UPSC-CMS 2021 Practice Questions

Q: The vaginal pH in childbearing age normally ranges between

4 - 5.5. ***4 - 5.5*** - A vaginal pH within the range of **4.0 to 5.5** is considered normal for women of childbearing age, indicating a healthy acidic environment. - This acidic pH is maintained primarily by **Lactobacillus species** bacteria, which produce lactic acid, protecting against pathogenic bacteria. *1 - 2* - A pH range of 1-2 is **extremely acidic** and would be highly corrosive, far outside the physiological range for the vagina. - This level of acidity is typically found in the **stomach**, not the vagina. *7 - 8* - A pH range of 7-8 is considered **alkaline** and suggests an imbalance in the vaginal flora, potentially leading to infections such as **bacterial vaginosis**. - A neutral to alkaline pH is harmful to the normal vaginal microbiota and can promote the growth of opportunistic pathogens. *2.5 - 3.5* - While acidic, a pH of 2.5-3.5 is generally **too low** for a healthy vagina in most women of childbearing age, as the normal range typically starts closer to 4.0. - Although the vagina is acidic, this range is at the **extreme lower end** and might indicate an altered microenvironment.

Q: Primary Dysmenorrhoea can be treated by which of the following? 1. Antiprostaglandin 2. Cyclic combined estrogen and progesterone preparations 3. Pre-sacral neurectomy 4. Uterine curettage

1, 2 and 3. ***1, 2 and 3*** - **Antiprostaglandins (NSAIDs)** are the first-line treatment for primary dysmenorrhea as they inhibit prostaglandin synthesis, reducing uterine contractions and pain. - **Cyclic combined estrogen and progesterone preparations (oral contraceptives)** are second-line therapy that suppress ovulation, leading to a thinner endometrium and reduced prostaglandin production, thereby alleviating dysmenorrhea. - **Pre-sacral neurectomy** is a surgical procedure that may be considered for severe, refractory primary dysmenorrhea that has failed medical management, though it is more commonly used for secondary dysmenorrhea and chronic pelvic pain. *1, 2, 3 and 4* - This option incorrectly includes **uterine curettage**, which is not a treatment for primary dysmenorrhea. - Uterine curettage is a diagnostic or therapeutic procedure for conditions like abnormal uterine bleeding or retained products of conception, not for menstrual pain management. *1, 2 and 4* - This option incorrectly includes **uterine curettage** while excluding pre-sacral neurectomy. - Curettage has no role in primary dysmenorrhea treatment, whereas the other interventions target the underlying pathophysiology. *2, 3 and 4* - This option incorrectly excludes **antiprostaglandins (NSAIDs)**, which are the cornerstone first-line therapy for primary dysmenorrhea. - It also incorrectly includes uterine curettage, which has no role in dysmenorrhea management.

Q: Which one of the following is an abnormal parameter in accordance with WHO Semen Analysis Criteria (Normal reference value)?

Volume 14%* - WHO criteria state that **≥ 4% of sperms should have normal morphology** (strict criteria) - A morphology of >14% is **well within the normal range** (more than 3 times the threshold) - This represents a normal finding, not an abnormality *Progressive forward motility of sperms > 50%* - WHO guidelines indicate that **progressive motility (PR) should be ≥ 32%** - Progressive forward motility of >50% is **significantly above the threshold** - This indicates excellent sperm motility and is a normal finding *Sperm concentration < 10 million/ml* - Normal reference value for sperm concentration is **≥ 15 million/ml** - While <10 million/ml would be considered abnormal (**oligozoospermia**), the question asks for "an abnormal parameter" - **Volume < 1.0 ml is the best answer** as it represents a more significant deviation from normal values (1.0 vs 1.5 ml threshold) compared to other parameters

Q: Which one of the following is the most important haematological condition to be ruled out while investigating a case of puberty menorrhagia ?

Coagulation disorder. ***Coagulation disorder*** - Puberty menorrhagia (excessive menstrual bleeding at puberty) is frequently linked to underlying **hemostatic dysfunction**, with **Von Willebrand Disease** being the most common cause. - A coagulation disorder can lead to **uncontrolled bleeding** during menstruation, necessitating thorough investigation to prevent severe blood loss and complications. *Leukemia* - While leukemia can cause **easy bruising** and **bleeding tendencies** due to thrombocytopenia or impaired platelet function, it is less common as the primary cause of isolated menorrhagia in puberty. - Leukemia would typically present with a broader range of symptoms, including systemic signs like **fatigue**, **fever**, and **lymphadenopathy**. *G-6PD deficiency* - G-6PD deficiency is primarily a cause of **hemolytic anemia**, triggered by certain drugs or foods, leading to red blood cell breakdown. - It does not directly cause prolonged or heavy menstrual bleeding (menorrhagia) as a primary symptom. *Anaemia* - Anaemia is often a **consequence** of heavy menstrual bleeding (menorrhagia) rather than its direct cause. - While iron deficiency anemia is common in young women with menorrhagia, addressing the underlying cause of the bleeding is crucial, which might be a coagulation disorder.

Q: Which of the following are risk factors for developing pelvic inflammatory disease in females? 1. Use of oral contraception pills 2. Multiple sexual partners 3. Lower socioeconomic status 4. Genetic predisposition

1, 2 and 3. ***1, 2 and 3*** - **Multiple sexual partners** is a well-established major risk factor for PID as it significantly increases exposure to sexually transmitted infections (STIs), particularly *Chlamydia trachomatis* and *Neisseria gonorrhoeae*, which are the primary causative organisms of PID. - **Lower socioeconomic status** is associated with increased PID risk due to reduced access to healthcare services, delayed diagnosis and treatment of STIs, and barriers to preventive care. - **Use of oral contraception pills** has a controversial relationship with PID. While OCPs do not prevent STIs and may be associated with behavioral factors (reduced condom use), the direct relationship remains debated. Some evidence suggests OCPs may actually provide modest protection against ascending infection by thickening cervical mucus. However, this option represents the best available answer among the choices given. *1, 2 and 4* - This incorrectly includes **genetic predisposition**, which is not an established risk factor for PID. PID is primarily an infectious disease driven by behavioral and socioeconomic factors, not genetic susceptibility. *2, 3 and 4* - This incorrectly includes **genetic predisposition** as a risk factor for PID, which lacks evidence-based support. - It also excludes oral contraception pills, making this option incomplete even considering the controversial role of OCPs. *1, 3 and 4* - This incorrectly includes **genetic predisposition** and critically excludes **multiple sexual partners**, which is the most significant and well-established behavioral risk factor for PID. - Missing this key risk factor makes this option clearly incorrect.

Q: A 65 year old postmenopausal lady presents in Gynaecology OPD with abdominal distension and weight loss. On investigation she was diagnosed to have an ovarian tumour. The most common type of ovarian tumour in this woman would be

Epithelial tumor. ***Epithelial tumor*** - **Epithelial ovarian tumors** are the most common type of ovarian cancer, accounting for about **90%** of all cases. - Their incidence significantly increases with age, particularly in **postmenopausal women**, making them the most likely diagnosis in a 65-year-old presenting with abdominal distension and weight loss. *Sex cord tumor* - **Sex cord-stromal tumors** are rare, comprising about **5-8%** of ovarian neoplasms. - While they can occur at any age, they are less common than epithelial tumors and often present with **hormonal symptoms** due to their steroidogenic capacity. *Germ cell tumor* - **Germ cell tumors** are also rare, primarily affecting **younger women and adolescents**, typically under 30 years old. - They tend to grow rapidly and can present with acute symptoms like sudden onset abdominal pain, which is less characteristic for a 65-year-old postmenopausal woman. *Trophoblastic tumor* - **Trophoblastic tumors** (specifically **gestational trophoblastic disease**) are primarily related to pregnancy and occur when there is abnormal proliferation of trophoblastic tissue, such as in a **hydatidiform mole** or **choriocarcinoma**. - These are extremely rare in a postmenopausal woman without a recent pregnancy history and are not considered ovarian tumors in the traditional sense.

Q: Which of the following are the characteristic features of Meigs' syndrome in a female? 1. Right sided hydrothorax 2. Ascites 3. Genital warts 4. Ovarian fibroma

1, 2 and 4. **1, 2 and 4** - **Meigs' syndrome** is defined by the triad of an **ovarian fibroma** (or other benign ovarian tumor), **ascites**, and **right-sided hydrothorax**. - All three components must be present for a clinical diagnosis of Meigs' syndrome. *1, 3 and 4* - While **right-sided hydrothorax** and an **ovarian fibroma** are components of Meigs' syndrome, **genital warts** are not. - **Genital warts** are caused by Human Papillomavirus (HPV) and are not associated with this syndrome. *2, 3 and 4* - **Ascites** and an **ovarian fibroma** are correctly identified as features, but **genital warts** are not part of Meigs' syndrome. - The syndrome specifically requires the presence of a **pleural effusion (hydrothorax)**, typically on the right side. *1, 2, 3 and 4* - This option mistakenly includes **genital warts**, which are not a feature of Meigs' syndrome. - The core diagnostic criteria are limited to the ovarian tumor, ascites, and hydrothorax.

Q: Which of the following are causes of GnRH dependent precocious puberty? 1. Constitutional 2. Tubercular Encephalitis 3. McCune-Albright syndrome 4. Primary hypothyroidism

1, 2 and 3. ***1, 2 and 3*** - **Constitutional precocious puberty** is the most common form of central (GnRH-dependent) precocious puberty, where the hypothalamic-pituitary-gonadal axis matures prematurely without an underlying organic cause [1]. - **Tubercular encephalitis** can cause CNS lesions that stimulate the hypothalamus, leading to premature GnRH release and subsequent central precocious puberty [1]. - **McCune-Albright syndrome** is primarily associated with GnRH-independent precocious puberty, but in a small percentage of cases, chronic stimulation of the ovaries (due to activating GNAS mutations) can eventually lead to secondary central (GnRH-dependent) precocious puberty via an exhausted feedback mechanism. *1 and 2 only* - This option is incorrect because while constitutional precocious puberty and tubercular encephalitis are causes of GnRH-dependent precocious puberty, McCune-Albright syndrome can also lead to GnRH-dependent precocious puberty secondarily. - It omits a valid cause, making it an incomplete answer. *2, 3 and 4* - This option incorrectly includes **primary hypothyroidism** as a cause of GnRH-dependent precocious puberty. Primary hypothyroidism is associated with GnRH-independent (peripheral) precocious puberty due to elevated TSH cross-reacting with FSH receptors. - It also omits **constitutional precocious puberty**, which is the most common cause of GnRH-dependent precocious puberty [1]. *1, 3 and 4* - This option incorrectly includes **primary hypothyroidism** as a cause of GnRH-dependent precocious puberty; it is a cause of GnRH-independent precocity. - While constitutional precocious puberty is a correct inclusion, the presence of primary hypothyroidism makes this option incorrect for GnRH-dependent causes.

Q: A couple presented to OPD with complaint of inability to conceive for the last 3 years. Husband was advised semen analysis. What is the WHO criterion for minimum sperm count per ml in normal semen?

15 million. ***15 million*** - The **WHO 2010 criteria** for normal semen analysis specifies a lower reference limit for sperm concentration as **15 million spermatozoa per mL**. - This count is considered the minimum threshold for **normal fertility potential** according to current international guidelines. *30 million* - While a higher sperm count, **30 million** is not the minimum threshold set by the WHO for normal semen analysis. - A count of 30 million would be considered well within the normal range, but the question specifically asks for the *minimum* criterion. *40 million* - **40 million** is significantly above the minimum sperm concentration required for normal fertility as per WHO guidelines. - This higher count would indicate robust spermatogenesis but is not the lower limit for defining normalcy. *10 million* - A sperm count of **10 million spermatozoa per mL** falls below the **WHO 2010 reference range** for normal sperm concentration. - This value would likely be considered **oligozoospermia** and could indicate reduced fertility potential.

Question 1

The vaginal pH in childbearing age normally ranges between

Accepted Answer

4 - 5.5

Answer

1 - 2

Answer

7 - 8

Answer

2.5 - 3.5

Question 2

Primary Dysmenorrhoea can be treated by which of the following?

1. Antiprostaglandin
2. Cyclic combined estrogen and progesterone preparations
3. Pre-sacral neurectomy
4. Uterine curettage

Accepted Answer

1, 2 and 3

Answer

1, 2, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 3

Which of the following is correct regarding obesity and infertility?

Accepted Answer

It is associated with hypogonadotropic hypogonadism

Answer

It is always associated with endometrial atrophy

Answer

It is associated with hypergonadotropic hypogonadism

Answer

There is no change in HPO axis

Question 4

Which one of the following is an abnormal parameter in accordance with WHO Semen Analysis Criteria (Normal reference value)?

Accepted Answer

Volume < 1.0 ml

Answer

Normal morphology of sperms > 14%

Answer

Progressive forward motility of sperms > 50%

Answer

Sperm concentration < 10 million/ml

Question 5

Which one of the following is the most important haematological condition to be ruled out while investigating a case of puberty menorrhagia ?

Accepted Answer

Coagulation disorder

Answer

Leukemia

Answer

G-6PD deficiency

Answer

Anaemia

Question 6

Which of the following are risk factors for developing pelvic inflammatory disease in females?

1. Use of oral contraception pills
2. Multiple sexual partners
3. Lower socioeconomic status
4. Genetic predisposition

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 7

A 65 year old postmenopausal lady presents in Gynaecology OPD with abdominal distension and weight loss. On investigation she was diagnosed to have an ovarian tumour. The most common type of ovarian tumour in this woman would be

Accepted Answer

Epithelial tumor

Answer

Sex cord tumor

Answer

Germ cell tumor

Answer

Trophoblastic tumor

Question 8

Which of the following are the characteristic features of Meigs' syndrome in a female?

1. Right sided hydrothorax
2. Ascites
3. Genital warts
4. Ovarian fibroma

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2, 3 and 4

Question 9

Which of the following are causes of GnRH dependent precocious puberty?

1. Constitutional
2. Tubercular Encephalitis
3. McCune-Albright syndrome
4. Primary hypothyroidism

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 10

A couple presented to OPD with complaint of inability to conceive for the last 3 years. Husband was advised semen analysis. What is the WHO criterion for minimum sperm count per ml in normal semen?

Accepted Answer

15 million

Answer

30 million

Answer

40 million

Answer

10 million

UPSC-CMS 2021

Obstetrics and Gynecology

Pediatrics

Physiology