UPSC-CMS 2010 Practice Questions

Q: Monoamniotic monochorionic twins develop when the division of cell mass occurs

after 8th day of fertilization. ***after 8th day of fertilization*** - If division occurs **after the 8th day** post-fertilization, the twins will share both the **amnion** and **chorion**, leading to monoamniotic monochorionic twins. - This late division stage means the **amniotic cavity** has already formed for both embryos, and they share the same amniotic fluid and placenta. *after 2 weeks of development of embryonic disc* - Division this late (after 2 weeks, or day 14) would be extremely rare and usually results in **conjoined twins**, as the embryonic disc has already significantly developed. - At this stage, the primitive streak has formed, and further division would likely involve shared organs or structures. *within 72 hours after fertilization* - Division within the first 72 hours (days 0-3) typically results in **dichorionic diamniotic twins**, meaning each twin has its own placenta and amniotic sac. - This early division occurs before the formation of the inner cell mass and trophoblast differentiate into distinct structures. *between 4th and 8th day of fertilization* - Division between days 4 and 8 most commonly leads to **monochorionic diamniotic twins**, where the twins share a placenta but have separate amniotic sacs. - This timing corresponds to the formation of a common chorion before the development of separate amniotic cavities.

Q: Match List-I (Signs of pregnancy) with List-II (Anatomical sites) and select the correct answer using the code given below the Lists:

A→3 B→4 C→2 D→1. ***A→3 B→4 C→2 D→1*** This question has inherent issues as the anatomical sites in List-II do not perfectly correspond to the signs in List-I. Based on the image provided and available options: - **A (Jacquemier's sign) → 3**: Jacquemier's sign refers to the **bluish-purple discoloration of the vagina and cervix** due to increased vascularity. While primarily a vaginal/cervical sign, if the list groups this under broader "uterine/pelvic" changes, this may be the intended match, though medically it is most specific to the vagina (which would be option 4). - **B (Chloasma gravidarum) → 4**: Chloasma gravidarum is the **hyperpigmentation of facial skin** (mask of pregnancy). This does NOT occur on the vagina. This matching appears incorrect unless List-II's option 4 refers to something other than "vagina" in the original source. - **C (Striae gravidarum) → 2**: Striae gravidarum are **stretch marks that typically appear on the abdomen** (also breasts, thighs). This match is **correct**. - **D (Montgomery's tubercles) → 1**: Montgomery's tubercles are **enlarged sebaceous glands on the areola of the breast**. This match is **correct**. *Other options are incorrect as they mismatch the anatomical sites for these well-established signs of pregnancy. The correct answer reflects the intended matching from the original UPSC-CMS 2010 examination, though some matches may not align perfectly with anatomical specificity.*

Q: If a patient of polycystic ovary syndrome on metformin conceives, how soon should the metformin be stopped?

Immediately following the diagnosis of pregnancy. ***Immediately following the diagnosis of pregnancy*** - Based on **current evidence**, metformin can be safely **discontinued once pregnancy is confirmed** in PCOS patients. - The primary role of metformin in PCOS is to improve **ovulation and achieve conception**—once pregnancy occurs, this goal is accomplished. - Recent large randomized trials (including **PregMet** and **MiTy studies**) have shown **no significant benefit** in continuing metformin during pregnancy for reducing miscarriage or gestational diabetes. - Current practice favors **individualized decisions**, but routine continuation is not standard. *After the 1st trimester* - This was **older practice** based on theoretical benefits of reducing early pregnancy loss. - However, systematic reviews and meta-analyses have **not confirmed** these benefits in well-designed trials. - While some clinicians may continue metformin through the first trimester in selected cases, this is not the standard recommendation for all PCOS pregnancies. *After the 2nd trimester* - Continuing metformin this long is **not evidence-based** for routine PCOS management. - While metformin may be continued throughout pregnancy for **gestational diabetes** management (separate indication), this is not specifically for PCOS. - Most guidelines do not support routine continuation beyond pregnancy confirmation for PCOS alone. *Before the onset of labour* - This timing has **no physiological basis** for PCOS-related metformin use. - If metformin is being used for gestational diabetes (different indication), timing of discontinuation would be individualized, but this is not the standard answer for PCOS patients.

Q: A pregnant woman presents at 28 weeks of gestation with haemoglobin level of 7 gm%; and peripheral smear reveals it to be of microcytic hypochromic type. What would be the correct option of therapy?

Injectable iron therapy. ***Injectable iron therapy*** - With a hemoglobin of **7 gm%** at **28 weeks of gestation**, the patient has **severe anemia** that requires a rapid increase in hemoglobin. - **Injectable iron therapy** provides a swift and effective way to replenish iron stores and improve hemoglobin levels, especially when oral iron absorption is insufficient or time is critical. *Blood transfusion* - While blood transfusions rapidly increase hemoglobin, they are generally reserved for **acute hemodynamic instability**, severe symptomatic anemia, or when immediate delivery is anticipated. - This patient, though severely anemic, does not present with criteria for **immediate transfusion**. *Oral iron and folic acid therapy* - **Oral iron therapy** is the standard treatment for moderate anemia, but for a hemoglobin of **7 gm%**, it may be too slow to raise hemoglobin levels quickly enough. - While folic acid is important in pregnancy, it doesn't directly address the **iron deficiency** indicated by microcytic hypochromic anemia. *Oral iron therapy* - **Oral iron therapy** is usually the first-line treatment for **iron deficiency anemia**. - However, at **7 gm% hemoglobin** in the **third trimester**, oral iron may not increase hemoglobin levels fast enough, and compliance or absorption issues could further delay recovery.

Q: Serum AFP (alpha fetoprotein) levels are increased at 16 weeks of pregnancy in all the following conditions, except

Down's syndrome. ***Down's syndrome*** - This condition is associated with **decreased** levels of maternal serum alpha-fetoprotein (MSAFP), not increased. - Decreased MSAFP, along with elevated human chorionic gonadotropin (hCG) and unconjugated estriol, forms part of the **triple screen** for Down's syndrome. *Gastroschisis* - **Gastroschisis** involves a defect in the abdominal wall allowing fetal intestines to float freely in the amniotic fluid. - This direct exposure of fetal blood vessels in the bowel to amniotic fluid leads to a significant leakage of **AFP**, resulting in markedly elevated maternal serum levels. *Multiple pregnancies* - In **multiple gestations** (e.g., twins or triplets), there are multiple fetuses producing AFP. - The combined production of AFP from all fetuses leads to a proportionally **higher total MSAFP** level, which is a normal finding for such pregnancies. *Neural tube defects* - **Neural tube defects** (NTDs) like anencephaly or spina bifida result from incomplete closure of the neural tube. - This allows **fetal CSF** and neural tissue to leak into the amniotic fluid, leading to significantly elevated levels of AFP in both amniotic fluid and maternal serum.

Q: The fetal well-being can be assessed by all of the following, except

Kleihauer-Betke test. ***Kleihauer-Betke test*** - The **Kleihauer-Betke test** is used to quantify the amount of **fetal hemoglobin** that has entered the maternal circulation, typically in cases of **fetomaternal hemorrhage**. - It does assess fetal red blood cells in maternal circulation but does not directly assess current fetal well-being in terms of **cardiac activity**, **movement**, or **oxygenation**. *non-stress test* - The **non-stress test (NST)** monitors **fetal heart rate (FHR)** accelerations in response to fetal movement as an indicator of adequate **fetal oxygenation** and **autonomic nervous system function**. - A **reactive NST** with appropriate accelerations is considered a sign of **fetal well-being**. *ultrasound* - **Ultrasound** is a versatile tool for assessing fetal well-being, providing information on **fetal growth**, **anatomy**, **amniotic fluid volume**, and **biophysical profile (BPP)**. - The BPP, which includes ultrasound observations of **fetal breathing**, **movement**, **muscle tone**, and **amniotic fluid volume**, along with an **NST**, offers a comprehensive assessment of fetal status. *contraction stress test* - The **contraction stress test (CST)** evaluates the response of the **fetal heart rate** to uterine contractions, which temporarily reduce placental blood flow. - A **negative CST** (no late decelerations) indicates good **fetal oxygen reserve** and is a reliable sign of **fetal well-being**.

Q: Which one of the following is diagnosed by Spiegelberg criteria?

Ovarian pregnancy. ***Ovarian pregnancy*** - Spiegelberg criteria are specifically used to diagnose an **ovarian ectopic pregnancy**, which is a rare form of ectopic pregnancy where the fertilized egg implants in the ovary. - The criteria include: the **fallopian tube and fimbria are intact** and separate from the ovary, the gestational sac is in the ovarian cortex, it is connected to the uterus by the **ovarian ligament**, and ovarian tissue can be histologically demonstrated in the sac wall. *Molar pregnancy* - This is a type of **gestational trophoblastic disease** characterized by abnormal growth of trophoblastic tissue, resulting in a non-viable pregnancy. - Diagnosis involves high levels of **hCG**, a "snowstorm" appearance on ultrasound, and histopathological examination, not Spiegelberg criteria. *Twin pregnancy* - This refers to the presence of **two fetuses** in a single pregnancy. - Diagnosis is primarily made via **ultrasound imaging** showing two distinct gestational sacs or two fetuses, and is unrelated to Spiegelberg criteria. *Uterine pregnancy* - This is a **normal intrauterine pregnancy** where the fertilized egg implants within the uterine cavity. - It is diagnosed by visualizing a gestational sac and eventually an embryo/fetus within the uterus by **ultrasound**, not by Spiegelberg criteria.

Question 1

Monoamniotic monochorionic twins develop when the division of cell mass occurs

Accepted Answer

after 8th day of fertilization

Answer

after 2 weeks of development of embryonic disc

Answer

within 72 hours after fertilization

Answer

between 4th and 8th day of fertilization

Question 2

Match List-I (Signs of pregnancy) with List-II (Anatomical sites) and select the correct answer using the code given below the Lists:

Accepted Answer

A→3  B→4  C→2  D→1

Answer

A→3  B→5  C→2  D→1

Answer

A→3  B→1  C→4  D→2

Answer

A→2  B→4  C→1  D→3

Question 3

If a patient of polycystic ovary syndrome on metformin conceives, how soon should the metformin be stopped?

Accepted Answer

Immediately following the diagnosis of pregnancy

Answer

After the 1st trimester

Answer

After the 2nd trimester

Answer

Before the onset of labour

Question 4

With reference to the transmission of HIV from mother to child, which one of the following statements is not correct?

Accepted Answer

Single dose of 200 mg nevirapine at the onset of labour eliminates the risk of HIV transmission to the newborn

Answer

The rate of transmission of HIV from mother to child is between 15-48%

Answer

HIV is transmitted through breast milk

Answer

In majority of cases, transmission of virus occurs during intrapartum period

Question 5

A pregnant woman presents at 28 weeks of gestation with haemoglobin level of 7 gm%; and peripheral smear reveals it to be of microcytic hypochromic type. What would be the correct option of therapy?

Accepted Answer

Injectable iron therapy

Answer

Blood transfusion

Answer

Oral iron and folic acid therapy

Answer

Oral iron therapy

Question 6

Serum AFP (alpha fetoprotein) levels are increased at 16 weeks of pregnancy in all the following conditions, except

Accepted Answer

Down's syndrome

Answer

gastroschisis

Answer

multiple pregnancies

Answer

neural tube defects

Question 7

The fetal well-being can be assessed by all of the following, except

Accepted Answer

Kleihauer-Betke test

Answer

non-stress test

Answer

ultrasound

Answer

contraction stress test

Question 8

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→3  B→4  C→1  D→2

Answer

A→1  B→4  C→3  D→2

Answer

A→2  B→4  C→1  D→3

Answer

A→4  B→1  C→3  D→2

Question 9

Which one of the following is diagnosed by Spiegelberg criteria?

Accepted Answer

Ovarian pregnancy

Answer

Molar pregnancy

Answer

Twin pregnancy

Answer

Uterine pregnancy

Question 10

Which of the following is the most appropriate management in a ruptured tubal pregnancy?

Accepted Answer

Quick resuscitation followed by laparotomy and excision of the offending tube

Answer

Autotransfusion of the fresh blood harvested from the peritoneal cavity

Answer

Blood transfusion immediately after the clamps have been placed to control the bleeding

Answer

Excision of the offending tube and the ipsilateral ovary (salpingo-oophorectomy)

UPSC-CMS 2010

Anatomy

Obstetrics and Gynecology