UPSC-CMS 2016 Practice Questions

Q: For a 40 year old hypertensive woman, which one of the following is not recommended for contraception?

NuvaRing. ***NuvaRing*** - **NuvaRing** is a **combined hormonal contraceptive** that releases both estrogen and progestin. - **Estrogen-containing contraception** is generally **contraindicated** or used with caution in women with uncontrolled hypertension due to an increased risk of **cardiovascular events** such as stroke and myocardial infarction. *IUCD* - **Intrauterine contraceptive devices (IUCDs)**, both copper and levonorgestrel-releasing, are considered **safe** and highly effective for women with hypertension. - They do not contain systemic hormones or contain only progestin, which has a minimal impact on blood pressure. *Minipill* - The **minipill** is a **progestin-only oral contraceptive**. - **Progestin-only contraceptives** are safe for women with hypertension as they do not carry the same cardiovascular risks associated with estrogen. *LNG IUD (LNg IUD)* - The **levonorgestrel-releasing intrauterine device (LNG IUD)** is a **progestin-only contraceptive**. - It is **safe** for women with hypertension because the progestin is primarily local, and it does not contain estrogen, thereby avoiding cardiovascular risks.

Q: Antisperm antibodies are usually present in:

Cervix. ***Cervix*** - The **cervical mucus** is the most clinically significant site in the **female reproductive tract** where **antisperm antibodies** interfere with fertility. - These antibodies can **agglutinate sperm**, **immobilize sperm**, or reduce their ability to penetrate through cervical mucus and reach the ovum, contributing to **immunological infertility**. - In the context of local immune responses affecting fertilization, the **cervix** acts as a critical immunological barrier where ASAs are detected and clinically relevant. - Note: Antisperm antibodies can also be detected in **serum** (blood) and are commonly found in **seminal plasma** in males, but among reproductive tract sites in females, the **cervix** is the primary location of clinical significance. *Vagina* - The **acidic environment** (pH 3.8-4.5) of the vagina is generally hostile to sperm, but it is not a primary site for antisperm antibody formation or action. - While some immune cells exist, the vagina's protective function relies more on acidic pH and normal flora rather than specific antisperm antibodies. *Fallopian tube* - The fallopian tubes are primarily involved in **sperm transport**, **fertilization**, and **embryo transport**, but are not a primary site where antisperm antibodies cause clinical infertility problems. - Although sperm encounter the tubal environment, the **cervical mucus** at the cervix acts as a more significant and earlier immunological barrier. *Uterus* - The uterine cavity is generally more accommodating to sperm after they pass through the cervical barrier, and is not the primary site for antisperm antibody-mediated infertility. - The **cervix** serves as the critical immunological checkpoint before sperm reach the uterine environment.

Q: For a woman who has been operated for chocolate cyst with normal menstrual cycle, any of the following may be prescribed except:

Tranexamic acid. ***Tranexamic acid*** - **Tranexamic acid** is an antifibrinolytic agent used to reduce **heavy menstrual bleeding** by inhibiting plasminogen activation. - In a woman with a **normal menstrual cycle** who has undergone surgery for a chocolate cyst, heavy bleeding is not an issue, so tranexamic acid would be **unnecessary** and not indicated for endometriosis management. *Oral progestogens* - **Oral progestogens** are commonly prescribed for endometriosis to **suppress ovarian activity** and induce decidualization and atrophy of endometrial implants. - They help manage symptoms like **pain** and prevent recurrence of chocolate cysts by creating a **progestin-dominant environment**. *Injection leuprolide* - **Leuprolide** is a **GnRH agonist** that creates a **hypoestrogenic state** by downregulating pituitary GnRH receptors, thereby suppressing ovarian hormone production. - This effectively reduces the growth of **endometrial implants** and manages endometriosis symptoms, often used post-operatively to prevent recurrence. *Tablet dienogest* - **Dienogest** is a **fourth-generation progestin** specifically approved for the treatment of endometriosis. - It works by suppressing ovarian estrogen production and inhibiting the growth of **endometrial lesions**, making it a suitable long-term post-operative therapy.

Q: A 30-year-old female has severe dysmenorrhoea and dyspareunia. On examination, uterus is 8-week size, uniformly enlarged and there is tenderness in posterior fornix. What is the most probable diagnosis?

Adenomyosis. ***Adenomyosis*** - **Adenomyosis** is characterized by the presence of **endometrial glands and stroma within the myometrium**, leading to a diffusely enlarged uterus and often presenting with **severe dysmenorrhoea** and **dyspareunia**. - A **uniformly enlarged, tender uterus** (described as 8 weeks size) in a patient with these symptoms is highly suggestive of adenomyosis, as the ectopic endometrial tissue causes pain and uterine enlargement. *Fibroid uterus* - **Fibroids (leiomyomas)** typically cause an **irregularly enlarged uterus** and can lead to heavy menstrual bleeding (menorrhagia) and pelvic pressure, but severe dyspareunia is less common. - While fibroids can cause an enlarged uterus and dysmenorrhoea, the **uniform enlargement** and prominent **tenderness of the posterior fornix** (suggesting broad involvement) are more aligned with adenomyosis. *Endometrial carcinoma* - **Endometrial carcinoma** typically presents with **postmenopausal bleeding** or abnormal uterine bleeding, often in older women, and usually does not cause a uniformly enlarged and tender uterus. - While it can cause pelvic pain, the specific presentation of **severe dysmenorrhoea and dyspareunia** with a diffusely enlarged and tender uterus is not characteristic of endometrial cancer. *Dysfunctional uterine bleeding* - **Dysfunctional uterine bleeding (DUB)** refers to abnormal bleeding that is not due to structural or systemic causes, often associated with **anovulation** and hormonal imbalances, primarily characterized by irregular or heavy periods. - DUB usually does not cause a **uniformly enlarged or tender uterus** and is less directly associated with the severe dysmenorrhoea and dyspareunia seen in this case.

Question 1

For a 40 year old hypertensive woman, which one of the following is not recommended for contraception?

Accepted Answer

NuvaRing

Answer

IUCD

Answer

Minipill

Answer

LNG IUD (LNg IUD)

Question 2

Antisperm antibodies are usually present in:

Accepted Answer

Cervix

Answer

Vagina

Answer

Fallopian tube

Answer

Uterus

Question 3

For a woman who has been operated for chocolate cyst with normal menstrual cycle, any of the following may be prescribed except:

Accepted Answer

Tranexamic acid

Answer

Oral progestogens

Answer

Injection leuprolide

Answer

Tablet dienogest

Question 4

A 30-year-old female has severe dysmenorrhoea and dyspareunia. On examination, uterus is 8-week size, uniformly enlarged and there is tenderness in posterior fornix. What is the most probable diagnosis?

Accepted Answer

Adenomyosis

Answer

Fibroid uterus

Answer

Endometrial carcinoma

Answer

Dysfunctional uterine bleeding

UPSC-CMS 2016

Internal Medicine

Obstetrics and Gynecology