UPSC-CMS 2023 Practice Questions

Q: The daily requirement of calcium during normal pregnancy is

1000 mg. ***1000 mg*** - This is the daily calcium requirement for **pregnant women aged 19 years and above** according to **ACOG** and many international guidelines. - Some guidelines, including **ICMR (2020)**, recommend **1200 mg/day** for all pregnant women, making both 1000-1200 mg acceptable ranges. - Adequate calcium intake supports **fetal skeletal development** and helps prevent complications such as **gestational hypertension** and **preeclampsia**. - This answer is accepted as the standard recommendation for normal pregnancy in most textbooks. *500 mg* - This amount is the recommended daily intake for **pre-school children**, not pregnant women. - Grossly insufficient during pregnancy, as the **fetus requires approximately 200-300 mg/day** for skeletal development, primarily drawn from maternal calcium stores. - Would lead to **maternal bone demineralization** and increased risk of pregnancy complications. *2000 mg* - This represents the **tolerable upper intake level (UL)** for calcium during pregnancy. - While not harmful in most cases, this higher dose is **unnecessarily excessive** for routine supplementation. - May cause side effects including **constipation, kidney stones**, and interference with absorption of other minerals like iron and zinc. *250 mg* - This is **significantly below the requirement** for both pregnant and non-pregnant adults (who need ~600-800 mg/day). - Such severe deficiency would result in **mobilization of maternal bone calcium** to meet fetal demands. - Would increase risk of **osteoporosis, pre-eclampsia**, and impaired fetal bone development.

Q: A 35-year-old woman who has completed her family shows a positive Pap smear (Cervical intraepithelial neoplasia III (CIN III)). What is to be done next?

Simple hysterectomy. ***Simple hysterectomy*** - **Simple (total) hysterectomy** is the **definitive treatment of choice** for **CIN III** in a woman who has **completed her family**. - It removes the **entire uterus and cervix**, eliminating the risk of **recurrence or progression** to invasive cancer. - This provides a **permanent cure** without the need for long-term surveillance required after excisional procedures. - Preferred over conisation in this scenario as **fertility preservation is not needed**. *Conisation* - **Conisation** (cone biopsy) is an excisional procedure that removes a cone-shaped piece of cervical tissue and is the **treatment of choice for CIN III when fertility preservation is desired**. - While it can be both diagnostic and therapeutic, it has a **10-15% recurrence rate** and requires **lifelong cervical surveillance**. - In a patient who has **completed her family**, a more definitive treatment (hysterectomy) is preferred over conisation. *Wertheim's hysterectomy* - **Wertheim's hysterectomy** (radical hysterectomy with pelvic lymphadenectomy) is indicated for **invasive cervical cancer** (Stage IA2-IIA). - **CIN III is a pre-invasive lesion**, not invasive cancer, making this procedure unnecessarily radical and associated with significant morbidity. - This would only be considered if invasion is confirmed on histopathology. *Cryotherapy* - **Cryotherapy** is an **ablative treatment** that destroys abnormal cervical tissue by freezing. - It is suitable for **CIN I or CIN II** with small lesions but is **inadequate for CIN III** due to: - Higher risk of **residual disease** (cannot assess depth of involvement) - **No histological specimen** obtained for margin assessment - Higher recurrence rates compared to excisional procedures

Q: While making a pelvic assessment in a gravid woman, the obstetrician can measure with examining finger the following diameter:

Diagonal conjugate. ***Diagonal conjugate*** - This is the only pelvic inlet diameter that can be directly measured clinically by the **examining finger**. - It extends from the **lower border of the pubic symphysis** to the **sacral promontory**. *True conjugate* - The true conjugate extends from the **upper border of the pubic symphysis** to the sacral promontory and cannot be directly measured due to the bladder. - It is an **estimated measurement**, usually derived by subtracting 1.5 to 2 cm from the diagonal conjugate. *Diameter of pelvic inlet* - This is a general term referring to various diameters of the pelvic inlet, some of which are not clinically measurable. - While one of its components, the diagonal conjugate, is measurable, the phrase "diameter of pelvic inlet" is too broad, and specific diameters are not directly accessible. *Obstetric conjugate* - This diameter is taken from the **innermost aspect of the pubic symphysis** to the sacral promontory, representing the shortest anteroposterior diameter the fetal head must pass. - Like the true conjugate, it cannot be directly measured clinically and is also estimated from the diagonal conjugate (approximately 0.5 cm less than the true conjugate).

Q: The perinatal complications of a diabetic pregnancy include : 1. Small for Gestational Age baby 2. Stillbirth 3. Hypoglycaemia 4. Respiratory distress syndrome Select the correct answer from the code given below :

2 and 3 only. ***2 and 3 only*** - **Stillbirth** is a major perinatal complication of diabetic pregnancy due to placental insufficiency, fetal hyperglycemia, and maternal ketoacidosis, occurring in up to 2-5% of poorly controlled cases. - **Neonatal hypoglycemia** occurs in 25-40% of infants of diabetic mothers due to fetal hyperinsulinemia. After delivery, the sudden withdrawal of maternal glucose supply while fetal insulin levels remain elevated leads to profound hypoglycemia within 1-2 hours of birth. - While **respiratory distress syndrome (RDS)** is also a recognized complication (due to delayed surfactant production from hyperinsulinemia), this question focuses on the most characteristic and immediate life-threatening perinatal complications requiring urgent monitoring and intervention. *1 and 2 only* - **Small for Gestational Age (SGA)** is NOT a typical complication of diabetic pregnancy. The classic presentation is **macrosomia** (Large for Gestational Age) due to fetal hyperinsulinemia driving increased glucose uptake and fat deposition. - SGA may occur in pre-gestational diabetes with severe vasculopathy, but this represents a minority of cases and is not the typical pattern. *1 and 4 only* - **Small for Gestational Age** is incorrect for the reasons stated above - diabetic pregnancies characteristically produce macrosomic infants, not growth-restricted ones. - **Respiratory distress syndrome** is indeed a complication, but the inclusion of the incorrect statement 1 makes this option wrong. *1 and 3 only* - **Small for Gestational Age** is fundamentally inconsistent with the pathophysiology of diabetic pregnancy, which involves fetal hyperglycemia and hyperinsulinemia leading to excessive growth. - **Hypoglycemia** is correct, but this option is invalidated by the inclusion of SGA.

Q: Antimicrobial prophylaxis is essential for a woman in labour who has

Heart disease. ***Heart disease*** - Historically, women with certain types of heart disease, especially those with **valvular abnormalities** or a history of **infective endocarditis**, were considered to require antimicrobial prophylaxis during labor and delivery. - **Important Note**: Current guidelines (AHA 2007 onwards, ACOG) **no longer recommend routine antimicrobial prophylaxis** for prevention of infective endocarditis during uncomplicated vaginal delivery or cesarean section, even in women with valvular heart disease. - Prophylaxis may still be indicated if there are **infected tissues**, **chorioamnionitis**, or other **infectious complications** during delivery. - This question reflects **older clinical practice** when antimicrobial prophylaxis was more broadly recommended for cardiac patients during labor. *Hypertension* - **Hypertension** during labor, whether **chronic** or **gestational**, does not increase the risk of infectious complications requiring antimicrobial prophylaxis. - Management focuses on **blood pressure control** and monitoring for complications like pre-eclampsia or eclampsia. *Diabetes mellitus* - While women with **diabetes mellitus** may have slightly increased infection risk, it is **not an indication** for routine antimicrobial prophylaxis during labor for endocarditis prevention. - Prophylaxis during labor is indicated for **Group B Streptococcus (GBS) colonization** or specific obstetric indications, not diabetes itself. *Renal disease* - **Renal disease** itself is **not an indication** for antimicrobial prophylaxis during labor. - Management focuses on monitoring the renal condition and managing fluid and electrolyte balance during pregnancy and delivery.

Q: A nulliparous woman presents with acute lower abdominal pain. She has a history of missed periods. The ultrasound examination shows an empty uterus. The cervical movements are very tender. The vital signs are stable. How will you manage her?

Admit her for observation. ***Admit her for observation*** - The patient presents with classic symptoms of a **potential ectopic pregnancy** (missed periods, lower abdominal pain, empty uterus on ultrasound, cervical motion tenderness). However, her **vital signs are stable**, indicating she is currently hemodynamically stable. - Admission for observation allows for close monitoring of vital signs, serial **beta-hCG measurements**, and repeat ultrasounds to confirm the diagnosis and assess for any signs of rupture, enabling timely intervention if needed. *Start a pitocin drip* - **Pitocin (oxytocin)** is used to induce labor or manage postpartum hemorrhage, as it contracts the uterus. - In a suspected ectopic pregnancy with an empty uterus, administering oxytocin would be ineffective and potentially harmful if a **tubal pregnancy** is present. *Treat her as a case of Pelvic Inflammatory Disease.* - While PID can cause lower abdominal pain and cervical motion tenderness, the history of **missed periods** and an **empty uterus on ultrasound** strongly suggest pregnancy complications rather than infection. - Treating for PID without ruling out ectopic pregnancy could lead to a catastrophic delay in managing a ruptured ectopic pregnancy. *Perform a laparotomy* - A laparotomy is an **invasive surgical procedure** typically reserved for confirmed or highly suspected cases of ruptured ectopic pregnancy or other acute abdominal emergencies. - Given the patient's **stable vital signs** and the possibility of a non-ruptured ectopic or even a miscarriage, immediate laparotomy is premature without further diagnostic assessment.

Q: In a pregnancy complicated by heart disease, which of the following is/are contraindicated? 1. External cephalic version 2. LSCS 3. Corrective surgery of the heart lesion 4. Prophylactic intravenous meth-ergine at the birth of anterior shoulder Select the correct answer from the code given below :

1 and 4 only. ***1 and 4 only*** - **External cephalic version (ECV)** is generally contraindicated in pregnancy complicated by heart disease because the procedure can induce uterine contractions, maternal stress, and potential hemodynamic instability, which may precipitate cardiac decompensation in susceptible patients. - **Prophylactic intravenous methergine (methylergonovine)** is **absolutely contraindicated** in patients with heart disease due to its potent **vasoconstrictive effects** leading to increased systemic vascular resistance, hypertension, and elevated afterload, which can precipitate acute cardiac failure or pulmonary edema. *1 only* - This option incorrectly identifies only ECV as contraindicated while missing the important contraindication of **methergine**, which is strongly contraindicated due to its cardiovascular effects. - Methergine-induced vasoconstriction can cause dangerous hemodynamic changes in cardiac patients. *1 and 3 only* - While ECV is contraindicated, **corrective cardiac surgery** is NOT contraindicated during pregnancy when indicated for maternal survival or significant functional improvement. - Cardiac surgery can be safely performed during pregnancy (ideally in second trimester) with cardiopulmonary bypass when maternal benefit outweighs risks, making this a potential therapeutic intervention rather than a contraindication. *1, 2, 3 and 4* - **LSCS (Lower Segment Cesarean Section)** is NOT contraindicated in heart disease; in fact, it is often the **preferred mode of delivery** in severe cardiac conditions (NYHA Class III-IV) to avoid the hemodynamic stress of prolonged labor and bearing down efforts. - Similarly, corrective cardiac surgery is not contraindicated when medically necessary.

Q: During a routine prenatal visit, a 22-week gravid woman is found to be affected with ankle oedema and new onset hypertension. The urine analysis reveals marked proteinuria. Which of the following, if it were to occur, would substantiate the diagnosis of eclampsia?

Seizures. ***Seizures*** - The development of **new-onset generalized tonic-clonic seizures** in a patient with pre-existing pre-eclampsia (hypertension and proteinuria during pregnancy) is the defining criterion for **eclampsia**. - These seizures are not attributable to other causes and are a severe complication of pre-eclampsia, indicating central nervous system involvement. *Molar pregnancy* - While molar pregnancy can be associated with early-onset and more severe pre-eclampsia due to high hCG levels and abnormal placental development, it is not a direct diagnostic criterion for **eclampsia** itself. - Eclampsia specifically refers to the occurrence of seizures in the context of pre-eclampsia, regardless of the underlying cause of the pre-eclampsia. *Thrombocytopenia* - **Thrombocytopenia** (platelet count <100,000/µL) is a potential complication of severe pre-eclampsia and a component of **HELLP syndrome** (Hemolysis, Elevated Liver enzymes, Low Platelets). - While it indicates worsening disease, the presence of thrombocytopenia alone does not define eclampsia; eclampsia is characterized by the occurrence of **seizures**. *Hyperuricaemia* - **Hyperuricaemia** (elevated serum uric acid) is a common finding in pre-eclampsia and often correlates with the severity of the disease. - However, it is a biochemical marker of kidney dysfunction and increased oxidative stress, not a defining diagnostic feature of **eclampsia**, which is specifically marked by the onset of **seizures**.

Q: In a gravid woman with placenta praevia, the following fetal complications are known to increase 1. Congenital malformations 2. Intrauterine growth retardation 3. Prematurity Select the correct answer from the code given below :

1, 2 and 3. ***1, 2 and 3*** - **Placenta praevia** is associated with an increased risk of **congenital malformations**, with studies showing a 2-3 fold increased risk compared to normal placentation. This includes CNS anomalies, cardiovascular defects, and musculoskeletal malformations. - **Intrauterine growth retardation (IUGR)** is a known complication due to impaired placental perfusion and suboptimal placental function in the lower uterine segment. - **Prematurity** is significantly increased with placenta praevia, often necessitating early delivery due to antepartum hemorrhage or other maternal-fetal complications. *1 and 2 only* - This option incorrectly excludes **prematurity**, which is one of the most significant fetal complications of placenta praevia. - Preterm delivery is often required due to recurrent bleeding episodes. *1 and 3 only* - This option incorrectly excludes **IUGR**, which is a well-documented complication. - The lower uterine segment has relatively poor vascularization, contributing to placental insufficiency. *2 and 3 only* - This option incorrectly excludes **congenital malformations**. - Multiple population-based studies have demonstrated an association between placenta praevia and increased rates of fetal anomalies, particularly involving the CNS and cardiovascular systems.

Q: A pregnant woman with 10 weeks gestation is diagnosed to have an ovarian cyst of 11 cm diameter. The best timing for the removal of the ovarian cyst is

In the second trimester (14-20 weeks). ***In the second trimester (14-20 weeks)*** - The **second trimester** is the optimal timing for elective surgery during pregnancy as **organogenesis is complete** (reducing teratogenic risk) but the uterus is not yet too large to complicate surgery. - An **11 cm ovarian cyst** is large and unlikely to resolve spontaneously, warranting surgical intervention rather than expectant management. *At the time of caesarean section* - This approach assumes a **planned C-section** is indicated, which is not supported at 10 weeks gestation when mode of delivery cannot be predetermined. - Delaying surgery until an uncertain future C-section risks **complications** like torsion, rupture, or further cyst growth during pregnancy. *Immediately* - **First trimester surgery** carries higher risk of **miscarriage** and potential teratogenic effects during the critical organogenesis period. - While immediate intervention might prevent complications, the risks of surgery at 10 weeks outweigh the benefits for an asymptomatic cyst. *Immediately after delivery* - Post-delivery surgery involves increased **vascularity** and complications related to **uterine involution** and tissue changes. - This timing requires a **separate surgical procedure** and anesthetic exposure, increasing overall morbidity compared to planned second trimester surgery.

Question 1

The daily requirement of calcium during normal pregnancy is

Accepted Answer

1000 mg

Answer

500 mg

Answer

2000 mg

Answer

250 mg

Question 2

A 35-year-old woman who has completed her family shows a positive Pap smear (Cervical intraepithelial neoplasia III (CIN III)). What is to be done next?

Accepted Answer

Simple hysterectomy

Answer

Wertheim's hysterectomy

Answer

Cryotherapy

Answer

Conisation

Question 3

While making a pelvic assessment in a gravid woman, the obstetrician can measure with examining finger the following diameter:

Accepted Answer

Diagonal conjugate

Answer

True conjugate

Answer

Diameter of pelvic inlet

Answer

Obstetric conjugate

Question 4

The perinatal complications of a diabetic pregnancy include :

1. Small for Gestational Age baby
2. Stillbirth
3. Hypoglycaemia
4. Respiratory distress syndrome

Select the correct answer from the code given below :

Accepted Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 and 4 only

Answer

1 and 3 only

Question 5

Antimicrobial prophylaxis is essential for a woman in labour who has

Accepted Answer

Heart disease

Answer

Hypertension

Answer

Diabetes mellitus

Answer

Renal disease

Question 6

A nulliparous woman presents with acute lower abdominal pain. She has a history of missed periods. The ultrasound examination shows an empty uterus. The cervical movements are very tender. The vital signs are stable. How will you manage her?

Accepted Answer

Admit her for observation

Answer

Start a pitocin drip

Answer

Treat her as a case of Pelvic Inflammatory Disease.

Answer

Perform a laparotomy

Question 7

In a pregnancy complicated by heart disease, which of the following is/are contraindicated?
1. External cephalic version
2. LSCS
3. Corrective surgery of the heart lesion
4. Prophylactic intravenous meth-ergine at the birth of anterior shoulder
Select the correct answer from the code given below :

Accepted Answer

1 and 4 only

Answer

1 only

Answer

1 and 3 only

Answer

1, 2, 3 and 4

Question 8

During a routine prenatal visit, a 22-week gravid woman is found to be affected with ankle oedema and new onset hypertension. The urine analysis reveals marked proteinuria. Which of the following, if it were to occur, would substantiate the diagnosis of eclampsia?

Accepted Answer

Seizures

Answer

Molar pregnancy

Answer

Thrombocytopenia

Answer

Hyperuricaemia

Question 9

In a gravid woman with placenta praevia, the following fetal complications are known to increase

1. Congenital malformations 
2. Intrauterine growth retardation 
3. Prematurity

Select the correct answer from the code given below :

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

1 and 3 only

Answer

2 and 3 only

Question 10

A pregnant woman with 10 weeks gestation is diagnosed to have an ovarian cyst of 11 cm diameter. The best timing for the removal of the ovarian cyst is

Accepted Answer

In the second trimester (14-20 weeks)

Answer

Immediately

Answer

Immediately after delivery

Answer

At the time of caesarean section

UPSC-CMS 2023

Obstetrics and Gynecology