UPSC-CMS 2022 Practice Questions

Q: In hyperemesis gravidarum, Wernicke's encephalopathy is seen due to the deficiency of

vitamin B1. ***vitamin B1*** - **Wernicke's encephalopathy** is directly caused by a severe deficiency of **thiamine (vitamin B1)**. - In **hyperemesis gravidarum**, persistent vomiting leads to inadequate intake and absorption of this vital vitamin. *vitamin B6* - Deficiency of **vitamin B6 (pyridoxine)** can cause peripheral neuropathy, glossitis, and dermatitis. - While important for many metabolic processes, its deficiency is not directly linked to Wernicke's encephalopathy. *vitamin B12* - **Vitamin B12 (cobalamin)** deficiency primarily results in megaloblastic anemia and subacute combined degeneration of the spinal cord. - It does not cause the specific neurological triad of Wernicke's encephalopathy. *vitamin B9* - Deficiency of **vitamin B9 (folate)** leads to megaloblastic anemia and is crucial for neural tube development. - It is not associated with the pathogenesis of Wernicke's encephalopathy.

Q: As per the PC & PNDT Act, permission will be given to perform the tests for detection of which of the following?

All of the above. ***All of the above*** - The **PC & PNDT Act** (Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994) permits prenatal diagnostic procedures specifically for detection of **chromosomal abnormalities**, **genetic metabolic diseases**, **haemoglobinopathies**, **sex-linked genetic diseases**, and **congenital anomalies** when there are medical indications. - All three conditions listed in the options (**sex-linked genetic diseases**, **chromosomal abnormalities**, and **haemoglobinopathies**) are explicitly mentioned in the Act as permissible reasons for prenatal testing. - The key principle is that these tests must be conducted only for detection of genetic/congenital abnormalities and **not for sex determination**, which is the primary prohibition under the Act. - Therefore, permission will be given for detection of all the conditions mentioned. *Why each individual option alone would be incomplete* - While each of the three conditions (**sex-linked genetic diseases**, **chromosomal abnormalities**, **haemoglobinopathies**) is individually permitted under the Act, selecting any single option would be incomplete. - The Act permits testing for all these categories of genetic disorders, not just one specific type. - This makes "All of the above" the most comprehensive and accurate answer.

Q: A 27-year-old female is complaining of grayish white discharge with fishy odour. There is no history of itching associated with discharge. Which one of the following is the most likely diagnosis?

Bacterial vaginosis. ***Bacterial vaginosis*** - The classic presentation includes **grayish-white vaginal discharge** with a **fishy odor**, especially after intercourse, and **absence of itching**. - This clinical picture aligns perfectly with **Amsel's criteria** for bacterial vaginosis, which include vaginal pH >4.5, clue cells on microscopy, and a positive whiff test. *Trichomoniasis* - Characteristically presents with a **frothy, greenish-yellow discharge** and often causes **vulvovaginal itching and irritation**, which are not reported here. - While it can cause a foamy discharge and sometimes a foul odor, the specific symptom profile given is less typical for trichomoniasis. *Urinary tract infection* - Primarily involves symptoms such as **dysuria (painful urination)**, frequent urination, and urgency, rather than vaginal discharge. - A UTI does not typically present with a "fishy-smelling grayish-white discharge" as its primary symptom. *Candidiasis* - Typically presents with a **thick, white, "cottage cheese-like" discharge** and is almost always associated with significant **vulvovaginal itching and burning**. - The absence of itching and the description of a grayish, fishy-smelling discharge make candidiasis highly unlikely.

Q: Which of the following is a contraindication for insertion of Intrauterine Contraceptive Device (IUCD)?

Suspected pregnancy. ***Suspected pregnancy*** - Insertion of an IUCD into a pregnant uterus is an **absolute contraindication** (WHO MEC Category 4). - Can lead to **septic abortion**, **miscarriage**, **uterine perforation**, or **ectopic pregnancy complications**. - **Pregnancy must be ruled out** before IUCD insertion through history, examination, and urine pregnancy test if indicated. *Age > 35 years* - Age alone is **not a contraindication** for IUCD insertion. - IUCDs are safe and highly effective for women over 35 years. - In fact, IUCDs are often preferred for older reproductive-age women due to high efficacy and non-hormonal options. *Severe dysmenorrhea* - **Not an absolute contraindication** for IUCD insertion. - **Copper IUCDs** may worsen dysmenorrhea and should be used with caution. - **Levonorgestrel-releasing IUCDs (LNG-IUS)** are actually **therapeutic** for severe dysmenorrhea and reduce menstrual blood loss. - The type of IUCD can be selected based on the clinical scenario. *Multiple sexual partners* - **Not a contraindication** for IUCD insertion per WHO Medical Eligibility Criteria. - While multiple partners increase STI risk, this can be addressed through **STI screening** and **barrier contraception counseling**. - IUCDs do not increase risk of PID in women without current cervical infection. - The outdated concern about PID risk has been refuted by modern evidence.

Q: The first-line drug for intrapartum prophylaxis against Group β Streptococcal (GBS) infection in pregnancy is

penicillin. ***penicillin*** - **Penicillin G** is the drug of choice for intrapartum GBS prophylaxis due to its **narrow spectrum** and proven efficacy in preventing neonatal GBS disease. - It rapidly achieves bactericidal concentrations in the amniotic fluid, effectively eradicating GBS from the maternal genital tract during labor. *doxycycline* - **Doxycycline** is a **tetracycline antibiotic** generally contraindicated in pregnancy due to potential adverse effects on fetal bone and tooth development. - It is not effective against GBS and is not used for its treatment or prophylaxis in pregnant women. *vancomycin* - **Vancomycin** is reserved for pregnant women with **severe penicillin allergy** (e.g., anaphylaxis) or isolates with known resistance to penicillin and clindamycin. - Its use is limited due to the need for intravenous administration and potential for ototoxicity or nephrotoxicity. *azithromycin* - **Azithromycin** is sometimes used for GBS prophylaxis in cases of penicillin allergy but is **less preferred** than clindamycin due to emerging GBS resistance. - It is not considered a first-line agent, and susceptibility testing is crucial if it is considered for use.

Q: Which of the following is NOT a component of the combined prenatal screening test in the first trimester?

2. MS AFP (α-Fetoprotein). ***2. MS AFP (α-Fetoprotein)*** - **MS AFP (maternal serum α-Fetoprotein)** is primarily used in the **second-trimester screening** (quad screen or triple screen) to detect **neural tube defects** and certain chromosomal abnormalities. - It is **NOT part of the first-trimester combined screening test**. - The first trimester combined screening is performed between **11-13+6 weeks** of gestation. *1. β-hCG* - **β-hCG** (beta-human chorionic gonadotropin) is a key biochemical marker used in the first-trimester combined screening. - Abnormal levels of **β-hCG** (elevated in Down syndrome, decreased in Trisomy 18) are integrated with other markers to calculate risk for chromosomal abnormalities. *3. Nuchal translucency* - **Nuchal translucency (NT)** measurement is a crucial ultrasound marker used in the first-trimester combined screening test. - Increased NT thickness (≥3.5 mm) is associated with a higher risk of **aneuploidies** (Down syndrome, Trisomy 18, Trisomy 13) and certain structural cardiac defects. *4. PAPP-A* - **PAPP-A** (Pregnancy-Associated Plasma Protein-A) is a biochemical marker included in the first-trimester combined screening. - Low levels of **PAPP-A** are associated with an increased risk of Down syndrome and other adverse pregnancy outcomes.

Q: Which of the following are correct regarding Placental Site Trophoblastic Tumour (PSTT)? 1. Low serum β-hCG 2. Composed mainly of cytotrophoblast 3. Highly responsive to chemo radiation 4. Confined to endometrium without myometrial invasion

1. Low serum β-hCG. ***Low serum β-hCG*** - **PSTT** originates from intermediate trophoblasts, which produce **human placental lactogen (hPL)** rather than **β-hCG**, leading to relatively low serum β-hCG levels. - This low **β-hCG** is a key differentiator from other gestational trophoblastic neoplasms like **choriocarcinoma**. *Confined to endometrium without myometrial invasion* - **PSTT** is known for its **local invasiveness** and frequently invades into the **myometrium**, and may even penetrate the serosa. - Its infiltrative growth pattern can lead to **uterine rupture** and significant **hemorrhage**. *Composed mainly of cytotrophoblast* - **PSTT** is primarily composed of **intermediate trophoblasts**, not cytotrophoblasts. - These intermediate trophoblasts are characterized by their **mononuclear appearance** and distinctive immunohistochemical staining pattern, including positivity for **hPL** and **cytokeratin**. *Highly responsive to chemo radiation* - PSTT is **not highly responsive** to chemotherapy; it often exhibits **chemoresistance**, especially in advanced stages. - Because of its chemoresistance, **surgery** (hysterectomy) is the primary treatment for localized disease, and systemic therapy options are more challenging.

Question 1

In hyperemesis gravidarum, Wernicke's encephalopathy is seen due to the deficiency of

Accepted Answer

vitamin B1

Answer

vitamin B6

Answer

vitamin B12

Answer

vitamin B9

Question 2

As per the PC & PNDT Act, permission will be given to perform the tests for detection of which of the following?

Accepted Answer

All of the above

Answer

Sex-linked genetic diseases

Answer

Chromosomal abnormalities

Answer

Haemoglobinopathies

Question 3

In which of the following situations might delayed cord clamping be contraindicated?

Accepted Answer

Need for immediate neonatal resuscitation where delayed clamping interferes

Answer

Placental abruption with maternal compromise

Answer

Severe maternal hemorrhage requiring immediate resuscitation

Answer

Cord prolapse requiring immediate delivery

Question 4

Which of the following best defines gestational hypertension?

Accepted Answer

Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 20 weeks of gestation in a previously normotensive woman

Answer

Sustained rise of blood pressure to 140/90 mmHg or more on two occasions 4-6 hours apart with proteinuria after 20 weeks of gestation

Answer

Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 12 weeks of gestation

Answer

Sustained rise of blood pressure to 150/100 mmHg or more on at least two occasions 2 hours apart after 20 weeks of gestation

Question 5

A 27-year-old female is complaining of grayish white discharge with fishy odour. There is no history of itching associated with discharge. Which one of the following is the most likely diagnosis?

Accepted Answer

Bacterial vaginosis

Answer

Trichomoniasis

Answer

Urinary tract infection

Answer

Candidiasis

Question 6

Which of the following is a contraindication for insertion of Intrauterine Contraceptive Device (IUCD)?

Accepted Answer

Suspected pregnancy

Answer

Age > 35 years

Answer

Severe dysmenorrhea

Answer

Multiple sexual partners

Question 7

Regarding the phenomenon of ‘lightening’ in primigravida at term pregnancy, which one of the following statements is correct?

Accepted Answer

It is a welcome sign since it indicates descent fetal head into pelvis.

Answer

It occurs earlier in primigravida compared to multigravida.

Answer

There are no bladder or bowel symptoms associated with this phenomenon.

Answer

It is associated with worsening cardiorespiratory embarrassment in mother.

Question 8

The first-line drug for intrapartum prophylaxis against Group β Streptococcal (GBS) infection in pregnancy is

Accepted Answer

penicillin

Answer

doxycycline

Answer

vancomycin

Answer

azithromycin

Question 9

Which of the following is NOT a component of the combined prenatal screening test in the first trimester?

Accepted Answer

2. MS AFP (α-Fetoprotein)

Answer

1. β-hCG

Answer

4. PAPP-A

Answer

3. Nuchal translucency

Question 10

Which of the following are correct regarding Placental Site Trophoblastic Tumour (PSTT)?

1. Low serum β-hCG
2. Composed mainly of cytotrophoblast
3. Highly responsive to chemo radiation
4. Confined to endometrium without myometrial invasion

Accepted Answer

1. Low serum β-hCG

Answer

4. Confined to endometrium without myometrial invasion

Answer

2. Composed mainly of cytotrophoblast

Answer

3. Highly responsive to chemo radiation

UPSC-CMS 2022

Biochemistry

Forensic Medicine

Obstetrics and Gynecology