Community Medicine
2 questionsWhich one of the following is defined as "the average number of children a woman would have if she were to pass through her reproductive years, bearing children at the same rates as the women now in each age group" ?
Which among the following is correct about yellow fever vaccination requirement for international travellers ? 1. Term of validity of the certificate is changed from 10 years to the duration of the life of the vaccinated person. 2. Lifetime validity of the certificate applies automatically to all existing and new certificates. 3. Validity of the certificate begins 4 days after vaccination. 4. In India, booster dose of yellow fever vaccine is required for those whose certificate is prior to the year 2016. Select the correct answer using the code given below :
UPSC-CMS 2023 - Community Medicine UPSC-CMS Practice Questions and MCQs
Question 181: Which one of the following is defined as "the average number of children a woman would have if she were to pass through her reproductive years, bearing children at the same rates as the women now in each age group" ?
- A. Net Reproduction Rate (NRR)
- B. Total Fertility Rate (TFR) (Correct Answer)
- C. General Fertility Rate (GFR)
- D. Age-Specific Fertility Rate (ASFR)
Explanation: **Total Fertility Rate (TFR)** - The **Total Fertility Rate (TFR)** is a measure of the average number of children a woman is expected to have over her lifetime, assuming current age-specific fertility rates. - It is a synthetic measure that reflects the reproductive patterns of a given population at a specific time. *Net Reproduction Rate (NRR)* - The **Net Reproduction Rate (NRR)** is similar to the Gross Reproduction Rate but also accounts for **mortality rates** among females before completing their reproductive years. - It measures the number of daughters a newborn girl can expect to have during her lifetime, considering current age-specific fertility and mortality rates. *General Fertility Rate (GFR)* - The **General Fertility Rate (GFR)** calculates the number of live births per 1,000 women of reproductive age (typically 15-49 years). - It is a broader measure than age-specific rates but does not project the total number of children a woman might have. *Age-Specific Fertility Rate (ASFR)* - An **Age-Specific Fertility Rate (ASFR)** measures the number of live births to women in a particular age group per 1,000 women in that same age group. - While it provides data for specific age cohorts, it does not combine these to give a lifetime average as described in the definition.
Question 182: Which among the following is correct about yellow fever vaccination requirement for international travellers ? 1. Term of validity of the certificate is changed from 10 years to the duration of the life of the vaccinated person. 2. Lifetime validity of the certificate applies automatically to all existing and new certificates. 3. Validity of the certificate begins 4 days after vaccination. 4. In India, booster dose of yellow fever vaccine is required for those whose certificate is prior to the year 2016. Select the correct answer using the code given below :
- A. 2 and 4
- B. 2 and 3
- C. 1 and 2 (Correct Answer)
- D. 1 and 3
Explanation: ***1 and 2*** - The **term of validity** of the International Certificate of Vaccination or Prophylaxis (ICVP) for yellow fever changed from 10 years to **lifetime duration** on **July 11, 2016** (WHO IHR amendment). - This **lifetime validity** applies automatically to all existing and new ICVPs, regardless of when they were issued. - Both statements accurately reflect current WHO International Health Regulations. *2 and 4* - While statement 2 is correct, statement 4 is incorrect; **India does not require a booster dose** for yellow fever even if the certificate is prior to 2016. - The lifetime validity supersedes all previous recommendations, and India follows WHO guidelines. *2 and 3* - While statement 2 is correct, statement 3 is incorrect; the **validity of the certificate begins 10 days after vaccination**, not 4 days. - This 10-day period allows for the development of adequate immune response to the yellow fever vaccine. *1 and 3* - While statement 1 is correct regarding the change to lifetime validity, statement 3 is incorrect; the **certificate's validity begins 10 days after vaccination**, not 4 days. - The 10-day waiting period is a standard requirement under WHO IHR.
Obstetrics and Gynecology
8 questionsBilateral total salpingectomy is a recommended surgical procedure to reduce the risk of :
Tongue bite occurs in eclampsia at :
Indication for removal of IUDs include which of the following ? 1. Perforation of uterus 2. Pregnancy with device in situ 3. One year after menopause 4. Persistent migraine Select the correct answer using the code given below :
Which of the following are the absolute contraindications for the use of combined oral contraceptive pills ? 1. Severe hypertension 2. Pregnancy 3. Diabetes with retinopathy 4. Gall bladder disease Select the correct answer using the code given below :
A 27-year-old recently married female comes to family planning clinic requesting for long term reversible contraception. Which one of the following is the best suited option for her ?
Which one of the following is an indication for knife conisation? 1. Treatment of Nabothian follicle 2. Diagnosis and directed biopsy of cervix when punch biopsy is inadequate 3. Unsatisfactory colposcopy (transformation zone not fully visible) 4. Negative endocervical curettage Select the correct answer using the code given below:
Which of the following statements regarding female sterilization is correct? 1. It can be done 24 - 48 hours following delivery. 2. Ideal time for interval ligation is luteal phase preceding menstruation. 3. It can be combined with medical termination of pregnancy. 4. It is a preventive measure against serous ovarian cancer. Select the correct answer using the code given below:
The most popular technique of tubal ligation is :
UPSC-CMS 2023 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 181: Bilateral total salpingectomy is a recommended surgical procedure to reduce the risk of :
- A. Uterine cancer
- B. Epithelial ovarian cancer (Correct Answer)
- C. Fallopian tube cancer
- D. Peritoneal cancer
Explanation: ***Epithelial ovarian cancer*** - Many high-grade serous ovarian cancers, the most common and aggressive type, are now believed to originate in the **distal fallopian tube** (specifically the fimbriae). - Removing the fallopian tubes significantly reduces the risk of these cancers, especially in women at **high genetic risk** (e.g., BRCA1/2 mutations) or undergoing hysterectomy for benign indications. *Uterine cancer* - Uterine cancer primarily affects the **endometrium** (lining of the uterus) or the **myometrium** (muscle wall). - Bilateral salpingectomy, which involves removing the fallopian tubes, does not directly influence the risk of uterine cancer. *Fallopian tube cancer* - While bilateral salpingectomy removes the fallopian tubes, the primary goal for risk reduction associated with these tubes is for **epithelial ovarian cancer**, not primary fallopian tube cancer itself. - Primary fallopian tube cancer is extremely rare, and often shares similar histopathological features and biological behavior with high-grade serous ovarian cancer. *Peritoneal cancer* - Peritoneal cancer can arise from the lining of the abdominal cavity, often with a similar histology to **serous ovarian cancer**. - While there might be some overlap in the pathogenesis, the strongest evidence for risk reduction with salpingectomy specifically targets the origin of **epithelial ovarian cancer** from the fallopian tube, rather than direct primary peritoneal cancer risk.
Question 182: Tongue bite occurs in eclampsia at :
- A. Tonic stage (Correct Answer)
- B. Coma stage
- C. Clonic stage
- D. Postictal stage
Explanation: ***Tonic stage*** - During the **tonic stage** of an eclamptic seizure, there is a sudden, sustained contraction of all muscles, including the **masseter muscles** (jaw muscles). - This forceful, sustained jaw clenching causes the teeth to clench tightly, leading to involuntary **biting of the tongue**. - The tonic phase lasts 10-20 seconds and is the first phase of the eclamptic seizure, characterized by rigid muscle contraction. *Coma stage* - The coma stage occurs after the seizure activity has ceased, and the patient is unconscious. - While aspiration or other complications can occur during this stage, **tongue biting** specifically happens during the active tonic phase of the seizure, not afterward. *Clonic stage* - The clonic stage follows the tonic stage and is characterized by rhythmic, jerking movements of the limbs and body. - Although there is muscle activity, the severe, **sustained jaw clenching** that causes tongue bite is specific to the tonic phase. - In the clonic phase, the jaw may rhythmically open and close, but the initial tongue bite has already occurred. *Postictal stage* - The postictal stage is the period of recovery immediately following a seizure. - The patient may be confused, drowsy, or unresponsive, but the active seizure movements, including **tongue biting**, have already occurred in the tonic phase.
Question 183: Indication for removal of IUDs include which of the following ? 1. Perforation of uterus 2. Pregnancy with device in situ 3. One year after menopause 4. Persistent migraine Select the correct answer using the code given below :
- A. 2, 3 and 4
- B. 1, 2 and 4 (Correct Answer)
- C. 1, 2 and 3
- D. 1 and 3 only
Explanation: ***Correct Answer: 1, 2 and 4*** **Statement 1 - Perforation of uterus:** ✅ **Valid indication** - Uterine perforation is a serious complication where the IUD punctures the uterine wall - This is an **absolute indication** for immediate removal to prevent further damage, infection, or injury to adjacent organs - Requires prompt surgical intervention **Statement 2 - Pregnancy with device in situ:** ✅ **Valid indication** - IUD should be removed if the strings are visible and removal is feasible - Removal reduces risks of **spontaneous abortion** (50% vs 25%), **septic abortion**, **preterm labor**, and **chorioamnionitis** - If strings are not visible, removal attempts may cause more harm than leaving it in place **Statement 4 - Persistent migraine:** ✅ **Valid indication (especially for hormonal IUDs)** - Relevant primarily for **levonorgestrel-releasing IUDs** (LNG-IUS) - Some women experience exacerbated or new-onset migraines due to hormonal fluctuations - Persistent or worsening migraines, especially **migraines with aura**, may warrant IUD removal - Less relevant for copper IUDs which have no hormonal effects *Statement 3 - One year after menopause:* ❌ **NOT an absolute indication** - While general guidelines suggest removal 1 year after menopause (if inserted after age 40), this is **NOT mandatory** - **Copper IUDs** can remain in place until age 55 if inserted after age 40, providing continued contraception - **LNG-IUS** may be retained for **endometrial protection** in women receiving estrogen replacement therapy - Removal is only necessary if the device is past its effective lifespan or causing symptoms - The decision should be individualized based on patient circumstances
Question 184: Which of the following are the absolute contraindications for the use of combined oral contraceptive pills ? 1. Severe hypertension 2. Pregnancy 3. Diabetes with retinopathy 4. Gall bladder disease Select the correct answer using the code given below :
- A. 1, 2 and 3 (Correct Answer)
- B. 2, 3 and 4
- C. 1, 2 and 4
- D. 1, 3 and 4
Explanation: ***Correct: 1, 2 and 3*** - According to **WHO Medical Eligibility Criteria (MEC) Category 4**, the absolute contraindications for combined oral contraceptive pills include **severe hypertension** (systolic ≥160 mmHg or diastolic ≥100 mmHg, or with vascular disease), **pregnancy** (COCs are unnecessary and contraindicated), and **diabetes with vascular complications** including retinopathy, nephropathy, or neuropathy. - These conditions carry unacceptable health risks with COC use: severe hypertension increases risk of **stroke and myocardial infarction**, pregnancy makes contraception unnecessary, and diabetes with retinopathy risks **worsening microvascular complications** and thrombotic events. - **Reference**: WHO MEC Category 4 conditions represent absolute contraindications where the risks outweigh any benefits. *Incorrect: 2, 3 and 4* - This incorrectly includes **gallbladder disease** as an absolute contraindication while excluding severe hypertension. - Gallbladder disease (current or history) is classified as **WHO MEC Category 2-3** (relative contraindication requiring clinical judgment), not Category 4. - COCs may slightly increase cholesterol saturation in bile, but this does not constitute an absolute contraindication. *Incorrect: 1, 2 and 4* - This omits **diabetes with retinopathy**, which is a well-established absolute contraindication. - Diabetes with microvascular complications (retinopathy, nephropathy, neuropathy) or disease duration >20 years is **WHO MEC Category 3/4** due to increased cardiovascular and thrombotic risk with estrogen-containing contraceptives. - It also incorrectly includes gallbladder disease as an absolute contraindication. *Incorrect: 1, 3 and 4* - This excludes **pregnancy**, which is the most fundamental contraindication for any contraceptive method. - While COCs are not significantly teratogenic, their use in pregnancy is medically unnecessary and classified as WHO MEC Category 4. - This option also incorrectly includes gallbladder disease, which is only a relative contraindication requiring monitoring, not an absolute prohibition.
Question 185: A 27-year-old recently married female comes to family planning clinic requesting for long term reversible contraception. Which one of the following is the best suited option for her ?
- A. Combined oral contraceptives
- B. Diaphragm
- C. Nexplanon (Correct Answer)
- D. Chhaya
Explanation: ***Nexplanon*** - This **etonogestrel implant** offers highly effective, **long-acting reversible contraception (LARC)** for up to three years, making it an excellent choice for a young woman seeking a long-term option. - It has a failure rate of less than 0.1% and is **progestin-only**, avoiding estrogen-related risks. *Combined oral contraceptives* - While effective, these require **daily adherence**, which might not be ideal for someone specifically requesting *long-term* and *reversible* contraception without daily commitment. - They also carry a slightly higher risk of **venous thromboembolism (VTE)** compared to progestin-only methods. *Diaphragm* - This is a **barrier method** requiring proper insertion, removal, and use with spermicide for each act of intercourse, making it less convenient for *long-term reversible* contraception. - Its typical use failure rate is significantly higher (around 12%) compared to LARC methods. *Chhaya* - Chhaya, or Saheli, is a **non-steroidal oral contraceptive** taken twice a week for the first three months, then once a week. - While it is a contraceptive option, it still requires regular weekly adherence and is not considered a **long-acting reversible contraceptive (LARC)** like an implant or IUD.
Question 186: Which one of the following is an indication for knife conisation? 1. Treatment of Nabothian follicle 2. Diagnosis and directed biopsy of cervix when punch biopsy is inadequate 3. Unsatisfactory colposcopy (transformation zone not fully visible) 4. Negative endocervical curettage Select the correct answer using the code given below:
- A. 1 and 4
- B. 1, 2 and 3
- C. 1 and 3 only
- D. 2 and 3 only (Correct Answer)
Explanation: ***2 and 3 only*** - **Knife conisation** (cold-knife conization) is a surgical procedure that removes a **cone-shaped piece of tissue** from the cervix for both diagnostic and therapeutic purposes. - **Statement 2 is correct**: Conisation is indicated for diagnosis and obtaining adequate tissue when punch biopsy is inadequate or when there is discrepancy between cytology, colposcopy, and histology. - **Statement 3 is correct**: Unsatisfactory colposcopy (when the transformation zone cannot be fully visualized) is a key indication for diagnostic conisation. *1, 2 and 3* - This option incorrectly includes treatment of **Nabothian follicles**. Nabothian cysts are benign retention cysts that are asymptomatic and require **no treatment**. They are not an indication for conisation. *1 and 4* - Both statements are **incorrect**. Nabothian follicles do not require treatment, and a **negative endocervical curettage (ECC)** is not an indication for conisation. In fact, a **positive ECC** (showing dysplasia) would be an indication. *1 and 3 only* - This option incorrectly includes **Nabothian follicle treatment**, which is not an indication for conisation as these are benign cysts requiring no intervention.
Question 187: Which of the following statements regarding female sterilization is correct? 1. It can be done 24 - 48 hours following delivery. 2. Ideal time for interval ligation is luteal phase preceding menstruation. 3. It can be combined with medical termination of pregnancy. 4. It is a preventive measure against serous ovarian cancer. Select the correct answer using the code given below:
- A. 1, 3 and 4 (Correct Answer)
- B. 1, 2 and 4
- C. 2, 3 and 4
- D. 1, 2 and 3
Explanation: ***1, 3 and 4*** - Female sterilization can indeed be performed **24-48 hours postpartum** because the fundus is still high, making the fallopian tubes easily accessible. - Female sterilization can be safely **combined with medical termination of pregnancy**, offering a convenient option for women who desire permanent contraception after an abortion. - **Tubal ligation has been shown to reduce the risk of ovarian cancer** by approximately 30%, likely by preventing carcinogens from ascending through the tubes or by altering ovarian blood supply and hormone levels. - **Opportunistic salpingectomy** (removal of fallopian tubes during sterilization) provides even greater protection against high-grade serous ovarian cancer, as many such cancers originate in the fimbrial end of the fallopian tube. *1, 2 and 3* - While statements 1 and 3 are correct, **statement 2 is incorrect**. The ideal time for interval tubal ligation is the **follicular phase (early proliferative phase)**, typically within the **first 7 days of the menstrual cycle**, NOT the luteal phase preceding menstruation. - Performing sterilization in the early follicular phase minimizes the risk of an **undiagnosed early pregnancy**, as this is shortly after menstruation when pregnancy is least likely. *1, 2 and 4* - While statements 1 and 4 are correct, **statement 2 is incorrect**. The luteal phase is NOT the ideal time for interval sterilization because this is when pregnancy risk is highest. - The **follicular phase** is preferred to ensure the woman is not pregnant at the time of the procedure. *2, 3 and 4* - While statements 3 and 4 are correct, **statement 2 is incorrect**. Standard practice recommends interval tubal ligation during the **follicular phase (days 1-7 of cycle)**, not the luteal phase. - The luteal phase carries a risk of operating on an early, undiagnosed pregnancy.
Question 188: The most popular technique of tubal ligation is :
- A. Madlener Operation
- B. Pomeroy Technique (Correct Answer)
- C. Uchida method
- D. Cornual resection
Explanation: ***Pomeroy Technique*** - The **Pomeroy technique** is the most widely performed method of tubal ligation due to its simplicity, ease of execution, and high efficacy. - It involves lifting a loop of the fallopian tube, ligating its base, and then excising the looped segment, leading to clear separation of the tubal ends. *Madlener Operation* - The Madlener operation involves crushing and ligating a loop of the **fallopian tube** without excising any segment. - This method has a higher failure rate compared to the Pomeroy technique due to the possibility of recanalization. *Uchida method* - The **Uchida method** is a more complex technique that involves injecting a solution into the subserosal layer of the fallopian tube to separate the mucosa and muscularis, followed by excision of a segment and burying the proximal end. - It is known for its high effectiveness but is less commonly performed due to its technical complexity. *Cornual resection* - **Cornual resection** involves removing a portion of the fallopian tube where it enters the uterine wall (the cornua). - This procedure is technically more challenging and is associated with a higher risk of complications, including hemorrhage, making it less popular as a primary method for sterilization.