin G** is the drug of choice for intrapartum GBS prophylaxis due to its **narrow spectrum** and proven efficacy in preventing neonatal GBS disease. - It rapidly achieves bactericidal concentrations in the amniotic fluid, effectively eradicating GBS from the maternal genital tract during labor. *doxycycline* - **Doxycycline** is a **tetracycline antibiotic** generally contraindicated in pregnancy due to potential adverse effects on fetal bone and tooth development. - It is not effective against GBS and is not used for its treatment or prophylaxis in pregnant women. *vancomycin* - **Vancomycin** is reserved for pregnant women with **severe penicillin allergy** (e.g., anaphylaxis) or isolates with known resistance to penicillin and clindamycin. - Its use is limited due to the need for intravenous administration and potential for ototoxicity or nephrotoxicity. *azithromycin* - **Azithromycin** is sometimes used for GBS prophylaxis in cases of penicillin allergy but is **less preferred** than clindamycin due to emerging GBS resistance. - It is not considered a first-line agent, and susceptibility testing is crucial if it is considered for use.
Question 57: Which of the following is NOT a component of the combined prenatal screening test in the first trimester?
- A. 1. β-hCG
- B. 2. MS AFP (α-Fetoprotein) (Correct Answer)
- C. 4. PAPP-A
- D. 3. Nuchal translucency
Explanation: ***2. MS AFP (α-Fetoprotein)*** - **MS AFP (maternal serum α-Fetoprotein)** is primarily used in the **second-trimester screening** (quad screen or triple screen) to detect **neural tube defects** and certain chromosomal abnormalities. - It is **NOT part of the first-trimester combined screening test**. - The first trimester combined screening is performed between **11-13+6 weeks** of gestation. *1. β-hCG* - **β-hCG** (beta-human chorionic gonadotropin) is a key biochemical marker used in the first-trimester combined screening. - Abnormal levels of **β-hCG** (elevated in Down syndrome, decreased in Trisomy 18) are integrated with other markers to calculate risk for chromosomal abnormalities. *3. Nuchal translucency* - **Nuchal translucency (NT)** measurement is a crucial ultrasound marker used in the first-trimester combined screening test. - Increased NT thickness (≥3.5 mm) is associated with a higher risk of **aneuploidies** (Down syndrome, Trisomy 18, Trisomy 13) and certain structural cardiac defects. *4. PAPP-A* - **PAPP-A** (Pregnancy-Associated Plasma Protein-A) is a biochemical marker included in the first-trimester combined screening. - Low levels of **PAPP-A** are associated with an increased risk of Down syndrome and other adverse pregnancy outcomes.
Question 58: Which of the following are correct regarding Placental Site Trophoblastic Tumour (PSTT)? 1. Low serum β-hCG 2. Composed mainly of cytotrophoblast 3. Highly responsive to chemo radiation 4. Confined to endometrium without myometrial invasion
- A. 1. Low serum β-hCG (Correct Answer)
- B. 4. Confined to endometrium without myometrial invasion
- C. 2. Composed mainly of cytotrophoblast
- D. 3. Highly responsive to chemo radiation
Explanation: ***Low serum β-hCG*** - **PSTT** originates from intermediate trophoblasts, which produce **human placental lactogen (hPL)** rather than **β-hCG**, leading to relatively low serum β-hCG levels. - This low **β-hCG** is a key differentiator from other gestational trophoblastic neoplasms like **choriocarcinoma**. *Confined to endometrium without myometrial invasion* - **PSTT** is known for its **local invasiveness** and frequently invades into the **myometrium**, and may even penetrate the serosa. - Its infiltrative growth pattern can lead to **uterine rupture** and significant **hemorrhage**. *Composed mainly of cytotrophoblast* - **PSTT** is primarily composed of **intermediate trophoblasts**, not cytotrophoblasts. - These intermediate trophoblasts are characterized by their **mononuclear appearance** and distinctive immunohistochemical staining pattern, including positivity for **hPL** and **cytokeratin**. *Highly responsive to chemo radiation* - PSTT is **not highly responsive** to chemotherapy; it often exhibits **chemoresistance**, especially in advanced stages. - Because of its chemoresistance, **surgery** (hysterectomy) is the primary treatment for localized disease, and systemic therapy options are more challenging.
Physiology
1 questionsIn hyperemesis gravidarum, Wernicke's encephalopathy is seen due to the deficiency of
UPSC-CMS 2022 - Physiology UPSC-CMS Practice Questions and MCQs
Question 51: In hyperemesis gravidarum, Wernicke's encephalopathy is seen due to the deficiency of
- A. vitamin B6
- B. vitamin B12
- C. vitamin B1 (Correct Answer)
- D. vitamin B9
Explanation: ***vitamin B1*** - **Wernicke's encephalopathy** is directly caused by a severe deficiency of **thiamine (vitamin B1)**. - In **hyperemesis gravidarum**, persistent vomiting leads to inadequate intake and absorption of this vital vitamin. *vitamin B6* - Deficiency of **vitamin B6 (pyridoxine)** can cause peripheral neuropathy, glossitis, and dermatitis. - While important for many metabolic processes, its deficiency is not directly linked to Wernicke's encephalopathy. *vitamin B12* - **Vitamin B12 (cobalamin)** deficiency primarily results in megaloblastic anemia and subacute combined degeneration of the spinal cord. - It does not cause the specific neurological triad of Wernicke's encephalopathy. *vitamin B9* - Deficiency of **vitamin B9 (folate)** leads to megaloblastic anemia and is crucial for neural tube development. - It is not associated with the pathogenesis of Wernicke's encephalopathy.