UPSC-CMS 2022 Practice Questions

Q: Which of the following is INCORRECT regarding genital warts (condyloma acuminata)? 1. It is usually single. 2. It is related to HPV Types 6 and 11. 3. It can be transmitted sexually. 4. It can involve vagina and anus.

It is usually single.. ***It is usually single.*** - **Genital warts (condyloma acuminata)** caused by Human Papillomavirus (HPV) are typically **multiple lesions**, not single. - They often appear as **clusters** or "cauliflower-like" growths in the anogenital region. *It can involve vagina and anus.* - **Genital warts** can indeed involve the **vagina, anus, vulva, penis, perineum, and cervix**, as these are common areas of HPV infection. - The type of sexual activity influences the location of the lesions. *It is related to HPV Types 6 and 11.* - **HPV types 6 and 11** are indeed the most common causes of **genital warts**, accounting for approximately 90% of cases. - These are considered **low-risk HPV types** because they are rarely associated with cancer. *It can be transmitted sexually.* - **Genital warts** are a classic example of a **sexually transmitted infection (STI)**. - Transmission occurs through **skin-to-skin contact** during sexual activity.

Q: Which of the following are the clinical features of hyperprolactinemia? 1. Hypergonadotropic hypogonadism 2. Hypogonadotropic hypergonadism 3. Oligomenorrhea 4. Heavy menstruation

3. Oligomenorrhea. ***Oligomenorrhea*** - **Oligomenorrhea** (infrequent or light menstruation) is a common symptom of **hyperprolactinemia** due to prolactin's inhibitory effect on **GnRH** and, consequently, **gonadotropin** release [1], [2]. - The resulting **estrogen deficiency** can lead to menstrual irregularities, including anovulation and delayed periods [3]. *Hypogonadotropic hypergonadism* - This condition involves **low gonadotropins** (LH, FSH) despite **high sex hormones**, which is not characteristic of **hyperprolactinemia**. - **Hyperprolactinemia** typically causes **hypogonadotropic hypogonadism** by suppressing pituitary gonadotropin release [2]. *Hypergonadotropic hypogonadism* - This is characterized by **high gonadotropins** (LH, FSH) and **low sex hormones**, indicating primary gonadal failure. - **Hyperprolactinemia** causes **low gonadotropins** by inhibiting **GnRH** pulsatility, leading to secondary gonadal dysfunction [1]. *Heavy menstruation* - **Heavy menstruation (menorrhagia)** is generally not associated with **hyperprolactinemia**; rather, **oligomenorrhea** or **amenorrhea** are typical due to **estrogen deficiency** [3]. - **Estrogen deficiency** results in an underdeveloped uterine lining, which is less likely to cause heavy bleeding.

Q: Metroplasty is the surgical procedure done for which one of the following uterine anomalies?

Septate uterus. ***Septate uterus*** - **Metroplasty**, specifically **hysteroscopic metroplasty**, is the primary surgical treatment for a septate uterus to remove the fibrous or muscular septum dividing the uterine cavity. - This procedure aims to improve reproductive outcomes by restoring normal uterine anatomy and reducing the risk of miscarriage or preterm birth. *Arcuate uterus* - An **arcuate uterus** is a mild indentation of the uterine fundus, considered a normal variant or a minor anomaly, and does not typically require metroplasty or surgical correction. - It is usually **asymptomatic** and not associated with increased risks of adverse pregnancy outcomes. *Uterus didelphys* - **Uterus didelphys** is characterized by two completely separate uteri, cervices, and often two vaginas, due to complete non-fusion of the paramesonephric ducts. - Surgical intervention like metroplasty is generally **not indicated** as it would involve fusing two distinct uteri, which is not feasible or beneficial. *Imperforate hymen* - An **imperforate hymen** is a congenital anomaly where the hymen completely obstructs the vaginal opening. - The surgical procedure for an imperforate hymen is a simple **hymenotomy** or hymenectomy to create an opening, not a metroplasty, as it involves the hymen and not the uterus itself.

Q: Which of the following is MOST effective as a first-line management for premenstrual syndrome?

Combined oral contraceptive pills. ***Combined oral contraceptive pills*** - **Combined oral contraceptive pills** are the **most comprehensive first-line pharmacological treatment** for **premenstrual syndrome (PMS)** by suppressing ovulation and stabilizing hormonal fluctuations throughout the menstrual cycle. - They address both physical and mood-related symptoms of PMS effectively. - Continuous or extended-cycle regimens can be particularly beneficial by reducing the number of menstrual periods and related symptom flares. *Niacin (vitamin B3)* - There is **no robust scientific evidence** to support the efficacy of **niacin (vitamin B3)** in the management of PMS symptoms. - While **vitamin B6** has some evidence for mild PMS symptoms, **niacin (B3)** is not recommended. - High doses of niacin can cause side effects such as flushing, itching, and gastrointestinal upset. *Diuretics* - **Spironolactone**, a potassium-sparing diuretic, can be effective for managing **specific fluid retention symptoms** associated with PMS, such as bloating and breast tenderness. - However, diuretics are typically used as **adjunctive therapy** for specific symptoms rather than comprehensive first-line management. - They do not address the broader spectrum of emotional and psychological symptoms of PMS. *Hysterectomy with oophorectomy* - **Hysterectomy with oophorectomy** (removal of the uterus and ovaries) is a **last-resort treatment** for severe, refractory Premenstrual Dysphoric Disorder (PMDD) after all medical therapies have failed. - This is an **irreversible surgical procedure** that induces immediate surgical menopause with significant risks and long-term implications. - It is **never a first-line treatment** for PMS management.

Q: Which of the following is the marker of ovarian reserve?

Anti-Mullerian hormone. ***Anti-Mullerian hormone*** - **Anti-Mullerian hormone (AMH)** is produced by the granulosa cells of small antral and pre-antral follicles in the ovary. - AMH levels correlate with the size of the **primordial follicle pool**, making it the **most reliable indicator of ovarian reserve**. - Unlike other markers, AMH remains relatively **constant throughout the menstrual cycle** and can be measured on any day. - AMH is the **preferred marker** in fertility assessment and IVF planning. *β-hCG* - **Beta-human chorionic gonadotropin (β-hCG)** is a hormone produced during pregnancy by the developing placenta. - Its presence indicates pregnancy and is not a marker for **ovarian reserve**. *Placental alkaline phosphatase* - **Placental alkaline phosphatase (PLAP)** is an enzyme produced by the placenta. - It serves as a biological marker for certain cancers (e.g., germ cell tumors) and sometimes for placental function, but not **ovarian reserve**. *Serum estradiol* - **Serum estradiol** levels fluctuate significantly throughout the menstrual cycle and are influenced by numerous factors. - While **Day 3 estradiol** combined with FSH was historically used for ovarian reserve assessment, elevated levels can indicate poor reserve (due to early follicular recruitment). - However, it is **not as reliable or cycle-independent as AMH** for assessing the overall **follicle pool**.

Q: In the PALM-COEIN classification by FIGO for abnormal uterine bleeding, ovulatory dysfunction is the cause in which one of the following conditions?

Polycystic ovarian syndrome. ***Polycystic ovarian syndrome*** - **Polycystic ovarian syndrome (PCOS)** is a chronic anovulatory disorder, making it a primary cause of **ovulatory dysfunction (O in PALM-COEIN)**. - The hormonal imbalances in PCOS interfere with normal follicular development and ovulation, leading to irregular or absent periods and abnormal uterine bleeding. *Pelvic inflammatory disease* - **Pelvic inflammatory disease (PID)** is an infection of the upper female reproductive tract causing inflammation, but it does not directly lead to primary ovulatory dysfunction. - PID falls under the **"E" for Endometrial causes** in the PALM-COEIN classification if it causes bleeding through endometrial inflammation or infection. *Adenomyosis* - **Adenomyosis** is a condition where endometrial tissue grows into the muscular wall of the uterus, causing heavy and painful periods. - This condition is classified under **"A" for Adenomyosis** in the PALM-COEIN classification, representing a structural cause of abnormal uterine bleeding, not ovulatory dysfunction. *Ovarian cancer* - **Ovarian cancer** is a malignancy of the ovaries and, while it can cause abnormal bleeding in advanced stages, it is not primarily due to ovulatory dysfunction. - Ovarian cancer is classified under **"M" for Malignancy and hyperplasia** in PALM-COEIN, indicating a structural and pathological cause, rather than an ovulatory problem.

Q: The reference point 'zero' in POPQ (Pelvic Organ Prolapse Quantification) classification is taken as

hymen. ***hymen*** - The **hymen** (or hymenal ring/hymenal caruncles in parous women) is the fixed anatomical reference point (zero point) in the POPQ classification system. - All measurements in POPQ are taken in centimeters relative to the hymenal ring, with **negative values** indicating positions above the hymen and **positive values** indicating descent beyond the hymen. - This landmark was chosen because it is **easily identifiable, reproducible, and remains relatively constant** regardless of the degree of prolapse. *ischial spine* - The **ischial spines** are important anatomical landmarks in the pelvis but are **not** used as the zero reference point in POPQ. - They are used for measuring **total vaginal length (TVL)** - the distance from the hymen to the posterior fornix with the prolapse reduced. - The ischial spines serve as internal palpable landmarks during pelvic examination but not as the measurement reference for prolapse staging. *perineal body* - The **perineal body** is a fibromuscular structure in the perineum and is measured in POPQ (as genital hiatus and perineal body measurements). - However, it is **not the zero reference point** because its position and integrity can be altered by prolapse, childbirth trauma, or surgical procedures. *mid-vagina* - The **mid-vagina** is not a standardized anatomical landmark and is **too variable** to serve as a fixed reference point. - POPQ requires precise, reproducible measurements, which cannot be achieved with such a vague landmark.

Q: Which of the following are the various treatment options for Twin-Twin Transfusion Syndrome (TTTS)?

All of the options. ***All of the options*** - **Laser photocoagulation**, **septostomy**, and **selective fetal reduction** are established treatment modalities for Twin-Twin Transfusion Syndrome (TTTS). - The choice of treatment depends on the **stage of TTTS**, gestational age, and specific presentation of the twins. *Laser photocoagulation* - This procedure involves using a **laser to ablate the anastomotic vessels** on the chorionic plate, which are responsible for the unequal blood flow between twins. - It is currently considered the **gold standard** for treating severe TTTS, particularly in stages II-IV, offering improved survival rates for both twins compared to other methods. *Septostomy* - **Septostomy** involves creating a small perforation in the dividing membrane between the two amniotic sacs to allow amniotic fluid to equilibrate between the sacs. - This can help decompress severe polyhydramnios in the recipient twin, but it does **not address the underlying vascular anastomoses**. - **Amnioreduction** (serial drainage of excess amniotic fluid) is a related but distinct palliative treatment option. *Selective fetal reduction* - This involves **terminating the life of one of the fetuses** in a multifetal pregnancy to improve the chances of survival for the remaining fetus. - It is typically considered in **severe, refractory cases of TTTS** where other treatments have failed or are not feasible, particularly if one twin has severe anomalies or irreversible damage.

Q: Which of the following drugs should be avoided in labouring women with bronchial asthma?

Prostaglandin F2α. ***Prostaglandin F2α*** - **Prostaglandin F2α** (e.g., **carboprost**) is a potent **bronchoconstrictor** and can exacerbate asthma, leading to severe respiratory distress in susceptible individuals. - Its use for **uterine atony** in labouring women with a history of asthma is generally contraindicated due to the risk of inducing an **asthma attack**. *Ergometrine* - **Ergometrine** is an **ergot alkaloid** used to prevent or treat **postpartum hemorrhage** by causing sustained uterine contractions. - While it can cause some adverse effects like nausea or hypertension, it is **not generally contraindicated** in asthma and does not directly cause bronchoconstriction. *Prostaglandin E1* - **Prostaglandin E1** (e.g., **misoprostol**) is used for cervical ripening and induction of labour, or for preventing postpartum hemorrhage. - It generally has **bronchodilating** properties and is therefore considered safe for use in patients with asthma. *Opioid analgesics* - **Opioid analgesics** (e.g., **pethidine**, **morphine**) are commonly used for pain relief during labour. - While they can cause respiratory depression at high doses, they do **not directly induce bronchoconstriction** and are generally safe for use in asthmatic patients when carefully monitored.

Question 1

Which of the following is INCORRECT regarding genital warts (condyloma acuminata)?

1. It is usually single.
2. It is related to HPV Types 6 and 11.
3. It can be transmitted sexually.
4. It can involve vagina and anus.

Accepted Answer

It is usually single.

Answer

It can involve vagina and anus.

Answer

It is related to HPV Types 6 and 11.

Answer

It can be transmitted sexually.

Question 2

Which of the following are the clinical features of hyperprolactinemia?

1. Hypergonadotropic hypogonadism
2. Hypogonadotropic hypergonadism
3. Oligomenorrhea
4. Heavy menstruation

Accepted Answer

3. Oligomenorrhea

Answer

2. Hypogonadotropic hypergonadism

Answer

1. Hypergonadotropic hypogonadism

Answer

4. Heavy menstruation

Question 3

Metroplasty is the surgical procedure done for which one of the following uterine anomalies?

Accepted Answer

Septate uterus

Answer

Arcuate uterus

Answer

Uterus didelphys

Answer

Imperforate hymen

Question 4

Which of the following is MOST effective as a first-line management for premenstrual syndrome?

Accepted Answer

Combined oral contraceptive pills

Answer

Hysterectomy with oophorectomy

Answer

Diuretics

Answer

Niacin (vitamin B3)

Question 5

Which of the following is the marker of ovarian reserve?

Accepted Answer

Anti-Mullerian hormone

Answer

β-hCG

Answer

Placental alkaline phosphatase

Answer

Serum estradiol

Question 6

In the PALM-COEIN classification by FIGO for abnormal uterine bleeding, ovulatory dysfunction is the cause in which one of the following conditions?

Accepted Answer

Polycystic ovarian syndrome

Answer

Pelvic inflammatory disease

Answer

Adenomyosis

Answer

Ovarian cancer

Question 7

Which of the following is INCORRECT regarding endometrial cancer?

1. Persistent progesterone stimulation is an important etiology.
2. It is more common in white population.
3. HNPCC (Hereditary Nonpolyposis Colorectal Cancer) syndrome is a high risk factor.
4. Adenocarcinoma is the commonest histopathology.

Accepted Answer

1. Persistent progesterone stimulation is an important etiology.

Answer

2. It is more common in white population.

Answer

3. HNPCC (Hereditary Nonpolyposis Colorectal Cancer) syndrome is a high risk factor.

Answer

4. Adenocarcinoma is the commonest histopathology.

Question 8

The reference point 'zero' in POPQ (Pelvic Organ Prolapse Quantification) classification is taken as

Accepted Answer

hymen

Answer

perineal body

Answer

ischial spine

Answer

mid-vagina

Question 9

Which of the following are the various treatment options for Twin-Twin Transfusion Syndrome (TTTS)?

Accepted Answer

All of the options

Answer

Laser photocoagulation

Answer

Septostomy

Answer

Selective fetal reduction

Question 10

Which of the following drugs should be avoided in labouring women with bronchial asthma?

Accepted Answer

Prostaglandin F2α

Answer

Ergometrine

Answer

Prostaglandin E1

Answer

Opioid analgesics

UPSC-CMS 2022

Dermatology

Internal Medicine

Obstetrics and Gynecology

Pharmacology