UPSC-CMS 2023 Practice Questions

Q: As per the Government of India guidelines, the daily dose of elemental iron recommended for prophylaxis during pregnancy is

100 mg/day for 100 days. ***100 mg/day for 100 days*** - As per the **Government of India guidelines**, the recommended daily dose of **elemental iron** for prophylaxis during pregnancy is 100 mg/day. - This dose is typically continued for at least **100 days** to ensure adequate iron stores and prevent iron deficiency anemia. *150 mg/day for 100 days* - This dose exceeds the **recommended daily prophylactic** amount of elemental iron specified by Indian government guidelines. - While higher doses may be used for **therapeutic treatment** of existing iron deficiency anemia, it is not the standard for prophylaxis. *200 mg/day for 100 days* - This amount is significantly higher than the standard **prophylactic recommendation** for elemental iron during pregnancy in India. - Such a high dose would typically only be prescribed for **treating severe anemia**, not for routine prevention. *50 mg/day for 100 days* - This dose is lower than the **recommended daily amount** for effective iron prophylaxis according to the Government of India guidelines. - Such a dose might be **insufficient** to maintain adequate iron levels and prevent anemia during pregnancy.

Q: The maternal serum alpha-fetoprotein concentration is elevated in the following conditions except

Foetal osteogenesis imperfecta. ***Foetal osteogenesis imperfecta*** - **Maternal serum alpha-fetoprotein (MSAFP)** levels are typically **normal** in cases of fetal osteogenesis imperfecta. - This condition involves **bone fragility and defective collagen synthesis** but does not cause exposure of fetal tissue or increased AFP production. - There is **no mechanism** for AFP leakage into maternal circulation, so MSAFP remains normal. *Foetal neural tube defect* - **Neural tube defects (NTDs)**, such as anencephaly or open spina bifida, cause direct **exposure of fetal neural tissue** to amniotic fluid. - This leads to leakage of **alpha-fetoprotein (AFP)** from the fetal bloodstream into the amniotic fluid and maternal circulation, resulting in **elevated MSAFP**. - This is the most common indication for MSAFP screening. *Multiple gestation* - In pregnancies with **multiple fetuses** (twins, triplets), the total amount of AFP produced by multiple placentas and fetuses is increased. - This naturally leads to **elevated MSAFP** levels compared to singleton pregnancy, even when all fetuses are healthy. - MSAFP values must be adjusted for number of fetuses. *Gestational trophoblastic disease* - Conditions like **complete hydatidiform mole** involve abnormal placental tissue **without a viable fetus**. - Since there is **no fetus to produce AFP**, MSAFP levels are typically **very low or undetectable**. - However, this option asks about conditions with **elevated** MSAFP, and GTD causes low levels, making it technically also an exception. - The **best answer** remains **fetal osteogenesis imperfecta** as the classic structural anomaly that does not elevate MSAFP, whereas GTD is distinguished by absence of a fetus entirely.

Q: In the quadruple test conducted as a part of screening, which is the most likely indicator of maternal-fetal placental unit?

Unconjugated estriol (uE3). ***Unconjugated estriol (uE3)*** - **Unconjugated estriol (uE3)** is the **classic marker of the intact maternal-fetal-placental unit** in the quadruple test - Its production requires coordinated function of **all three components**: - **Fetal adrenal glands** produce DHEA-S (dehydroepiandrosterone sulfate) - **Fetal liver** converts DHEA-S to 16-OH-DHEA-S - **Placenta** converts 16-OH-DHEA-S to estriol - This unique biosynthetic pathway makes **uE3 the most specific indicator** of integrated maternal-fetal-placental unit function - Low uE3 levels can indicate fetal adrenal hypoplasia, placental sulfatase deficiency, or compromised fetal well-being *Inhibin-A* - **Inhibin-A** is a glycoprotein produced primarily by the **placenta** during pregnancy and is part of the quadruple test - While it reflects placental function, it is produced **only by the placenta**, not requiring fetal organ participation - Elevated Inhibin-A is associated with increased risk of Down syndrome and adverse pregnancy outcomes - It does **not** represent the integrated maternal-fetal-placental unit as comprehensively as uE3 *PAPP-A* - **PAPP-A** (Pregnancy-Associated Plasma Protein A) is a placental protein measured in **first trimester screening** (combined test with free β-hCG and nuchal translucency) - It is **not part of the quadruple test**, which is a **second trimester** screening panel - Low PAPP-A in first trimester is associated with chromosomal abnormalities and adverse pregnancy outcomes *Acetylcholinesterase* - **Acetylcholinesterase** is measured in **amniotic fluid**, not maternal serum - It is used as a confirmatory marker for **open neural tube defects (ONTDs)** and ventral wall defects - It is **not part of the quadruple test** and does not indicate overall maternal-fetal-placental unit function - The quadruple test uses **AFP, uE3, hCG, and Inhibin-A** measured in maternal serum

Q: A fourth-gravida with three living children presents at 38 weeks of pregnancy with abdominal pain and vaginal bleeding. On examination, the uterus is tense and tender, and the foetal heart sounds are absent. What is the probable diagnosis?

Accidental haemorrhage. ***Accidental haemorrhage*** - The combination of **abdominal pain**, **vaginal bleeding**, a **tense and tender uterus**, and **absent fetal heart sounds** strongly indicates accidental hemorrhage (placental abruption). - This condition involves the premature separation of the **placenta** from the uterine wall, leading to concealed or revealed bleeding and frequently resulting in fetal demise. *Vasa praevia* - Characterized by **fetal blood vessels** crossing the cervical os, making the fetus vulnerable to hemorrhage. - While it causes **painless vaginal bleeding**, it typically does not present with a **tense and tender uterus** or immediate fetal demise unless there is membrane rupture. *Ectopic pregnancy* - Occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. - Presents with **abdominal pain** and **vaginal bleeding**, but this occurs in the **first trimester**, not at 38 weeks of pregnancy. *Placenta praevia* - Involves the placenta covering the cervical os, leading to **painless vaginal bleeding**. - Unlike accidental hemorrhage, the uterus is typically **soft and non-tender**, and fetal heart sounds are usually present.

Q: A 25-year-old woman with a history of three consecutive abortions has been investigated thoroughly to determine the cause of recurrent pregnancy loss. In the absence of a demonstrable cause, what is the chance of a viable birth in subsequent pregnancy?

60%. ***60%*** - In cases of **unexplained recurrent pregnancy loss** (3 consecutive miscarriages with no identifiable cause), approximately **60-70%** of women will achieve a successful live birth in their subsequent pregnancy with supportive care. - This favorable prognosis reflects that many recurrent losses are due to **sporadic chromosomal abnormalities** rather than persistent underlying pathology. - **Unexplained RPL** actually has a better prognosis than explained RPL, as there is no persistent pathological factor. - Supportive care including reassurance, regular monitoring, and psychological support improves outcomes. *40%* - This underestimates the success rate for unexplained recurrent pregnancy loss. - A **40%** success rate would suggest a poorer prognosis more typical of cases with **identified but untreated underlying causes** or more complex pathology. - Current evidence supports a higher success rate (60-70%) for unexplained cases. *20-30%* - This represents a significantly poor prognosis not typical for unexplained recurrent pregnancy loss. - Such low rates might be seen in cases with **severe untreated underlying conditions** such as antiphospholipid syndrome without treatment or structural uterine anomalies. - This does not reflect the natural history of unexplained RPL. *Less than 20%* - This represents an extremely poor prognosis inconsistent with unexplained recurrent pregnancy loss. - Such rates would only be expected in cases with **severe, uncorrectable pathology** or multiple comorbidities. - The question specifically states "absence of a demonstrable cause," making this option incorrect.

Q: In a woman with molar pregnancy with a uterus size of 28 weeks, the treatment of choice is

Suction evacuation. ***Suction evacuation*** - For **molar pregnancy**, especially with a large uterine size (28 weeks in this case), **suction evacuation** is the treatment of choice to remove the abnormal trophoblastic tissue. - This method is preferred due to its safety and efficacy in emptying the uterus while minimizing complications like hemorrhage or uterine perforation. *Hysteroscopy* - **Hysteroscopy** is primarily used for diagnosing and treating intrauterine pathologies such as polyps or fibroids, and for endometrial assessment. It is not the primary treatment for molar pregnancy. - It involves inserting a scope into the uterus and is not designed for the large-volume tissue removal required in a molar pregnancy of this size. *Hysterectomy* - **Hysterectomy** (surgical removal of the uterus) is generally reserved for rare cases of recurrent molar pregnancy, when the patient desires no future fertility, or in the context of invasive molar disease or choriocarcinoma. It is not the initial treatment of choice. - It is an overly aggressive approach for an initial presentation of molar pregnancy, especially if the patient wishes to preserve fertility. *Medical induction with prostaglandins* - **Medical induction** using prostaglandins is typically used for therapeutic abortion or managing missed abortions, but it is contraindicated in molar pregnancy. - Prostaglandins can lead to vigorous uterine contractions and potentially cause a rapid expulsion of molar tissue into the systemic circulation, increasing the risk of **trophoblastic embolization** and choriocarcinoma.

Q: Foetal anaemia can be detected non-invasively by Doppler ultrasonography on the basis of an increase in the

Peak systolic velocity of the middle cerebral artery. ***Peak systolic velocity of the middle cerebral artery*** - **Foetal anaemia** causes increased **cardiac output** and redistribution of blood flow to vital organs, leading to an increase in **peak systolic velocity (PSV)** in the **middle cerebral artery (MCA)**. - This increased velocity indicates **cerebral vasodilation**, a compensatory mechanism to maintain oxygen delivery to the foetal brain in situations of hypoxia due to anaemia. *SD ratio in the anterior cerebral artery* - The **SD ratio (systolic/diastolic ratio)** is more commonly used in umbilical artery flow. A higher SD ratio in cerebral arteries typically suggests increased downstream resistance, which is not characteristic of foetal anaemia. - In foetal anaemia, the cerebral arteries would typically show **decreased resistance**, leading to a lower, not higher, SD ratio. *SD ratio in the umbilical artery* - An increased **SD ratio in the umbilical artery** often indicates **placental insufficiency** or **foetal growth restriction**, not necessarily **foetal anaemia**. - While placental insufficiency can lead to foetal anaemia, the direct Doppler marker for anaemia is the MCA PSV, reflecting the foetal response to hypoxia. *Peak systolic velocity of the anterior cerebral artery* - While both anterior and middle cerebral arteries are part of the cerebral circulation, the **middle cerebral artery (MCA)** is the most widely validated and sensitive vessel for detecting changes in **foetal blood flow** due to **anaemia**. - Changes in the anterior cerebral artery's PSV are not as reliably linked to the diagnosis of foetal anaemia as those in the MCA.

Q: A pregnant mother is referred with a prolonged second stage of labour. On examination, the foetal heart sound is 120/min, and the head is at -1 station with severe moulding. What will be the most appropriate management?

Perform LSCS. ***Perform LSCS*** - The combination of **prolonged second stage of labor**, fetal head at **-1 station**, and **severe molding** strongly suggests **cephalopelvic disproportion** or **obstructed labor**. - **LSCS is the safest option** to prevent maternal complications (uterine rupture, cervical lacerations) and fetal complications (hypoxia, trauma), as the severe molding indicates prolonged compression and failed descent despite adequate time in second stage. *Start pitocin drip* - **Contraindicated** with severe molding and high station as it suggests **cephalopelvic disproportion**. - Increased contractions could lead to **uterine rupture** without achieving delivery and would worsen fetal head molding, potentially causing **fetal distress**. *Apply ventouse and deliver* - **Contraindicated** - Ventouse requires fetal head engagement (preferably **+2 station or below**), but the head is at **-1 station**. - At -1 station with severe molding, ventouse application would be **ineffective and dangerous**, with risk of scalp lacerations, **cephalohematoma**, and failed extraction. *Apply obstetric forceps and deliver* - **Contraindicated** - Forceps require fetal head to be engaged (at least **0 station**), but at **-1 station**, forceps application is **dangerous and inappropriate**. - Attempting forceps at high station risks severe **maternal trauma** (cervical lacerations, uterine rupture) and **fetal injury**, as standard obstetric guidelines prohibit forceps use above 0 station.

Q: The respective hormones responsible for the breast milk secretion and ejection are, in that order:

Prolactin and Oxytocin. ***Prolactin and Oxytocin*** - **Prolactin** is the primary hormone responsible for the **synthesis and secretion of milk** from the mammary glands. - **Oxytocin** is responsible for the **milk ejection reflex**, causing contraction of myoepithelial cells around the alveoli and ducts to release milk. *Oestrogen and Prolactin* - **Oestrogen** primarily plays a crucial role in the **development of the mammary glands** during puberty and pregnancy, but it inhibits milk secretion. - While **prolactin** is involved in milk secretion, oestrogen's role is not milk ejection. *Oxytocin and Prolactin* - This option reverses the order of the hormones' functions; **oxytocin** is for ejection, not secretion first. - **Prolactin** is for milk secretion, not ejection. *Prolactin and Oestrogen* - **Prolactin** is responsible for milk secretion. - **Oestrogen** *inhibits* milk secretion and is not involved in milk ejection.

Q: A "double bubble" sign on an antenatal ultrasound examination in a gravid woman is diagnostic of

Duodenal atresia. ***Duodenal atresia*** - The **"double bubble" sign** on antenatal ultrasound is highly characteristic of duodenal atresia, representing a dilated **stomach** and a dilated **proximal duodenum**. - This finding indicates an **obstruction distal to the pylorus**, preventing normal passage of fluid and gas. *Anencephaly* - Anencephaly is a severe birth defect where a baby is born without parts of the **brain** and **skull**, and it is characterized by the absence of the skull vault. - It is identified by the absence of the **cranial vault** and **cerebral hemispheres**, not by an abdominal "double bubble." *Meningomyelocele* - Meningomyelocele is a type of **spina bifida** where the spinal cord and meninges protrude through an opening in the back. - This condition is typically diagnosed by visualizing a **spinal defect** with a sac-like protrusion, not gastric or duodenal distension. *Hydronephrosis* - Hydronephrosis involves the **swelling of one or both kidneys** due to a buildup of urine, often caused by an obstruction in the urinary tract. - It is identified by **dilated renal pelves** and calyces on ultrasound, not the "double bubble" sign, which relates to the gastrointestinal tract.

Question 1

As per the Government of India guidelines, the daily dose of elemental iron recommended for prophylaxis during pregnancy is

Accepted Answer

100 mg/day for 100 days

Answer

150 mg/day for 100 days

Answer

200 mg/day for 100 days

Answer

50 mg/day for 100 days

Question 2

The maternal serum alpha-fetoprotein concentration is elevated in the following conditions except

Accepted Answer

Foetal osteogenesis imperfecta

Answer

Foetal neural tube defect

Answer

Multiple gestation

Answer

Gestational trophoblastic disease

Question 3

In the quadruple test conducted as a part of screening, which is the most likely indicator of maternal-fetal placental unit?

Accepted Answer

Unconjugated estriol (uE3)

Answer

PAPP-A

Answer

Inhibin-A

Answer

Acetylcholinesterase

Question 4

A fourth-gravida with three living children presents at 38 weeks of pregnancy with abdominal pain and vaginal bleeding. On examination, the uterus is tense and tender, and the foetal heart sounds are absent. What is the probable diagnosis?

Accepted Answer

Accidental haemorrhage

Answer

Vasa praevia

Answer

Ectopic pregnancy

Answer

Placenta praevia

Question 5

A 25-year-old woman with a history of three consecutive abortions has been investigated thoroughly to determine the cause of recurrent pregnancy loss. In the absence of a demonstrable cause, what is the chance of a viable birth in subsequent pregnancy?

Accepted Answer

60%

Answer

Less than 20%

Answer

40%

Answer

20-30%

Question 6

In a woman with molar pregnancy with a uterus size of 28 weeks, the treatment of choice is

Accepted Answer

Suction evacuation

Answer

Hysteroscopy

Answer

Hysterectomy

Answer

Medical induction with prostaglandins

Question 7

Foetal anaemia can be detected non-invasively by Doppler ultrasonography on the basis of an increase in the

Accepted Answer

Peak systolic velocity of the middle cerebral artery

Answer

SD ratio in the anterior cerebral artery

Answer

Peak systolic velocity of the anterior cerebral artery

Answer

SD ratio in the umbilical artery

Question 8

A pregnant mother is referred with a prolonged second stage of labour. On examination, the foetal heart sound is 120/min, and the head is at -1 station with severe moulding. What will be the most appropriate management?

Accepted Answer

Perform LSCS

Answer

Start pitocin drip

Answer

Apply ventouse and deliver

Answer

Apply obstetric forceps and deliver

Question 9

The respective hormones responsible for the breast milk secretion and ejection are, in that order:

Accepted Answer

Prolactin and Oxytocin

Answer

Oestrogen and Prolactin

Answer

Oxytocin and Prolactin

Answer

Prolactin and Oestrogen

Question 10

A "double bubble" sign on an antenatal ultrasound examination in a gravid woman is diagnostic of

Accepted Answer

Duodenal atresia

Answer

Anencephaly

Answer

Meningomyelocele

Answer

Hydronephrosis

UPSC-CMS 2023

Community Medicine

Obstetrics and Gynecology

Physiology

Radiology