UPSC-CMS 2009 Practice Questions

Q: Following statements are correct about levonorgestrel containing intra-uterine contraceptive device (Mirena) except

It increases the risk of ectopic pregnancy. ***It increases the risk of ectopic pregnancy*** - This statement is **INCORRECT**. The **levonorgestrel-releasing IUD (Mirena)** does NOT increase the absolute risk of ectopic pregnancy compared to women not using contraception. - In fact, it **significantly reduces** the risk of ectopic pregnancy by preventing pregnancy altogether. The absolute risk of ectopic pregnancy is much lower in IUD users than in non-contraceptive users. *It reduces the risk of pelvic inflammatory disease* - The **levonorgestrel-releasing IUD (Mirena)** actually reduces the risk of PID. This is because **progestin thickens cervical mucus**, creating a barrier that can prevent ascending infection. - Unlike older copper IUDs, newer IUDs (both copper and hormonal) are generally not associated with an increased risk of PID after the first month following insertion. *It releases 20 µg/day of levonorgestrel* - The **Mirena IUD** is designed to release approximately **20 micrograms of levonorgestrel per day** initially, which then gradually decreases over its lifespan. - This consistent low-dose release is crucial for its contraceptive and therapeutic effects. *It increases the risk of ovarian cyst formation* - **Levonorgestrel-releasing IUDs** can increase the incidence of **functional ovarian cysts**. This is because the hormonal action can interfere with the normal follicular development and ovulation cycle. - These cysts are usually benign, asymptomatic, and resolve spontaneously.

Q: What is the drug of choice for emergency contraception ?

Levonorgestrel only pill. ***Levonorgestrel only pill*** - **Levonorgestrel-only pills (LNG-EC)** are the most common and effective form of emergency contraception globally, available over-the-counter in many regions. - It works primarily by **inhibiting or delaying ovulation** and is most effective when taken as soon as possible after unprotected intercourse. *High dose oestrogen alone* - High-dose estrogen alone is **not used** for emergency contraception due to its high incidence of side effects like severe nausea and vomiting. - While estrogens can affect implantation, their use without progestin for EC is **ineffective and unsafe** compared to other methods. *Danazol* - **Danazol** is an attenuated androgen that was explored for emergency contraception but has been largely **abandoned** due to variable efficacy and a high incidence of side effects like androgenic effects. - It works by suppressing ovulation and endometrial development but is **inferior** to levonorgestrel or ulipristal acetate. *Yuzpe regimen (combined oral pill)* - The **Yuzpe regimen** uses a combination of estrogen and progestin from regular oral contraceptive pills, which is **less effective** and has more side effects (nausea, vomiting) than levonorgestrel-only pills. - This method requires taking **two doses 12 hours apart**, making it less convenient than single-dose levonorgestrel.

Q: Minipill containing 75 µg of desogestrel is used for contraception. Which of the following is its schedule of administration ?

Taken continuously without pill-free intervals. **Taken continuously without pill-free intervals** - **Minipills**, containing only progestin such as desogestrel, are designed for continuous daily administration to maintain consistent progestin levels and contraceptive efficacy. - Unlike combined oral contraceptive pills, minipills do not include a **pill-free interval** as there is no estrogen component to initiate a withdrawal bleed. *Taken once a day pill for 3 months with 7 days pill free interval* - This regimen is more characteristic of **extended-cycle combined oral contraceptives** or specific progestin-only regimens not typically applied to standard minipills like desogestrel. - A 7-day pill-free interval is usually for combined oral contraceptives to allow for a **withdrawal bleed**. *Taken for 21 days with 7 days pill free interval* - This is the standard regimen for **combined oral contraceptive pills**, which contain both estrogen and progestin. - The 7-day pill-free interval allows for a **hormone withdrawal bleed**, which is not part of minipill administration. *Taken once a day pill for 2 months with 7 days pill free interval* - This schedule is not a standard administration for either **minipills** or typical combined oral contraceptives. - **Continuous use** is crucial for minipills to maintain their contraceptive effect.

Q: What is the most common cause of vault prolapse following hysterectomy ?

Failure to identify and repair enterocele. ***Failure to identify and repair enterocele*** - An **enterocele** is a type of **hernia** in which the peritoneum and small bowel descend into the space between the vagina and rectum. - If an existing **enterocele** is not identified and repaired during hysterectomy, it can **worsen over time** and contribute significantly to **vaginal vault prolapse**. *Obesity* - While **obesity** is a risk factor for pelvic organ prolapse in general due to increased intra-abdominal pressure, it is not considered the most common direct cause of **vault prolapse specifically after hysterectomy**. - It contributes to general weakening of pelvic floor support but is less direct in causing vault collapse than a missed enterocele. *Chronic cough* - **Chronic cough** increases intra-abdominal pressure and is a risk factor for the development or worsening of pelvic organ prolapse. - However, similar to obesity, it's a general contributor to prolapse and not typically the most common direct cause of **vault prolapse** as compared to surgical factors. *Diabetes mellitus* - **Diabetes mellitus** can contribute to overall tissue weakness and neuropathy, potentially affecting pelvic floor support over time. - It is not considered a primary or frequent direct cause of **vaginal vault prolapse** following hysterectomy.

Q: Following which of the tubectomy procedures listed below, best result is achieved for reversal sterilization (recanalization procedure) ?

Fallopian ring occlusion. ***Fallopian ring occlusion*** - This method uses a **silicone band** to occlude the fallopian tube, causing minimal damage to the surrounding tissue. - The small segment of the tube affected allows for a **higher success rate** in re-anastomosis during reversal sterilization due to preserved tubal length and integrity. *Electrocoagulation* - This method involves **burning and destroying** a significant segment of the fallopian tube with an electric current. - The extensive tissue damage and scarring make **recanalization difficult** and significantly reduce the success of reversal. *Irving method* - This procedure involves **ligating and dissecting** the fallopian tube, then burying the proximal end into the broad ligament. - The complex anatomical alteration and potential for **significant scarring** make reversal challenging and less successful. *Pomeroy ligation* - This technique involves **ligating and excising a loop** of the fallopian tube, which causes moderate tissue damage and segment removal. - While reversal is possible, the **removal of a tubal segment** can result in a shorter tube and a lower success rate compared to tubal ring occlusion.

Q: Which one of the following is not a third generation progestogen used in combined oral contraceptive pills ?

Levonorgestrel. ***Levonorgestrel*** - **Levonorgestrel** is a **second-generation progestogen** commonly used in combined oral contraceptive pills and emergency contraception. - While effective, it tends to have higher androgenic activity compared to third-generation progestogens. *Norgestimate* - **Norgestimate** is a **third-generation progestogen** known for its lower androgenic activity. - It is often favored in combined oral contraceptives to minimize androgenic side effects like acne and hirsutism. *Gestodene* - **Gestodene** is a **third-generation progestogen** that has minimal androgenic activity and high progestational potency. - It is frequently included in modern combined oral contraceptives to improve cycle control and reduce side effects. *Desogestrel* - **Desogestrel** is also a **third-generation progestogen** and is an active metabolite of etonogestrel. - It is characterized by its low androgenic effects and is used in various combined oral contraceptive formulations.

Q: Consider the following list of cancers: 1. Ovarian cancer 2. Colon cancer 3. Endometrial cancer 4. Breast cancer What is the effect of combined oral contraceptive pills on the above?

Protection against 1, 2 and 3. **Protection against 1, 2, and 3** - Combined oral contraceptive (COC) pills are known to **reduce the risk of ovarian and endometrial cancer**, effects that can persist for decades after discontinuation. This is primarily due to the suppression of ovulation and the direct effect of progestin on the endometrium. - COC use also offers some **protection against colorectal cancer**, with studies showing a modest reduction in risk, potentially related to changes in bile acid metabolism or other hormonal effects. *Increased risk of 3 and 4 only* - While COCs **decrease the risk of endometrial cancer (3)**, they are associated with a **modest, temporary increase in the risk of breast cancer (4)**, which typically returns to baseline 10 years after cessation. - This option incorrectly states an increased risk for endometrial cancer and doesn't account for the protective effects on ovarian and colon cancer. *Decreased risk of 1 and 2 only* - COCs do **decrease the risk of ovarian cancer (1) and colon cancer (2)**. - However, this option is incomplete as it overlooks the significant protective effect on **endometrial cancer (3)**. *Increased risk of 2 and 3 only* - COCs actually **decrease the risk of both colon cancer (2) and endometrial cancer (3)**. - This statement directly contradicts the established protective effects of COCs on these cancer types.

Q: What is the content of ethinyl estradiol in very low dose oral contraceptives ?

20 µg. ***20 µg*** - Very low-dose oral contraceptives typically contain **20 µg of ethinyl estradiol**. This dosage is chosen to minimize estrogen-related side effects while maintaining contraceptive efficacy. - While it offers fewer side effects, its **contraceptive reliability** might be slightly lower than standard doses, and it could lead to more **breakthrough bleeding**. *15 µg* - Oral contraceptives with **15 µg of ethinyl estradiol** are considered ultra-low dose and are less common. - This dosage carries a higher risk of **breakthrough bleeding** and potentially reduced efficacy compared to 20 µg. *25 µg* - An oral contraceptive containing **25 µg of ethinyl estradiol** falls within the low-dose range, but it is not classified as "very low dose" given that 20 µg is the typical threshold for that designation. - While still generally well-tolerated, it contains slightly more estrogen than the very low-dose options. *30 µg* - This concentration of ethinyl estradiol is characteristic of **low-dose oral contraceptives**, but not "very low dose." - It offers good contraceptive efficacy with a relatively low incidence of estrogen-related side effects.

Q: After how many hours of LH surge does the ovulation occur?

24-36 hours. ***24-36 hours*** - The **luteinizing hormone (LH) surge** triggers the final maturation of the oocyte and rupture of the dominant follicle. - Ovulation typically occurs **24-36 hours after the onset of the LH surge**, or approximately **10-18 hours after the LH peak**. - This is the **standard timeframe** taught in reproductive physiology and corresponds to the physiological cascade required for follicular rupture. *12-24 hours* - This timeframe is **too early** for ovulation to occur after the LH surge onset. - While some follicular changes begin during this period, the complete maturation and rupture process typically requires more time. - This might represent the interval from LH peak in some cases, but not from surge onset. *12-36 hours* - This range is **too broad** and includes both early (12h) and appropriate (24-36h) timeframes. - While the upper range is correct, the lower bound extends into a period when ovulation has typically not yet occurred. - Less precise than the 24-36 hour window. *24-48 hours* - While ovulation can occasionally occur up to 48 hours post-surge, this is **less common**. - The upper limit (48h) extends beyond the typical ovulation window. - Most ovulations are completed by 36 hours after the LH surge onset.

Question 1

Following statements are correct about levonorgestrel containing intra-uterine contraceptive device (Mirena) except

Accepted Answer

It increases the risk of ectopic pregnancy

Answer

It reduces the risk of pelvic inflammatory disease

Answer

It releases 20 µg/day of levonorgestrel

Answer

It increases the risk of ovarian cyst formation

Question 2

What is the drug of choice for emergency contraception ?

Accepted Answer

Levonorgestrel only pill

Answer

High dose oestrogen alone

Answer

Danazol

Answer

Yuzpe regimen (combined oral pill)

Question 3

Minipill containing 75 µg of desogestrel is used for contraception. Which of the following is its schedule of administration ?

Accepted Answer

Taken continuously without pill-free intervals

Answer

Taken once a day pill for 3 months with 7 days pill free interval

Answer

Taken for 21 days with 7 days pill free interval

Answer

Taken once a day pill for 2 months with 7 days pill free interval

Question 4

What is the most common cause of vault prolapse following hysterectomy ?

Accepted Answer

Failure to identify and repair enterocele

Answer

Obesity

Answer

Chronic cough

Answer

Diabetes mellitus

Question 5

Following which of the tubectomy procedures listed below, best result is achieved for reversal sterilization (recanalization procedure) ?

Accepted Answer

Fallopian ring occlusion

Answer

Electrocoagulation

Answer

Irving method

Answer

Pomeroy ligation

Question 6

Folic acid deficiency is characterized by the following features except

Accepted Answer

Microcytes

Answer

Macrocytes

Answer

Howell-Jolly bodies

Answer

Hypersegmented neutrophils

Question 7

Which one of the following is not a third generation progestogen used in combined oral contraceptive pills ?

Accepted Answer

Levonorgestrel

Answer

Norgestimate

Answer

Gestodene

Answer

Desogestrel

Question 8

Consider the following list of cancers:

1. Ovarian cancer
2. Colon cancer
3. Endometrial cancer
4. Breast cancer

What is the effect of combined oral contraceptive pills on the above?

Accepted Answer

Protection against 1, 2 and 3

Answer

Increased risk of 3 and 4 only

Answer

Decreased risk of 1 and 2 only

Answer

Increased risk of 2 and 3 only

Question 9

What is the content of ethinyl estradiol in very low dose oral contraceptives ?

Accepted Answer

20 µg

Answer

15 µg

Answer

25 µg

Answer

30 µg

Question 10

After how many hours of LH surge does the ovulation occur?

Accepted Answer

24-36 hours

Answer

24-48 hours

Answer

12-24 hours

Answer

12-36 hours

UPSC-CMS 2009

Obstetrics and Gynecology

Pathology

Pharmacology

Physiology