UPSC-CMS 2023 Practice Questions

Q: Which of the following set of muscles collectively form the muscle 'Levator Ani' that forms the pelvic floor ? 1. Puborectalis 2. Pubococcygeus 3. Sacrococcygeus 4. Iliococcygeus Select the correct answer using the code given below :

1, 2 and 4. ***1, 2 and 4*** - The **levator ani** muscle group is comprised of three distinct muscles: **puborectalis**, **pubococcygeus**, and **iliococcygeus** [1]. - These muscles collectively form the main component of the **pelvic floor**, supporting pelvic organs and controlling continence [1]. - The levator ani, together with the coccygeus muscle, forms the **pelvic diaphragm**. *2, 3 and 4* - This option incorrectly includes the **sacrococcygeus** muscle, which is not part of the **levator ani** group. - The **sacrococcygeus** is a small, vestigial muscle found anterior to the sacrum and coccyx, and is separate from the pelvic diaphragm. - It excludes the **puborectalis**, which is an essential component of the levator ani [1]. *1, 3 and 4* - This option incorrectly includes the **sacrococcygeus** muscle, which is not a component of the **levator ani**. - It excludes the **pubococcygeus**, a major and essential component of the **levator ani** complex, critical for maintaining pelvic floor integrity and function [1]. *1, 2 and 3* - This option incorrectly includes the **sacrococcygeus** muscle and excludes the **iliococcygeus**. - The **iliococcygeus** muscle is a distinct and recognized part of the **levator ani** alongside the puborectalis and pubococcygeus [1].

Q: Blood supply to the uterus comes from which of the following arteries ? 1. Ovarian artery 2. Vaginal artery 3. Uterine artery 4. Inferior vesical artery Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - The **uterine artery** is the primary blood supply to the uterus, originating from the internal iliac artery, and is crucial for uterine nutrition [1]. - The **ovarian artery** (a branch of the aorta) also contributes to the blood supply, forming anastomoses with the uterine artery, especially at the cornua [1]. - The **vaginal artery**, a branch of the internal iliac artery, forms anastomoses with the cervical branches of the uterine artery, providing additional blood supply to the lower uterus and cervix [1]. *2, 3 and 4* - This option incorrectly includes the **inferior vesical artery** as a direct supply to the uterus while omitting the ovarian artery, which is a significant contributor. - While the **inferior vesical artery** supplies the bladder and lower ureter, its direct anastomoses sufficient for uterine perfusion are limited. *1, 3 and 4* - This choice incorrectly includes the **inferior vesical artery** as a direct significant uterine supply and omits the **vaginal artery**, which provides relevant anastomoses to the lower uterus. - The **inferior vesical artery** primarily supplies the bladder and does not have a major, direct contribution to the main body of the uterus [2]. *1, 2 and 4* - This option incorrectly includes the **inferior vesical artery** as a primary or significant contributor while omitting the **uterine artery**, which is the main arterial supply to the uterus. - The **uterine artery** is essential for uterine function, and its absence from this selection makes the option incorrect from a physiological standpoint.

Q: NACO (National AIDS Control Organization) in India works towards which of the following causes? 1. Screening high-risk cases of HIV 2. Facilitating adoption of orphans 3. Public education towards safe sex 4. Providing antiretroviral therapy. Select the correct answer using the code given below:

1, 3 and 4. **1, 3 and 4** - **NACO** (National AIDS Control Organization) is the primary body in India responsible for formulating policy and implementing programs for **HIV/AIDS prevention and control**. - Its core functions include **screening high-risk cases** for HIV, conducting **public education campaigns** on safe sex practices to prevent transmission, and ensuring access to **antiretroviral therapy (ART)** for those infected. *2, 3 and 4* - While NACO focuses on preventing and managing HIV/AIDS, **facilitating the adoption of orphans** (Option 2) is not a direct or primary function of NACO. - NACO's mandate centers on health-related interventions, not social welfare programs like adoption. *1, 2 and 4* - This option incorrectly includes "facilitating adoption of orphans" (Option 2) as a function of NACO. - Public education (Option 3) is a crucial component of NACO's strategy that is omitted in this selection. *1, 2 and 3* - This option incorrectly includes "facilitating adoption of orphans" (Option 2) and omits "providing antiretroviral therapy" (Option 4). - Providing **ART** is a fundamental and critical service directly managed and supported by NACO.

Q: Vesicovaginal fistula is classified as complicated if it has which of the following features ? 1. Size - more than 3 cm 2. Bladder involvement - Trigonal/Juxta-urethral 3. Location - Midvaginal 4. Presence of prior radiation Select the correct answer using the code given below :

1, 2 and 4. ***1, 2 and 4*** * A vesicovaginal fistula is considered **complicated** if it has a size of **more than 3 cm**, involves the **trigone or juxta-urethral region** of the bladder, or is associated with **prior radiation therapy**. * These factors indicate a greater challenge in surgical repair and a higher risk of recurrence. * Trigonal involvement is complicated because it may involve ureteral orifices, and juxta-urethral fistulas risk urinary continence. *1, 2 and 3* * While a size of more than 3 cm and trigonal/juxta-urethral bladder involvement are criteria for a complicated fistula, a **midvaginal location** is generally not considered a complicating factor on its own. * **Low vaginal (juxta-urethral) fistulas** or those in scarred, immobile areas are more challenging, not midvaginal locations. *1, 3 and 4* * A size of more than 3 cm and prior radiation are indeed factors that classify a fistula as complicated. * However, a **midvaginal location** alone does not typically complicate the repair to the same extent as trigonal bladder involvement or a history of radiation. *2, 3 and 4* * Trigonal/juxta-urethral bladder involvement and prior radiation are definite complicating factors. * Yet, a **midvaginal location** is less of a complicating factor compared to a **large size (more than 3 cm)**, which is a major determinant of fistula complexity.

Q: Which one of the following is a prerequisite for Endometrial Ablation ?

Completed childbearing. ***Correct: Completed childbearing*** **Completed childbearing** is the key **prerequisite** for **endometrial ablation (EA)**. This is a fundamental requirement because: - **EA significantly impairs or destroys fertility** by ablating the endometrial lining essential for implantation - Pregnancy after EA is **rare and high-risk**, with increased chances of **miscarriage, ectopic pregnancy, preterm birth, and placental abnormalities** (placenta accreta, previa) - Patients must be **thoroughly counseled** that EA is intended as a permanent solution and future pregnancy is contraindicated - Most guidelines and consent protocols require documentation that the patient has completed childbearing or accepts permanent loss of fertility - While not an absolute contraindication if a patient insists, the strong recommendation is that childbearing should be complete *Incorrect: Presence of large submucous fibroids* - Large submucous fibroids are a **CONTRAINDICATION**, not a prerequisite - Fibroids distort the uterine cavity, making safe and effective ablation **difficult or impossible** - They may require **hysteroscopic myomectomy** first, or EA may not be appropriate at all - This is the opposite of a prerequisite *Incorrect: Desire to maintain fertility* - This is a strong **CONTRAINDICATION** for EA - EA destroys the endometrium needed for pregnancy - Patients desiring future fertility should pursue other treatments for abnormal uterine bleeding - This directly contradicts the purpose and effects of the procedure *Incorrect: Uterine size >16 weeks* - A uterus larger than **12 weeks' gestation** is a **relative contraindication** or limitation - Increased risk of **incomplete ablation, perforation**, and treatment failure - Large uteri often indicate underlying pathology needing alternative management - This is a contraindication, not a prerequisite

Q: Which of the following days of menstrual cycle is best for endometrial sampling to diagnose ovulation?

21st - 23rd day. ***21st - 23rd day*** - This period corresponds to the **mid-secretory phase** (~7 days post-ovulation), when **progesterone-induced secretory changes** are fully established and most reliable for histological confirmation of ovulation. - The endometrium shows **mature secretory features** including prominent subnuclear vacuoles, stromal edema, and spiral artery development, making it the **textbook recommendation** for endometrial dating. *12th - 14th day* - This represents the **late proliferative phase** or **periovulatory period**, when ovulation is occurring but secretory changes have not yet developed. - Endometrial histology would show **proliferative features** with straight tubular glands and mitotic activity, lacking the progesterone effect needed to diagnose ovulation. *16th - 20th day* - This period falls in the **early secretory phase**, showing only **initial secretory changes** that may be incomplete or unreliable for definitive diagnosis. - While some progesterone effect may be present, the changes are **not fully mature** compared to the optimal 21st-23rd day window recommended in standard gynecology texts. *8th - 10th day* - This corresponds to the **early proliferative phase**, well before ovulation occurs, when estrogen dominates and no secretory changes are present. - Endometrial sampling would show **proliferative endometrium** with no evidence of progesterone effect, making it unsuitable for diagnosing ovulation.

Q: A 27-year-old female married for 3 years regularly cohabiting with husband presents to Gynaecology OPD with complaints of inability to conceive for 2 years. During clinical evaluation hysterosalpingography was done which revealed irregular outline of uterine cavity and rigid fallopian tubes with nodulations. Most likely cause for this condition is :

Genital Tuberculosis. ***Genital Tuberculosis*** - The combination of **infertility**, an **irregular uterine cavity outline**, and **rigid fallopian tubes with nodulations** on hysterosalpingography (HSG) is highly suggestive of genital tuberculosis. - **Tuberculosis** can cause significant scarring and obstruction in the female reproductive tract, leading to these characteristic HSG findings and impaired fertility. *Syphilis* - While syphilis is a sexually transmitted infection, it typically causes **chancre formation**, **rash**, and systemic symptoms; it does not typically lead to the described HSG findings of an irregular uterine cavity or rigid, nodulated fallopian tubes. - Infertility can be a consequence of untreated syphilis (e.g., through miscarriage), but the specific morphological changes seen in the uterus and tubes are not characteristic of this infection. *Genital Herpes* - Genital herpes is caused by the herpes simplex virus and is characterized by recurrent outbreaks of **painful blisters and ulcers** in the genital area. - It does not cause structural changes to the uterus or fallopian tubes that would result in an irregular uterine outline or rigid, nodulated tubes as seen on HSG. *Gonorrhoea* - Gonorrhoea can cause **pelvic inflammatory disease (PID)**, which can lead to tubal damage and infertility; however, the typical HSG findings are often **hydrosalpinx** or extensive peritubal adhesions, rather than rigid, nodulated tubes with an irregular uterine outline. - While it can result in tubal obstruction, the specific pattern described in the question (irregular uterine outline, rigid tubes with nodulations) is more characteristic of the chronic inflammatory and fibrotic changes associated with tuberculosis.

Q: Prophylactic oophorectomy is recommended in high risk women with which of the following ? 1. Carrying BRCA1 or BRCA2 genes 2. Family history of breast, colon, ovarian cancer 3. Patients having tubo-ovarian abscess Select the correct answer using the code given below :

1 and 2 only. ***1 and 2 only*** - Prophylactic oophorectomy is strongly recommended for women carrying **BRCA1 or BRCA2 genes** due to a significantly increased lifetime risk of developing ovarian and breast cancer. - A strong **family history of breast, colon, or ovarian cancer**, especially in multiple first-degree relatives or at early ages, indicates a higher genetic predisposition that warrants consideration for prophylactic oophorectomy. *1, 2 and 3* - While carrying BRCA1/2 genes and a significant family history are indications, a **tubo-ovarian abscess (TOA)** is an infectious condition that requires antibiotic treatment and possibly surgical drainage, not a prophylactic oophorectomy for cancer risk reduction. - Prophylactic oophorectomy is performed to reduce cancer risk in genetically predisposed individuals, which is unrelated to the management of an acute infectious process like TOA. *2 and 3 only* - This option incorrectly excludes **BRCA1 or BRCA2 gene carriers**, who are among the highest-risk group for ovarian and breast cancer, making prophylactic oophorectomy a crucial primary prevention strategy. - The inclusion of **tubo-ovarian abscess** as an indication for prophylactic oophorectomy is incorrect, as TOA is an inflammatory condition, not a genetic predisposition to cancer. *1 and 3 only* - This option incorrectly includes **tubo-ovarian abscess (TOA)** as a reason for prophylactic oophorectomy; TOA is an infection requiring specific medical or surgical treatment, not risk-reducing surgery for cancer. - This option incorrectly excludes a **strong family history of breast, colon, or ovarian cancer** as a separate indication for prophylactic oophorectomy, especially when genetic testing might not have identified a specific mutation but a high familial risk remains.

Q: Which one of the following is the distinguishing feature to differentiate Gartner's cyst from Cystocele ?

Gartner's cyst is not reducible. ***Gartner's cyst is not reducible*** * **Gartner's cysts** are typically **fixed structures** within the vagina, representing remnants of the Wolffian duct, and therefore cannot be reduced or pushed back into place. * The **immobility** and non-reducibility of the cyst is a key characteristic that helps differentiate it from conditions like cystocele. * A **cystocele** is a prolapse of the bladder into the vagina, which is **reducible** (can be pushed back) and typically shows an impulse on coughing due to increased intra-abdominal pressure. *There is no impulse on coughing in cystocele* * This statement is **incorrect** as a **cystocele** typically **does show a cough impulse** due to increased intra-abdominal pressure transmitted through the prolapsed bladder. * The presence of a cough impulse is a characteristic feature of cystocele, not its absence. *Marked cough impulse in Gartner's cyst* * **Gartner's cysts** are fluid-filled sacs and do not transmit increased intra-abdominal pressure from coughing, therefore they typically **do not have a cough impulse**. * A marked cough impulse is more characteristic of a prolapsed organ, like a cystocele or rectocele, not a fixed cystic structure. *Margins are ill-defined in Gartner's cyst* * **Gartner's cysts** usually have **well-defined margins** as they are encapsulated structures. * Ill-defined margins might suggest an infiltrative process or inflammation, which is not characteristic of a simple Gartner's cyst.

Q: 'Schiller-Duval body' is a characteristic histological feature of which one of the following cancers?

Endodermal sinus tumour. ***Endodermal sinus tumour*** - **Schiller-Duval bodies** are pathognomonic histological structures found in **endodermal sinus tumours** (also known as yolk sac tumours). - These structures mimic the primitive glomerulus, consisting of a central capillary surrounded by tumour cells within a cyst-like space. *Non-gestational ovarian choriocarcinoma* - Characterized by the presence of **syncytiotrophoblast** and **cytotrophoblast** cells, often arranged in bilaminar structures [2]. - While it can produce **human chorionic gonadotropin (hCG)**, it does not typically feature Schiller-Duval bodies [2], [3]. *Dysgerminoma* - Composed of large, rounded, uniform cells with clear cytoplasm and prominent nuclei, often arranged in cords or nests separated by fibrous septa infiltrated by **lymphocytes**. - This tumour is analogous to testicular seminoma and does not contain Schiller-Duval bodies. *Sex cord stromal tumours* - A diverse group of tumours, including **granulosa cell tumours** and **Sertoli-Leydig cell tumours**, which originate from the ovarian stroma or sex cords [1]. - Histological features vary widely but generally involve granulosa cells, theca cells, Sertoli cells, or Leydig cells, and do not include Schiller-Duval bodies [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1037-1038. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, p. 982. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036.

Question 1

Which of the following set of muscles collectively form the muscle 'Levator Ani' that forms the pelvic floor ?

1. Puborectalis
2. Pubococcygeus
3. Sacrococcygeus
4. Iliococcygeus

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Question 2

Blood supply to the uterus comes from which of the following arteries ?

1. Ovarian artery
2. Vaginal artery
3. Uterine artery
4. Inferior vesical artery

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Question 3

NACO (National AIDS Control Organization) in India works towards which of the following causes?

1. Screening high-risk cases of HIV
2. Facilitating adoption of orphans
3. Public education towards safe sex
4. Providing antiretroviral therapy.

Select the correct answer using the code given below:

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 4

Vesicovaginal fistula is classified as complicated if it has which of the following features ?

1. Size - more than 3 cm

2. Bladder involvement - Trigonal/Juxta-urethral

3. Location - Midvaginal

4. Presence of prior radiation

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 5

Which one of the following is a prerequisite for Endometrial Ablation ?

Accepted Answer

Completed childbearing

Answer

Desire to maintain fertility

Answer

Uterine size >16 weeks

Answer

Presence of large submucous fibroids

Question 6

Which of the following days of menstrual cycle is best for endometrial sampling to diagnose ovulation?

Accepted Answer

21st - 23rd day

Answer

12th - 14th day

Answer

8th - 10th day

Answer

16th - 20th day

Question 7

A 27-year-old female married for 3 years regularly cohabiting with husband presents to Gynaecology OPD with complaints of inability to conceive for 2 years. During clinical evaluation hysterosalpingography was done which revealed irregular outline of uterine cavity and rigid fallopian tubes with nodulations. Most likely cause for this condition is :

Accepted Answer

Genital Tuberculosis

Answer

Syphilis

Answer

Genital Herpes

Answer

Gonorrhoea

Question 8

Prophylactic oophorectomy is recommended in high risk women with which of the following ?

1. Carrying BRCA1 or BRCA2 genes 
2. Family history of breast, colon, ovarian cancer 
3. Patients having tubo-ovarian abscess

Select the correct answer using the code given below :

Accepted Answer

1 and 2 only

Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 3 only

Question 9

Which one of the following is the distinguishing feature to differentiate Gartner's cyst from Cystocele ?

Accepted Answer

Gartner's cyst is not reducible

Answer

There is no impulse on coughing in cystocele

Answer

Marked cough impulse in Gartner's cyst

Answer

Margins are ill-defined in Gartner's cyst

Question 10

'Schiller-Duval body' is a characteristic histological feature of which one of the following cancers?

Accepted Answer

Endodermal sinus tumour

Answer

Non-gestational ovarian choriocarcinoma

Answer

Dysgerminoma

Answer

Sex cord stromal tumours

UPSC-CMS 2023

Anatomy

Community Medicine

Obstetrics and Gynecology

Pathology