UPSC-CMS 2013 Practice Questions

Q: All of the following are eligibility criteria for female sterilization except :

At least two living children should be present. ***At least two living children should be present*** - The number of **living children** is NOT a mandatory eligibility criterion for female sterilization in India. - The **Ministry of Health and Family Welfare** has explicitly removed parity requirements to expand access to sterilization services. - Current guidelines emphasize **informed consent** and **voluntary participation**, not the number of children. - This is the correct answer as it is clearly NOT an eligibility criterion. *Client should be married* - **Marital status** is also NOT a mandatory eligibility criterion in current Indian family planning guidelines. - However, this has been inconsistently applied, and the removal of the **two-child norm** is more explicitly documented. - Modern guidelines focus on individual autonomy and informed choice regardless of marital status. *Client's age should not be less than 22 years or more than 49 years* - **Minimum age of 22 years** is a valid eligibility criterion to ensure maturity and informed decision-making. - The upper age limit is generally aligned with reproductive age, though this varies. - Age restriction is a legitimate criterion under Indian guidelines. *Client or her spouse must not have undergone sterilisation in the past* - This is a logical eligibility consideration to prevent **duplicate sterilization** within a couple. - If one partner is already sterilized, the other typically does not need the procedure. - This ensures efficient use of resources and prevents unnecessary surgeries.

Q: Misoprostol can be used in obstetric practice by the following routes except:

Intravenous. ***Intravenous*** - Misoprostol is **not used intravenously** in obstetric practice due to safety concerns - IV administration could lead to **rapid, uncontrolled systemic effects** including severe adverse events like **cardiovascular collapse** and anaphylactoid reactions - The drug formulation is not intended for IV use, and its rapid absorption via this route would pose significant maternal risk - All approved obstetric uses employ **oral, sublingual, vaginal, or buccal routes** *Vaginal* - Vaginal administration is commonly used in obstetrics for **cervical ripening** and **labor induction** - Also used for **management of miscarriage** and **postpartum hemorrhage** - Allows for **gradual absorption** with local effect on the cervix and uterus *Sub-lingual* - Sublingual misoprostol is effectively absorbed through the **oral mucosa** - Used for **labor induction** and **management of postpartum hemorrhage** - Offers **rapid onset of action** and bypasses first-pass metabolism *Oral* - Oral administration is used for **medical abortion**, **miscarriage management**, and **labor induction** - Also approved for prevention of **NSAID-induced gastric ulcers** (non-obstetric indication) - Absorption is slower with lower peak concentrations compared to sublingual or vaginal routes

Q: During the first 6 months of lactation, which amongst the following contraceptives is not advisable?

Combined oral contraceptive pills. ***Combined oral contraceptive pills*** - **Combined oral contraceptive pills (COCs)** contain both **estrogen** and **progestin**, and the synthetic estrogen component can potentially reduce breast milk supply, which is critical during the initial 6 months of breastfeeding. - Estrogen may also alter the composition of breast milk, and there's a theoretical concern about **estrogen excretion into breast milk** affecting the newborn during this vulnerable period. *Norplant* - **Norplant** (levonorgestrel implants) contains only **progestin**, which is generally considered safe for use during breastfeeding from 6 weeks postpartum. - Progestin-only contraceptives do not significantly affect milk supply or infant health. *DMPA* - **DMPA (depot medroxyprogesterone acetate)** is an injectable contraceptive containing only **progestin**. It is considered safe and effective during breastfeeding, typically from 6 weeks postpartum. - It does not negatively impact milk production or infant growth and development. *Progestin only pills* - **Progestin-only pills (POPs)** are safe for use during breastfeeding, usually initiated immediately postpartum or from 6 weeks. - They do not contain estrogen, thereby avoiding the concerns associated with combined oral contraceptives regarding milk supply and infant exposure.

Q: Oral contraceptives may provide protection against the following malignancies except :

Cervical cancer. ***Cervical cancer*** - Oral contraceptives (OCPs) are associated with an **increased risk of cervical cancer**, particularly with prolonged use, due to their potential influence on the immune response to **HPV infection**. - OCPs do not provide protection against cervical cancer; instead, they are considered a **risk factor** in its development. *Endometrial cancer* - OCPs, especially with their progestin component, offer significant **protection against endometrial cancer** by counteracting unopposed estrogen effects on the endometrium. - This protective effect is evident after just a few years of use and can persist for decades after discontinuation. *Ovarian cancer* - Oral contraceptive use is well-established to **reduce the risk of ovarian cancer**, with the protective effect increasing with longer duration of use. - This protection is thought to be mediated by the **suppression of ovulation**, thereby reducing the continuous trauma to the ovarian surface epithelium. *None of the options* - This option is incorrect because OCPs do provide protection against several malignancies, specifically endometrial and ovarian cancers, but actually increase the risk of cervical cancer.

Q: The following drugs are effective in the management of menorrhagia except :

Prostaglandins. ***Prostaglandins*** - Prostaglandins, particularly **PGE2** and **PGF2α**, are generally associated with **increased uterine contractions** and **vasodilation**, which can worsen menstrual bleeding rather than reduce it. - While cyclooxygenase inhibitors (NSAIDs) work by inhibiting prostaglandin synthesis, exogenous prostaglandins themselves are not used to treat menorrhagia and can exacerbate it. *Progestational agents* - Progestins help to **stabilize the endometrium**, reducing excessive bleeding by inducing decidualization and limiting endometrial growth. - They can be administered orally, via injection, or through an **intrauterine device (IUD)** like the levonorgestrel-releasing IUD (Mirena), which is highly effective. *Non-steroidal anti-inflammatory drugs* - NSAIDs reduce menorrhagia by **inhibiting prostaglandin synthesis** in the endometrium, which leads to reduced vasodilation and uterine contractions. - They also help alleviate associated **dysmenorrhea** (menstrual pain). *Anti-fibrinolytic drugs* - These drugs, such as **tranexamic acid**, work by **inhibiting plasminogen activation**, thereby preventing the breakdown of fibrin clots within the uterus. - This promotes clot stability and reduces menstrual blood loss significantly.

Q: Out of the following, select the histologic type of endometrial cancer which has the worst prognosis:

Papillary serous carcinoma. ***Papillary serous carcinoma*** - This subtype is considered a **Type II endometrial cancer**, which is often **aggressive**, poorly differentiated, and has a high metastatic potential. [1] - It frequently presents at an advanced stage and has a **poor prognosis** due to its rapid growth and tendency for widespread peritoneal dissemination. [1] *Clear cell carcinoma* - While also a **Type II endometrial cancer** with an aggressive course, it generally has a slightly better prognosis than papillary serous carcinoma. - It is characterized by polygonal cells with **clear cytoplasm** and often presents with more localized disease compared to serous carcinoma. *Mucinous adenocarcinoma* - This is typically classified as a **Type I endometrial cancer**, which is low-grade and generally associated with a **favorable prognosis**. [1] - It is characterized by cells producing **mucin**, often resembling endocervical adenocarcinoma. *Well differentiated endometrioid adenocarcinoma* - This is the **most common type of endometrial cancer** and is typically a **Type I cancer**, associated with a very **good prognosis**. [1] - It is characterized by glandular differentiation that closely resembles normal endometrial glands, driven by unopposed estrogen exposure. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1021-1024.

Q: Mifepristone used for inducing abortion acts on :

Progesterone receptors. ***Progesterone receptors*** - **Mifepristone** is a **progesterone receptor antagonist**, meaning it blocks the action of progesterone [1]. - In pregnancy, **progesterone** is crucial for maintaining the uterine lining and preventing contractions, so blocking its action leads to **endometrial shedding** and uterine contractions [1].*Uterine contractility* - While mifepristone ultimately affects **uterine contractility**, this is an **indirect effect** of blocking progesterone [1]. - The direct action is on the **receptors themselves**, not the contractility mechanism.*Hypothalamopituitary ovarian axis* - Mifepristone does **not primarily act** on the **hypothalamic-pituitary-ovarian axis**. - Its main effect is directly on the **uterine tissue** by blocking progesterone's local action.*All of the options* - As mifepristone's primary and direct mechanism is through **progesterone receptor antagonism**, this option is incorrect [1]. - The effects on uterine contractility are secondary to its receptor blockade.

Q: Which method of vasectomy has the highest failure rate ?

Open ended vasectomy with granulation formation. ***Open ended vasectomy with granulation formation*** - This method involves either leaving the testicular end of the **vas deferens** open or allowing the formation of a **sperm granuloma**, which is believed to reduce post-vasectomy pain and congestion. - However, this approach carries a higher risk of **recanalization** and failure because sperm can potentially find a pathway through the granuloma or the open end, leading to unintended pregnancy. *Use of hemoclips with 1-4 cm gap after cutting proximal and distal ends* - The use of **hemoclips** with a significant gap (1-4 cm) between the clipped ends of the vas deferens is a common and generally effective method. - While failure is possible due to clip displacement or recanalization, the gap and mechanical obstruction provided by the clips make it more reliable than open-ended techniques. *Cutting and ligating vas to occlude the proximal and distal lumen* - **Cutting and ligating** both the proximal and distal ends of the vas deferens creates a clear physical barrier, preventing sperm transport. - This method is considered highly effective as it involves both severance and occlusion, significantly reducing the chance of recanalization. *Cutting the vas and turning the ends backwards and ligating with suture material* - This technique, often referred to as **fascial interposition** or burying the ends, involves cutting the vas, turning one or both ends back, and ligating them into the fascial sheath. - This creates an additional anatomical barrier, further separating the cut ends and making recanalization much more difficult, thus offering a very high success rate.

Question 1

All of the following are eligibility criteria for female sterilization except :

Accepted Answer

At least two living children should be present

Answer

Client should be married

Answer

Client's age should not be less than 22 years or more than 49 years

Answer

Client or her spouse must not have undergone sterilisation in the past

Question 2

Misoprostol can be used in obstetric practice by the following routes except:

Accepted Answer

Intravenous

Answer

Vaginal

Answer

Sub-lingual

Answer

Oral

Question 3

Following are the contraindications for laparoscopic female sterilization except :

Accepted Answer

Hiatus hernia

Answer

Respiratory dysfunction

Answer

Heart disease

Answer

Obesity

Question 4

A man underwent vasectomy, but 6 months later his wife was 16 week pregnant. What is the most likely cause ?

Accepted Answer

Failure to use additional contraception in postoperative period

Answer

Recanalisation of vas

Answer

Pregnancy antedating vasectomy

Answer

Failure of operative procedure

Question 5

During the first 6 months of lactation, which amongst the following contraceptives is not advisable?

Accepted Answer

Combined oral contraceptive pills

Answer

Norplant

Answer

DMPA

Answer

Progestin only pills

Question 6

Oral contraceptives may provide protection against the following malignancies except :

Accepted Answer

Cervical cancer

Answer

Endometrial cancer

Answer

Ovarian cancer

Answer

None of the options

Question 7

The following drugs are effective in the management of menorrhagia except :

Accepted Answer

Prostaglandins

Answer

Progestational agents

Answer

Non-steroidal anti-inflammatory drugs

Answer

Anti-fibrinolytic drugs

Question 8

Out of the following, select the histologic type of endometrial cancer which has the worst prognosis:

Accepted Answer

Papillary serous carcinoma

Answer

Clear cell carcinoma

Answer

Mucinous adenocarcinoma

Answer

Well differentiated endometrioid adenocarcinoma

Question 9

Mifepristone used for inducing abortion acts on :

Accepted Answer

Progesterone receptors

Answer

Uterine contractility

Answer

Hypothalamopituitary ovarian axis

Answer

All of the options

Question 10

Which method of vasectomy has the highest failure rate ?

Accepted Answer

Open ended vasectomy with granulation formation

Answer

Use of hemoclips with 1-4 cm gap after cutting proximal and distal ends

Answer

Cutting and ligating vas to occlude the proximal and distal lumen

Answer

Cutting the vas and turning the ends backwards and ligating with suture material

UPSC-CMS 2013

Community Medicine

Obstetrics and Gynecology

Pathology

Pharmacology

Surgery