UPSC-CMS 2021 Practice Questions

Q: Compared to breast milk, colostrum has

higher protein content. ***higher protein content*** - Colostrum is rich in **immunoglobulins** (antibodies) and other **protective proteins**, which are crucial for the newborn's immune system. - These proteins, including **IgA**, **lactoferrin**, and **growth factors**, contribute to its higher protein concentration (2-3 times higher) compared to mature breast milk. *lower water content* - Colostrum does have **slightly lower water content** (~87%) compared to mature breast milk (~88-90%), making it more concentrated. - However, this difference is minimal and not the most clinically significant distinguishing feature compared to the marked protein difference. *higher carbohydrate content* - Colostrum has a **lower carbohydrate content** (primarily lactose) compared to mature breast milk. - Mature milk develops a higher lactose content to support the infant's increasing energy demands. *higher fat content* - **Mature breast milk** has a significantly **higher fat content** than colostrum. - The fat in mature milk provides the primary source of energy for the rapidly growing infant, which is less critical in early colostrum feeding.

Q: What are Spiegelberg's criteria for diagnosis of ovarian pregnancy? 1. Tube on the affected side must be intact 2. Gestational sac must be in the position of ovary 3. Ovary is connected to uterus by utero-ovarian ligament 4. Ovarian tissue must be detected on the wall on histological examination

1, 2, 3 and 4. ***1, 2, 3 and 4*** * **Spiegelberg's criteria** are the established diagnostic criteria for **ovarian pregnancy**, first described in 1878. * All four criteria must be met for diagnosis: **(1) intact fallopian tube** on the affected side (rules out tubal pregnancy), **(2) gestational sac must occupy the position of the ovary**, **(3) the ovary must be connected to the uterus by the utero-ovarian ligament** (confirms normal anatomical position), and **(4) ovarian tissue must be histologically identified in the wall of the gestational sac** (definitive confirmation). * The **histological confirmation** of ovarian tissue is essential for definitive diagnosis and distinguishes it from other ectopic pregnancies. *1, 2 and 3 only* * While these three criteria establish the anatomical location and rule out tubal pregnancy, **histological confirmation** of ovarian tissue within the gestational sac wall (criterion 4) is essential for definitive diagnosis. * Without histological proof, other extrauterine pregnancies (such as advanced tubal pregnancies involving the ovary secondarily) could mimic the clinical and imaging features. *2, 3 and 4 only* * The **intact ipsilateral fallopian tube** (criterion 1) is critical for differentiating primary ovarian pregnancy from tubal pregnancy with secondary ovarian involvement. * Without confirming tube integrity, a tubal ectopic that has eroded into or adhered to ovarian tissue cannot be definitively excluded. *1 and 4 only* * These two criteria alone are insufficient; the gestational sac must be demonstrably located in the position of the ovary (criterion 2) and the ovary must maintain its normal anatomical connection to the uterus (criterion 3). * Missing the specific ovarian location and anatomical confirmation would lead to incomplete diagnosis and potential confusion with other forms of ectopic pregnancy.

Q: During pregnancy iron supplementation is needed for

all pregnant mothers from 16 weeks onwards. ***all pregnant mothers from 16 weeks onwards*** - **Physiological anemia** of pregnancy typically manifests around the **second trimester**, necessitating prophylactic iron supplementation. - Starting at **16 weeks** ensures adequate iron stores before the greatest increase in maternal red cell mass and fetal iron demands. *all pregnant mothers since 6 weeks of pregnancy* - Iron requirements do not significantly increase until the **second trimester**, so starting supplementation at **6 weeks** is unnecessarily early for most women. - Early supplementation can lead to side effects like **nausea and constipation** in the first trimester, potentially reducing compliance. *only those pregnant mothers who have Hb < 10 gm%* - Waiting until **hemoglobin levels drop below 10 gm/dL** indicates **established anemia**, which should ideally be prevented. - **Prophylactic supplementation** is recommended for all pregnant women to prevent iron deficiency before it becomes clinically apparent. *only those pregnant mothers who are not eating green vegetables* - While green vegetables are a source of **non-heme iron**, the bioavailability is lower than heme iron, and adequate intake is often insufficient to meet the significantly increased demands of pregnancy. - Dietary intake alone is often **not enough to prevent iron deficiency** in pregnancy, regardless of vegetable consumption patterns.

Q: The clinical feature of physiological edema in pregnancy is:

disappears or markedly reduced on rest. ***disappears or markedly reduced on rest*** - **Physiological edema** in pregnancy is typically mild and **dependent**, meaning it tends to accumulate in the lower extremities due to **gravity** and increased venous pressure. - When the pregnant individual rests, especially in an elevated position, the gravitational pressure on the lower limbs is reduced, allowing for the **redistribution of fluid** and a decrease in visible swelling. *is usually of moderate or severe grade* - **Physiological edema** is typically **mild** and localized to the ankles and feet. - **Moderate or severe edema**, especially if sudden in onset, generalized, or associated with other symptoms, might indicate a pathological condition like **preeclampsia** or **cardiac dysfunction**. *is associated with cardiac or renal pathology* - **Physiological edema** is a normal part of pregnancy, resulting from hormonal changes, increased blood volume, and uterine pressure, and is **not indicative** of underlying cardiac or renal disease. - Edema linked to **cardiac** or **renal pathology** would typically be more severe, generalized, and accompanied by other specific symptoms or laboratory abnormalities related to the respective organ systems. *is present on both lower limbs and abdomen* - **Physiological edema** predominantly affects the **lower limbs** (ankles, feet, sometimes hands and face) due to gravity and venous stasis, becoming more noticeable later in the day. - While some mild abdominal swelling can occur due to uterine growth, significant **abdominal wall edema** is not a characteristic feature of physiological edema and could suggest other causes.

Q: The normal rate of dilatation of the cervix in a primigravida in the active phase of labor is

1 cm/hour. ***1 cm/hour*** - The **active phase** of labor in a **primigravida** (first-time mother) is characterized by a cervical dilatation rate of at least 1 cm per hour. - This rate signifies good progress and is often used as a benchmark on a **partogram** to monitor labor. *0.25 cm/hour* - This rate is significantly **slower** than normal for the active phase of labor in a primigravida and would indicate **abnormal labor progression**, possibly requiring intervention. - Such a slow rate might be seen in the **latent phase** or in cases of **protracted labor**. *0.75 cm/hour* - While closer, this rate is still **below the expected minimum** for a primigravida in the active phase, suggesting slightly slower than optimal progress. - It could still indicate a **protracted active phase**, particularly if it persists. *0.5 cm/hour* - This rate is **substantially slower** than the typical progress in the active phase of labor for a primigravida. - It would be a strong indicator of **failure to progress** and would likely warrant a thorough evaluation for potential causes such as **cephalopelvic disproportion** or ineffective uterine contractions.

Q: In the mechanism of normal labour the engaging transverse diameter is

Biparietal diameter (9.5 cm). ***Biparietal diameter (9.5 cm)*** - In normal labor, with the fetus in a **flexed attitude**, the **biparietal diameter** is the widest transverse diameter of the fetal head that engages in the maternal pelvis. - This diameter measures approximately **9.5 cm** and indicates the distance between the two parietal eminences. *Bimastoid diameter (7.5 cm)* - The **bimastoid diameter** measures the widest transverse diameter at the base of the skull, going from one mastoid process to the other. - At **7.5 cm**, it is too small to be the primary engaging transverse diameter of the fetal head in normal labor, which involves the broader cranial vault. *Suboccipitofrontal diameter (10 cm)* - The **suboccipitofrontal diameter** is typically the engaging diameter when the fetal head is in a **deflexed attitude** (e.g., military presentation). - This diameter measures approximately **10 cm**, indicating moderate extension, which is not characteristic of normal labor where good flexion is expected. *Suboccipitobregmatic diameter (9.5 cm)* - The **suboccipitobregmatic diameter** is the smallest and most favorable anteroposterior diameter for engagement when the fetal head is **well-flexed**. - While it also measures **9.5 cm**, it is an **anteroposterior diameter**, not a transverse diameter, and hence not the answer to the question regarding transverse engaging diameter.

Q: In non-lactating mothers, after delivery, ovulation

may occur as early as 2 weeks. ***may occur as early as 2 weeks*** - In non-lactating mothers, the **hypothalamic-pituitary-ovarian axis** recovers relatively quickly after delivery because it is not suppressed by prolactin. - The earliest documented return of ovulation can be as soon as **2 weeks postpartum**, although 4-6 weeks is more common. *may occur as early as 4 weeks* - While 4 weeks is a common timeframe for ovulation to resume in non-lactating mothers, it is not the **earliest possible occurrence**. - This option misses the possibility of an even earlier return of **fertility**. *is unusual before 6 weeks* - This statement is incorrect as ovulation can, and frequently does, occur **before 6 weeks postpartum** in non-lactating women. - Delaying ovulation until 6 weeks is more typical in breast-feeding women due to **prolactin's inhibitory effect** on gonadotropin-releasing hormone. *may occur as early as 6 weeks* - Similar to the 4-week option, while ovulation can occur at 6 weeks, it is not the **earliest possible time point** for a non-lactating mother. - Assuming 6 weeks as the earliest timeframe could lead to an underestimation of the **risk of conception**.

Q: Which of the following are the pre-requisites of outlet forceps delivery? 1. Bladder should be empty 2. Membranes should be intact 3. Cervix should be fully dilated 4. Fetal skull has reached level of pelvic floor

1, 3 and 4. ***1, 3 and 4*** - For an **outlet forceps delivery**, the **bladder must be empty** to prevent trauma during instrumentation and to create more space in the pelvis. - A **fully dilated cervix** (10 cm) is an absolute prerequisite, ensuring that the fetal head can pass without causing cervical lacerations. The **fetal skull must have reached the pelvic floor**, indicating the head is at or beyond +2 station, and the sagittal suture is in the anteroposterior diameter. *1, 2 and 4* - While an **empty bladder** and the **fetal skull at the pelvic floor** are prerequisites, the **membranes should not be intact** for forceps delivery. - Intact membranes would require artificial rupture (amniotomy) before applying forceps to avoid membrane stripping or fetal injury. *1, 2 and 3* - An **empty bladder** and **fully dilated cervix** are essential, but **intact membranes** are not a prerequisite, as they must be ruptured for a safe forceps application. - The fetal head must also be at the **level of the pelvic floor**, which is missing from this option. *2, 3 and 4* - While a **fully dilated cervix** and the **fetal skull at the pelvic floor** are necessary, **intact membranes** are not desirable for forceps delivery, and an **empty bladder** is a crucial missing prerequisite. - Omitting the requirement for an **empty bladder** significantly increases the risk of maternal injury.

Question 1

Compared to breast milk, colostrum has

Accepted Answer

higher protein content

Answer

lower water content

Answer

higher carbohydrate content

Answer

higher fat content

Question 2

What are Spiegelberg's criteria for diagnosis of ovarian pregnancy?

1. Tube on the affected side must be intact
2. Gestational sac must be in the position of ovary
3. Ovary is connected to uterus by utero-ovarian ligament
4. Ovarian tissue must be detected on the wall on histological examination

Accepted Answer

1, 2, 3 and 4

Answer

1, 2 and 3 only

Answer

2, 3 and 4 only

Answer

1 and 4 only

Question 3

Which one of the following statements regarding fetal well being is NOT correct?

Accepted Answer

Modified Biophysical profile includes Non-stress test and fetal breathing

Answer

Mothers perceive 88% of fetal movements

Answer

Daily fetal movement count is a simple reliable method of fetal well being

Answer

Healthy fetus should have minimum of 10 movements in 12 hours period

Question 4

Which of the following statements are correct with respect to antenatal USG examination?

1. It helps in detecting gross fetal anomalies
2. It helps in identifying multiple pregnancies
3. It helps in identifying viable pregnancy
4. Best dating is possible with third trimester ultrasound scan

Accepted Answer

1, 2 and 3 only

Answer

3 and 4 only

Answer

1 and 2 only

Answer

1, 2, 3 and 4

Question 5

During pregnancy iron supplementation is needed for

Accepted Answer

all pregnant mothers from 16 weeks onwards

Answer

all pregnant mothers since 6 weeks of pregnancy

Answer

only those pregnant mothers who have Hb < 10 gm%

Answer

only those pregnant mothers who are not eating green vegetables

Question 6

The clinical feature of physiological edema in pregnancy is:

Accepted Answer

disappears or markedly reduced on rest

Answer

is usually of moderate or severe grade

Answer

is associated with cardiac or renal pathology

Answer

is present on both lower limbs and abdomen

Question 7

The normal rate of dilatation of the cervix in a primigravida in the active phase of labor is

Accepted Answer

1 cm/hour

Answer

0.25 cm/hour

Answer

0.75 cm/hour

Answer

0.5 cm/hour

Question 8

In the mechanism of normal labour the engaging transverse diameter is

Accepted Answer

Biparietal diameter (9.5 cm)

Answer

Bimastoid diameter (7.5 cm)

Answer

Suboccipitofrontal diameter (10 cm)

Answer

Suboccipitobregmatic diameter (9.5 cm)

Question 9

In non-lactating mothers, after delivery, ovulation

Accepted Answer

may occur as early as 2 weeks

Answer

may occur as early as 4 weeks

Answer

is unusual before 6 weeks

Answer

may occur as early as 6 weeks

Question 10

Which of the following are the pre-requisites of outlet forceps delivery?

1. Bladder should be empty
2. Membranes should be intact
3. Cervix should be fully dilated
4. Fetal skull has reached level of pelvic floor

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

UPSC-CMS 2021

Biochemistry

Obstetrics and Gynecology