UPSC-CMS 2020 Practice Questions

Q: The components of partograph are all EXCEPT:

Maternal respiratory rate. ***Maternal respiratory rate*** - While important for overall maternal well-being, **maternal respiratory rate** is not a standard component recorded on a partograph. - The partograph primarily focuses on monitoring fetal well-being, cervical dilation, and uterine contractions to track labor progress. *Fetal heart rate* - **Fetal heart rate** is a crucial component of the partograph, regularly plotted to assess fetal well-being and identify signs of distress. - It helps in detecting fetal hypoxia and guiding interventions if necessary during labor. *Time* - **Time** is a fundamental axis on the partograph, allowing for the plotting of all other parameters against a temporal scale. - This enables the healthcare provider to visualize the progression of labor and identify deviations from normal patterns. *Maternal urine analysis* - **Maternal urine analysis** for protein, acetone, or glucose is a standard component of the partograph. - It helps in assessing maternal hydration status and detecting potential complications like pre-eclampsia or gestational diabetes that might impact labor or fetal health.

Q: Which of the following information are provided by partograph? 1. Colour of liquor 2. Uterine contractions with duration and frequency 3. Dilatation of cervix Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - A **partograph** is a composite graphical record of key maternal and fetal parameters during labor, specifically designed to monitor the progress of labor and to identify deviations from normal. - It includes charting the **colour of liquor**, **uterine contractions (frequency and duration)**, and **cervical dilatation** to assess the progression of labor. *2 and 3 only* - This option is incorrect because the partograph also records the **colour of liquor** in addition to uterine contractions and cervical dilatation. - The colour of liquor provides vital information about fetal well-being, such as the presence of **meconium**, which indicates fetal distress. *1 and 3 only* - This option is incorrect because the partograph also records the **frequency and duration of uterine contractions**, which are crucial for assessing the power and effectiveness of labor. - Uterine contractions are fundamental to the progress of cervical dilatation and fetal descent. *1 and 2 only* - This option is incorrect because the partograph also records the **dilatation of the cervix**, which is the primary indicator of the progress of the first stage of labor. - The rate of cervical dilatation is crucial for determining if labor is progressing normally or if there is a **protracted labor** requiring intervention.

Q: Hysterosalpingography (HSG) is least helpful in detecting which of the following?

Pelvic adhesions. ***Pelvic adhesions*** - HSG primarily visualizes the uterine cavity and fallopian tubes, making it **poorly suited to detect adhesions outside these structures**. - **Pelvic adhesions** are better evaluated with **laparoscopy**, which allows direct visualization of the abdominal and pelvic organs. *Asherman syndrome* - This condition involves **intrauterine adhesions** which manifest as filling defects or synechiae within the uterine cavity on HSG. - HSG is highly effective in detecting these adhesions and their extent. *Congenital uterine anomaly* - HSG can visualize the shape of the uterine cavity and detect various **congenital anomalies** such as a septate, bicornuate, or arcuate uterus. - The contrast dye fills the uterus, outlining its internal morphology. *Tubal patency* - One of the primary uses of HSG is to assess the **patency of the fallopian tubes** by observing the free spill of contrast into the peritoneal cavity. - Blockages or hydrosalpinges can be clearly identified.

Q: Which of the following are characteristics of Trichomonas vaginitis? 1. Presence of greenish frothy discharge 2. Vaginal pH > 4.5 3. Presence of clue cells in microscopic examination 4. Strawberry spots on the vaginal mucosa Select the correct answer using the code given below:

1, 2 and 4. ***1, 2 and 4*** - **Trichomonas vaginalis** infection classically presents with a **greenish, frothy, malodorous vaginal discharge**, and the vaginal pH is typically **elevated (>4.5)** due to the pathogen's metabolic activity. - The presence of **strawberry spots (colpitis macularis)** on the vaginal and cervical mucosa is a hallmark sign, resulting from punctate hemorrhages. *1, 3 and 4* - This option correctly includes **greenish frothy discharge** and **strawberry spots**, which are characteristic of *Trichomonas vaginitis*. - However, the inclusion of "presence of **clue cells**" is incorrect as clue cells are pathognomonic for **bacterial vaginosis**, not *Trichomonas*. *2, 3 and 4* - This option correctly identifies **vaginal pH > 4.5** and **strawberry spots** as features of *Trichomonas vaginitis*. - The presence of **clue cells** is a misattribution to *Trichomonas* infection; instead, clue cells are defining features of **bacterial vaginosis**. *1, 2 and 3* - While **greenish frothy discharge** and **vaginal pH > 4.5** are indeed characteristic of *Trichomonas vaginitis*, the presence of **clue cells** is a diagnostic criterion for **bacterial vaginosis**. - **Strawberry spots** are a distinct feature of *Trichomonas* that is missing from this selection.

Q: Tumor marker of epithelial ovarian carcinoma is:

CA-125. ***CA-125*** - **CA-125 (Cancer Antigen 125)** is the most widely used and validated tumor marker for detecting and monitoring **epithelial ovarian carcinoma**. - Elevated levels are found in approximately 80% of women with epithelial ovarian cancer, making it useful in guiding treatment decisions and assessing recurrence. *Alpha feto protein* - **Alpha-fetoprotein (AFP)** is primarily elevated in **germ cell tumors** of the ovary (e.g., endodermal sinus tumor) or in hepatocellular carcinoma and some testicular cancers, not epithelial ovarian carcinoma. - Its presence usually indicates a different histological subtype of ovarian malignancy. *Beta HCG* - **Beta-human chorionic gonadotropin (β-hCG)** is a tumor marker utilized for detecting **germ cell tumors**, particularly **choriocarcinoma** and some embryonal carcinomas, as well as pregnancy. - It is not typically elevated in epithelial ovarian carcinoma. *LDH* - **Lactate dehydrogenase (LDH)** is a general marker of **tissue damage or high cell turnover**, elevated in many cancers, including dysgerminoma (an ovarian germ cell tumor), but it is not specific for epithelial ovarian carcinoma. - Due to its lack of specificity, LDH alone is not considered the primary tumor marker for epithelial ovarian cancer.

Q: The most common site of cervical cancer is:

Transformation zone. ***Transformation zone*** - The **transformation zone** is where the squamous epithelium of the **ectocervix** meets the columnar epithelium of the **endocervix**. - This area is highly susceptible to **human papillomavirus (HPV) infection**, which is the primary cause of cervical cancer, making it the most common site of origin. *Endocervix* - The **endocervix** is lined by columnar epithelium and primarily gives rise to **adenocarcinoma**, which is less common than squamous cell carcinoma. - While cervical cancer can occur here, it is not the most frequent site of origin for all types of cervical cancer. *Isthmus* - The **isthmus** is the narrow lower part of the uterus, superior to the cervix. - It is not a primary site for the development of cervical cancer; cancerous changes typically originate within the cervical regions proper. *Ectocervix* - The **ectocervix** is the vaginal portion of the cervix, covered by stratified squamous epithelium. - While **squamous cell carcinomas** frequently occur in the cervix, they mostly originate in the transformation zone, not the ectocervix itself.

Q: The placenta synthesizes all EXCEPT:

Dehydroepiandrosterone. ***Dehydroepiandrosterone*** - **Dehydroepiandrosterone (DHEA)** is primarily synthesized in the **adrenal cortex** of both the fetus and the mother. - The placenta primarily converts DHEA into other steroids, such as **estrogens**, rather than synthesizing DHEA itself. *Oestriol* - The placenta plays a crucial role in synthesizing **oestriol**, particularly by utilizing **androgen precursors** from the fetal adrenal gland. - This synthesis is a key indicator of **feto-placental unit** well-being. *Corticotrophin releasing hormone* - The placenta extensively synthesizes **Corticotropin-releasing hormone (CRH)**, which gradually increases throughout pregnancy. - Placental CRH is thought to be involved in the **timing of parturition** and the regulation of fetal adrenal development. *PAPP-A (Pregnancy Associated Plasma Protein A)* - **PAPP-A** is a glycoprotein synthesized by the **syncytiotrophoblast** cells of the placenta. - It serves as an important biochemical marker in **combined first-trimester screening** for chromosomal abnormalities like Down syndrome.

Q: Withdrawal bleeding following administration of progesterone in a case of secondary amenorrhea indicates all EXCEPT:

Defect in pituitary gland. ***Defect in pituitary gland*** - While withdrawal bleeding after progesterone suggests the problem lies at the **hypothalamic-pituitary level** (anovulation with adequate estrogen), it does **not definitively rule out all pituitary defects**. - The pituitary may still produce sufficient **FSH to stimulate ovarian estrogen production** but have defective **LH surge mechanism** (WHO Group II anovulation). - Examples include **hyperprolactinemia** or **functional hypothalamic amenorrhea** where estrogen production is preserved despite pituitary-hypothalamic dysfunction. - This is the **EXCEPT answer** because the other options are more definitively confirmed by withdrawal bleeding. *Absence of pregnancy* - Withdrawal bleeding after progesterone administration **definitively confirms absence of pregnancy**. - Pregnancy would prevent withdrawal bleeding due to sustained progesterone production by the corpus luteum and placenta. - This is a key diagnostic exclusion in the evaluation of **secondary amenorrhea**. *Endometrium is responsive to estrogen* - The occurrence of withdrawal bleeding **definitively demonstrates** that the endometrium has been exposed to adequate estrogen and has proliferated. - This proliferative endometrium then sheds when progesterone is withdrawn, confirming **normal endometrial responsiveness to hormonal stimulation**. - This rules out **Asherman syndrome** and other uterine factors. *Production of endogenous estrogen* - Withdrawal bleeding **definitively confirms** that there has been sufficient **endogenous estrogen production** to prime the endometrium. - The estrogen causes endometrial thickening, which then sheds when progesterone is withdrawn. - This indicates **adequate ovarian function** in terms of estrogen synthesis and rules out **hypergonadotropic hypogonadism** (ovarian failure).

Q: Monilial vaginitis is commonly associated with all EXCEPT:

Treatment of malaria with chloroquine. ***Treatment of malaria with chloroquine*** - **Chloroquine** is an antimalarial drug and has no direct known association with an increased risk of **monilial vaginitis (candidiasis)**. - Unlike antibiotics, corticosteroids, or immunosuppressants, chloroquine does not significantly alter the vaginal flora or immune response in a way that predisposes to Candida overgrowth. *Prolonged antibiotic therapy* - **Antibiotics** can disrupt the normal vaginal flora by killing off beneficial bacteria (like *Lactobacillus*), leading to an overgrowth of **Candida albicans**. - This altered microbial balance is a common cause of **vulvovaginal candidiasis (VVC)**. *Pregnancy* - Hormonal changes during **pregnancy**, particularly elevated estrogen levels, can increase **glycogen deposition** in vaginal epithelial cells. - This provides a rich food source for **Candida**, making pregnant women more susceptible to **monilial vaginitis**. *Diabetes Mellitus* - **Poorly controlled diabetes mellitus** leads to hyperglycemia, which can result in **elevated glucose levels** in vaginal secretions. - This increased glucose serves as a nutrient for **Candida albicans**, fostering its growth and making diabetic women more prone to recurrent **vaginal yeast infections**.

Q: Intraoperative recognition of ureter is by which of the following features? 1. Transparent tubular appearance 2. Pale glistening appearance 3. Longitudinal vessels on surface 4. Circumferential vessels on surface Select the correct answer using the code given below:

2 and 3. ***2 and 3*** - The ureter has a characteristic **pale, glistening appearance** (often described as "pearly white"), which helps distinguish it from surrounding tissues during surgery. - The presence of **longitudinal vessels** running along its surface is a key anatomical feature for intraoperative identification. - Additional identification feature: The ureter shows **peristaltic waves** when gently stimulated or pinched with forceps. *2 and 4* - While the ureter is indeed **pale and glistening**, the vessels on its surface are **longitudinal**, not circumferential. - **Circumferential vessels** would encircle the structure, which is not characteristic of ureteric vascular anatomy. *1 and 3* - The ureter is a tubular structure, but it is **not transparent**; it has a distinct **opaque, pale coloration**. - Although **longitudinal vessels** are correctly present, the transparency descriptor is inaccurate and not a reliable identification feature. *1 and 4* - The ureter is **not transparent** (it's opaque), and its vessels are **longitudinal**, not circumferential. - Neither of these features accurately describes the intraoperative appearance of the ureter.

Question 1

The components of partograph are all EXCEPT:

Accepted Answer

Maternal respiratory rate

Answer

Fetal heart rate

Answer

Time

Answer

Maternal urine analysis

Question 2

Which of the following information are provided by partograph?

1. Colour of liquor
2. Uterine contractions with duration and frequency
3. Dilatation of cervix

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 3 only

Answer

1 and 2 only

Question 3

Hysterosalpingography (HSG) is least helpful in detecting which of the following?

Accepted Answer

Pelvic adhesions

Answer

Asherman syndrome

Answer

Congenital uterine anomaly

Answer

Tubal patency

Question 4

Which of the following are characteristics of Trichomonas vaginitis?

1. Presence of greenish frothy discharge
2. Vaginal pH > 4.5
3. Presence of clue cells in microscopic examination
4. Strawberry spots on the vaginal mucosa

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 5

Tumor marker of epithelial ovarian carcinoma is:

Accepted Answer

CA-125

Answer

Alpha feto protein

Answer

Beta HCG

Answer

LDH

Question 6

The most common site of cervical cancer is:

Accepted Answer

Transformation zone

Answer

Endocervix

Answer

Isthmus

Answer

Ectocervix

Question 7

The placenta synthesizes all EXCEPT:

Accepted Answer

Dehydroepiandrosterone

Answer

Oestriol

Answer

Corticotrophin releasing hormone

Answer

PAPP-A (Pregnancy Associated Plasma Protein A)

Question 8

Withdrawal bleeding following administration of progesterone in a case of secondary amenorrhea indicates all EXCEPT:

Accepted Answer

Defect in pituitary gland

Answer

Absence of pregnancy

Answer

Endometrium is responsive to estrogen

Answer

Production of endogenous estrogen

Question 9

Monilial vaginitis is commonly associated with all EXCEPT:

Accepted Answer

Treatment of malaria with chloroquine

Answer

Prolonged antibiotic therapy

Answer

Pregnancy

Answer

Diabetes Mellitus

Question 10

Intraoperative recognition of ureter is by which of the following features?

1. Transparent tubular appearance
2. Pale glistening appearance
3. Longitudinal vessels on surface
4. Circumferential vessels on surface

Select the correct answer using the code given below:

Accepted Answer

2 and 3

Answer

2 and 4

Answer

1 and 3

Answer

1 and 4

UPSC-CMS 2020

Obstetrics and Gynecology

Surgery