Anatomy
1 questionsWhich of the following are correct regarding pelvic cellular tissue? 1. It supports the pelvic organs. 2. It forms protective sheath for blood vessels and terminal part of ureter. 3. It prevents infection to be spread out of pelvis. 4. Marked hypertrophy of pelvic cellular tissue occurs in pregnancy. Select the answer using the code given below.
UPSC-CMS 2024 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 61: Which of the following are correct regarding pelvic cellular tissue? 1. It supports the pelvic organs. 2. It forms protective sheath for blood vessels and terminal part of ureter. 3. It prevents infection to be spread out of pelvis. 4. Marked hypertrophy of pelvic cellular tissue occurs in pregnancy. Select the answer using the code given below.
- A. 1, 2 and 3
- B. 1, 3 and 4
- C. 1, 2 and 4 (Correct Answer)
- D. 2, 3 and 4
Explanation: ***1, 2 and 4*** - Pelvic cellular tissue (parametrium/paracervix) provides crucial **structural support** to the uterus, cervix, and bladder, preventing **pelvic organ prolapse** (Statement 1 is correct) [1]. - It forms a **protective sheath** around important structures including the **uterine vessels** and **terminal portions of the ureters**, safeguarding them from injury (Statement 2 is correct) [1]. - During **pregnancy**, the parametrium undergoes **marked hypertrophy and hyperplasia** with increased vascularity to accommodate and support the enlarging uterus and increased blood flow (Statement 4 is correct) [2]. - Statement 3 is **incorrect** because pelvic cellular tissue does NOT prevent infection spread; rather, it is a **loose connective tissue space** that can serve as a **pathway for infection dissemination** within the pelvis (parametritis, pelvic cellulitis) [1]. *1, 2 and 3* - This combination incorrectly includes Statement 3. The pelvic cellular tissue actually facilitates infection spread rather than preventing it from spreading out of the pelvis [1]. *1, 3 and 4* - Statement 3 is incorrect as explained above. The loose areolar tissue of the parametrium is a potential space for infection spread, not a barrier [1]. *2, 3 and 4* - While statements 2 and 4 are correct [1], [2], Statement 3 is incorrect, and this option omits Statement 1, which is clearly correct regarding structural support.
Internal Medicine
1 questionsWhich of the following statements are correct regarding iron deficiency? 1. More common in older age group 2. More common in females of reproductive age 3. Associated with heavy menstrual bleeding 4. Commonly caused by chronic blood loss Select the correct answer using the code given below.
UPSC-CMS 2024 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 61: Which of the following statements are correct regarding iron deficiency? 1. More common in older age group 2. More common in females of reproductive age 3. Associated with heavy menstrual bleeding 4. Commonly caused by chronic blood loss Select the correct answer using the code given below.
- A. 1, 2 and 3
- B. 1, 2 and 4 (Correct Answer)
- C. 2, 3 and 4
- D. 1, 3 and 4
Explanation: ***1, 2 and 4*** * **Iron deficiency** is indeed more common in **older age groups**, often due to decreased dietary intake, malabsorption, or chronic diseases [1], [3]. * It is also frequently observed in **females of reproductive age**, primarily due to physiological iron loss through menstruation [2]. * **Chronic blood loss** from various sources, such as gastrointestinal bleeding [1] or heavy menstruation [2], is a very common cause of iron deficiency [3]. *1, 2 and 3* * While iron deficiency is common in older age groups and females of reproductive age, the statement that it is *only* associated with heavy menstrual bleeding isn't comprehensive enough, as chronic blood loss is a broader and more common cause [1]. * Though heavy menstrual bleeding is a significant cause of iron deficiency in women, this option omits chronic blood loss as a more general and equally important cause. *2, 3 and 4* * This option incorrectly implies that iron deficiency is *not* more common in older age groups, which is a known demographic at risk [3]. * While **heavy menstrual bleeding** and **chronic blood loss** are major causes, excluding the increased prevalence in older populations makes this option incomplete. *1, 3 and 4* * This option inaccurately suggests that iron deficiency is *not* more common in females of reproductive age, which is a key demographic for iron deficiency due to menstrual blood loss [2]. * It correctly identifies chronic blood loss and heavy menstrual bleeding as causes but misses a significant demographic for prevalence.
Obstetrics and Gynecology
7 questionsWhich of the following are risk factors for Pelvic Inflammatory Disease (PID)? 1. Multiple sexual partners 2. IUD use 3. Genetic predisposition 4. Sexually active teenagers Select the correct answer using the code given below.
Which one of the following is correct regarding choriocarcinoma?
Which of the following are favourable factors in prognosis of ovarian malignancy? 1. Older age group 2. Well-differentiated tumour 3. Smaller tumour volume 4. Younger age group Select the correct answer using the code given below.
Which of the following are symptoms of genital tuberculosis? 1. Postmenopausal bleeding 2. Infertility 3. Chronic pelvic pain 4. Oligomenorrhoea Select the correct answer using the code given below.
Which of the following are correct regarding androgen insensitivity syndrome? 1. Inherited as X-linked recessive disorder 2. Karyotype is 46 XXY 3. It is also called testicular feminization 4. Confirmation of diagnosis by gonadal biopsy Select the answer using the code given below.
A 16-year-old girl with primary amenorrhoea presents to the gynaecology OPD for evaluation. She has normal secondary sexual characters. Her karyotype is 46,XX and ultrasound reveals normal ovaries and tubes but absent uterus. What is her clinical diagnosis?
Which of the following are essential steps of Fothergill's operation? 1. Laparoscopic or vaginal ligation 2. Amputation of cervix 3. Plication of Mackenrodt's ligaments in front of cervix 4. Anterior colporrhaphy Select the correct answer using the code given below.
UPSC-CMS 2024 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 61: Which of the following are risk factors for Pelvic Inflammatory Disease (PID)? 1. Multiple sexual partners 2. IUD use 3. Genetic predisposition 4. Sexually active teenagers Select the correct answer using the code given below.
- A. 1, 2 and 3
- B. 1, 2 and 4 (Correct Answer)
- C. 1, 3 and 4
- D. 2, 3 and 4
Explanation: ***1, 2 and 4*** - **Multiple sexual partners** is a well-established risk factor for PID as it increases exposure to sexually transmitted infections (STIs), particularly *Chlamydia trachomatis* and *Neisseria gonorrhoeae*, which are the primary causative organisms of PID. - **IUD use** increases the risk of PID, particularly during the first 3 weeks after insertion when the insertion procedure can introduce vaginal flora into the upper genital tract. The risk returns to baseline after this initial period. - **Sexually active teenagers** are at higher risk due to biological factors (cervical ectopy with larger area of columnar epithelium susceptible to infection) and behavioral factors (multiple partners, inconsistent condom use, higher rates of STIs). *1, 2 and 3* - This option incorrectly includes **genetic predisposition** as a primary risk factor for PID. - PID is predominantly an **infectious disease** caused by ascending infection from the lower genital tract, not directly linked to genetic predisposition. *1, 3 and 4* - This option incorrectly includes **genetic predisposition** while correctly identifying multiple sexual partners and sexually active teenagers. - Genetic factors are not established risk factors for PID compared to behavioral and infectious causes. *2, 3 and 4* - This option incorrectly includes **genetic predisposition** and omits multiple sexual partners, which is one of the most important behavioral risk factors for PID. - The primary risk factors are related to sexual behavior and STI exposure, not genetics.
Question 62: Which one of the following is correct regarding choriocarcinoma?
- A. Vaginal bleeding is the commonest presenting symptom (Correct Answer)
- B. About 20-30% of patients with molar pregnancies develop choriocarcinoma
- C. Highly resistant tumour to chemotherapy
- D. Primary site of involvement is fallopian tube
Explanation: ***Vaginal bleeding is the commonest presenting symptom*** - **Vaginal bleeding** (often irregular or persistent) is the most frequent symptom of choriocarcinoma, especially when it arises after a hydatidiform mole or pregnancy. - This bleeding can be accompanied by symptoms related to distant metastases, highlighting the aggressive nature of the disease. *About 20-30% of patients with molar pregnancies develop choriocarcinoma* - The risk of developing choriocarcinoma after a **hydatidiform mole** is much lower than 20-30%; it's estimated to be around 2-3% after a complete mole and less than 0.5% after a partial mole. - The majority of molar pregnancies resolve spontaneously without progressing to choriocarcinoma. *Highly resistant tumour to chemotherapy* - Choriocarcinoma is notably one of the most **chemosensitive solid tumors** and generally responds very well to chemotherapy, even in advanced stages. - This high sensitivity to chemotherapy is a key characteristic that distinguishes it from many other cancers. *Primary site of involvement is fallopian tube* - The primary site of choriocarcinoma is usually the **uterus**, developing from gestational trophoblastic tissue. - While it can metastasize widely, the fallopian tube is not its primary site of involvement.
Question 63: Which of the following are favourable factors in prognosis of ovarian malignancy? 1. Older age group 2. Well-differentiated tumour 3. Smaller tumour volume 4. Younger age group Select the correct answer using the code given below.
- A. 1, 3 and 4
- B. 2, 3 and 4 (Correct Answer)
- C. 1, 2 and 4
- D. 1, 2 and 3
Explanation: ***2, 3 and 4*** - **Well-differentiated tumours** indicate less aggressive cell growth and a better prognosis due to their similarity to normal tissue and slower metastatic potential. - **Smaller tumour volume** implies less disease burden, making the cancer more amenable to treatment and reducing the likelihood of widespread metastasis. - **Younger age group** is often associated with better overall health, greater tolerance to aggressive treatments, and a more robust immune response, contributing to a better prognosis in ovarian cancer. *1, 3 and 4* - **Younger age group**, **well-differentiated tumour**, and **smaller tumour volume** are indeed favorable prognostic factors. - However, **older age group** is generally associated with a poorer prognosis in ovarian malignancy due to increased comorbidities and decreased tolerance to aggressive therapies. *1, 2 and 4* - While **well-differentiated tumours** and **younger age group** are favorable, **older age group** is typically a poor prognostic indicator. - This option incorrectly includes older age as a favorable factor and omits **smaller tumour volume**, which is a significant positive prognosticator. *1, 2 and 3* - This option incorrectly lists **older age group** as a favorable factor, which usually indicates a poorer prognosis. - It also includes **well-differentiated tumour** and **smaller tumour volume**, which are indeed favorable, but is flawed by the inclusion of older age.
Question 64: Which of the following are symptoms of genital tuberculosis? 1. Postmenopausal bleeding 2. Infertility 3. Chronic pelvic pain 4. Oligomenorrhoea Select the correct answer using the code given below.
- A. 1, 2 and 4
- B. 1, 2 and 3
- C. 1, 3 and 4
- D. 2, 3 and 4 (Correct Answer)
Explanation: ***2, 3 and 4*** * **Genital tuberculosis** (GTB) predominantly affects women of reproductive age (20-40 years) and classically presents with the triad of **infertility, menstrual irregularities, and pelvic pain**. * **Infertility** is the most common presentation (70-80% of cases), primarily due to **tubal damage and scarring** affecting the fallopian tubes, which are involved in 90-100% of GTB cases. * **Chronic pelvic pain** occurs in 20-30% of cases due to pelvic adhesions, inflammation, and peritoneal involvement. * **Oligomenorrhoea** and other menstrual abnormalities (including amenorrhoea) are common (25-50% of cases) due to **endometrial involvement** causing destruction of the endometrium and affecting normal cyclical changes. *1, 2 and 4* * This option incorrectly includes **postmenopausal bleeding**, which is NOT a typical or well-established symptom of genital tuberculosis. * GTB primarily affects women during their reproductive years, not postmenopausal women. The disease presentation is centered around reproductive dysfunction in younger women. * This option also excludes **chronic pelvic pain**, which is a recognized symptom in the clinical presentation of GTB. *1, 2 and 3* * This option incorrectly includes **postmenopausal bleeding**, which is not a characteristic symptom of genital tuberculosis. * While infertility and chronic pelvic pain are valid symptoms, **oligomenorrhoea** and other menstrual irregularities are more commonly reported than postmenopausal bleeding in the clinical presentation of GTB. *1, 3 and 4* * This option incorrectly includes **postmenopausal bleeding** while excluding infertility. * **Infertility** is the single most common presenting feature of female genital tuberculosis and should not be excluded from any correct answer about typical GTB symptoms.
Question 65: Which of the following are correct regarding androgen insensitivity syndrome? 1. Inherited as X-linked recessive disorder 2. Karyotype is 46 XXY 3. It is also called testicular feminization 4. Confirmation of diagnosis by gonadal biopsy Select the answer using the code given below.
- A. 1, 2 and 3
- B. 1, 2 and 4
- C. 2, 3 and 4
- D. 1, 3 and 4 (Correct Answer)
Explanation: ***1, 3 and 4*** - Androgen insensitivity syndrome (AIS) is inherited as an **X-linked recessive disorder** due to mutations in the androgen receptor gene on the X chromosome - It is also known as **testicular feminization syndrome** because affected individuals have a male karyotype (46, XY) with testes but develop a female phenotype due to androgen resistance - **Gonadal biopsy** can confirm the presence of testicular tissue and is used in diagnosis, though clinical features, hormonal profiles (high testosterone with high LH), and genetic testing are also important diagnostic tools - Statement 2 is incorrect: the karyotype is **46, XY** (not 46, XXY) *1, 2 and 3* - This combination is incorrect because statement 2 is false - The karyotype in AIS is **46, XY**, not 46, XXY - A karyotype of **46, XXY** is characteristic of **Klinefelter syndrome**, not AIS - While statements 1 and 3 are correct, including the false statement 2 makes this option incorrect *1, 2 and 4* - This combination is incorrect because statement 2 is false - The standard karyotype for AIS is **46, XY** with functional testes producing normal to high levels of testosterone - Patients are genetically male but phenotypically female due to **androgen receptor insensitivity** - 46, XXY (Klinefelter syndrome) presents with small testes, hypogonadism, and gynecomastia—a completely different clinical picture *2, 3 and 4* - This combination is incorrect because statement 2 is false - AIS patients have **46, XY karyotype** with intra-abdominal or inguinal testes - They present with primary amenorrhea, absent uterus and upper vagina, and normal female external genitalia in complete AIS - The key pathophysiology is **androgen receptor defect**, not chromosomal aneuploidy
Question 66: A 16-year-old girl with primary amenorrhoea presents to the gynaecology OPD for evaluation. She has normal secondary sexual characters. Her karyotype is 46,XX and ultrasound reveals normal ovaries and tubes but absent uterus. What is her clinical diagnosis?
- A. Primary ovarian failure
- B. Androgen insensitivity syndrome
- C. Turner syndrome
- D. Mayer-Rokitansky-Küster-Hauser syndrome (Correct Answer)
Explanation: ***Mayer-Rokitansky-Küster-Hauser syndrome (MRKH)*** - This syndrome is characterized by **agenesis of the uterus and upper vagina** in a genotypically and phenotypically normal female (46,XX karyotype, normal ovaries, and normal secondary sexual characteristics). - The presence of **normal secondary sexual characteristics** indicates normal ovarian function and estrogen production, ruling out ovarian failure as the primary cause of amenorrhea. *Primary ovarian failure* - This condition would typically lead to **absent or delayed development of secondary sexual characteristics** due to insufficient estrogen production by the ovaries. - The patient's **normal secondary sexual characteristics** contradict primary ovarian failure. *Androgen insensitivity syndrome* - Individuals with CAIS are **genetically male (46,XY)** but phenotypically female, with **absent or rudimentary uterus** and internal female reproductive organs. - While they have absent menses and normal secondary sexual characteristics (due to peripheral conversion of androgens to estrogens), their **karyotype is 46,XY**, not 46,XX as in this patient. *Turner syndrome* - This syndrome is characterized by a **45,X karyotype**, leading to **gonadal dysgenesis** (streak gonads) and thus absent or delayed secondary sexual characteristics. - The patient's **normal secondary sexual characteristics** and **46,XX karyotype** rule out Turner syndrome.
Question 67: Which of the following are essential steps of Fothergill's operation? 1. Laparoscopic or vaginal ligation 2. Amputation of cervix 3. Plication of Mackenrodt's ligaments in front of cervix 4. Anterior colporrhaphy Select the correct answer using the code given below.
- A. 1, 2 and 3
- B. 1, 2 and 4
- C. 2, 3 and 4 (Correct Answer)
- D. 1, 3 and 4
Explanation: ***2, 3 and 4*** - **Fothergill's operation** (also known as Manchester operation) is a surgical procedure for **pelvic organ prolapse** that involves amputation of the cervix, plication of Mackenrodt's ligaments, and anterior colporrhaphy. - The goal is to correct **cervical elongation** and provide support to the uterus and bladder. *1, 2 and 3* - This option incorrectly includes "laparoscopic or vaginal ligation" as an essential step. Fothergill's operation does not typically involve ligation of structures; it focuses on correcting prolapse through tissue reshaping and support. - While cervical amputation and plication of Mackenrodt's ligaments are essential, ligation is not a characteristic component. *1, 2 and 4* - This option also incorrectly includes "laparoscopic or vaginal ligation" and misses the crucial step of "plication of Mackenrodt's ligaments in front of cervix." - The plication of these ligaments is fundamental to providing uterine support and is a defining feature of the Fothergill's procedure. *1, 3 and 4* - This option again incorrectly includes "laparoscopic or vaginal ligation" and omits "amputation of the cervix." - Cervical amputation is an essential component of Fothergill's operation, addressing cervical elongation which contributes to prolapse.
Pharmacology
1 questionsWhich one of the following drugs is most effective in the treatment of gestational trophoblastic neoplasia?
UPSC-CMS 2024 - Pharmacology UPSC-CMS Practice Questions and MCQs
Question 61: Which one of the following drugs is most effective in the treatment of gestational trophoblastic neoplasia?
- A. Actinomycin D
- B. Cisplatin
- C. Gemcitabine
- D. Methotrexate (Correct Answer)
Explanation: ***Methotrexate*** - **Methotrexate** is the most commonly used first-line chemotherapy for **low-risk gestational trophoblastic neoplasia (GTN)**, with cure rates exceeding 90% as a single agent. - It works by inhibiting **dihydrofolate reductase**, thereby blocking DNA synthesis and cell proliferation in rapidly dividing trophoblastic cells. - Administered as a single agent in various regimens (weekly IM, 5-day course, or 8-day alternating with folinic acid). *Actinomycin D* - **Actinomycin D** is an equally effective alternative first-line agent for low-risk GTN with similar cure rates to methotrexate. - However, the question asks for the "most effective," and both drugs have comparable efficacy; methotrexate is often preferred initially due to its favorable side effect profile and ease of administration. - Actinomycin D is frequently used when methotrexate resistance develops or as part of combination therapy for high-risk disease. *Cisplatin* - **Cisplatin** is a platinum-based chemotherapy drug reserved for **high-risk or resistant GTN**, typically as part of multi-drug regimens like EMA-CO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, Vincristine). - While effective in combination therapy, it is not used as first-line monotherapy for GTN. *Gemcitabine* - **Gemcitabine** is an antimetabolite used in various cancers but is **not a standard drug** for GTN treatment. - It may be considered for **refractory or resistant cases** as part of salvage therapy, but is not part of standard first-line or second-line protocols for GTN.