Obstetrics and Gynecology
8 questionsWhich of the following factors are associated with cord prolapse during labour? I. Malpresentations II. Contracted pelvis III. Induction with engaged presenting part IV. Prematurity Select the correct answer using the code given below :
Which of the following are correct in the treatment of cracked nipple? I. Correct attachment (Latch on) will provide immediate relief from pain and rapid healing. II. If pain, mother should use breast pump and the infant is fed with the expressed milk. III. Antifungal medication (such as miconazole or nystatin) is applied to treat both the mother's nipple and the baby's mouth if there is oral thrush. Select the answer using the code given below:
Which of the following are correct regarding puerperal blues ? I. Its incidence is around 50 %. II. There is no specific metabolic or endocrine derangement. III. Treatment is reassurance and psychological support. Select the answer using the code given below :
The Matthews Duncan process has been described for :
A P1L1 lady after 4 hours of delivery is suffering from persistent, severe pain in the perineal region, rectal tenesmus, bearing down feeling and retention of urine. The probable diagnosis is :
According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage labour?
According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position? I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice. II. For a woman without epidural analgesia, upright birthing position may be adopted. III. For a woman with epidural analgesia, lithotomy and supine position only are recommended. Select the answer using the code given below :
Twin pregnancy should have ultrasound at 10-13 weeks to confirm which of the following? I. Number of foetus II. Viability of foetus III. Chorionicity of twins IV. Malformation in either foetus Select the correct answer using the code given below :
UPSC-CMS 2025 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 181: Which of the following factors are associated with cord prolapse during labour? I. Malpresentations II. Contracted pelvis III. Induction with engaged presenting part IV. Prematurity Select the correct answer using the code given below :
- A. I, II, III and IV
- B. III and IV only
- C. I, II and IV only (Correct Answer)
- D. I, II and III only
Explanation: ***I, II and IV only*** - **Cord prolapse** occurs when the umbilical cord descends ahead of the presenting fetal part, often due to factors that prevent the presenting part from fitting snugly into the pelvis. - **Malpresentations** (e.g., footling breech, transverse lie), **contracted pelvis** (hindering engagement), and **prematurity** (smaller fetus, more amniotic fluid) all increase the risk by creating a space for the cord to fall through. - **Induction with engaged presenting part** is NOT a risk factor because when the presenting part is well-engaged in the pelvis, it acts as a barrier preventing cord prolapse. *I, II, III and IV* - This option incorrectly includes **induction with engaged presenting part** as a risk factor for cord prolapse. - When the presenting part is engaged, it fills the pelvic inlet and prevents the cord from prolapsing. *III and IV only* - This option is incomplete as it misses crucial risk factors like **malpresentations** and **contracted pelvis**. - **Induction with engaged presenting part** is not a risk factor for cord prolapse. *I, II and III only* - This option incorrectly includes **induction with engaged presenting part** as an association with cord prolapse. - It also omits **prematurity**, which is a significant risk factor due to the disproportionately large amount of amniotic fluid relative to the fetal size.
Question 182: Which of the following are correct in the treatment of cracked nipple? I. Correct attachment (Latch on) will provide immediate relief from pain and rapid healing. II. If pain, mother should use breast pump and the infant is fed with the expressed milk. III. Antifungal medication (such as miconazole or nystatin) is applied to treat both the mother's nipple and the baby's mouth if there is oral thrush. Select the answer using the code given below:
- A. I, II and III (Correct Answer)
- B. I and III only
- C. II and III only
- D. I and II only
Explanation: ***I, II and III*** - All three statements provide accurate and essential interventions for managing **cracked nipples** in breastfeeding mothers. - **Correct latch-on** is fundamental to prevention and healing, expressing milk can provide relief and maintain supply, and **antifungal treatment** is indicated if candidiasis is suspected in both mother and infant. *I and III only* - This option incorrectly omits statement II, which describes a valid and often necessary intervention for managing pain and ensuring continued feeding. - Using a **breast pump** allows the nipple to rest and heal while the infant still receives breast milk. *II and III only* - This option incorrectly omits statement I, which highlights the crucial role of **correct attachment (latch-on)** as the primary solution for preventing and healing cracked nipples. - Without addressing the latch, other interventions may only provide temporary relief. *I and II only* - This option incorrectly omits statement III, which addresses the potential for **candidiasis (thrush)** as a cause of nipple pain and cracking. - If thrush is present, antifungal treatment of both mother and baby is necessary for resolution.
Question 183: Which of the following are correct regarding puerperal blues ? I. Its incidence is around 50 %. II. There is no specific metabolic or endocrine derangement. III. Treatment is reassurance and psychological support. Select the answer using the code given below :
- A. I, II and III (Correct Answer)
- B. I and II only
- C. II and III only
- D. I and III only
Explanation: ***I, II and III*** - Puerperal blues, or **baby blues**, are very common, affecting around **50-80%** of new mothers within a few days postpartum. - It is a transient condition thought to be related to **hormonal shifts** after childbirth, but without a specific, long-lasting metabolic or endocrine derangement requiring medical intervention. Its management involves **reassurance and psychological support**, as it typically resolves on its own without formal psychiatric treatment. *I and II only* - While statement I (incidence around 50%) is correct, and statement II (no specific metabolic or endocrine derangement) is also correct, this option excludes the crucial aspect of management, which is important for understanding the condition. - The typical management of puerperal blues involves reassurance and support, making statement III integral to a complete understanding. *II and III only* - This option correctly identifies the lack of specific derangement and the treatment approach, but it underestimates the prevalence of puerperal blues. - The incidence is significantly higher than implied by excluding statement I, making it a less accurate choice overall. *I and III only* - This option accurately describes the high incidence and the treatment strategy but overlooks the scientific understanding of its etiology. - The lack of a specific metabolic or endocrine derangement (statement II) is a key characteristic differentiating it from more severe postpartum psychiatric conditions.
Question 184: The Matthews Duncan process has been described for :
- A. controlled contraction in active management of third stage of labour
- B. central separation of placenta in normal labour
- C. marginal separation of placenta in normal labour (Correct Answer)
- D. reposition of acute inversion of uterus following vaginal delivery
Explanation: ***Marginal separation of placenta in normal labour*** - The **Matthews Duncan method** describes the process of **placental separation** where the placenta detaches from its **edges first**, leading to bleeding from the exposed maternal surface. - This type of separation is one of the two main mechanisms by which the placenta separates from the **uterine wall** during the third stage of labor. *Controlled contraction in active management of third stage of labour* - This refers to techniques like **controlled cord traction** and **fundal massage**, which are part of the active management to expedite placental delivery and prevent hemorrhage. - While it's a part of third stage management, it describes an intervention for placental expulsion, not a specific mechanism of placental detachment. *Central separation of placenta in normal labour* - This is known as the **Schultze method**, where placental separation begins in the **center**, leading to the fetal surface presenting first and less visible bleeding during separation. - The question specifically asks about the **Matthews Duncan process**, which is distinct from central separation. *Reposition of acute inversion of uterus following vaginal delivery* - **Uterine inversion** is a rare but severe complication where the **fundus** collapses through the **cervix**. - Repositioning involves manual or surgical techniques to return the uterus to its normal anatomical position and is unrelated to placental separation mechanisms.
Question 185: A P1L1 lady after 4 hours of delivery is suffering from persistent, severe pain in the perineal region, rectal tenesmus, bearing down feeling and retention of urine. The probable diagnosis is :
- A. Complete perineal tear
- B. Cervical tear
- C. Supralevator hematoma (Correct Answer)
- D. Vulval hematoma
Explanation: ***Supralevator hematoma*** - A **supralevator hematoma** typically presents with severe, deep perineal or suprapubic pain, often accompanied by rectal tenesmus, a bearing-down sensation, and urinary retention due to mass effect and nerve compression. - These hematomas are often **not visible externally**, as they are located above the levator ani muscle, making them difficult to diagnose without imaging or a high index of suspicion. *Complete perineal tear* - A **complete perineal tear** involves the anal sphincter and rectal mucosa, causing severe pain, but would typically present with visible disruption of the perineum and often fecal incontinence, rather than a deep, unobservable mass effect. - While severe pain is present, the symptom complex of **rectal tenesmus, bearing down feeling, and urinary retention** in the absence of visible external trauma points away from a simple perineal tear. *Cervical tear* - A **cervical tear** would primarily cause significant **postpartum hemorrhage**, often with bright red blood, rather than the deep perineal pain, rectal tenesmus, and urinary retention described. - While pain can occur, it's usually localized to the cervix or lower abdomen and not associated with a **bearing-down sensation** or difficulty voiding due to a mass. *Vulval hematoma* - A **vulval hematoma** causes severe pain and is usually **visible externally** as a tense, tender, and often discolored swelling of the labia. - While it can cause urinary retention due to pressure on the urethra, the deep, severe pain and **rectal tenesmus** with a "bearing down" feeling, without visible external swelling, make a supralevator hematoma more likely.
Question 186: According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage labour?
- A. Duration of active stage of primigravida should not exceed 8 hours
- B. Duration of active stage of multigravida should not exceed 6 hours
- C. Duration of active stage of primigravida should not exceed 18 hours
- D. Duration of latent phase of primigravida has not been established (Correct Answer)
Explanation: ***Duration of latent phase of primigravida has not been established*** - The **WHO Intrapartum Care Guidelines 2018** state that for both primigravid and multiparous women, the duration of the **latent phase of labor** has significant variability and a specific maximum duration to define prolonged labor has not been established. - This reflects the understanding that the latent phase can be variable and does not necessarily require intervention if the woman and fetus are well. *Duration of active stage of primigravida should not exceed 8 hours* - The 2018 WHO guidelines suggest that the **active phase of first-stage labor** for a **primigravida** can be up to **12 hours** or even longer, as long as there is continuous progress in cervical dilation. - The concept of a rigid 8-hour limit for all primigravidae in the active phase is not supported by current evidence-based guidelines, which emphasize individual progress. *Duration of active stage of multigravida should not exceed 6 hours* - For **multigravid women**, the active phase of the first stage of labor is generally shorter than for primigravidae, but the WHO guidelines do not set a strict upper limit of 6 hours. - Instead, they emphasize that progress in cervical dilation should be monitored, and interventions should be based on a lack of progress along with other clinical indicators, rather than a fixed time frame. *Duration of active stage of primigravida should not exceed 18 hours* - While the active phase of labor can be prolonged, a "should not exceed 18 hours" limit is not explicitly defined in the way it is presented. - The **WHO guidelines** advocate for continuous monitoring of cervical dilation, with an expected rate of at least 1 cm/hour during the active phase, acknowledging that some women may have slower but still physiological progress.
Question 187: According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position? I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice. II. For a woman without epidural analgesia, upright birthing position may be adopted. III. For a woman with epidural analgesia, lithotomy and supine position only are recommended. Select the answer using the code given below :
- A. I, II and III
- B. II and III only
- C. I and II only (Correct Answer)
- D. I and III only
Explanation: ***I and II only*** - According to the **WHO Intrapartum Care Guidelines 2018**, for women **without epidural analgesia**, the adoption of **birthing position** should be the **individual woman's choice** (Statement I is correct). - **Upright positions** (including sitting, standing, kneeling, squatting, or hands-and-knees) are specifically **encouraged** for women without epidural as they may reduce duration of second stage of labor and instrumental delivery rates (Statement II is correct). - The WHO guidelines emphasize **woman-centered care** and respect for maternal preferences regarding birthing positions. *I, II and III* - This option is **incorrect** because Statement III is false. - The WHO 2018 guidelines do **NOT** restrict women with epidural analgesia to only lithotomy and supine positions. - Even with epidural, women should be **encouraged to adopt positions of their choice**, including lateral and supported upright positions when feasible. *II and III only* - This option is **incorrect** as it omits Statement I, which correctly reflects the WHO principle of **individual woman's choice** for birthing position. - Statement III is also **false** - women with epidural are not limited to only lithotomy and supine positions according to WHO guidelines. *I and III only* - This option is **incorrect** because Statement III is false. - WHO guidelines advocate for **flexible positioning** even with epidural analgesia, not restriction to lithotomy and supine positions only. - The guidelines support exploring various positions based on maternal comfort, clinical circumstances, and healthcare provider support.
Question 188: Twin pregnancy should have ultrasound at 10-13 weeks to confirm which of the following? I. Number of foetus II. Viability of foetus III. Chorionicity of twins IV. Malformation in either foetus Select the correct answer using the code given below :
- A. I and III only
- B. II and IV only
- C. I, II, III and IV
- D. I, II and III only (Correct Answer)
Explanation: ***I, II and III only*** - A **first-trimester ultrasound** (10-13 weeks) in a twin pregnancy is essential for confirming the **number of fetuses**, assessing their **viability** (cardiac activity), and most importantly determining the **chorionicity of twins**. - **Chorionicity determination** is crucial at this stage as it guides the entire pregnancy management - monochorionic twins require more intensive surveillance due to higher risks. - While nuchal translucency screening for chromosomal abnormalities is performed at 11-13+6 weeks, **systematic structural malformation screening is NOT the primary objective** of the first-trimester scan and is typically performed at **18-22 weeks**. *I and III only* - While confirming the **number of fetuses** and **chorionicity** is essential, this option incorrectly omits the assessment of **fetal viability**. - Confirming cardiac activity and viability of both fetuses is a fundamental component of the first-trimester ultrasound examination. *II and IV only* - This option fails to include the most critical aspects of first-trimester twin ultrasound: confirming the **number of fetuses** and determining **chorionicity**. - Additionally, **malformation screening** is NOT a primary objective at 10-13 weeks; detailed anomaly scanning is performed in the second trimester (18-22 weeks). *I, II, III and IV* - While this option correctly includes fetal number, viability, and chorionicity determination, it incorrectly adds **malformation screening** as a primary objective. - **Structural anomaly scanning** is performed during the **mid-trimester ultrasound (18-22 weeks)**, not at 10-13 weeks, when organ development is more complete and detailed anatomical survey is possible.
Pharmacology
1 questionsDetection of magnesium toxicity in a patient receiving magnesium sulphate is noticed by which of the following? I. Loss of tendon reflexes II. Increased respiratory rate III. Heart block, prolonged PR interval IV. Cardiac arrest Select the correct answer using the code given below :
UPSC-CMS 2025 - Pharmacology UPSC-CMS Practice Questions and MCQs
Question 181: Detection of magnesium toxicity in a patient receiving magnesium sulphate is noticed by which of the following? I. Loss of tendon reflexes II. Increased respiratory rate III. Heart block, prolonged PR interval IV. Cardiac arrest Select the correct answer using the code given below :
- A. III and IV only
- B. I and III only
- C. I, III and IV (Correct Answer)
- D. II and IV only
Explanation: ***I, III and IV*** - **Loss of tendon reflexes** is an early sign of magnesium toxicity, typically occurring at serum magnesium levels between **4-6 mEq/L**. - **Heart block** and a **prolonged PR interval** are cardiac manifestations of magnesium toxicity, indicating impaired electrical conduction in the heart. **Cardiac arrest** represents the most severe cardiac complication, usually occurring with very high magnesium levels (**>15 mEq/L**). *III and IV only* - This option correctly identifies **heart block** (prolonged PR interval) and **cardiac arrest** as signs of magnesium toxicity. - However, it **omits the loss of tendon reflexes**, which is a crucial and often earlier indicator of toxicity. *I and III only* - This option correctly includes **loss of tendon reflexes** and **heart block** (prolonged PR interval) as signs of magnesium toxicity. - It **fails to include cardiac arrest**, which is a severe and critical consequence of profound magnesium toxicity. *II and IV only* - **Increased respiratory rate** is generally **not a sign of magnesium toxicity**; rather, magnesium toxicity can lead to **respiratory depression** or arrest. - While **cardiac arrest** is a correct sign, the inclusion of increased respiratory rate makes this option inaccurate.
Psychiatry
1 questionsWhich one of the following is correct regarding postpartum psychosis?
UPSC-CMS 2025 - Psychiatry UPSC-CMS Practice Questions and MCQs
Question 181: Which one of the following is correct regarding postpartum psychosis?
- A. Electro convulsive therapy is the first treatment of choice.
- B. Recurrence rate in subsequent pregnancy is 60-70 %. (Correct Answer)
- C. There is often no family history of psychosis.
- D. Its onset is usually within 4 days of delivery.
Explanation: ***Recurrence rate in subsequent pregnancy is 60-70%.*** - Postpartum psychosis carries a **high recurrence risk**, making subsequent pregnancies a concern for women with a history of the condition. - This high recurrence rate (ranging from 50-80% across studies) underscores the importance of close monitoring and prophylactic treatment in future pregnancies. *Electro convulsive therapy is the first treatment of choice.* - **ECT** is considered for severe cases of postpartum psychosis, particularly when there is rapid deterioration, severe suicidality, or catatonia, rather than being the first-line treatment. - Initial management typically involves a combination of **antipsychotics and mood stabilizers**, often in an inpatient setting for safety. *There is often no family history of psychosis.* - A **family history of psychosis**, especially bipolar disorder or schizophrenia, is a **significant risk factor** for postpartum psychosis. - Genetic predisposition plays a substantial role, making this statement incorrect—family history is commonly present. *Its onset is usually within 4 days of delivery.* - While postpartum psychosis has a **rapid onset**, stating "usually within 4 days" is too restrictive. - The condition typically manifests within the **first 2-4 weeks after delivery**, with approximately **50% of cases occurring within the first week** and peak incidence in the first 2 weeks. - This makes the 4-day timeframe an underestimate of the typical onset window.