UPSC-CMS 2020 Practice Questions

Q: Consider the following regarding examination of a rape victim: 1. Emergency pill is provided 2. Internal examination must be performed 3. HIV testing is done Which of the above statements is/are correct?

1 and 3 only. ***1 and 3 only*** - **Emergency contraception** (emergency pill) is important to prevent unwanted pregnancy and should be offered and administered as soon as possible after sexual assault. - **HIV testing** is crucial for baseline assessment and to determine the need for **post-exposure prophylaxis (PEP)** against HIV. *1, 2 and 3* - While emergency contraception and HIV testing are critical, **internal examination** is not always mandatory and should only be performed with the **explicit consent** of the victim, and only if considered medically necessary or for forensic evidence collection. - The victim has the right to refuse any part of the examination. *2 only* - This option is incorrect because, as explained, an **internal examination** is not mandatory and requires **informed consent**. - Emergency contraception and HIV testing are also vital components of care. *3 only* - This option is incomplete as it correctly identifies the importance of **HIV testing**, but misses the crucial role of **emergency contraception** in preventing pregnancy after sexual assault. - Both are critical aspects of immediate medical care.

Q: Which one of the following is NOT a risk factor for the development of placenta previa?

Maternal anaemia. ***Maternal anaemia*** - **Maternal anaemia** is generally considered a *consequence* of conditions like antenatal hemorrhage from placenta previa, rather than a direct risk factor for its development. - While anaemia is common in pregnancy and can exacerbate outcomes, it does not independently increase the likelihood of the placenta implanting abnormally close to or over the cervical os. *Maternal age* - **Advanced maternal age** (typically over 35 years) is a well-established risk factor for placenta previa. - This is thought to be due to an increased incidence of pre-existing uterine abnormalities and degenerative changes in the endometrium. *Previous caesarean section* - A **previous caesarean section** significantly increases the risk of placenta previa due to the presence of a uterine scar. - The placenta may preferentially implant over the scar tissue, which can be less vascular, leading to a lower implantation and potentially previa. *Smoking* - **Smoking** during pregnancy is a recognized risk factor for placenta previa, potentially due to hypoxic-ischemic effects on the endometrium. - It may contribute to abnormal placentation by inducing compensatory placental hypertrophy and extending the placental surface area, increasing the chance of covering the cervical os.

Q: Common clinical presentations of moderate to severe abruption are all EXCEPT:

Prolonged labour. ***Prolonged labour*** - While **placental abruption** can sometimes lead to **uterine dysfunction** and difficulties in labor progression, **prolonged labor** is *not* a characteristic or common clinical presentation of an abruption itself. - The primary concerns with abruption are **hemorrhage**, **fetal compromise**, and rapid progression to delivery due to **uterine irritability**. *Uterine tenderness* - **Uterine tenderness** is a classic and common sign of **placental abruption**, resulting from the extravasation of blood into the myometrium. - This tenderness is often localized over the site of the abruption and can range from mild to severe depending on the extent of the blood collection. *Unexplained preterm labour* - **Placental abruption** is a known cause of **preterm labor**, often presenting as uterine contractions and pain. - The irritation of the uterus by blood and the presence of **prostaglandins** released during the abruption process can trigger premature contractions. *Fetal distress* - **Fetal distress**, indicated by **non-reassuring fetal heart rate patterns** like decelerations or bradycardia, is a common and serious consequence of **placental abruption**. - This occurs due to the reduction in **placental perfusion** and oxygen exchange between the mother and fetus.

Q: The initial prevention strategy for antiphospholipid syndrome will be: 1. Steroids 2. Heparin 3. Low dose aspirin 4. Progesterone support Which of the above is/are correct?

2 and 3. ***2 and 3*** - For pregnant women with antiphospholipid syndrome (APS), a combination of **low-dose aspirin** and **low molecular weight heparin (LMWH)** or **unfractionated heparin (UFH)** is the most widely accepted and effective initial prevention strategy to prevent pregnancy complications. - **Low-dose aspirin** helps reduce platelet aggregation, while **heparin** inhibits coagulation, addressing both thrombotic tendencies associated with APS. *1 and 4* - **Steroids** are typically reserved for severe manifestations of APS, such as catastrophic APS or refractory cases, and are not part of the initial standard preventative regimen. - **Progesterone support** is indicated for threatened miscarriage or luteal phase defect but does not address the underlying thrombotic risk in APS for pregnancy prevention. *3 only* - While **low-dose aspirin** is an important component, it is insufficient on its own for preventing pregnancy complications in women with antiphospholipid syndrome due to the high thrombotic risk. - **Heparin**, either LMWH or UFH, is crucial to provide adequate anticoagulation and is always used in conjunction with aspirin for initial prevention. *3 and 4* - **Low-dose aspirin** is appropriate, but **progesterone support** (4) is not a primary measure for preventing thrombotic events or pregnancy complications specifically linked to antiphospholipid syndrome. - The critical missing component in this option is **heparin**, which is essential for anticoagulation in APS pregnancies.

Q: Diagnostic criteria for PCOS are: 1. Oligo/amenorrhea 2. Hyperandrogenism 3. Polycystic ovaries on ultrasound Which of the above are correct?

1, 2 and 3. ***1, 2 and 3*** - All three listed features are the **Rotterdam criteria** for diagnosing PCOS, which is the most widely used diagnostic system. - The Rotterdam criteria require **at least 2 out of 3** of the following: **(1) oligo-ovulation/anovulation** (clinically presenting as oligo/amenorrhea), **(2) clinical or biochemical hyperandrogenism**, and **(3) polycystic ovaries on ultrasound**. - Since all three listed features are valid diagnostic criteria, the correct answer includes all of them (1, 2, and 3). - Note: Diagnosis requires meeting 2 out of 3 criteria, but all 3 are recognized valid criteria. *2 and 3 only* - This option incorrectly excludes **oligo/amenorrhea** (oligo-ovulation/anovulation). - Oligo/amenorrhea is a core criterion in the Rotterdam criteria and represents the ovulatory dysfunction that is central to PCOS. - Excluding this criterion makes the option incomplete. *1 and 3 only* - This option incorrectly excludes **hyperandrogenism**. - Hyperandrogenism (clinical signs like hirsutism, acne, or biochemical elevation of androgens) is a fundamental criterion in the Rotterdam criteria. - It reflects the hormonal dysregulation that characterizes PCOS and cannot be excluded as a valid diagnostic criterion. *1 and 2 only* - This option incorrectly excludes **polycystic ovaries on ultrasound**. - The ultrasound finding of polycystic ovarian morphology (≥12 follicles measuring 2-9 mm or ovarian volume >10 mL) is an essential criterion in the Rotterdam criteria. - Excluding this morphological feature makes the option incomplete.

Q: Which of the following symptoms can be associated with pelvic organ prolapse? 1. Difficulty in passing urine 2. Incomplete evacuation of urine 3. Urgency and frequency Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - Pelvic organ prolapse can cause **urinary symptoms** due to anatomical distortion affecting the bladder and urethra. - Patients may experience **difficulty in initiating micturition**, the sensation of **incomplete emptying**, **increased urgency**, and **frequency** as common manifestations. *1 and 3 only* - This option is incomplete as it excludes **incomplete evacuation of urine**, which is a frequent symptom of pelvic organ prolapse. - The sensation of incomplete emptying is often due to the physical obstruction or kink in the urethra caused by the prolapsed organ. *2 and 3 only* - This option is incorrect because it dismisses **difficulty in passing urine**, also known as **voiding dysfunction**, which can be a direct result of urethral compression or angulation. - **Voiding dysfunction** is a key symptom that impacts quality of life for women with prolapse. *1 and 2 only* - This choice omits **urgency and frequency**, common irritative symptoms of the bladder often associated with pelvic organ prolapse. - Even without infection, bladder irritation can stem from changes in bladder support and position caused by the prolapse.

Q: A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true regarding the above case? 1. Bartholin's abscess may be the likely diagnosis 2. It is to be managed by marsupialisation 3. Gonococcus is the most common pathogenic organism Select the correct answer using the code given below:

1 and 2 only. ***1 and 2 only*** - The presentation of **painful, unilateral vulvar swelling for 3 days** is highly suggestive of a **Bartholin's abscess**, making statement 1 correct. - **Marsupialization** is a valid surgical management option for Bartholin's abscess. While **incision and drainage with Word catheter placement** is preferred for acute cases, marsupialization can be performed and is especially indicated for recurrent cases. Statement 2 is considered true as marsupialization is an accepted treatment modality. - **Statement 3 is false**: Gonococcus is NOT the most common organism. **Polymicrobial infections** (E. coli, Staphylococcus, Streptococcus, anaerobes) are most common in current practice. Gonococcus accounts for <10% of cases. *3 only* - This option is incorrect because statement 3 alone is false (Gonococcus is not the most common organism), while statements 1 and 2 are true. - Selecting only statement 3 contradicts the clinical presentation and current microbiology data. *1, 2 and 3* - This option is incorrect because **statement 3 is false**. Gonococcus is no longer the most common pathogenic organism causing Bartholin's abscesses. - **Polymicrobial infections** predominate in modern practice, making this combination incorrect. *1 and 3 only* - This option is incorrect because it excludes statement 2 (marsupialization is a valid management option) while including statement 3 (which is false regarding Gonococcus being the most common organism). - This combination is medically inaccurate on both counts.

Q: Which one of the following is NOT a sign of separation of placenta?

The fundal height reduces further. ***The fundal height reduces further*** - A **reduction in fundal height** is not a sign of placental separation; rather, the fundus often rises slightly as the separated placenta descends into the lower uterine segment. - After separation, the uterus typically becomes **globular** and the fundus may rise to a level above the umbilicus. *Apparent lengthening of the cord with slight gush of vaginal bleeding* - **Lengthening of the umbilical cord** outside the vagina is a classic sign of placental separation, indicating the placenta has descended. - A **gush of blood** often occurs as the placenta detaches from the uterine wall, releasing pooled blood from the retroplacental space. *Uterus becomes globular, firm and ballotable* - After separation, the uterus contracts strongly, becoming more **globular** and **firm** as it expels the placenta. - The uterus may feel **ballotable** if the placenta is still within the uterine cavity but detached. *Slight bulging in the suprapubic region* - A **slight bulging in the suprapubic region** (above the symphysis pubis) indicates that the separated placenta has descended into the lower uterine segment or vagina, creating a palpable mass. - This sign is often referred to as a "boggy" or "fullness" sensation in the lower abdomen due to the descended placenta.

Q: Consider the following cardinal movements of mechanism of normal labor: 1. Engagement 2. Internal rotation 3. Flexion 4. Restitution 5. Crowning 6. External rotation What is the correct sequence of movements in labor in occipito-lateral position?

1, 3, 2, 5, 4 and 6. ***1, 3, 2, 5, 4 and 6*** - This sequence accurately represents the order of events during normal vaginal delivery **in occipito-lateral position**, starting with **engagement** and progressing through the cardinal movements. - The sequence follows: **Engagement (1)** → **Flexion (3)** → **Internal rotation (2)** from occipito-lateral to occipito-anterior → **Crowning (5)** during extension phase → **Restitution (4)** → **External rotation (6)**. - While **crowning** is not technically a cardinal movement, it occurs during the **extension** phase and marks the emergence of the fetal head at the introitus. - In **occipito-lateral position**, internal rotation is essential for converting the position to occipito-anterior for delivery. *3, 1, 2, 4, 6 and 5* - This sequence incorrectly places **flexion before engagement**, which is physiologically impossible as the fetal head must first engage in the pelvic inlet before significant flexion occurs. - **Crowning** is placed after external rotation, but crowning occurs during the extension phase, well before restitution and external rotation. *1, 2, 3, 4, 5 and 6* - This sequence incorrectly places **internal rotation before flexion**, whereas flexion typically occurs first to reduce the presenting diameter and facilitate internal rotation. - The sequence also places **crowning after restitution**, which contradicts the normal progression where crowning occurs during extension, before restitution. *2, 1, 3, 4, 5 and 6* - This sequence incorrectly begins with **internal rotation before engagement**, which is physiologically impossible as the fetal head must be engaged in the pelvis before it can rotate. - **Engagement** must always be the first cardinal movement.

Q: Common trisomies resulting in spontaneous abortion are all EXCEPT:

Trisomy 1. ***Trisomy 1*** - **Trisomy 1** is considered **lethal** and results in very early embryonic demise, often before a pregnancy is recognized, making it an extremely rare finding in spontaneous abortions. - The presence of an extra copy of such a large, gene-rich chromosome is **incompatible with early development**. *Trisomy 21* - **Trisomy 21 (Down syndrome)** is the most common autosomal trisomy that can result in a live birth, but it is also a frequent cause of **spontaneous abortion**. - While many pregnancies with Trisomy 21 result in live births, a significant proportion (approximately **75-80%**) end in miscarriage. *Trisomy 18* - **Trisomy 18 (Edwards syndrome)** is a common trisomy found in spontaneous abortions, second only to Trisomy 16. - While it can result in live births, the majority of fetuses with Trisomy 18 **miscarry spontaneously**. *Trisomy 16* - **Trisomy 16** is the most common trisomy identified in early spontaneous abortions, accounting for a large percentage of all chromosomal abnormalities leading to miscarriage. - It is considered **lethal** and is almost exclusively found in miscarried fetuses, with very rare exceptions of mosaic forms.

Question 1

Consider the following regarding examination of a rape victim:

1. Emergency pill is provided
2. Internal examination must be performed
3. HIV testing is done
Which of the above statements is/are correct?

Accepted Answer

1 and 3 only

Answer

1, 2 and 3

Answer

2 only

Answer

3 only

Question 2

Which one of the following is NOT a risk factor for the development of placenta previa?

Accepted Answer

Maternal anaemia

Answer

Maternal age

Answer

Previous caesarean section

Answer

Smoking

Question 3

Common clinical presentations of moderate to severe abruption are all EXCEPT:

Accepted Answer

Prolonged labour

Answer

Uterine tenderness

Answer

Fetal distress

Answer

Unexplained preterm labour

Question 4

The initial prevention strategy for antiphospholipid syndrome will be:
1. Steroids
2. Heparin
3. Low dose aspirin
4. Progesterone support
Which of the above is/are correct?

Accepted Answer

2 and 3

Answer

1 and 4

Answer

3 only

Answer

3 and 4

Question 5

Diagnostic criteria for PCOS are:

1. Oligo/amenorrhea
2. Hyperandrogenism
3. Polycystic ovaries on ultrasound

Which of the above are correct?

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 3 only

Answer

1 and 2 only

Question 6

Which of the following symptoms can be associated with pelvic organ prolapse?

1. Difficulty in passing urine
2. Incomplete evacuation of urine
3. Urgency and frequency

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Question 7

A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true regarding the above case?

1. Bartholin's abscess may be the likely diagnosis
2. It is to be managed by marsupialisation
3. Gonococcus is the most common pathogenic organism

Select the correct answer using the code given below:

Accepted Answer

1 and 2 only

Answer

3 only

Answer

1, 2 and 3

Answer

1 and 3 only

Question 8

Which one of the following is NOT a sign of separation of placenta?

Accepted Answer

The fundal height reduces further

Answer

Apparent lengthening of the cord with slight gush of vaginal bleeding

Answer

Uterus becomes globular, firm and ballotable

Answer

Slight bulging in the suprapubic region

Question 9

Consider the following cardinal movements of mechanism of normal labor:

1. Engagement
2. Internal rotation
3. Flexion
4. Restitution
5. Crowning
6. External rotation

What is the correct sequence of movements in labor in occipito-lateral position?

Accepted Answer

1, 3, 2, 5, 4 and 6

Answer

3, 1, 2, 4, 6 and 5

Answer

1, 2, 3, 4, 5 and 6

Answer

2, 1, 3, 4, 5 and 6

Question 10

Common trisomies resulting in spontaneous abortion are all EXCEPT:

Accepted Answer

Trisomy 1

Answer

Trisomy 21

Answer

Trisomy 18

Answer

Trisomy 16

UPSC-CMS 2020

Forensic Medicine

Obstetrics and Gynecology

Pathology