UPSC-CMS 2023 Practice Questions

Q: The following are the branches of the anterior division of internal iliac artery except

Superior rectal artery. ***Superior rectal artery*** - This artery is a direct continuation of the **inferior mesenteric artery**, which is a branch of the **abdominal aorta**, not the internal iliac artery. - It supplies the **superior part of the rectum** and is not associated with the internal iliac artery's divisions. *Inferior vesical artery* - This artery typically arises from the **anterior division of the internal iliac artery** and supplies the **bladder** and male reproductive organs. - It is a correct branch of the anterior division, making it an incorrect answer to the "except" question. *Uterine artery* - The **uterine artery** is a significant branch of the **anterior division of the internal iliac artery** in females. - It supplies the **uterus**, vagina, and surrounding structures, confirming its origin from the anterior division. *Middle rectal artery* - This artery originates from the **anterior division of the internal iliac artery** and supplies the **middle portion of the rectum**. [1] - It is a recognized branch of the anterior division, so it is not the exception.

Q: The use of condoms for protection against sexually transmitted diseases qualifies as

Specific protection. ***Specific protection*** - **Specific protection** involves measures aimed at preventing particular diseases by reducing exposure to their causes or by enhancing resistance against them. - Using condoms directly acts against the transmission of **sexually transmitted infections (STIs)**, thus making it a form of specific protection. *Primordial prevention* - **Primordial prevention** focuses on addressing underlying social and economic conditions that contribute to disease risk. - It targets **root causes** before risk factors for a disease even develop in the population. *Health promotion* - **Health promotion** is a broader concept that includes educational and environmental efforts to support healthy lifestyles and reduce overall disease risk. - While condom use could be part of a health promotion campaign, the act itself is a more targeted intervention. *Secondary prevention* - **Secondary prevention** involves early detection and prompt treatment of existing health problems to prevent their progression or complications. - This would include activities like **STI screening** and starting treatment after diagnosis, not preventing initial transmission.

Q: Child survival index is the percentage of children surviving till the age of

5 years. ***5 years*** - The **child survival index** is a public health indicator that measures the proportion of children who survive to their **fifth birthday**. - This age is critical as it marks the end of the highest risk period for childhood mortality from infectious diseases and malnutrition. *15 years* - This age range would be related to **adolescent survival rates**, which are distinct from the specific focus of the child survival index. - While important for overall population health, it does not define the traditional child survival index. *1 year* - Survival up to **one year of age** is typically measured by the **infant mortality rate**, which is a separate but related indicator of child health. - The child survival index extends beyond infancy to capture early childhood health outcomes. *3 years* - While an important developmental stage, survival to **three years** is not the universally accepted cutoff for the definition of the child survival index. - The standard definition focuses on survival until the completion of the **fifth year of life**.

Q: The causative organism of Chancroid is

Haemophilus ducreyi. ***Haemophilus ducreyi*** - **Chancroid** is a sexually transmitted infection characterized by painful genital ulcers and regional lymphadenopathy, caused by the bacterium **Haemophilus ducreyi**. - This bacterium is a **Gram-negative coccobacillus** that requires specific culture media for isolation. *Chlamydia trachomatis* - **Chlamydia trachomatis** is responsible for **chlamydia**, a common STI, and can also cause **lymphogranuloma venereum (LGV)**, which presents with lymphadenopathy and sometimes genital ulcers but not typically the soft, painful ulcers seen in chancroid. - Infections with *Chlamydia trachomatis* are often **asymptomatic** or cause symptoms like urethritis, cervicitis, or proctitis. *Klebsiella granulomatis* - **Klebsiella granulomatis** (formerly *Calymmatobacterium granulomatis*) is the causative agent of **granuloma inguinale** (also known as donovanosis). - **Granuloma inguinale** presents with painless, beefy red, friable ulcerative lesions, which clinically differ from the painful ulcers of chancroid. *Psittacosis lymphogranuloma group* - This option incorrectly groups **psittacosis** (caused by *Chlamydia psittaci*) with **lymphogranuloma venereum (LGV)**, which is caused by specific serovars of *Chlamydia trachomatis*. - **Psittacosis** is primarily a pulmonary infection transmitted by birds, while **LGV** is a sexually transmitted infection distinct from chancroid.

Q: The diagnostic criteria for bacterial vaginosis include the following except

Vaginal pH 4.5**, due to the decrease in lactic acid-producing bacteria. *Presence of clue cells* - **Clue cells** are a hallmark of bacterial vaginosis, characterized by vaginal epithelial cells studded with bacteria, obscuring their borders. - Their presence is one of the **Amsel criteria** for diagnosing bacterial vaginosis. *Positive whiff test* - A **positive whiff test** involves adding a drop of 10% potassium hydroxide (KOH) to vaginal discharge, producing a strong, fishy odor. - This odor is due to the release of **amines** produced by anaerobic bacteria, and it is a key diagnostic criterion for bacterial vaginosis. *Homogenous vaginal discharge* - The discharge in bacterial vaginosis is typically described as **thin, milky white, or grayish, and homogenous**. - This characteristic appearance is one of the **Amsel criteria** and helps distinguish it from other forms of vaginitis.

Q: A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?

Trichomoniasis. ***Trichomoniasis*** - The classic presentation of **greenish, frothy vaginal discharge** coupled with **strawberry cervix (multiple punctate spots)** is highly characteristic of trichomoniasis, caused by the parasite *Trichomonas vaginalis*. - This infection often causes **vaginal itching, irritation**, and dyspareunia. *Chlamydia infection* - Chlamydia often presents with **mucopurulent cervical discharge** and can be **asymptomatic**, but typically does not cause frothy, green discharge or strawberry cervix. - It is more commonly associated with symptoms like **dysuria** or **post-coital bleeding** when symptomatic. *Gonococcal vaginitis* - Gonorrhea typically causes **purulent discharge** that may be yellowish or greenish, but it is not typically frothy. - It is also associated with **dysuria** and pelvic pain, but the strawberry cervix is not a common finding. *Candidiasis* - Candidiasis (yeast infection) typically presents with a **thick, white, curd-like vaginal discharge**, often described as cottage cheese-like. - It is associated with **intense vulvovaginal itching and burning**, but not a frothy discharge or strawberry cervix.

Q: A 60-year-old woman presents with postmenopausal bleeding per vaginum. Both per vaginum and per speculum examination reveal no abnormality, and the Pap smear is normal. What will be the most appropriate management?

Measure endometrial thickness with ultrasound. ***Measure endometrial thickness with ultrasound*** - **Postmenopausal bleeding (PMB)** is a significant symptom that requires thorough evaluation to rule out **endometrial hyperplasia** or **carcinoma**, even with normal clinical exams and Pap smear. - Measuring **endometrial thickness with transvaginal ultrasound (TVS)** is the **first-line investigation** for PMB to assess for abnormalities. - **Endometrial thickness >4-5mm** warrants further evaluation with **endometrial biopsy** to rule out malignancy. - This is a non-invasive, cost-effective screening tool with high sensitivity for detecting endometrial pathology. *Keep her under observation* - This approach is inappropriate for PMB, as **10-15% of cases** can indicate underlying serious pathology like **endometrial cancer**. - **Prompt investigation** is necessary to ensure timely diagnosis and treatment. - Observation without investigation can lead to dangerous delays in cancer diagnosis. *Administer haemostatics* - Administering haemostatics addresses the symptom (bleeding) but does not identify or treat the underlying cause, which could be malignant. - This would delay crucial diagnostic evaluation and potentially worsen the prognosis if a **malignant condition** is present. - **PMB always requires investigation**, not symptomatic treatment alone. *Hysterectomy* - Hysterectomy is an invasive surgical procedure and is considered a definitive treatment, not a diagnostic step in this initial presentation. - It would only be contemplated after a definitive diagnosis of a serious condition, such as **endometrial cancer**, is made via less invasive means (e.g., endometrial biopsy). - Diagnostic workup should proceed stepwise: **TVS → endometrial biopsy → treatment decision**.

Q: Hormonal contraceptives are contraindicated in women

who have thromboembolic disorders. **who have thromboembolic disorders** - **Estrogen** components of hormonal contraceptives increase the risk of **venous thromboembolism** (VTE), including deep vein thrombosis and pulmonary embolism, especially in women with pre-existing clotting disorders or risk factors. - This increased risk is a major contraindication due to the potential for serious, life-threatening complications. *less than 25 years of age* - Age itself is not a contraindication for hormonal contraceptive use; many young women use them safely and effectively. - The **risk of VTE** from hormonal contraceptives is generally lower in younger women compared to older women, especially those over 35 years old and who smoke. *who are normotensive* - **Normotension** is a normal blood pressure reading, which is not a contraindication for hormonal contraceptive use. - In fact, women with well-controlled hypertension may use some hormonal contraceptives, although close monitoring is often required. *who have anaemia* - **Anemia** is not a contraindication to hormonal contraceptive use and, in some cases, can even be improved by them. - Hormonal contraceptives can reduce menstrual blood loss, thereby potentially improving or preventing **iron-deficiency anemia**.

Q: The absence of fructose in the seminal fluid indicates a defect of

Seminal vesicles. ***Seminal vesicles*** - The **seminal vesicles** are responsible for producing and secreting a significant portion of the seminal fluid, including **fructose**. - **Fructose** serves as the primary **energy source** for sperm motility; its absence indicates a defect in these glands. *Leydig cells* - **Leydig cells** are located in the testes and primarily produce **testosterone**, which is crucial for male sexual development and spermatogenesis. - While important for sperm production indirectly, they do not directly contribute to the **fructose content** of seminal fluid. *Hypothalamic-pituitary axis* - The **hypothalamic-pituitary axis** regulates testicular function by releasing hormones like **GnRH**, **LH**, and **FSH**, which control testosterone production and spermatogenesis. - A defect here would primarily affect hormone levels and sperm production, not directly the **fructose secretion** from seminal vesicles. *Testicular tubular epithelium* - The **testicular tubular epithelium** (Sertoli cells and germ cells) is involved in **spermatogenesis**, the process of sperm formation. - While essential for producing mature sperm, it does not contribute to the production or secretion of **fructose** into the seminal fluid.

Q: The genetic inheritance of Haemophilia is

Sex-linked recessive. ***Sex-linked recessive*** - Hemophilia, specifically hemophilia A and B, is inherited in an **X-linked recessive** pattern. - Males, having only one X chromosome, are predominantly affected, as a single copy of the mutated gene on the X chromosome leads to the condition. *Autosomal recessive* - Autosomal recessive disorders require **two copies** of the mutated gene (one from each parent) to manifest, and affect males and females equally. - This inheritance pattern does not explain the male predominance and carrier status in females seen in hemophilia. *Autosomal dominant* - Autosomal dominant disorders require only **one copy** of the mutated gene to cause the disease, and also affect males and females equally. - This pattern would mean an affected parent has a 50% chance of passing the condition to each child, which is not characteristic of hemophilia. *Sex-linked dominant* - Sex-linked dominant disorders would affect both males and females, with affected fathers passing the trait to **all their daughters** but none of their sons. - This pattern is not consistent with the inheritance of hemophilia, where affected mothers can pass it to their sons.

Question 1

The following are the branches of the anterior division of internal iliac artery except

Accepted Answer

Superior rectal artery

Answer

Inferior vesical artery

Answer

Uterine artery

Answer

Middle rectal artery

Question 2

The use of condoms for protection against sexually transmitted diseases qualifies as

Accepted Answer

Specific protection

Answer

Primordial prevention

Answer

Health promotion

Answer

Secondary prevention

Question 3

Child survival index is the percentage of children surviving till the age of

Accepted Answer

5 years

Answer

15 years

Answer

1 year

Answer

3 years

Question 4

The causative organism of Chancroid is

Accepted Answer

Haemophilus ducreyi

Answer

Chlamydia trachomatis

Answer

Klebsiella granulomatis

Answer

Psittacosis lymphogranuloma group

Question 5

The diagnostic criteria for bacterial vaginosis include the following except

Accepted Answer

Vaginal pH < 4.5

Answer

Presence of clue cells

Answer

Positive whiff test

Answer

Homogenous vaginal discharge

Question 6

A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?

Accepted Answer

Trichomoniasis

Answer

Chlamydia infection

Answer

Gonococcal vaginitis

Answer

Candidiasis

Question 7

A 60-year-old woman presents with postmenopausal bleeding per vaginum. Both per vaginum and per speculum examination reveal no abnormality, and the Pap smear is normal. What will be the most appropriate management?

Accepted Answer

Measure endometrial thickness with ultrasound

Answer

Keep her under observation

Answer

Administer haemostatics

Answer

Hysterectomy

Question 8

Hormonal contraceptives are contraindicated in women

Accepted Answer

who have thromboembolic disorders

Answer

less than 25 years of age

Answer

who are normotensive

Answer

who have anaemia

Question 9

The absence of fructose in the seminal fluid indicates a defect of

Accepted Answer

Seminal vesicles

Answer

Leydig cells

Answer

Hypothalamic-pituitary axis

Answer

Testicular tubular epithelium

Question 10

The genetic inheritance of Haemophilia is

Accepted Answer

Sex-linked recessive

Answer

Autosomal recessive

Answer

Autosomal dominant

Answer

Sex-linked dominant

UPSC-CMS 2023

Anatomy

Community Medicine

Microbiology

Obstetrics and Gynecology

Physiology