UPSC-CMS 2025 Practice Questions

Q: Which of the following statements are correct regarding audit in Obstetrics and Gynaecology? I. It can replace the out of date clinical practices with better ones. II. It is an efficient educational tool. III. It should be based on scientific evidences with facts and figures. IV. It is not labour-intensive. Select the answer using the code given below :

I, II and III. ***Correct: I, II and III*** - Statement I is correct: Clinical audit aims to improve **patient care** and **outcomes** by systematically reviewing care against explicit criteria, identifying areas for improvement, and implementing changes that **replace outdated practices** with evidence-based approaches. - Statement II is correct: Audit serves as a powerful **educational tool** by providing feedback to clinicians, highlighting best practices, and encouraging critical appraisal of current methods. - Statement III is correct: Effective audits must be based on **scientific evidence** with facts and figures to ensure validity, robustness, and clinical relevance. - Statement IV is **incorrect**: Clinical audit is **labour-intensive**, requiring significant time, resources, and coordination for data collection, analysis, meetings, implementation of changes, and follow-up assessments. *Incorrect: I, II and IV* - While statements I and II are correct, statement IV is incorrect because audit is generally **labour-intensive**, not the opposite. Effective audits involve substantial resource-demanding tasks. *Incorrect: I, III and IV* - While statements I and III are correct (audit replaces outdated practices with evidence-based approaches), statement IV is incorrect as thorough audits require **considerable effort and resources**. *Incorrect: II, III and IV* - While statements II and III are correct (audit as educational tool based on scientific evidence), statement IV is incorrect; audits often require **substantial time and effort** for all phases of the audit cycle.

Q: Which of the following statements about hysterosalpingography, as a diagnostic procedure, are correct? I. Tubal patency assessment following tuboplasty operation II. Diagnosis of uterine synechiae III. Detection of IUD IV. Diagnosis of subserosal fibroid Select the answer using the code given below :

I, II and III. ***I, II and III*** Hysterosalpingography (HSG) is a radiological procedure that uses contrast material injected into the uterus to visualize the **uterine cavity** and **fallopian tubes** under fluoroscopy. It is specifically useful for: **Statement I - Tubal patency assessment following tuboplasty operation** ✓ - HSG is the standard procedure to evaluate whether fallopian tubes remain patent after reconstructive tubal surgery **Statement II - Diagnosis of uterine synechiae** ✓ - HSG excellently demonstrates intrauterine adhesions (Asherman's syndrome) as filling defects in the uterine cavity **Statement III - Detection of IUD** ✓ - Radiopaque IUDs are easily visualized on HSG, and the procedure can confirm proper IUD position within the uterine cavity **Statement IV - Diagnosis of subserosal fibroid** ✗ - **Subserosal fibroids** project outward from the uterine serosa into the peritoneal cavity - HSG only outlines the **endometrial cavity** and **tubal lumen**, not external uterine surfaces - These fibroids do not impinge on the uterine cavity and therefore cannot be visualized by HSG - Better diagnosed by **ultrasound** or **MRI** *I, II and IV* - While HSG is excellent for assessing tubal patency and diagnosing uterine synechiae (I and II), it cannot diagnose **subserosal fibroids** which are located on the outer surface of the uterus and do not affect the uterine cavity outline. *II, III and IV* - This option correctly identifies HSG's utility in diagnosing **uterine synechiae** and detecting **IUDs**, but incorrectly includes **subserosal fibroids** which cannot be visualized by this procedure. *I, III and IV* - This option accurately includes HSG's role in assessing **tubal patency** and detecting **IUDs**, but mistakenly includes diagnosis of **subserosal fibroids** which require imaging modalities that visualize the external uterine surface.

Q: Which of the following are indications of endometrial sampling? I. Routine screening in asymptomatic premenopausal women II. Endometrial polyp III. Postmenopausal bleeding IV. Abnormal uterine bleeding Select the correct answer using the code given below :

II, III and IV. ***II, III and IV*** - **Endometrial polyps** require sampling for histopathological diagnosis and to assess for malignancy, especially when symptomatic or found in postmenopausal women. - **Postmenopausal bleeding** is a red-flag symptom that mandates endometrial sampling to rule out **endometrial hyperplasia** or **endometrial carcinoma**, as 5-10% of cases are associated with malignancy. - **Abnormal uterine bleeding** in premenopausal or perimenopausal women often requires endometrial sampling to investigate underlying causes such as **endometrial hyperplasia**, **polyps**, **endometritis**, or **malignancy**. *I, II and IV* - This option incorrectly includes **routine screening in asymptomatic premenopausal women (I)**, which is NOT an indication for endometrial sampling. - Endometrial sampling is not recommended for routine screening in asymptomatic women without risk factors or concerning symptoms. *I, III and IV* - This option also incorrectly includes **routine screening (I)** as an indication. - Additionally, it excludes **endometrial polyps (II)**, which are a definite indication for endometrial sampling when detected. *I, II and III* - This option incorrectly includes **routine screening (I)** while excluding **abnormal uterine bleeding (IV)**. - **Abnormal uterine bleeding** is one of the most common and important indications for endometrial evaluation across all age groups.

Q: A 30-year-old P3L3 female presents in Gynaecology emergency with acute abdominal pain and vaginal bleeding of short duration (1 hour). She gives history of tubal ligation after birth of third child. On examination, right adnexal tenderness was found and os was closed. What is the probable diagnosis?

Ectopic pregnancy. ***Ectopic pregnancy*** - This patient presents with **acute abdominal pain** and **vaginal bleeding** of short duration, with right adnexal tenderness and a closed os, highly suggestive of an ectopic pregnancy even after a tubal ligation. Tubal ligation does not provide 100% protection against pregnancy. - The history of **tubal ligation** increases the risk for ectopic pregnancy, as fertilization can still occur with the ovum implanting outside the uterus. *Complete abortion* - A complete abortion would typically involve the **passage of all products of conception**, after which the pain and bleeding would subside, and the os would generally be closed or closing. - This patient's symptoms are more acute and localized to the **adnexa**, which is less typical for a complete abortion occurring in a non-pregnant uterus (given the tubal ligation). *Pelvic inflammatory disease* - **Pelvic inflammatory disease (PID)** usually presents with **vaginal discharge/cervicitis**, **fever**, and bilateral abdominal pain. - While adnexal tenderness can be present, the acute onset with vaginal bleeding in a patient post-tubal ligation makes ectopic pregnancy a more concerning and probable diagnosis. *Appendicitis* - **Appendicitis** typically presents with **right lower quadrant pain** that often migrates from the periumbilical region, but usually lacks vaginal bleeding or adnexal tenderness. - The combination of **vaginal bleeding** and adnexal tenderness points away from appendicitis and more towards a gynecological origin.

Q: Which of the following is measured without any straining while examination under POP-Q system?

TVL. ***TVL*** - **Total Vaginal Length (TVL)** is the **only measurement** in the POP-Q system that is taken **exclusively at rest without straining**. - It is measured from the **hymen to the posterior fornix** (or vaginal cuff in post-hysterectomy cases) with the patient in supine lithotomy position. - This measurement reflects the overall depth of the vagina and provides important anatomical context for prolapse assessment. *Point D* - **Point D** represents the location of the **posterior fornix** (or vaginal cuff scar in post-hysterectomy). - In the POP-Q system, Point D is measured **both at rest and with maximal straining** to assess the degree of **uterine descent or vaginal vault prolapse**. - The difference between rest and strain measurements helps quantify the extent of apical support defects. *GH* - **Genital Hiatus (GH)** is measured from the **external urethral meatus to the posterior hymen**. - GH is measured **both at rest and during maximal Valsalva straining** in the standard POP-Q protocol. - The measurement increases with straining as pelvic floor muscles relax, reflecting the functional capacity of the pelvic floor. *Pb* - **Perineal Body (Pb)** is measured from the **posterior margin of the genital hiatus to the mid-anal opening**. - Like GH, Pb is measured **both at rest and with straining** in the POP-Q examination. - Changes with straining can indicate perineal descent or posterior compartment defects like rectocele.

Q: Which of the following are Amsel's diagnostic criteria? I. Vaginal pH>4.5 II. Positive Whiff test III. Presence of clue cells >20 % IV. Positive bacterial vaginal culture Select the correct answer using the code given below :

I, II and III. ***I, II and III*** - Amsel's criteria are used for diagnosing **bacterial vaginosis** and include a vaginal pH >4.5, a positive **Whiff test** (amine odor with KOH), and the presence of **clue cells** (>20%) on microscopy. - The presence of at least three out of these four criteria is generally considered diagnostic for bacterial vaginosis. *I, III and IV* - This option incorrectly includes a **positive bacterial vaginal culture** as an Amsel's criterion. - Bacterial vaginal culture is generally not part of Amsel's criteria for diagnosing bacterial vaginosis, as it is often difficult to interpret due to the polymicrobial nature of the condition and doesn't differentiate between normal flora and pathogenic overgrowth. *I, II and IV* - This option also incorrectly includes a **positive bacterial vaginal culture** as an Amsel's criterion. - Amsel's criteria rely on direct, rapid clinical assessment rather than labor-intensive culture methods for diagnosis of bacterial vaginosis. *II, III and IV* - This option incorrectly includes a **positive bacterial vaginal culture** and omits **vaginal pH >4.5**, which is a key component of Amsel's criteria. - The elevated vaginal pH is crucial as it indicates a shift from the normal acidic vaginal environment, making it a critical diagnostic marker.

Q: Which of the following are poor prognostic factors in endometrial adenocarcinoma? I. Estrogen and progesterone receptor positivity II. HER-2/neu gene expression III. Histologic types papillary serous or clear cell carcinoma IV. Aneuploid tumours Select the correct answer using the code given below :

II, III and IV. ***II, III and IV*** - **HER-2/neu gene expression**, **papillary serous or clear cell histologic types**, and **aneuploid tumors** are all associated with a more aggressive disease course and worse outcomes in endometrial adenocarcinoma [1]. - These factors indicate less differentiated and often more resistant cancer, leading to higher recurrence rates and lower survival [1]. *I, III and IV* - This option incorrectly includes **estrogen and progesterone receptor positivity** as a poor prognostic factor, which is actually a favorable prognostic indicator. - **HER-2/neu gene expression** is a significant poor prognostic factor but is excluded from this option. *I, II and IV* - This option incorrectly includes **estrogen and progesterone receptor positivity** as a poor prognostic factor. - It also incorrectly excludes **histologic types papillary serous or clear cell carcinoma**, which are well-established poor prognostic factors [1]. *I, II and III* - This option incorrectly lists **estrogen and progesterone receptor positivity** as a poor prognostic factor. - It also incorrectly excludes **aneuploid tumors**, which are recognized indicators of poor prognosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1017-1024.

Question 1

Opening of Bartholin's duct is in the :

Accepted Answer

vestibule outside the hymen at the junction of the anterior 2/3rd and posterior 1/3rd in the groove between the hymen and labium minus

Answer

periurethral region in anterior 1/3rd of labia minora

Answer

superficial perineal pouch at the junction of anterior 1/3rd and posterior 1/3rd

Answer

groove between labia majora and labia minora

Question 2

Which of the following statements are correct regarding audit in Obstetrics and Gynaecology?
I. It can replace the out of date clinical practices with better ones.
II. It is an efficient educational tool.
III. It should be based on scientific evidences with facts and figures.
IV. It is not labour-intensive.

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

I, III and IV

Answer

II, III and IV

Question 3

Which of the following statements about hysterosalpingography, as a diagnostic procedure, are correct?
I. Tubal patency assessment following tuboplasty operation
II. Diagnosis of uterine synechiae
III. Detection of IUD
IV. Diagnosis of subserosal fibroid

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Question 4

Which of the following are indications of endometrial sampling?
I. Routine screening in asymptomatic premenopausal women
II. Endometrial polyp
III. Postmenopausal bleeding
IV. Abnormal uterine bleeding

Select the correct answer using the code given below :

Accepted Answer

II, III and IV

Answer

I, II and IV

Answer

I, III and IV

Answer

I, II and III

Question 5

A 30-year-old P3L3 female presents in Gynaecology emergency with acute abdominal pain and vaginal bleeding of short duration (1 hour). She gives history of tubal ligation after birth of third child. On examination, right adnexal tenderness was found and os was closed. What is the probable diagnosis?

Accepted Answer

Ectopic pregnancy

Answer

Complete abortion

Answer

Pelvic inflammatory disease

Answer

Appendicitis

Question 6

For which of the following conditions, surgery is indicated in a case of Fibroid Uterus ?
I. Symptomatic and failed medical management
II. Size >12 weeks
III. Pedunculated fibroid

Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

I and II only

Answer

I and III only

Answer

II and III only

Question 7

Which of the following is measured without any straining while examination under POP-Q system?

Accepted Answer

TVL

Answer

Point D

Answer

GH

Answer

Pb

Question 8

Which of the following are criteria for opting Le Fort's operation for surgical correction of pelvic organ prolapse?
I. Procidentia in old age
II. Unfit for long duration surgery
III. Associated uterine pathology
IV. Coital function no longer required

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I and II only

Answer

I, III and IV

Question 9

Which of the following are Amsel's diagnostic criteria?
I. Vaginal pH>4.5
II. Positive Whiff test
III. Presence of clue cells >20 %
IV. Positive bacterial vaginal culture

Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

I, III and IV

Answer

I, II and IV

Answer

II, III and IV

Question 10

Which of the following are poor prognostic factors in endometrial adenocarcinoma?
I. Estrogen and progesterone receptor positivity
II. HER-2/neu gene expression
III. Histologic types papillary serous or clear cell carcinoma
IV. Aneuploid tumours

Select the correct answer using the code given below :

Accepted Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and IV

Answer

I, II and III

UPSC-CMS 2025

Anatomy

Community Medicine

Obstetrics and Gynecology

Pathology