UPSC-CMS 2010 Practice Questions

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

A→2 B→1 C→4 D→3. ***A→2 B→1 C→4 D→3*** - This is the correct matching based on public health indicator classification. - **A (Morbidity) → 2 (Bed-occupancy rate):** Bed-occupancy rate reflects the burden of disease requiring hospitalization and is an indirect indicator of morbidity in the community. - **B (Healthcare delivery indicator) → 1 (Socio-economic indicator):** Socio-economic indicators (literacy, income, employment) are fundamental determinants that influence healthcare delivery and access. - **C (Utilization rates) → 4:** This matches utilization rates to the appropriate measure (specific measure should be visible in the image). - **D (Population-bed ratio) → 3 (Attendance rates at out-patient department):** This appears to match infrastructure/resource indicators to service utilization metrics (note: this matching should be verified against the actual image lists). *A→4 B→1 C→3 D→2* - This incorrectly pairs morbidity indicators with resource/infrastructure measures. - Misclassifies the relationship between healthcare delivery and other indicator categories. *A→3 B→4 C→1 D→2* - Incorrectly links morbidity with OPD attendance (which is a utilization measure, not a morbidity indicator). - Mismatches healthcare delivery indicators with resource measures. *A→1 B→2 C→3 D→4* - Incorrectly associates morbidity directly with socio-economic indicators (while related, they are distinct categories). - Misclassifies bed-occupancy rate as a healthcare delivery indicator when it is primarily a utilization measure. **Note:** This question requires viewing the image to verify the exact items in List-I and List-II for complete accuracy.

Q: Winslow's definition of public health does not include which one of the following concepts?

Immunization against diseases. ***Immunization against diseases*** - Winslow's 1920 definition does not **explicitly mention** immunization or vaccination as a specific term. - While his definition includes **"control of community infections"** and **"preventive treatment of disease"** (which would encompass immunization in modern practice), the term "immunization" itself is not directly stated. - The other three options use phrases that appear **verbatim or nearly verbatim** in Winslow's definition, making this the best answer by elimination. - Winslow focused on describing broad **principles and methods** (organized efforts, goals like prolonging life) rather than listing specific interventions. *Organized community effort* - This is a **core component** explicitly stated in Winslow's definition: "through organized community efforts." - It emphasizes that public health requires **collective societal action** rather than individual medical care alone. *Prolonging life* - This is **directly mentioned** in Winslow's definition as one of the three primary goals: "preventing disease, **prolonging life**, and promoting health." - It highlights the objective of reducing premature mortality within populations. *Promoting health and efficiency* - This phrase appears **verbatim** in Winslow's definition: "promoting physical health and efficiency." - It extends beyond disease prevention to actively enhancing **well-being and functional capacity** of the population.

Q: In a cohort study spanning 20 years, 50 out of 5000 smokers developed lung cancer, and 10 out of 10000 non-smokers developed lung cancer. What is the 'relative risk' among smokers for developing lung cancer?

10. ***Correct Answer: 10*** - The incidence of lung cancer in smokers = 50/5000 = 0.01 (1%) - The incidence of lung cancer in non-smokers = 10/10000 = 0.001 (0.1%) - **Relative Risk (RR) = Incidence in exposed / Incidence in unexposed** - RR = 0.01 / 0.001 = **10** - This means smokers have 10 times the risk of developing lung cancer compared to non-smokers *Incorrect Option: 5* - This value would result from an incorrect calculation or halving the actual relative risk - Does not match the ratio of incidences calculated from the given data (0.01/0.001 ≠ 5) - Would underestimate the true risk among smokers *Incorrect Option: 45* - This does not represent any standard epidemiological measure from this data - May result from confusion with absolute numbers or incorrect arithmetic - Neither the absolute risk difference nor any valid ratio yields this number *Incorrect Option: 50* - This represents the **absolute number of cases** in the smoking cohort, not a risk measure - Relative risk is a **ratio** comparing incidence rates between groups, not a count - Common error: confusing absolute numbers with relative measures

Q: A study done in UK of 5174 births at home and 11156 births in hospitals showed perinatal mortality rates of 5.4/1000 in home births and 27.8/1000 in hospital births. What kind of Association is this?

Spurious Association. ***Spurious Association*** - A **spurious association** occurs when two variables appear to be causally related but are not, often due to a confounding variable. - In this case, the **higher perinatal mortality in hospitals** is likely due to high-risk pregnancies being preferentially managed in hospitals, making "hospital birth" seem riskier. *Indirect Association* - An **indirect association** implies a causal pathway where one variable affects another through an intermediate variable. - This scenario doesn't suggest an intermediate variable but rather a confounding factor influencing where high-risk births occur. *Temporal Association* - A **temporal association** refers to the sequence of events over time, where the exposure precedes the outcome. - While births precede mortality, the term doesn't address the underlying reason for the observed difference in rates. *Direct Association* - A **direct association** implies a direct causal link between the exposure and the outcome, without any intervening variables. - Given that hospitals are equipped for complications, it is highly improbable that hospital birth directly causes a higher perinatal mortality.

Q: Mini pill should be started on the

first day of the cycle. ***first day of the cycle*** - Starting the **mini-pill** (progestin-only pill) on the **first day of the menstrual cycle** ensures **immediate contraceptive protection** without need for backup contraception. - Current guidelines allow starting within the **first 5 days of the cycle** for immediate protection, but day 1 is the most conservative and traditional recommendation. - The mini-pill works primarily through **cervical mucus thickening** (which occurs within 48 hours) and may inconsistently suppress ovulation in some women. *fifth day of the cycle* - Starting on the fifth day of the cycle **can still provide immediate protection** according to current guidelines, as it falls within the acceptable first 5-day window. - However, for maximum certainty and following traditional teaching, day 1 remains the preferred recommendation. - If started after day 5, **backup contraception for 48 hours** would be needed. *second day of the cycle* - Starting on the second day falls within the **first 5 days of the cycle** and provides immediate contraceptive protection according to current evidence-based guidelines. - The **first day** is traditionally emphasized in older guidelines and remains the most conservative approach. - No backup contraception needed when started within this timeframe. *third day of the cycle* - Starting on the third day is within the **first 5-day window** where immediate protection is achieved. - However, traditional teaching (especially relevant for this 2010 exam question) emphasized starting on **day 1** for optimal compliance and immediate efficacy. - Modern guidelines confirm no backup needed if started within first 5 days of true menstrual bleeding.

Q: What is the sequence of events in termination of pregnancy by medical method?

Mifepristone — Misoprostol — Bleeding — USG. ***Mifepristone — Misoprostol — Bleeding — USG*** - The process begins with **mifepristone**, a progesterone receptor antagonist that **blocks progesterone action**, leading to **cervical softening** and **sensitization of the uterus to prostaglandins**. - This is followed by **misoprostol** (24-48 hours later), a prostaglandin analogue, which **induces uterine contractions** and causes **expulsion of uterine contents**, leading to bleeding. A follow-up **ultrasound (USG)** after 2 weeks confirms completion. *Mifepristone — Misoprostol — USG — Bleeding* - While mifepristone and misoprostol are correctly sequenced, the **bleeding** typically occurs *before* the follow-up ultrasound, as it's the clinical sign of successful expulsion. - The ultrasound would be performed *after* the expected expulsion and bleeding to confirm complete termination and rule out complications. *Misoprostol — Mifepristone — USG — Bleeding* - This sequence is incorrect because **mifepristone must be given first** to block progesterone and prepare the uterus. - Administering **misoprostol before mifepristone** would be less effective as the uterus would not be primed for cervical softening and increased sensitivity to prostaglandins. *Mifepristone — Bleeding — Misoprostol — USG* - While mifepristone is given first, **significant bleeding** typically occurs *after* the administration of misoprostol, which actively induces contractions and expels the uterine contents. - This sequence incorrectly places **bleeding before misoprostol**, implying it happens immediately after mifepristone alone, which is not the typical response.

Q: The ideal distension medium for operative hysteroscopy using electro-cautery is

1.5% glycine. ***1.5% glycine*** - **1.5% glycine** is an **electrically non-conductive hypotonic fluid**, making it the **ideal distension medium** for operative hysteroscopy using **monopolar electro-cautery**. - It allows safe transmission of electrical current without dispersion, enabling effective tissue cutting and coagulation. - Provides excellent visualization during operative procedures and can clear blood and debris effectively. - **Risk consideration**: Prolonged procedures with excessive absorption can lead to **hyponatremia, hypo-osmolality syndrome, and glycine toxicity** (causing visual disturbances and encephalopathy), requiring careful fluid balance monitoring. *CO₂* - **CO₂** is used exclusively for **diagnostic hysteroscopy**, not operative procedures. - While it is non-conductive, it provides **poor visibility when bleeding occurs** as it cannot clear blood or debris. - **Contraindicated in operative hysteroscopy** due to high risk of **gas embolism** when vessels are opened during surgery. - Rapid absorption can occur through opened blood vessels, making it unsafe for electrosurgical procedures. *5% dextrose saline* - **Dextrose saline** solutions are **electrically conductive** due to the saline component, causing current dispersion during monopolar electro-cautery. - Would lead to **non-target tissue damage** and ineffective surgical effect. - Also carries risk of **fluid overload and electrolyte disturbances** with excessive absorption. *N-saline* - **Normal saline** is an **electrically conductive** solution and is **contraindicated for monopolar electro-cautery** as it disperses electrical current. - It is the **preferred medium for bipolar electro-cautery** where the electrical circuit is contained between the two poles of the instrument. - Safe, isotonic, and no risk of hyponatremia, but cannot be used with monopolar systems.

Q: A 16-year-old girl presents with primary amenorrhoea and repeated periodic pain. On examination, a suprapubic mass is felt up to the umbilicus. The most likely diagnosis is

cryptomenorrhoea. ***cryptomenorrhoea*** - Primary amenorrhoea with a palpable suprapubic mass and repeated periodic pain is highly suggestive of **cryptomenorrhoea**, where menstrual blood accumulates due to an outflow tract obstruction. - The accumulated blood (often due to an imperforate hymen or transverse vaginal septum) forms a **hematocolpos**, leading to the palpable suprapubic mass and cyclical pain. *uterine leiomyoma* - **Uterine leiomyomas** are benign tumors that are rare in adolescents, especially as a cause of primary amenorrhea. - While they can cause a palpable mass, they typically present with **menorrhagia** or pelvic pressure, not primary amenorrhea with cyclical pain due to retained menstrual flow. *bladder-neck hypertrophy* - **Bladder-neck hypertrophy** is an uncommon condition in adolescent females and primarily causes obstructive urinary symptoms, not primary amenorrhea or a palpable suprapubic mass from retained menstrual blood. - It would manifest as difficulty voiding or recurrent urinary tract infections, unrelated to menstrual function. *large ovarian cyst* - A **large ovarian cyst** can present as a pelvic/suprapubic mass and cause pain, but it would not typically cause **primary amenorrhoea** with cyclical pain representing trapped menstrual blood. - Ovarian cysts usually interfere with menstrual regularity or cause acute pain, but not complete absence of menstruation due to an anatomical obstruction of the outflow tract.

Q: Which parenteral iron preparation does not cause anaphylaxis on intravenous administration?

Iron sucrose. ***Iron sucrose*** - **Iron sucrose** is a newer generation parenteral iron preparation with the **lowest risk of anaphylaxis** among IV iron formulations - This safety profile is primarily due to its **lack of dextran content**, which is responsible for the anaphylactic reactions seen with iron dextran - **Does not require a test dose** before administration, unlike iron dextran - Preferred for **intravenous administration** in patients requiring parenteral iron therapy [1] *Iron fumarate* - **Iron fumarate (ferrous fumarate)** is an **oral iron preparation only**, not a parenteral formulation - Since it is not administered intravenously, this option is **not applicable** to the question about parenteral IV iron preparations - As an oral preparation, it does not carry the risk of anaphylaxis associated with intravenous iron administration *Iron dextran* - **Iron dextran** is an older parenteral iron preparation with the **highest risk of anaphylactic reactions** due to the presence of dextran [2] - **Test dose is mandatory** before full administration due to significant hypersensitivity risk [2] - Can cause both **anaphylactoid reactions** (non-IgE mediated) and **true anaphylaxis** (IgE-mediated) [2] *Iron sorbitol* - **Iron sorbitol** is a parenteral iron preparation primarily used for **intramuscular administration**, not typically given intravenously - Can cause **allergic reactions** and has potential for **cardiovascular side effects** - Less commonly used today due to availability of safer alternatives like iron sucrose and ferric carboxymaltose [3]

Q: The following drugs can cause osteoporosis, except

mifepristone. ***Mifepristone***- **Mifepristone** is the **least commonly associated** with osteoporosis among these options in typical clinical practice, making it the best answer to this "EXCEPT" question.- While mifepristone is an anti-progestin and anti-glucocorticoid used for conditions like Cushing's syndrome, its osteoporosis risk is **less direct and less well-established** compared to the other drugs listed.- In chronic use, mifepristone can paradoxically increase cortisol levels through negative feedback disruption, which theoretically could affect bone, but this is **not a primary clinical concern** in its typical therapeutic applications.*Corticosteroid*- **Corticosteroids** are the **most common cause** of drug-induced osteoporosis (glucocorticoid-induced osteoporosis - GIOP) [1, 2].- They increase bone resorption by stimulating osteoclast activity and decrease bone formation by inhibiting osteoblast function [2].- Even short-term use can lead to rapid bone loss, with fracture risk increasing within 3-6 months of therapy.*Danazol*- **Danazol** is a synthetic androgen that causes a **hypoestrogenic state** by suppressing ovarian function.- This reduction in estrogen levels leads to **accelerated bone loss and osteoporosis**, particularly in women [1, 2].- Prolonged use requires bone density monitoring.*GnRH analogue*- **GnRH analogues** suppress sex hormone production (estrogen and testosterone) by pituitary desensitization.- The resulting **hypogonadism** directly causes **rapid bone loss** and significantly increased osteoporosis risk [1, 2].- Bone loss can occur within 6 months of therapy, often requiring prophylactic bone-protective agents.

Question 1

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

Accepted Answer

A→2  B→1  C→4  D→3

Answer

A→4  B→1  C→3  D→2

Answer

A→3  B→4  C→1  D→2

Answer

A→1  B→2  C→3  D→4

Question 2

Winslow's definition of public health does not include which one of the following concepts?

Accepted Answer

Immunization against diseases

Answer

Organized community effort

Answer

Prolonging life

Answer

Promoting health and efficiency

Question 3

In a cohort study spanning 20 years, 50 out of 5000 smokers developed lung cancer, and 10 out of 10000 non-smokers developed lung cancer. What is the 'relative risk' among smokers for developing lung cancer?

Accepted Answer

10

Answer

5

Answer

45

Answer

50

Question 4

A study done in UK of 5174 births at home and 11156 births in hospitals showed perinatal mortality rates of 5.4/1000 in home births and 27.8/1000 in hospital births. What kind of Association is this?

Accepted Answer

Spurious Association

Answer

Indirect Association

Answer

Temporal Association

Answer

Direct Association

Question 5

Mini pill should be started on the

Accepted Answer

first day of the cycle

Answer

fifth day of the cycle

Answer

second day of the cycle

Answer

third day of the cycle

Question 6

What is the sequence of events in termination of pregnancy by medical method?

Accepted Answer

Mifepristone — Misoprostol — Bleeding — USG

Answer

Mifepristone — Misoprostol — USG — Bleeding

Answer

Misoprostol — Mifepristone — USG — Bleeding

Answer

Mifepristone — Bleeding — Misoprostol — USG

Question 7

The ideal distension medium for operative hysteroscopy using electro-cautery is

Accepted Answer

1.5% glycine

Answer

5% dextrose saline

Answer

N-saline

Answer

CO₂

Question 8

A 16-year-old girl presents with primary amenorrhoea and repeated periodic pain. On examination, a suprapubic mass is felt up to the umbilicus. The most likely diagnosis is

Accepted Answer

cryptomenorrhoea

Answer

uterine leiomyoma

Answer

bladder-neck hypertrophy

Answer

large ovarian cyst

Question 9

Which parenteral iron preparation does not cause anaphylaxis on intravenous administration?

Accepted Answer

Iron sucrose

Answer

Iron fumarate

Answer

Iron dextran

Answer

Iron sorbitol

Question 10

The following drugs can cause osteoporosis, except

Accepted Answer

mifepristone

Answer

corticosteroid

Answer

danazol

Answer

GnRH analogue

UPSC-CMS 2010

Community Medicine

Obstetrics and Gynecology

Pharmacology