UPSC-CMS 2023 Practice Questions

Q: Which of the following are blood values of Iron Deficiency Anaemia ? 1. Serum iron is less than 30 mg/100 mL 2. Total iron binding capacity is less than 400 µg/mL 3. Percentage saturation is 10% or less 4. Serum ferritin is below 30 µg/mL Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - In **iron deficiency anemia**, **serum iron** levels are typically **less than 30 µg/dL** [1] (or 30 mg/100 mL), indicating a reduced iron supply. - The **percentage saturation** of transferrin with iron falls to **10% or less** [1] because there is insufficient iron to bind to the available transferrin. - **Serum ferritin**, which reflects iron stores, is significantly **reduced, usually below 30 ng/mL** (or 30 µg/mL) [1]. *1, 2 and 4* - While options 1 and 4 are correct, option 2 stating **total iron binding capacity (TIBC) less than 400 µg/mL** is incorrect. - In iron deficiency, the body attempts to increase iron absorption by producing more transferrin, leading to an **elevated TIBC** [1] (often >400 µg/dL). *1, 2 and 3* - Although options 1 and 3 are correct for iron deficiency anemia, option 2, which states **TIBC is less than 400 µg/mL**, is false. - **TIBC is elevated** in iron deficiency, reflecting an increased capacity for iron binding due to increased transferrin. *2, 3 and 4* - While options 3 and 4 are correct, option 2, suggesting **TIBC is less than 400 µg/mL**, is inaccurate. - **TIBC** is typically **increased** in iron deficiency anemia as the body tries to maximize any available iron.

Q: Surgical treatment by 'ventrosuspension of uterus' is used for what condition ?

Pelvic organ prolapse. **Pelvic organ prolapse** * **Ventrosuspension of the uterus**, also known as uteropexy, is a surgical procedure to **reposition and fix the uterus** in its anatomical position and support the vaginal vault, aiming to correct **pelvic organ prolapse**. * This procedure involves attaching sutures from the **anterior uterine wall to the anterior abdominal wall**, either directly to the rectus fascia or other strong ligaments, to alleviate symptoms of prolapse. * *Retroversion of uterus* * **Retroversion** is a common anatomical variant where the uterus is tilted backward, and it typically **does not require surgical intervention** unless associated with severe symptoms like dyspareunia or chronic pelvic pain, which are usually managed via different approaches. * While ventrosuspension could technically reposition a retroverted uterus, it is **not the primary indication** given its generally asymptomatic nature and the availability of less invasive options. * *Vault prolapse* * **Vault prolapse** specifically refers to the descent of the vaginal cuff **after a hysterectomy**, where there is no uterus present to suspend. * Therefore, "ventrosuspension of the uterus" is **not applicable after a hysterectomy** as the uterus is absent. * *Rupture of uterus* * **Uterine rupture** is an obstetric emergency involving a **tear in the uterine wall**, usually occurring during labor, and it is a life-threatening condition for both mother and fetus. * Management involves **immediate surgical repair (laparotomy)** and delivery, not elective suspension procedures like ventrosuspension.

Q: A 29-year-old female with 3 months amenorrhoea presents to gynaecology OPD with complaints of something coming out of her vagina. On clinical evaluation she was found to have single live pregnancy with second degree uterine prolapse. Which one of the following is the best management plan for her ?

Pessary treatment. ***Pessary treatment*** - **Symptomatic uterine prolapse during pregnancy** (patient complaining of "something coming out") requires **active management**, not just reassurance. - **Pessary insertion** is the **first-line treatment** for symptomatic uterine prolapse in pregnancy, providing mechanical support and immediate symptom relief. - **Ring pessary or Hodge pessary** can be safely used to support the prolapsed uterus until natural ascension occurs in the second trimester. - Combined with **bed rest** and **knee-chest position**, pessaries effectively manage symptoms while allowing pregnancy to continue. - The pessary can typically be removed after **16-20 weeks** when the gravid uterus naturally rises out of the pelvis. *Reassurance* - While it's true that the growing uterus will naturally ascend in the second trimester (reducing the prolapse), **reassurance alone is inadequate** for a patient with **active symptoms**. - Reassurance would be appropriate for **asymptomatic** or **mild prolapse**, but this patient has second-degree prolapse with troublesome symptoms requiring intervention. - Leaving symptomatic prolapse untreated risks complications like **cervical edema, ulceration, infection**, and increased patient distress. *Cerclage operation* - **Cervical cerclage** addresses **cervical insufficiency** to prevent preterm birth, not uterine prolapse. - It does not provide mechanical support for a prolapsed uterus and is not indicated in this clinical scenario. *Cervical amputation* - **Cervical amputation (trachelectomy)** is a radical procedure for **cervical cancer** or severe cervical pathology. - It would be **contraindicated in ongoing pregnancy** and carries significant risks of pregnancy loss. - Completely inappropriate for managing uterine prolapse.

Q: Which of the following can be a complication in the baby due to post maturity of pregnancy ?

Meconium aspiration. ***Meconium aspiration*** - **Post-term pregnancies** (>42 weeks) are associated with **oligohydramnios** and **placental insufficiency**, leading to fetal distress - Fetal distress causes passage of **meconium** into amniotic fluid, which can be aspirated during gasping movements - **Meconium aspiration syndrome** is one of the **most characteristic complications** of post-maturity - This is the **most recognized** complication among the options listed *Hypoglycemia* - Post-term infants **ARE actually at risk** for hypoglycemia - Mechanism: **Placental insufficiency** leads to depleted fetal **glycogen stores** and subcutaneous fat - However, this is **less specific** to post-term pregnancy compared to meconium aspiration, as it occurs in multiple conditions - While medically correct, meconium aspiration is the more characteristic complication *Intraventricular hemorrhage* - This is primarily a complication of **prematurity**, especially in very low birth weight infants - Caused by fragility of the **germinal matrix** in preterm brains - **Not associated with post-term pregnancy** *Polycythemia* - Post-term infants **can develop polycythemia** (hematocrit >65%) - Mechanism: Chronic **placental insufficiency** → fetal hypoxia → increased **erythropoietin production** - While this is a recognized complication, **meconium aspiration** remains the **most classic and frequently tested** complication of post-maturity

Q: Intrahepatic cholestasis of pregnancy presents with which of the following features ? 1. Pruritus after 28 weeks gestation, especially in palms and soles 2. Serum bilirubin levels > 5 mg% 3. Raised levels of serum bile acids 4. Features subside within two weeks postpartum Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - **Intrahepatic cholestasis of pregnancy (ICP)** is characterized by **pruritus** without skin lesions, which typically begins in the **late second or third trimester (after 28 weeks gestation)**. The itching is often most severe on the **palms and soles**. - A hallmark of ICP is **elevated serum bile acid levels** (typically >10 μmol/L). The condition and its symptoms **subside rapidly** after delivery, usually **within 1-2 weeks postpartum**, as hormonal influences resolve. *1, 2 and 3* - This option incorrectly includes the feature of **serum bilirubin levels > 5 mg%**. While bilirubin levels can be mildly elevated in ICP, they typically remain below this threshold, and values **above 5 mg%** would suggest a more severe or alternative cause of **liver dysfunction**. - The other features (**pruritus after 28 weeks, raised serum bile acids**) are indeed characteristic of ICP. *1, 2 and 4* - This option also incorrectly includes **serum bilirubin levels > 5 mg%**, which is uncharacteristic for ICP and would warrant further investigation for other liver pathologies. - The presence of pruritus and the resolution postpartum are correct features. *2, 3 and 4* - This option incorrectly includes **serum bilirubin levels > 5 mg%** and does not include **pruritus as a primary symptom**, which is the most common presenting complaint of ICP. - While raised bile acids and postpartum resolution are correct, the absence of pruritus as a core feature and the high bilirubin level make this option incorrect.

Q: Which of the following are correct regarding 'Chhaya' contraceptive ? 1. It has potent anti-estrogenic and weak estrogenic property. 2. Failure rate is 1 - 4 per HWY (Hundred Women Years) of use. 3. It inhibits ovulation. 4. It creates asynchrony between zygote and endometrium. Select the correct answer using the code given below :

1, 2 and 4. ***1, 2 and 4*** - **Chhaya (Centchroman)** is a **non-steroidal oral contraceptive** that acts primarily through its **anti-estrogenic effects** on the endometrium, while also possessing weak estrogenic properties. - Its mechanism of action leads to **asynchrony between the zygote and endometrium**, preventing implantation, and it has a reported **failure rate of 1-4 per 100 women-years**. *1, 3 and 4* - This option incorrectly includes the statement that Chhaya **inhibits ovulation**. Chhaya is a **non-hormonal contraceptive** and does not primarily prevent ovulation; rather, it makes the uterus unreceptive to implantation. - Its main contraceptive effect is through altering the endometrium, which does not typically include an anovulatory mechanism. *2, 3 and 4* - This option is incorrect because Chhaya **does not inhibit ovulation**. This mechanism is typically associated with hormonal contraceptives, which suppress the hypothalamic-pituitary-ovarian axis. - The primary action of Chhaya is on the endometrium, making it unsuitable for implantation, not preventing the release of an egg. *1, 2 and 3* - This option is incorrect because Chhaya **does not inhibit ovulation**. While it has potent anti-estrogenic and weak estrogenic properties (1) and a failure rate of 1-4 per HWY (2), it does not act by preventing egg release (3). - Its contraceptive efficacy is mainly due to its impact on the endometrial lining and ovum transport.

Q: Which of the following are examples of LARC (Long Acting Reversible Contraceptives) ? 1. Copper-T 380A 2. Implants 3. LNG-IUS Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - **Long-acting reversible contraceptives (LARCs)** include all methods that are effective for an extended period, do not require daily attention, and are reversible. The **Copper-T 380A intra-uterine device (IUD)**, **subdermal implants**, and the **levonorgestrel-releasing intra-uterine system (LNG-IUS)** all fit this description. - These methods are highly effective due to minimal user error and provide contraception for several years, making them ideal for long-term birth control. *1 and 3 only* - This option incorrectly excludes **implants**, which are a well-established and highly effective form of LARC, offering contraception for up to three years. - While Copper-T 380A and LNG-IUS are indeed LARCs, the exclusion of implants makes this option incomplete. *1 and 2 only* - This option incorrectly excludes the **levonorgestrel-releasing intra-uterine system (LNG-IUS)**, which is an increasingly popular and effective LARC, providing contraception for up to five years. - The LNG-IUS is a hormonal LARC often used for both contraception and managing heavy menstrual bleeding. *2 and 3 only* - This option incorrectly excludes the **Copper-T 380A IUD**, which is a non-hormonal LARC. - The Copper-T 380A is one of the most widely used LARCs globally, offering highly effective contraception for up to ten years.

Q: How many times in a year does withdrawal bleeding occur in extended continuous regimens of combined oral contraceptive pills?

4. **4** - **Extended continuous regimens** of combined oral contraceptive pills typically involve taking active pills for 84 days, followed by a 7-day placebo or hormone-free interval. - This regimen results in **four withdrawal bleeds per year**, as opposed to thirteen for conventional cyclic regimens. *6* - This frequency of withdrawal bleeding would be more common with regimens that have shorter active pill cycles, such as 21 days active with 7 days off, but not with typical extended continuous use. - While some custom regimens might approach this frequency, it is not the standard for "extended continuous" which aims to reduce bleeding frequency. *3* - A frequency of three withdrawal bleeds per year would imply a longer continuous active pill phase than the typical 84 days, such as 112 days on active pills followed by a 7-day break. - While such regimens exist, they are less commonly described as the standard "extended continuous" which typically refers to the 84/7 day cycle. *5* - Five withdrawal bleeds per year is not a standard frequency for either conventional cyclic or typical extended continuous oral contraceptive regimens. - It would require an unusual cycle length for active pills and break days that does not correspond to common prescribing patterns.

Q: Clinical features of an infant with Fetal growth retardation at birth include which of the following ? 1. Physical features give 'an old man look'. 2. Baby is alert, reflexes are normal. 3. Thick fat accumulates around shoulders of baby. Select the correct answer using the code given below :

1 and 2 only. ***1 and 2 only*** - Infants with **fetal growth restriction (FGR)** often have a **wasted appearance** with sparse subcutaneous fat, giving them an "old man look" due to prominence of skin folds and bones. - Despite their small size, typically FGR infants are **neurologically intact** at birth, maintaining normal alertness and reflexes. *1, 2 and 3* - This option is incorrect because the third statement, regarding **thick fat accumulation**, is not characteristic of FGR infants. FGR involves **poor fetal growth**, leading to reduced subcutaneous fat. - **Thick fat** would suggest normal or even accelerated growth, which is contrary to the definition of fetal growth restriction. *2 and 3 only* - This option is incorrect as it includes the incorrect statement about **thick fat accumulation** (statement 3) and omits the correct finding of an "old man look" (statement 1), which is a classic presentation of FGR. - While statement 2 is correct regarding alertness and reflexes, the inclusion of statement 3 makes this option invalid. *1 and 3 only* - This option is incorrect because statement 3, describing **thick fat accumulation**, is contrary to the features of FGR, which are characterized by **poor fat reserves** and a wasted appearance. - It also omits the correct statement about the baby being alert with normal reflexes (statement 2).

Question 1

Which of the following are blood values of Iron Deficiency Anaemia ?

1. Serum iron is less than 30 mg/100 mL
2. Total iron binding capacity is less than 400 µg/mL
3. Percentage saturation is 10% or less
4. Serum ferritin is below 30 µg/mL

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 2

Surgical treatment by 'ventrosuspension of uterus' is used for what condition ?

Accepted Answer

Pelvic organ prolapse

Answer

Retroversion of uterus

Answer

Vault prolapse

Answer

Rupture of uterus

Question 3

A 29-year-old female with 3 months amenorrhoea presents to gynaecology OPD with complaints of something coming out of her vagina. On clinical evaluation she was found to have single live pregnancy with second degree uterine prolapse. Which one of the following is the best management plan for her ?

Accepted Answer

Pessary treatment

Answer

Reassurance

Answer

Cerclage operation

Answer

Cervical amputation

Question 4

During delivery of HIV infected women, which of the following are recommended ?

1. Zidovudine (ZDV) is given at the onset of labour.

2. Elective caesarean delivery reduces the risk of vertical transmission.

3. Amniotomy and oxytocin augmentation should be done.

4. Antiretroviral therapy should be given to all neonates.

Select the correct answer using the code given below :

Accepted Answer

1 and 2 only

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 5

Which of the following can be a complication in the baby due to post maturity of pregnancy ?

Accepted Answer

Meconium aspiration

Answer

Hypoglycemia

Answer

Intraventricular hemorrhage

Answer

Polycythemia

Question 6

Intrahepatic cholestasis of pregnancy presents with which of the following features ?

1. Pruritus after 28 weeks gestation, especially in palms and soles
2. Serum bilirubin levels > 5 mg%
3. Raised levels of serum bile acids
4. Features subside within two weeks postpartum

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 7

Which of the following are correct regarding 'Chhaya' contraceptive ?

1. It has potent anti-estrogenic and weak estrogenic property.

2. Failure rate is 1 - 4 per HWY (Hundred Women Years) of use.

3. It inhibits ovulation.

4. It creates asynchrony between zygote and endometrium.

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 8

Which of the following are examples of LARC (Long Acting Reversible Contraceptives) ?

1. Copper-T 380A 
2. Implants 
3. LNG-IUS

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Question 9

How many times in a year does withdrawal bleeding occur in extended continuous regimens of combined oral contraceptive pills?

Accepted Answer

4

Answer

6

Answer

3

Answer

5

Question 10

Clinical features of an infant with Fetal growth retardation at birth include which of the following ?

1. Physical features give 'an old man look'. 
2. Baby is alert, reflexes are normal. 
3. Thick fat accumulates around shoulders of baby.

Select the correct answer using the code given below :

Accepted Answer

1 and 2 only

Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

UPSC-CMS 2023

Internal Medicine

Obstetrics and Gynecology

Pediatrics