UPSC-CMS 2019 Practice Questions

Q: Which of the following is NOT the hormonal basis for hyperemesis gravidarum?

Excess of Human Placental Lactogen. ***Excess of Human Placental Lactogen*** - **Human placental lactogen (hPL)** is primarily involved in **metabolic adaptation** during pregnancy, promoting insulin resistance and glucose availability for the fetus. - While essential for fetal growth, hPL has **no direct causal link** to the pathophysiology of nausea and vomiting in hyperemesis gravidarum. *High serum levels of Estrogen* - **Elevated estrogen levels** during pregnancy are believed to contribute to nausea and vomiting by affecting **gastrointestinal motility** and the central chemoreceptor trigger zone. - The rapid increase and high concentrations of estrogen correlate with the severity of symptoms in many pregnant women. *Excess of Progesterone* - **High progesterone levels** can cause **relaxation of smooth muscle**, including that of the gastrointestinal tract, leading to delayed gastric emptying and increased gastroesophageal reflux. - These effects can exacerbate nausea and vomiting, making it a contributing factor to hyperemesis gravidarum. *Excess of Chorionic Gonadotropin* - **High levels of human chorionic gonadotropin (hCG)** are strongly implicated in the etiology of hyperemesis gravidarum, with symptoms often correlating with peaks in hCG levels in early pregnancy. - hCG is thought to stimulate the **thyroid gland** (due to structural similarity to TSH) and directly affect the **chemoreceptor trigger zone** in the brain, inducing nausea and vomiting.

Q: Consider the following statements regarding pregnancy with Rh isoimmunization: 1. Indirect coombs test is performed in mother 2. Methergin is withheld at delivery of anterior shoulder 3. Middle cerebral artery peak systolic velocity is an accurate method to predict fetal anemia Which of the statements given above are correct?

1 and 3 only. ***1 and 3 only*** - The **indirect Coombs test (IAT)** is performed on the mother's serum to detect **Rh antibodies**, which is essential for diagnosing and monitoring Rh isoimmunization. - **Middle cerebral artery peak systolic velocity (MCA-PSV)** >1.5 MoM is a non-invasive and highly accurate ultrasound method to predict moderate to severe **fetal anemia** in Rh-isoimmunized pregnancies, guiding the need for intrauterine transfusion. - Statement 2 is **incorrect**: While minimizing fetomaternal hemorrhage is important in Rh isoimmunization, there is **no specific evidence-based guideline** that Methergine should be routinely withheld at delivery of the anterior shoulder in Rh-negative mothers. The focus is on **timely Anti-D administration** (within 72 hours postpartum) rather than avoiding specific uterotonics. *1 and 2 only* - Statement 1 is correct, but statement 2 is incorrect. - Methergine (methylergonovine) is not specifically contraindicated in Rh isoimmunization; its main contraindications include **hypertension and preeclampsia** due to vasoconstrictive effects. - Prevention of Rh sensitization focuses on **Anti-D immunoglobulin administration**, not withholding uterotonics. *2 and 3 only* - Statement 3 is correct regarding **MCA-PSV** accuracy for fetal anemia detection. - Statement 2 is incorrect: Methergine withholding is not a standard practice specifically for Rh isoimmunization management. *1, 2 and 3* - Statements 1 and 3 are correct. - Statement 2 is incorrect: There is no established protocol to withhold Methergine at delivery of the anterior shoulder specifically for Rh isoimmunization. Management focuses on **preventing sensitization through Anti-D prophylaxis**, **monitoring with antibody titers**, and **detecting fetal anemia via MCA-PSV**, not on avoiding specific uterotonics.

Q: In pregnancy with Down syndrome consider the following biomarkers: 1. β HCG is raised 2. α FP is raised 3. Inhibin A is decreased Which of the above statements is/are correct?

1 only. ***1 only*** - In pregnancies affected by **Down syndrome (Trisomy 21)**, the levels of **β-hCG** (human chorionic gonadotropin) are typically found to be **elevated**. This is a well-established biochemical marker used in prenatal screening. - The increased production of β-hCG is thought to be from the **placenta**, which may be functioning differently in pregnancies with Down syndrome. *1, 2 and 3* - This option is incorrect because while **β-hCG is raised**, **α-fetoprotein (αFP)** is typically **decreased** in pregnancies with Down syndrome, not raised. - Furthermore, **inhibin A** is usually **raised**, not decreased, making both statements 2 and 3 false for Down syndrome. *1 and 2 only* - This option is incorrect because although **β-hCG is raised**, **α-fetoprotein (αFP)** is characteristically **decreased** in pregnancies with Down syndrome, making statement 2 inaccurate. - The elevated αFP is usually associated with **neural tube defects** or other fetal anomalies. *2 and 3 only* - This option is incorrect as both statements 2 and 3 are factually wrong for Down syndrome. **α-fetoprotein (αFP)** is typically **decreased**, not raised, in pregnancies with Down syndrome. - Similarly, **inhibin A** levels are typically **raised**, not decreased, in such pregnancies, often incorporated into the quad screen for prenatal screening.

Q: A 25 year old G2P1L1, Rh –ve woman presented at 30 weeks gestation to the antenatal clinic, the indirect Coomb's test (ICT) was found to be positive. What would be the next line of management?

ICT titers to be closely monitored at weekly intervals. **ICT titers to be closely monitored at weekly intervals** - A **positive Indirect Coombs Test (ICT)** in an Rh-negative pregnant woman indicates the presence of maternal antibodies against fetal Rh antigens. The next step is to monitor the **titer** to assess the risk of **hemolytic disease of the fetus and newborn (HDFN)**. - Serial monitoring of ICT titers, typically every 2-4 weeks, helps to determine if the antibody levels are increasing, which would indicate a heightened risk to the fetus and necessitate further intervention. *Anti D to be given* - **Anti-D immunoglobulin** is administered to prevent **sensitization** in Rh-negative mothers who have not yet formed antibodies. - Since the ICT is already positive, the mother has already been **sensitized** and produced antibodies, making Anti-D administration ineffective at this stage. *Baby is to be delivered as soon as possible* - Premature delivery carries significant risks for the neonate due to **immaturity of organ systems**. - Delivery is usually reserved for cases of severe fetal compromise, not simply a positive ICT without further evidence of fetal anemia. *Amniocentesis for estimation of bilirubin by Liley's chart is to be done* - **Amniocentesis** for bilirubin estimation using **Liley's chart** is an invasive procedure that carries risks, including **infection** and **fetal loss**. - It is typically reserved for cases where **ICT titers are critically high** or there is evidence of fetal anemia on **Doppler ultrasound**, not as the initial management step for a positive ICT.

Q: Given below are the Obstetric maneuvers and their indications. Which one of the following is correctly matched?

Ritgen's maneuver – Controlled delivery of fetal head. ***Ritgen's maneuver*** - This maneuver is used for the **controlled delivery of the fetal head** to prevent rapid expulsion, which can lead to maternal perineal trauma. - It involves applying pressure to the fetal chin through the perineum while simultaneously applying pressure to the occiput to facilitate slow and controlled extension of the head. *McRobert's maneuver* - McRobert's maneuver is used to manage **shoulder dystocia**, not after the delivery of the head in a breech presentation. - It involves hyperflexing the mother's hips towards her abdomen to rotate the symphysis pubis and increase the pelvic outlet dimension. *Lovset's maneuver* - Lovset's maneuver is used to deliver the **arms in a breech presentation**, not the foot. - It involves rotating the fetal trunk to bring the anterior shoulder under the maternal symphysis pubis, allowing the delivery of the posterior arm. *Pinard's maneuver* - Pinard's maneuver is used for the delivery of the **extended legs in a breech presentation**, not an extended arm. - It involves pressure in the popliteal fossa to flex the knee, allowing the foot to be grasped and delivered.

Q: The Maternal serum α-fetoprotein level is elevated in all EXCEPT:

Down syndrome. ***Down syndrome*** - In **Down syndrome (Trisomy 21)**, the maternal serum **alpha-fetoprotein (MSAFP) level is typically decreased**, not elevated. - This characteristic **low MSAFP** is a key marker used in screening for Down syndrome in the second trimester. *Omphalocele* - **Omphalocele** involves the protrusion of abdominal organs through an umbilical defect, covered by a membrane. - Due to the **exposed fetal gut**, there is leakage of **alpha-fetoprotein** into the amniotic fluid and maternal circulation, leading to **elevated MSAFP**. *Intra uterine death* - In cases of **intrauterine fetal death**, there can be a release of fetal alpha-fetoprotein into the maternal circulation due to **fetal tissue breakdown**. - This often results in a **transient elevation of MSAFP levels**. *Neural tube defect* - **Neural tube defects (NTDs)**, such as **anencephaly** and **spina bifida**, are characterized by incomplete closure of the neural tube. - The **exposed neural tissue** allows **alpha-fetoprotein** to leak directly into the amniotic fluid and then into the maternal bloodstream, causing a significant **elevation of MSAFP**.

Q: Which one of the following statements regarding Bartholin's glands is NOT true?

Gonococci is the most common cause of Bartholin's abscess. ***Gonococci is the most common causing Bartholin's abscess*** - This statement is **incorrect** because while *Neisseria gonorrhoeae* can cause Bartholin's abscess, polymicrobial infections involving **Escherichia coli (E. coli)** are far more common. - **Anaerobic bacteria** and other enteric organisms frequently contribute to Bartholin's gland infections and abscess formation. *Duct opens in the groove between hymen and labia minora at 4 and 8 o'clock positions* - This is a **true** statement, accurately describing the typical anatomical location where the ducts of the Bartholin's glands open onto the vulva. - This specific position makes the ducts vulnerable to **obstruction and infection**. *The duct is lined by columnar epithelium* - This is a **true** statement, as the ducts of the Bartholin's glands are indeed lined by **columnar epithelium**, which transitions to squamous epithelium as it approaches the vestibular opening. - This type of lining is characteristic of glands that secrete mucus. *They are situated in superficial perineal pouch* - This is a **true** statement, as the Bartholin's glands are located within the **superficial perineal pouch** (or superficial perineal space), posterior to the vestibular bulbs. - Their presence in this space is clinically relevant for understanding their anatomy and pathology.

Q: An 18-year-old unmarried girl comes with complaints of heavy, prolonged bleeding during menses. Which among the following investigations is NOT usually advised?

Dilatation and curettage. ***Dilatation and curettage*** - This is an **invasive surgical procedure** used diagnostically and therapeutically for heavy uterine bleeding, but it is generally *not* the initial or routinely advised investigation for an 18-year-old unmarried girl with heavy menstrual bleeding. - In a young, unmarried patient, less invasive methods are preferred unless other investigations point to a structural abnormality requiring tissue diagnosis or therapeutic intervention. *Urine pregnancy test* - A urine pregnancy test is **essential** to rule out pregnancy-related complications (e.g., ectopic pregnancy, miscarriage) as a cause of heavy vaginal bleeding, even in unmarried individuals. - **Abnormal uterine bleeding** can be the presenting symptom of an early pregnancy loss. *Coagulation profile* - Heavy and prolonged bleeding, especially from a young age (as suggested by "18-year-old girl"), raises suspicion for an **underlying coagulopathy** (e.g., Von Willebrand disease). - A coagulation profile (including PT, aPTT, platelet count, and sometimes specific factor assays) is crucial to **assess bleeding risk** and guide management. *Ultrasound uterus and adnexa* - An ultrasound is a **non-invasive imaging technique** that can identify structural causes of abnormal uterine bleeding, such as **fibroids, polyps, adenomyosis**, or ovarian pathologies. - It helps in assessing the **uterine lining and ovarian morphology**, which is important in evaluating the cause of heavy menstrual bleeding.

Q: Which one of the following is true about Basal body temperature? 1. Shows a biphasic pattern during menstrual cycle 2. Rises by 0.3-0.5°C after ovulation due to progesterone 3. Can be used to confirm that ovulation has occurred 4. Remains constant throughout the menstrual cycle Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - Basal Body Temperature (BBT) exhibits a **biphasic pattern** during the menstrual cycle, with a lower temperature in the follicular phase (before ovulation) and a higher temperature in the luteal phase (after ovulation). - The rise in BBT of **0.3-0.5°C** following ovulation is a direct result of increased **progesterone** secretion from the corpus luteum, which has thermogenic properties. - BBT is a **retrospective indicator** that **confirms ovulation has occurred** by showing the sustained temperature elevation, making it useful for tracking ovulation patterns over time. *2, 3 and 4* - This option is incorrect because BBT does **not remain constant** throughout the menstrual cycle; it shows a characteristic **biphasic pattern** with lower temperatures before ovulation and higher temperatures after. *1, 3 and 4* - This option is incorrect because statement 4 is false - BBT does **not remain constant** but rather demonstrates a **biphasic shift** with a temperature rise after ovulation. *All of the above* - This option is incorrect because statement 4 is false - BBT shows a **biphasic pattern**, not a constant temperature throughout the cycle.

Q: In a fetus with Spina bifida, which of the following sign/signs may be seen on ultrasound?

All of these. ***All of these*** - The presence of the **banana sign**, **lemon sign**, and a **visible vertebral or overlying tissue defect** are all characteristic ultrasound findings in a fetus with spina bifida. - These signs indicate associated structural abnormalities in the **brain** and **spine** due to the neural tube defect. - All three findings are clinically significant and commonly used for prenatal diagnosis. **Banana sign** - This refers to the shape of the **cerebellum** appearing flattened and curved like a banana due to its caudal displacement into the foramen magnum in **Chiari II malformation**, which is frequently associated with spina bifida. - It is an important indicator of **hindbrain herniation**. **Lemon sign** - The lemon sign describes the shape of the fetal skull, where the frontal bones are indented, making the head appear like a **lemon** on axial view. - This sign is often seen in cases of **spina bifida** and is caused by **bifrontal bone scalloping**. **Defect seen in vertebral bodies or tissue overlying it** - This is the **direct visualization** of the open neural tube defect (myelomeningocele or meningocele) in the spine. - It involves a discontinuity in the **vertebral arches** and/or the overlying soft tissues.

Question 1

Which of the following is NOT the hormonal basis for hyperemesis gravidarum?

Accepted Answer

Excess of Human Placental Lactogen

Answer

High serum levels of Estrogen

Answer

Excess of Progesterone

Answer

Excess of Chorionic Gonadotropin

Question 2

Consider the following statements regarding pregnancy with Rh isoimmunization:

1. Indirect coombs test is performed in mother
2. Methergin is withheld at delivery of anterior shoulder
3. Middle cerebral artery peak systolic velocity is an accurate method to predict fetal anemia Which of the statements given above are correct?

Accepted Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1, 2 and 3

Question 3

In pregnancy with Down syndrome consider the following biomarkers:

1. β HCG is raised
2. α FP is raised
3. Inhibin A is decreased
Which of the above statements is/are correct?

Accepted Answer

1 only

Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Question 4

A 25 year old G2P1L1, Rh –ve woman presented at 30 weeks gestation to the antenatal clinic, the indirect Coomb's test (ICT) was found to be positive. What would be the next line of management?

Accepted Answer

ICT titers to be closely monitored at weekly intervals

Answer

Anti D to be given

Answer

Baby is to be delivered as soon as possible

Answer

Amniocentesis for estimation of bilirubin by Liley's chart is to be done

Question 5

Given below are the Obstetric maneuvers and their indications. Which one of the following is correctly matched?

Accepted Answer

Ritgen's maneuver – Controlled delivery of fetal head

Answer

McRobert's maneuver – After coming head of breech

Answer

Lovset's maneuver – Delivery of foot in breech

Answer

Pinard's maneuver – Delivery of extended arm

Question 6

The Maternal serum α-fetoprotein level is elevated in all EXCEPT:

Accepted Answer

Down syndrome

Answer

Omphalocele

Answer

Intra uterine death

Answer

Neural tube defect

Question 7

Which one of the following statements regarding Bartholin's glands is NOT true?

Accepted Answer

Gonococci is the most common cause of Bartholin's abscess

Answer

The duct is lined by columnar epithelium

Answer

Duct opens in the groove between hymen and labia minora at 4 and 8 o'clock positions

Answer

They are situated in superficial perineal pouch

Question 8

An 18-year-old unmarried girl comes with complaints of heavy, prolonged bleeding during menses. Which among the following investigations is NOT usually advised?

Accepted Answer

Dilatation and curettage

Answer

Urine pregnancy test

Answer

Coagulation profile

Answer

Ultrasound uterus and adnexa

Question 9

Which one of the following is true about Basal body temperature?
1. Shows a biphasic pattern during menstrual cycle
2. Rises by 0.3-0.5°C after ovulation due to progesterone
3. Can be used to confirm that ovulation has occurred
4. Remains constant throughout the menstrual cycle
Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

All of the above

Question 10

In a fetus with Spina bifida, which of the following sign/signs may be seen on ultrasound?

Accepted Answer

All of these

Answer

Banana sign

Answer

Lemon sign

Answer

Defect seen in vertebral bodies or tissue overlying it

UPSC-CMS 2019

Obstetrics and Gynecology

Physiology

Radiology