A typical case of Iron Deficiency Anaemia (IDA) in pregnancy will show which of the following?
1. Hb less than 10 g/dL
2. PCV less than 30%
3. MCHC more than 30%
4. Microcytic hypochromic picture on peripheral blood smear (PBS).
Select the correct answer using the code given below:
UPSC-CMS 2023 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 151: A typical case of Iron Deficiency Anaemia (IDA) in pregnancy will show which of the following?
1. Hb less than 10 g/dL
2. PCV less than 30%
3. MCHC more than 30%
4. Microcytic hypochromic picture on peripheral blood smear (PBS).
Select the correct answer using the code given below:
A. 1, 2 and 4 (Correct Answer)
B. 1, 2 and 3
C. 2, 3 and 4
D. 1 and 4 only
Explanation: ***1, 2 and 4***
- All three options (Hb < 10 g/dL, PCV < 30%, and microcytic hypochromic picture on PBS) are characteristic features of **iron deficiency anemia (IDA)** in pregnancy [1].
- While exact thresholds can vary, these values generally indicate significant anemia and the classic morphological changes associated with IDA [1].
*1, 2 and 3*
- This option incorrectly includes "MCHC more than 30%." IDA is characterized by **hypochromia**, meaning **MCHC (mean corpuscular hemoglobin concentration)** is typically *less than* 30%, not more [1].
- The other two points (Hb < 10 g/dL and PCV < 30%) are consistent with IDA [1].
*2, 3 and 4*
- This option incorrectly includes "MCHC more than 30%," which is contrary to the **hypochromic** nature of IDA [1].
- While PCV < 30% and microcytic hypochromic picture on PBS are correct, the inclusion of incorrect MCHC value makes this choice invalid.
*1 and 4 only*
- This option correctly identifies Hb less than 10 g/dL and a microcytic hypochromic picture on PBS as features of IDA [1].
- However, it omits **PCV less than 30%**, which is also a common finding in IDA, making it an incomplete answer compared to the most comprehensive correct option.
Obstetrics and Gynecology
9 questions
Q151
Which of the following are the clinical features of molar pregnancy ?
1. History of amenorrhea and vaginal bleeding
2. Patient has excessive vomiting
3. History of expulsion of grape-like vesicles
Select the correct answer using the code given below :
Q152
Which of the following vaccines can be given to a pregnant woman ?
1. COVID vaccine
2. Measles, Mumps, Rubella vaccine
3. Hepatitis B vaccine
4. Rabies vaccine
Select the correct answer using the code given below :
Q153
Which of the following are the characteristics of true labour pains ?
1. Intensity and duration of contractions increase progressively
2. Progressive effacement and dilatation of the cervix
3. Formation of the 'bag of forewaters'
4. Pain is confined to lower abdomen and groin
Select the correct answer using the code given below :
Q154
Which are the parts of active management of third stage of labour?
1. Injection oxytocin 10 units IM within 1 minute of delivery of baby
2. Uterine massage after placental delivery
3. Controlled cord traction
4. Delayed cord clamping as per indications
Select the correct answer using the code given below:
Q155
Which of the following are correct regarding acute mastitis ?
1. It usually occurs in first 2 - 4 weeks postpartum.
2. Microscopic examination of breast milk shows leukocyte count more than 10^6/mL and bacterial count more than 10^3/mL.
3. Common organisms are bacteroids, E. coli and Klebsiella.
4. The source of infection is infant's nose and throat.
Select the correct answer using the code given below :
Q156
As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), complete tear of External Anal Sphincter is of degree :
Q157
What are the causes of lactation failure after delivery ?
1. Infrequent suckling
2. Depression or anxiety state in the puerperium
3. Prolactin inhibition
Select the correct answer using the code given below :
Q158
Secondary arrest of dilatation during the process of labour may be due to which of the following factors ?
1. Poor uterine contractions
2. Cessation of cervical dilatation despite strong uterine contractions
3. Disproportion and malpresentation
Select the correct answer using the code given below :
Q159
Which of the following correctly defines the first stage of labor?
1. Full dilatation of cervix to the expulsion of the fetus from the birth canal
2. Maternal bearing down efforts and ends with the delivery of the baby
3. The onset of true labor pains and ends with the full dilatation of cervix
4. The formation of bag of waters
UPSC-CMS 2023 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 151: Which of the following are the clinical features of molar pregnancy ?
1. History of amenorrhea and vaginal bleeding
2. Patient has excessive vomiting
3. History of expulsion of grape-like vesicles
Select the correct answer using the code given below :
A. 1, 2 and 3 (Correct Answer)
B. 1 and 3 only
C. 2 and 3 only
D. 1 and 2 only
Explanation: ***1, 2 and 3***
- **All three are clinical features of molar pregnancy (hydatidiform mole)**
- **Amenorrhea and vaginal bleeding**: Classic presentation seen in most cases. Vaginal bleeding typically occurs in the first or early second trimester and is the most common presenting symptom
- **Excessive vomiting (hyperemesis gravidarum)**: Occurs in approximately 25-30% of cases due to abnormally high levels of **hCG** produced by the proliferating trophoblastic tissue, much higher than in normal pregnancy
- **Expulsion of grape-like vesicles**: This is a **pathognomonic (definitive) sign** of molar pregnancy. While it may not be the initial presenting symptom and often occurs during spontaneous expulsion or evacuation, it is a characteristic clinical feature when present
- **Other features**: Uterine size larger than dates, absent fetal heart sounds, pre-eclampsia before 20 weeks, and markedly elevated serum hCG levels
*1 and 2 only*
- This option incorrectly excludes the **expulsion of grape-like vesicles**, which is a definitive clinical feature of molar pregnancy
- While vesicle expulsion may occur later in the clinical course, the question asks about clinical features, not just initial presenting symptoms
*2 and 3 only*
- This option omits **amenorrhea and vaginal bleeding**, which are the most common and important presenting symptoms
- Vaginal bleeding occurs in 80-90% of molar pregnancies and is typically the chief complaint
*1 and 3 only*
- This option incorrectly excludes **excessive vomiting**, which is a well-recognized clinical feature occurring in 25-30% of cases
- Hyperemesis gravidarum associated with molar pregnancy can be severe due to extremely elevated hCG levels
Question 152: Which of the following vaccines can be given to a pregnant woman ?
1. COVID vaccine
2. Measles, Mumps, Rubella vaccine
3. Hepatitis B vaccine
4. Rabies vaccine
Select the correct answer using the code given below :
A. 1, 2 and 3
B. 1, 3 and 4 (Correct Answer)
C. 2, 3 and 4
D. 1, 2 and 4
Explanation: ***1, 3 and 4***
The vaccines that can be safely given during pregnancy are:
- **COVID-19 vaccine** (mRNA or inactivated virus) is recommended for pregnant women to protect against severe illness. It has been shown to be safe and effective, and provides passive immunity to the newborn.
- **Hepatitis B vaccine** is safe during pregnancy as it is an inactivated vaccine. Vaccination can provide protection for both the mother and the newborn, preventing vertical transmission.
- **Rabies vaccine** (inactivated) is given in situations of exposure to rabies, as the risk of rabies infection (which is almost 100% fatal) far outweighs any theoretical risk from the vaccine during pregnancy.
*1, 2 and 3*
This option incorrectly includes the **Measles, Mumps, Rubella (MMR) vaccine**, which is a live attenuated vaccine and is **contraindicated in pregnancy** due to the theoretical risk of congenital infection. While COVID-19 and Hepatitis B vaccines are safe, the inclusion of MMR makes this option incorrect.
*2, 3 and 4*
This option is incorrect because the **Measles, Mumps, Rubella (MMR) vaccine** is a live attenuated vaccine and is contraindicated during pregnancy. Women should be counseled to avoid pregnancy for at least 4 weeks after receiving MMR vaccine. Hepatitis B and Rabies vaccines are safe, but the presence of MMR makes this choice incorrect.
*1, 2 and 4*
This option incorrectly includes the **Measles, Mumps, Rubella (MMR) vaccine**, which is a live attenuated vaccine and should not be given to pregnant women. COVID-19 and Rabies vaccines are safe in pregnancy, but the contraindication for MMR makes this selection incorrect.
Question 153: Which of the following are the characteristics of true labour pains ?
1. Intensity and duration of contractions increase progressively
2. Progressive effacement and dilatation of the cervix
3. Formation of the 'bag of forewaters'
4. Pain is confined to lower abdomen and groin
Select the correct answer using the code given below :
A. 1, 2 and 4
B. 1, 3 and 4
C. 2, 3 and 4
D. 1, 2 and 3 (Correct Answer)
Explanation: ***Correct Answer: 1, 2 and 3***
- **Progressive increase in intensity and duration of contractions** (1) is a hallmark of true labor, as uterine activity becomes more coordinated and forceful over time.
- **Progressive effacement and dilatation of the cervix** (2) are the definitive signs of true labor, indicating that the uterus is actively working to prepare for birth.
- The **formation of the 'bag of forewaters'** (3) occurs as the lower uterine segment stretches and the fetal head descends, causing the membranes to bulge into the cervical os, which is characteristic of advancing labor.
*Incorrect: 1, 2 and 4*
- While options 1 and 2 are true, the statement that **pain is confined to the lower abdomen and groin** (4) is incorrect; true labor pain typically **starts in the back and radiates anteriorly** to the lower abdomen.
- True labor pain is typically felt as a **wave-like contraction** that encompasses the entire uterus, not just localized to the lower abdomen and groin.
*Incorrect: 1, 3 and 4*
- Options 1 and 3 are correct diagnostic characteristics, but **pain confined to the lower abdomen and groin** (4) is not accurate for true labor pain, which usually involves the back as well.
- The absence of **progressive cervical changes** (2) makes this option incomplete as a definition of true labor.
*Incorrect: 2, 3 and 4*
- While **progressive effacement and dilatation of the cervix** (2) and **formation of the 'bag of forewaters'** (3) are signs of true labor, the characteristic that **pain is confined to the lower abdomen and groin** (4) is incorrect.
- This option also omits the crucial feature of **increasing intensity and duration of contractions** (1), which is a primary indicator of true labor.
Question 154: Which are the parts of active management of third stage of labour?
1. Injection oxytocin 10 units IM within 1 minute of delivery of baby
2. Uterine massage after placental delivery
3. Controlled cord traction
4. Delayed cord clamping as per indications
Select the correct answer using the code given below:
A. 1, 2 and 3 (Correct Answer)
B. 1, 2 and 4
C. 2, 3 and 4
D. 1, 3 and 4
Explanation: ***1, 2 and 3***
- **Active management of the third stage of labor (AMTSL)** consists of three key interventions: **prophylactic uterotonic administration** (oxytocin 10 units IM within 1 minute of delivery), **controlled cord traction**, and **uterine massage after placental delivery**.
- These interventions work synergistically to prevent **postpartum hemorrhage** by promoting rapid uterine contraction and complete placental expulsion.
- This combination represents the **WHO-recommended standard** for AMTSL.
*1, 2 and 4*
- **Delayed cord clamping** (4) is an important **neonatal intervention** for improving iron stores and hemoglobin levels in the newborn, but it is **not a component of AMTSL**.
- While this option correctly includes **oxytocin administration** (1) and **uterine massage** (2), it omits **controlled cord traction** (3), which is essential for safe placental delivery.
- Delayed cord clamping is typically performed **before** AMTSL interventions begin.
*2, 3 and 4*
- This option omits **immediate prophylactic oxytocin** (1), which is the **most critical component** of AMTSL for preventing postpartum hemorrhage.
- Without prompt uterotonic administration, the risk of **uterine atony** and subsequent hemorrhage increases significantly.
- Additionally, **delayed cord clamping** (4) is not part of the AMTSL protocol.
*1, 3 and 4*
- This option omits **uterine massage after placental delivery** (2), which is important for ensuring sustained uterine contraction and detecting early signs of atony.
- While **oxytocin** (1) and **controlled cord traction** (3) are correctly included, **delayed cord clamping** (4) is **not a component of AMTSL**.
- The absence of uterine massage reduces the completeness of active management.
Question 155: Which of the following are correct regarding acute mastitis ?
1. It usually occurs in first 2 - 4 weeks postpartum.
2. Microscopic examination of breast milk shows leukocyte count more than 10^6/mL and bacterial count more than 10^3/mL.
3. Common organisms are bacteroids, E. coli and Klebsiella.
4. The source of infection is infant's nose and throat.
Select the correct answer using the code given below :
A. 1, 3 and 4
B. 1, 2 and 3
C. 1, 2 and 4 (Correct Answer)
D. 2, 3 and 4
Explanation: ***1, 2 and 4***
- **Acute mastitis** most frequently occurs within the **first 2-4 weeks postpartum** during lactation establishment (Statement 1 correct)
- Diagnosis of infectious mastitis is confirmed by **breast milk culture** showing **leukocyte count > 10^6/mL** and **bacterial count > 10^3/mL** (Statement 2 correct)
- **The primary source of infection** is the infant's **nose and throat flora**, which colonizes the mother's nipple and invades through cracks or fissures (Statement 4 correct)
- **Staphylococcus aureus** is the most common causative organism, not Bacteroides, E. coli, or Klebsiella (Statement 3 incorrect)
*1, 3 and 4*
- While statements 1 and 4 are correct, statement 3 incorrectly identifies the common organisms
- The primary organism responsible for acute mastitis is **Staphylococcus aureus** from infant's oral flora, not anaerobes or gram-negative organisms
*1, 2 and 3*
- Statements 1 and 2 are correct, but statement 3 is incorrect
- **Staphylococcus aureus** accounts for the vast majority of mastitis cases, not Bacteroides, E. coli, or Klebsiella
*2, 3 and 4*
- Statements 2 and 4 are correct, but statement 3 incorrectly identifies the causative organisms
- The correct organism is **Staphylococcus aureus**, not the organisms listed in statement 3
Question 156: As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), complete tear of External Anal Sphincter is of degree :
A. 2c
B. 3c (Correct Answer)
C. 3b
D. 3a
Explanation: ***3c***
- A **3c tear** involves a **complete tear** of the **external anal sphincter (EAS)**, often along with the internal anal sphincter (IAS) being involved in any degree during obstetric anal sphincter injury (OASI).
- According to the RCOG (Royal College of Obstetricians and Gynaecologists) 2007 classification, this signifies a severe and complete disruption of the external sphincter.
*2c*
- A **2c tear** would typically refer to a **more extensive second-degree perineal tear** involving deeper muscle layers, but it does **not involve the anal sphincters**.
- Second-degree tears involve the skin, vaginal mucosa, and perineal muscles but spare the anal sphincter complex.
*3b*
- A **3b tear** signifies a **partial tear of the external anal sphincter (EAS)**, with **more than 50%** of the muscle thickness being torn.
- While it involves the EAS, it is not a complete tear as described in the question, differentiating it from a 3c tear.
*3a*
- A **3a tear** indicates an **involvement of the external anal sphincter (EAS)**, specifically a partial tear of the EAS involving **less than 50%** of its thickness.
- This is a less severe injury than a 3b or 3c tear and does not represent a complete tear of the EAS.
Question 157: What are the causes of lactation failure after delivery ?
1. Infrequent suckling
2. Depression or anxiety state in the puerperium
3. Prolactin inhibition
Select the correct answer using the code given below :
A. 1 and 2 only
B. 2 and 3 only
C. 1 and 3 only
D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3***
- **Infrequent suckling** directly reduces the stimulation needed for **prolactin release** and **milk production**, leading to lactation failure.
- **Depression or anxiety** can interfere with the **let-down reflex** by inhibiting **oxytocin release** and also decrease a mother's motivation and ability to breastfeed effectively.
- Any condition causing **prolactin inhibition**, such as certain medications (e.g., dopamine agonists) or specific medical conditions (e.g., Sheehan's syndrome), will directly prevent milk synthesis.
*1 and 2 only*
- This option correctly identifies infrequent suckling and emotional states as causes but fails to include **prolactin inhibition**, which is a direct and significant physiological factor in lactation failure.
- Excluding **prolactin inhibition** provides an incomplete understanding of all potential causes for inadequate milk production.
*2 and 3 only*
- This option correctly recognizes the impact of emotional states and prolactin inhibition but overlooks **infrequent suckling**, which is one of the most common behavioral reasons for reduced milk supply.
- Lack of adequate and frequent nipple stimulation is crucial for establishing and maintaining a robust milk supply.
*1 and 3 only*
- This option correctly identifies infrequent suckling and prolactin inhibition but omits the significant role of **maternal psychological states** like depression and anxiety in successful lactation.
- Emotional well-being heavily influences the **milk ejection reflex** and overall breastfeeding success.
Question 158: Secondary arrest of dilatation during the process of labour may be due to which of the following factors ?
1. Poor uterine contractions
2. Cessation of cervical dilatation despite strong uterine contractions
3. Disproportion and malpresentation
Select the correct answer using the code given below :
A. 1 and 2 only
B. 1, 2 and 3 (Correct Answer)
C. 1 and 3 only
D. 2 and 3 only
Explanation: ***1, 2 and 3***
- **Secondary arrest of dilatation** refers to a cessation of cervical dilatation in the active phase of labor after the cervix has already begun to dilate, often attributed to **poor uterine contractions** (hypocontractility) hindering cervical progress.
- While weak contractions are a common cause, secondary arrest can also occur despite **strong uterine contractions** if there's an underlying mechanical issue, such as **cephalopelvic disproportion** or **fetal malpresentation**, preventing the fetal head from descending and dilating the cervix effectively.
*1 and 2 only*
- This option incorrectly excludes **disproportion and malpresentation** as potential causes of secondary arrest of dilatation.
- Both poor uterine contractions and cessation of dilatation despite strong contractions are valid causes, but overlooking mechanical impediments like disproportion leaves the explanation incomplete.
*1 and 3 only*
- This option overlooks the scenario where **cervical dilatation ceases despite strong uterine contractions**, which is a distinct presentation of arrest that points to mechanical obstruction rather than purely ineffective contractions.
- While poor contractions and disproportion/malpresentation are important, the specified scenario of strong contractions with no progress is also a key factor.
*2 and 3 only*
- This option incorrectly omits **poor uterine contractions** as a primary and very common cause of secondary arrest of dilatation.
- Weak or uncoordinated contractions are often the first factor investigated when cervical progression stalls.
Question 159: Which of the following correctly defines the first stage of labor?
1. Full dilatation of cervix to the expulsion of the fetus from the birth canal
2. Maternal bearing down efforts and ends with the delivery of the baby
3. The onset of true labor pains and ends with the full dilatation of cervix
4. The formation of bag of waters
A. 1, 2 and 4
B. 1, 3 and 4
C. 1, 2 and 3
D. 2, 3 and 4 (Correct Answer)
Explanation: ***Correct Answer: Only Statement 3***
The **first stage of labor** is accurately defined by **statement 3 only**: "The onset of true labor pains and ends with the full dilatation of cervix"
**Statement 3 - The onset of true labor pains and ends with the full dilatation of cervix** ✓
- This is the **accurate and complete definition** of the **first stage of labor**
- Begins with regular, progressive uterine contractions
- Ends when cervix reaches **10 cm (full) dilatation**
- Divided into **latent phase** (0-6 cm) and **active phase** (6-10 cm)
- Duration varies but averages 8-12 hours in primigravidas
**Why other statements are INCORRECT:**
*Statement 1 - Full dilatation of cervix to the expulsion of the fetus*
- This describes the **SECOND stage of labor**, NOT the first stage
- Second stage: begins at full cervical dilatation (10 cm) and ends with delivery of baby
*Statement 2 - Maternal bearing down efforts and ends with the delivery of the baby*
- This also describes the **SECOND stage of labor**
- Active pushing occurs after full dilatation, not during the first stage
*Statement 4 - The formation of bag of waters*
- The amniotic sac forms during **pregnancy**, not during labor
- Its rupture may occur during labor but does not define the first stage
- Not a defining characteristic of any labor stage
**Note:** Among the given options, **"2, 3 and 4"** is selected as it contains the correct statement (3). However, strictly speaking, only statement 3 correctly defines the first stage of labor. Statements 2 and 4 do not define the first stage.