UPSC-CMS 2024 Practice Questions

Q: Injectable medroxyprogesterone IP 150 mg/mL contraceptive injection is available in Family Health Programme of the Government of India under the name

Antara. ***Antara*** - **Antara** is the brand name under which the **injectable contraceptive medroxyprogesterone acetate (DMPA)**, 150 mg/mL, is available in the Family Health Programme of the Government of India. - It is a **long-acting reversible contraceptive (LARC)** providing contraception for three months with a single injection. *Saheli* - **Saheli** is the brand name for **Centchroman (Ormeloxifene)**, a non-steroidal oral contraceptive pill used once a week in India. - It is **not an injectable contraceptive** and has a different mechanism of action than medroxyprogesterone. *Sahiba* - **Sahiba** is not a recognized brand name for a contraceptive product available within the Indian Government's Family Health Programme. - This option is a **distractor** and does not correspond to any known contraceptive. *Sayana Press* - **Sayana Press** is a brand name for **depot medroxyprogesterone acetate (DMPA) subcutaneous injection**, often used in self-administration programs in some countries. - While it contains MPA, the specific program and formulation mentioned in the question (150 mg/mL intramuscular) under the Indian Government's FHP is represented by **Antara**.

Q: As per the Open Vial Policy, partially used multidose vials of which of the following vaccines can be used over more than one immunization session? 1. BCG vaccine 2. DPT vaccine 3. Hepatitis B vaccine 4. Measles vaccine Select the correct answer using the code given below.

2 and 3 only. **2 and 3 only** - The **Open Vial Policy (OVP)** allows for the continued use of partially used **DPT (Diphtheria, Pertussis, Tetanus)** and **Hepatitis B vaccines** in multidose vials over multiple immunization sessions. - This policy is based on the vaccine's stability, **preservative content**, and the low risk of contamination when handled correctly. *1, 2 and 4* - This option incorrectly includes the **BCG vaccine** and **Measles vaccine**. - **BCG** and **Measles vaccines** are **live attenuated vaccines** that come in single-dose vials or require specific handling for same-day use once reconstituted, and are **not covered by the OVP** for use over multiple sessions. *1, 3 and 4* - This option incorrectly includes the **BCG vaccine** and **Measles vaccine** which are **not eligible** for extended use under the OVP. - Both BCG and Measles vaccines are **sensitive to heat and light** and easily contaminated once reconstituted. *1 and 2 only* - This option incorrectly includes the **BCG vaccine** and excludes the **Hepatitis B vaccine**. - As previously stated, **BCG vaccine is excluded** from the OVP, while **Hepatitis B vaccine** is explicitly included due to its inactivated nature and preservative content.

Q: The statement, "Health is a dynamic equilibrium between man and environment and disease a maladjustment of the human organism to environment" explains which one of the following concepts of health?

Ecological. ***Ecological*** - This concept views health as a **dynamic balance** between the individual and their physical, social, and cultural **environment**. - Disease is understood as an **imbalance or maladjustment** to these environmental factors. *Holistic* - The holistic concept emphasizes the interconnectedness of all aspects of an individual—**physical, mental, spiritual, and social**—rather than focusing on environmental interactions. - It suggests that health is achieved when there is harmony within these interconnected aspects. *Psychosocial* - This concept specifically highlights the influence of **psychological (thoughts, emotions)** and **social (family, community)** factors on health and disease. - While environment is a component, it doesn't primarily define health as an equilibrium with the broader environment. *Biomedical* - The biomedical concept defines health as the **absence of disease** and focuses on the **pathophysiological mechanisms** of illness. - It primarily views disease as a deviation from normal biological functioning, without significant emphasis on environmental equilibrium.

Q: The table given below shows three broad components under which the objectives of the National Health Policy, 2017 can be grouped, along with examples of goals/objectives under each component. How many of the pairs shown in the table are correctly matched? Select the correct answer using the code given below.

Only one of the pairs. ***Only one of the pairs*** - According to the **National Health Policy 2017**, only **Pair 1** is correctly matched. - Pair 1 correctly matches 'Health status and programme impact' with the objective of **increasing life expectancy at birth from 67.5 to 70 years by 2025**. - This objective directly reflects an improvement in the overall health status of the population and is a stated goal in NHP 2017. *Only two of the pairs* - This option is incorrect because only one pair is accurately matched according to the National Health Policy 2017. - While Pair 2 mentions an immunization target, the specific pairing of component and objective may not align with NHP 2017's classification. *All of the pairs* - This option is incorrect because not all pairs shown in the table are correctly matched with their respective broad components as per the **National Health Policy 2017**. - Only the first pair accurately reflects the policy's stated objectives for that particular broad component. *None of the pairs* - This option is incorrect because **Pair 1 is correctly matched**. - The goal to increase life expectancy from 67.5 to 70 years by 2025 is a direct indicator of improved health status and is accurately categorized under 'Health status and programme impact' in NHP 2017.

Q: Which of the following are indications of cold knife conization? 1. Inconsistent findings between colposcopy, cytology and directed biopsy 2. Persistent CIN-1 lesion in women willing for future fertility 3. Carcinoma in situ 4. Unsatisfactory colposcopic finding where the entire margin of lesion is not visible Select the correct answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - **Inconsistent findings** between colposcopy, cytology, and directed biopsy necessitate a conization to obtain a more definitive diagnosis and rule out higher-grade lesions or early invasion. - **Carcinoma in situ (CIS)**, also known as CIN 3, requires excisional treatment such as cold knife conization to remove the entire lesion and provide a complete pathological assessment of the margins, which is crucial for determining further management. - An **unsatisfactory colposcopic finding**, particularly when the entire transformation zone and thus the margins of the lesion are not visible, indicates that the full extent of the abnormality cannot be adequately assessed. Cold knife conization allows for removal of the entire endocervical canal for comprehensive evaluation. *2, 3 and 4* - This option is incorrect because **persistent CIN-1 lesions**, especially in women desiring future fertility, are often managed with observation and repeat cytology/colposcopy rather than excisional biopsy, due to the high rate of spontaneous regression and the potential for conization to affect cervical competence. *1, 2 and 3* - This option is incorrect as it includes **persistent CIN-1 lesions** as an indication for cold knife conization, which is generally not the primary management strategy due to the typically benign course of CIN-1. *1, 2 and 4* - This option is incorrect because **persistent CIN-1 lesions** are not a standard indication for cold knife conization, particularly when future fertility is a concern.

Q: Which of the following are factors for poor outcome following tuboplasty? 1. Dense pelvic adhesions 2. Length of reconstructed tube less than 4 cm 3. Bilateral hydrosalpinx 4. Reversal after 5 years of sterilization procedure Select the correct answer using the code given below.

1, 2 and 3. ***1, 2 and 3*** - **Dense pelvic adhesions** impair tubal motility and increase the risk of ectopic pregnancy, leading to poor outcomes after tuboplasty. - A **reconstructed tube length less than 4 cm** significantly reduces the available surface area for fertilization and embryo transport, negatively impacting fertility success rates. - **Bilateral hydrosalpinx** indicates severe tubal damage with impaired ciliary function and potentially toxic fluid accumulation, which drastically reduces the chances of successful pregnancy even after surgical repair. *1, 2 and 4* - This option incorrectly includes "Reversal after 5 years of sterilization procedure" while omitting bilateral hydrosalpinx, which is a more significant poor prognostic factor. - While duration since sterilization can influence outcomes, anatomical factors like hydrosalpinx are more critical predictors of tuboplasty failure. *2, 3 and 4* - This option incorrectly omits "Dense pelvic adhesions," which is one of the most important poor prognostic factors in tuboplasty. - Severe pelvic adhesions directly compromise tubal function and significantly increase ectopic pregnancy risk. *1, 3 and 4* - This option incorrectly omits "Length of reconstructed tube less than 4 cm," which is a critical anatomical factor directly influencing tuboplasty success. - Adequate tubal length is essential for proper gamete transport and fertilization; tubes shorter than 4 cm have significantly reduced success rates.

Q: Which of the following conditions are indications of removal of intrauterine device? 1. Persistent irregular uterine bleeding 2. Perforation of uterus 3. Pyelonephritis 4. Pregnancy with device in situ Select the correct answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** - **Persistent irregular uterine bleeding** that does not respond to medical management is an indication for IUD removal according to WHO guidelines and standard clinical practice. After ruling out other causes and attempting conservative management, persistent problematic bleeding warrants removal. - **Uterine perforation** by an IUD is a serious complication requiring immediate removal to prevent further injury, infection, migration of the device, or damage to adjacent organs. - **Pregnancy with an IUD in situ** increases the risk of complications including septic abortion, miscarriage, preterm birth, and chorioamnionitis. If the IUD strings are visible, removal is recommended (preferably in the first trimester). *1 and 2* - While these are both valid indications, this option is incomplete as it omits pregnancy with IUD in situ, which is also a strong indication for removal. *2 and 4* - Both uterine perforation and pregnancy with IUD are indications for removal, but this option incorrectly excludes persistent irregular uterine bleeding, which is also an indication when unresponsive to treatment. *1, 2 and 3* - **Pyelonephritis** (kidney infection) is not an indication for IUD removal as it is a urinary tract infection unrelated to IUD use. The IUD does not cause or complicate pyelonephritis, and treatment involves appropriate antibiotics without device removal.

Q: Ulipristal acetate (progesterone receptor modulator) should not be prescribed as emergency contraceptive in women with

liver dysfunction. ***Correct: liver dysfunction*** - **Ulipristal acetate** is extensively metabolized in the **liver** by the CYP450 enzyme system, predominantly CYP3A4. - In individuals with **severe hepatic impairment**, the metabolism of ulipristal acetate can be impaired, leading to increased plasma concentrations and potential adverse effects. - **Severe liver dysfunction** is a documented contraindication in product labeling. *Incorrect: glaucoma* - There is **no known contraindication** for ulipristal acetate use in individuals with **glaucoma**. - Its mechanism of action primarily involves progesterone receptors and does not directly impact intraocular pressure. *Incorrect: coagulopathy* - Ulipristal acetate does **not significantly affect blood coagulation** parameters or platelet function. - It is not contraindicated in individuals with **coagulopathy**, unlike some estrogen-containing contraceptives. *Incorrect: kidney failure* - While urinary excretion of ulipristal acetate metabolites occurs, the **primary elimination pathway is fecal** (approximately 90%). - **Kidney failure** is not considered a contraindication, and dose adjustments are generally not required.

Q: Which of the following are major complications of oral pills? 1. Cholestasis jaundice 2. Chloasma and acne 3. Venous thromboembolism 4. Breast cancer Select the correct answer using the code given below.

1, 2 and 3. ***1, 2 and 3*** - **Cholestasis jaundice** is a rare but serious hepatic complication of oral contraceptive pills (OCPs), caused by the estrogen component leading to impaired bile flow. - **Venous thromboembolism (VTE)** is one of the most serious and well-documented major complications of OCPs, with increased risk particularly in the first year of use and with higher estrogen doses. - **Chloasma and acne** are common dermatological side effects of OCPs. While technically not "life-threatening major complications," they are clinically significant adverse effects that affect quality of life and compliance. Some classifications include these as "major" due to their frequency and impact on continuation. - Note: The distinction between "major complications" and "common side effects" can vary by source. This answer reflects the inclusive interpretation. *1, 3 and 4* - This option includes **breast cancer** as a major complication. Current evidence shows a small increased risk during active use that diminishes after discontinuation. However, the relationship is complex and not consistently classified as a "major complication" in standard teaching. - It excludes **chloasma and acne**, which are very common adverse effects frequently listed among OCP-related problems. *1, 2 and 4* - This option includes **breast cancer**, which has nuanced and often conflicting evidence regarding its association with OCPs. - It excludes **venous thromboembolism**, which is indisputably the most serious life-threatening complication of oral contraceptive use and must be included in any list of major complications. *2, 3 and 4* - This option excludes **cholestasis jaundice**, which is a recognized serious hepatic complication of OCPs. - It incorrectly includes **breast cancer** as a major complication while omitting cholestatic jaundice, which is more consistently classified as a complication in pharmacology texts.

Q: A 25-year-old newly married female on liver enzyme inducers is requesting contraceptive advice in family planning clinic. Which of the following would be the most reliable method of contraception for her?

Depo-Provera injection. ***Depo-Provera injection*** - Among the listed options, **Depo-Provera** (medroxyprogesterone acetate depot injection) is considered the most reliable for women on enzyme-inducing drugs - While **enzyme inducers do affect progestin-only injectables**, the effect is **less pronounced** than with combined oral contraceptives due to the **high dose and depot formulation** - Provides **long-acting contraception** (3 months) that is **not user-dependent**, eliminating issues with daily compliance - **Note:** Current guidelines suggest considering **shortened dosing intervals** (10-11 weeks instead of 12) or preferably **copper IUD** (non-hormonal, unaffected by drug interactions) as first-line, but among these options, this is most reliable *Combined oral contraceptive pill* - **Combined OCPs** contain both estrogen and progestin, which undergo **extensive hepatic metabolism** - **Enzyme-inducing drugs** (rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's wort) significantly **increase metabolism**, reducing plasma levels by up to **50%** - This leads to **contraceptive failure** and unintended pregnancy - **Least suitable option** for this patient *Diaphragm* - A **barrier method** that is **unaffected by drug interactions** - However, has a **higher typical-use failure rate** (12% per year) compared to highly effective methods - Requires **proper fitting, insertion technique, and use with spermicide** - **User-dependent** effectiveness makes it less reliable than long-acting methods *Male condom* - **Barrier method** with **no drug interaction concerns** - **Typical-use failure rate** of approximately **13% per year** due to inconsistent or incorrect use - Effectiveness is **highly user-dependent** - Less reliable than long-acting hormonal methods for pregnancy prevention

Question 1

Injectable medroxyprogesterone IP 150 mg/mL contraceptive injection is available in Family Health Programme of the Government of India under the name

Accepted Answer

Antara

Answer

Saheli

Answer

Sahiba

Answer

Sayana Press

Question 2

As per the Open Vial Policy, partially used multidose vials of which of the following vaccines can be used over more than one immunization session?

1. BCG vaccine
2. DPT vaccine
3. Hepatitis B vaccine
4. Measles vaccine

Select the correct answer using the code given below.

Accepted Answer

2 and 3 only

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

1 and 2 only

Question 3

The statement, "Health is a dynamic equilibrium between man and environment and disease a maladjustment of the human organism to environment" explains which one of the following concepts of health?

Accepted Answer

Ecological

Answer

Holistic

Answer

Psychosocial

Answer

Biomedical

Question 4

The table given below shows three broad components under which the objectives of the National Health Policy, 2017 can be grouped, along with examples of goals/objectives under each component.

How many of the pairs shown in the table are correctly matched?

Select the correct answer using the code given below.

Accepted Answer

Only one of the pairs

Answer

Only two of the pairs

Answer

All of the pairs

Answer

None of the pairs

Question 5

Which of the following are indications of cold knife conization?

1. Inconsistent findings between colposcopy, cytology and directed biopsy
2. Persistent CIN-1 lesion in women willing for future fertility
3. Carcinoma in situ
4. Unsatisfactory colposcopic finding where the entire margin of lesion is not visible

Select the correct answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 6

Which of the following are factors for poor outcome following tuboplasty?

1. Dense pelvic adhesions
2. Length of reconstructed tube less than 4 cm
3. Bilateral hydrosalpinx
4. Reversal after 5 years of sterilization procedure

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 7

Which of the following conditions are indications of removal of intrauterine device?

1. Persistent irregular uterine bleeding
2. Perforation of uterus
3. Pyelonephritis
4. Pregnancy with device in situ

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1 and 2

Answer

2 and 4

Answer

1, 2 and 3

Question 8

Ulipristal acetate (progesterone receptor modulator) should not be prescribed as emergency contraceptive in women with

Accepted Answer

liver dysfunction

Answer

glaucoma

Answer

coagulopathy

Answer

kidney failure

Question 9

Which of the following are major complications of oral pills?

1. Cholestasis jaundice
2. Chloasma and acne
3. Venous thromboembolism
4. Breast cancer

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 10

A 25-year-old newly married female on liver enzyme inducers is requesting contraceptive advice in family planning clinic. Which of the following would be the most reliable method of contraception for her?

Accepted Answer

Depo-Provera injection

Answer

Diaphragm

Answer

Male condom

Answer

Combined oral contraceptive pill

UPSC-CMS 2024

Community Medicine

Obstetrics and Gynecology

Pharmacology