UPSC-CMS 2013 Practice Questions

Q: During pregnancy, vaccination can be given against all these diseases except :

Mumps. ***Mumps*** - The **mumps vaccine** is a **live attenuated vaccine**, meaning it contains a weakened form of the virus. - Live attenuated vaccines are generally **contraindicated in pregnancy** due to the theoretical risk of transmitting the vaccine virus to the fetus. *Hepatitis A* - The **Hepatitis A vaccine** is an **inactivated (killed) vaccine**. - Inactivated vaccines are generally considered **safe during pregnancy** if there's a significant risk of exposure. *Tetanus* - The **tetanus toxoid vaccine (Tdap)** is recommended during every pregnancy to protect the newborn from **pertussis (whooping cough)** and provide maternal protection against tetanus. - It is an **inactivated vaccine** and is very safe for both mother and fetus. *Hepatitis B* - The **Hepatitis B vaccine** is a **recombinant vaccine**, meaning it's made from a component of the virus. - It is considered **safe in pregnancy** and is recommended for pregnant women at risk of acquiring hepatitis B.

Q: What is the likely cause of primary amenorrhoea together with retention of urine in an adolescent girl ?

Haematocolpos. ***Haematocolpos*** - **Haematocolpos** is the accumulation of menstrual blood in the vagina due to an **imperforate hymen** or other outflow obstruction, causing primary amenorrhoea. - The retained blood can exert pressure on the urethra and bladder, leading to **urinary retention**. *Testicular Feminizing syndrome* - Also known as **Androgen Insensitivity Syndrome**, individuals have a 46, XY karyotype but appear female externally due to androgen receptor defects. - It causes primary amenorrhoea but typically does not present with urinary retention as the Mullerian ducts regress, meaning there is no uterus and therefore no menstrual blood to accumulate. *Adrenal hyperplasia* - **Congenital adrenal hyperplasia (CAH)** can cause virilization in females, leading to ambiguous genitalia and primary amenorrhoea due to hormonal imbalances. - While it can affect reproductive development, urinary retention due to menstrual blood accumulation is not a typical presentation. *Turner's syndrome* - **Turner's syndrome (45, XO)** is characterized by ovarian dysgenesis and primary amenorrhoea due to the absence of ovarian function. - Individuals often have distinctive features like a short stature and a webbed neck, but urinary retention is not a direct consequence of the syndrome itself.

Q: Histological type of endometrium that is suggestive of ovulation is :

secretory phase. ***secretory phase*** - The **secretory phase** of the endometrium occurs *after* ovulation and is characterized by the effects of **progesterone** produced by the corpus luteum. - Histologically, this phase shows **tortuous glands** with **secretory activity** (containing glycogen and mucus), and a **stroma that becomes edematous**, preparing the uterus for potential implantation. *cystic glandular hyperplasia* - This is a form of **endometrial hyperplasia** characterized by abundant, dilated glands of varying sizes and stroma, typically occurring due to **unopposed estrogen stimulation**. - It does not indicate ovulation; rather, it often results from **anovulation** or other conditions causing persistent estrogen exposure without a subsequent progesterone phase. *adenomatous hyperplasia* - **Adenomatous hyperplasia** (or complex hyperplasia) involves glandular crowding and architectural abnormalities, representing a more advanced form of hyperplasia compared to simple cystic hyperplasia. - It arises from **unopposed estrogen** and is not indicative of normal ovulation; it can be a precursor to endometrial carcinoma, especially if **atypia** is present. *proliferative phase* - The **proliferative phase** occurs *before* ovulation under the influence of **estrogen**, during which the endometrium regrows and thickens. - Histologically, it features relatively **straight, tubular glands** and a compact stroma, and while it precedes ovulation, it does not confirm that ovulation has occurred.

Q: A pregnant woman in third trimester has normal blood pressure in the arms when standing and sitting but drops to 90/50 when lying down. What is the likely cause?

Compression of inferior vena cava. ***Compression of inferior vena cava*** - In the third trimester, the **gravid uterus** can compress the **inferior vena cava (IVC)** when the woman lies supine, reducing **venous return** to the heart. - This decreased preload leads to a drop in **cardiac output** and consequently a fall in **blood pressure** (supine hypotensive syndrome). *Compression of uterine artery* - Compression of the uterine artery would primarily affect **placental blood flow** and fetal well-being, but it is not the direct cause of the mother's systemic hypotension. - **Uterine artery compression** does not significantly impact overall systemic blood pressure in the mother. *Compression of aorta* - While the gravid uterus can compress the **aorta** (aortocaval compression), this typically leads to reduced blood flow to the lower extremities and uterus, not a generalized drop in systemic blood pressure, as collateral circulation usually compensates. - **Aortic compression** can cause a difference in blood pressure between the upper and lower extremities, but the scenario describes a drop in overall systemic pressure when recumbent. *Compression of internal iliac artery* - Compression of the internal iliac artery would mainly affect blood supply to the **pelvic organs** and gluteal region, but it does not account for the significant drop in systemic blood pressure observed in the supine position. - This compression would not cause a generalized reduction in **venous return** to the heart, which is the primary mechanism for supine hypotension.

Q: Which of the following is an absolute contraindication to breastfeeding according to WHO guidelines?

Active, untreated maternal tuberculosis. ***Active, untreated maternal tuberculosis*** - According to **WHO guidelines**, active, untreated tuberculosis in the mother IS an **absolute contraindication to direct breastfeeding** due to the risk of transmission to the infant through respiratory droplets during close contact. - However, **expressed breast milk** can be given to the infant during this period as TB is not transmitted through breast milk itself. - Once the mother has received **at least 2 weeks of appropriate anti-tubercular treatment** and is no longer infectious, **direct breastfeeding can be safely resumed**. - This is a temporary contraindication that becomes resolved with treatment, but in the untreated state, it is considered absolute for direct breastfeeding. *Maternal diarrhoea* - **Maternal diarrhea** is NOT a contraindication to breastfeeding according to WHO. - Antibodies in breast milk actually help **protect the infant** from gastrointestinal infections. - Mothers should maintain **good hand hygiene** to prevent fecal-oral transmission, but breastfeeding should continue. - Maternal hydration should be maintained to ensure adequate milk production. *1st 24 hours after Caesarean section* - The **first 24 hours after cesarean section** is NOT a contraindication to breastfeeding. - **Early initiation of breastfeeding** within the first hour after delivery is recommended even after C-section to promote bonding and establish milk supply. - While positioning may require adjustment due to surgical pain, this is managed with **proper support and pain relief**, not by withholding breastfeeding. - Skin-to-skin contact and breastfeeding should be facilitated as soon as the mother is alert and responsive. *None of the above* - This is incorrect because active, untreated maternal tuberculosis IS an absolute contraindication to direct breastfeeding according to WHO guidelines, though expressed breast milk can still be provided.

Q: A 15-year old unmarried girl comes with history of dysmenorrhea. Age of menarche is 12 years. Per abdominal and per rectum examination reveal nothing abnormal. You will treat the patient with :

Reassurance and giving antispasmodics during menses. ***Reassurance and giving antispasmodics during menses*** - The patient presents with **primary dysmenorrhea**, indicated by the onset of symptoms with menarche and normal pelvic examination findings in an unmarried girl. - **Antispasmodics** (e.g., NSAIDs like ibuprofen or mefenamic acid) taken during menses effectively reduce pain by inhibiting prostaglandin synthesis, which causes uterine contractions. *Reassurance and giving antispasmodics throughout the month* - While **reassurance** is appropriate, taking antispasmodics throughout the entire month is **unnecessary** and can lead to adverse effects, as the pain is cyclical and directly related to menstruation. - **Antispasmodics** are most effective when taken a day or two before the onset of menstruation and continued during the painful days. *Hormones* - **Hormonal therapy** (e.g., combined oral contraceptives) is a valid treatment option for dysmenorrhea, especially if non-steroidal anti-inflammatory drugs (NSAIDs) are ineffective or if contraception is also desired. - However, for a 15-year-old unmarried girl with typical primary dysmenorrhea and no other complications, **NSAIDs/antispasmodics** are generally the first-line and usually sufficient treatment. *Antibiotics* - **Antibiotics** are used to treat bacterial infections, and there is no indication of infection (e.g., fever, unusual discharge, pelvic inflammatory disease) in this patient's presentation. - Using antibiotics without an identified infection is inappropriate and contributes to **antibiotic resistance**.

Q: A pregnant lady with 37 weeks gestation has been admitted with a history of premature rupture of membranes for 6 hours. She is best treated with:

antibiotics followed by labour induction. ***antibiotics followed by labour induction*** - For premature rupture of membranes (PROM) at full term (≥37 weeks gestation), **antibiotics** are given to prevent maternal and neonatal infection due to the prolonged rupture, and **labour induction** is recommended to reduce the risk of chorioamnionitis and neonatal sepsis. - The risk of infection increases significantly with the duration of membrane rupture, making active management with induction preferable over expectant management. - Current guidelines recommend induction within 24 hours of membrane rupture at term. *steroids followed by labour induction* - **Antenatal steroids** (e.g., betamethasone, dexamethasone) are primarily used to promote fetal lung maturity in cases of anticipated preterm birth, typically between 24 and 34 weeks gestation. - At **37 weeks gestation**, the fetal lungs are generally mature, so steroids offer no significant benefit and would only delay necessary intervention. *expectant management* - **Expectant management** (waiting for spontaneous labor) at term PROM significantly increases the risk of maternal and neonatal infections including chorioamnionitis, endometritis, and neonatal sepsis. - Studies show that active management with induction reduces infection rates without increasing cesarean section rates. - While most women will go into spontaneous labor within 24 hours, the infection risk during the waiting period outweighs the benefits of avoiding induction. *steroids and tocolytic agents* - As established, **steroids** are not indicated at 37 weeks gestation. - **Tocolytic agents** are used to suppress uterine contractions and prolong pregnancy in cases of preterm labor, which is contraindicated in PROM at term as delaying delivery increases infection risk without providing significant fetal benefit.

Q: The ferning of cervical mucus is due to the high concentration of :

Sodium chloride. ***Sodium chloride*** - The characteristic **ferning pattern** observed in cervical mucus is primarily due to the crystallization of **sodium chloride** under the influence of estrogen. - This crystallization occurs as the mucus dries on a slide, forming a fern-like pattern that indicates high estrogen levels and often signifies the periovulatory period. *Sodium bicarbonate* - While present in bodily fluids, **sodium bicarbonate** does not directly contribute to the characteristic fern-like crystallization seen in cervical mucus. - Its primary role is buffering, maintaining pH balance, rather than forming crystal patterns. *Potassium chloride* - Although potassium ions are present in cervical secretions, **potassium chloride** does not specifically form the classic fenestrated pattern observed in ferning. - The unique crystallization properties of sodium chloride distinguish it from other salts in this context. *Potassium bicarbonate* - Similar to sodium bicarbonate, **potassium bicarbonate** does not contribute to the fern phenomenon of cervical mucus. - It plays a role in pH regulation but not in the distinct crystallization pattern associated with estrogen and fertility.

Q: Which one of the following statements is not correct about fetal circulation?

Umbilical artery carries oxygenated blood to the fetus. ***Umbilical artery carries oxygenated blood to the fetus*** - This statement is incorrect because the **umbilical arteries** carry **deoxygenated blood** and waste products away from the fetus to the placenta. - Oxygenated blood is carried *to* the fetus by the **umbilical vein**. *Umbilical artery carries deoxygenated fetal blood to the placenta* - This statement is correct. The **umbilical arteries** are responsible for transporting **deoxygenated blood** and metabolic waste products from the fetal circulation back to the placenta for exchange with the maternal blood. - This is a key component of the fetoplacental circulation. *Two umbilical arteries and one umbilical vein traverse through the fetus and placenta* - This statement is correct. The **umbilical cord** typically contains **two umbilical arteries** and one **umbilical vein**. - This arrangement facilitates efficient nutrient and gas exchange between the mother and fetus. *Umbilical vein carries oxygenated blood to the fetus* - This statement is correct. The **umbilical vein** carries **oxygenated blood** rich in nutrients from the placenta to the fetus. - This is the main conduit for essential substances required for fetal growth and development.

Question 1

During pregnancy, vaccination can be given against all these diseases except :

Accepted Answer

Mumps

Answer

Hepatitis A

Answer

Tetanus

Answer

Hepatitis B

Question 2

What is the likely cause of primary amenorrhoea together with retention of urine in an adolescent girl ?

Accepted Answer

Haematocolpos

Answer

Testicular Feminizing syndrome

Answer

Adrenal hyperplasia

Answer

Turner's syndrome

Question 3

Histological type of endometrium that is suggestive of ovulation is :

Accepted Answer

secretory phase

Answer

cystic glandular hyperplasia

Answer

adenomatous hyperplasia

Answer

proliferative phase

Question 4

A pregnant woman in third trimester has normal blood pressure in the arms when standing and sitting but drops to 90/50 when lying down. What is the likely cause?

Accepted Answer

Compression of inferior vena cava

Answer

Compression of uterine artery

Answer

Compression of aorta

Answer

Compression of internal iliac artery

Question 5

Which of the following is an absolute contraindication to breastfeeding according to WHO guidelines?

Accepted Answer

Active, untreated maternal tuberculosis

Answer

Maternal diarrhoea

Answer

None of the above

Answer

1st 24 hours after Caesarean section

Question 6

Meconium aspiration syndrome can be prevented by taking the following measures except :

Accepted Answer

Delivering the baby by emergency caesarean section

Answer

Amnioinfusion

Answer

Oropharyngeal suctioning

Answer

Suctioning of trachea through laryngoscope

Question 7

A 15-year old unmarried girl comes with history of dysmenorrhea. Age of menarche is 12 years. Per abdominal and per rectum examination reveal nothing abnormal. You will treat the patient with :

Accepted Answer

Reassurance and giving antispasmodics during menses

Answer

Reassurance and giving antispasmodics throughout the month

Answer

Hormones

Answer

Antibiotics

Question 8

A pregnant lady with 37 weeks gestation has been admitted with a history of premature rupture of membranes for 6 hours. She is best treated with:

Accepted Answer

antibiotics followed by labour induction

Answer

steroids followed by labour induction

Answer

expectant management

Answer

steroids and tocolytic agents

Question 9

The ferning of cervical mucus is due to the high concentration of :

Accepted Answer

Sodium chloride

Answer

Sodium bicarbonate

Answer

Potassium chloride

Answer

Potassium bicarbonate

Question 10

Which one of the following statements is not correct about fetal circulation?

Accepted Answer

Umbilical artery carries oxygenated blood to the fetus

Answer

Umbilical artery carries deoxygenated fetal blood to the placenta

Answer

Two umbilical arteries and one umbilical vein traverse through the fetus and placenta

Answer

Umbilical vein carries oxygenated blood to the fetus

UPSC-CMS 2013

Obstetrics and Gynecology

Physiology