UPSC-CMS 2009 Practice Questions

Q: The commonly seen depression deformity of the chest wall is known as

Pectus excavatum. ***Pectus excavatum*** - This is a common congenital chest wall deformity characterized by an **inward depression of the sternum** and costal cartilages, creating a caved-in appearance of the chest. - It is often referred to as "funnel chest" due to the characteristic depression. *Kyphosis* - **Kyphosis** is an exaggerated, forward rounding of the back, often described as a hunchback. - It refers to a spinal curvature, not a depression of the chest wall itself. *Pectus carinatum* - **Pectus carinatum** is a chest wall deformity where the sternum protrudes outward, often referred to as "pigeon chest." - This is the opposite of a depression and involves a prominent, rather than sunken, chest. *Manubriosternal junction* - This term refers to the **normal anatomical landmark** where the manubrium meets the body of the sternum, also known as the sternal angle or angle of Louis. - It is not a deformity but a standard anatomical feature of the sternum.

Q: Motility disorders of the oesophagus are best diagnosed by

Manometry. ***Manometry*** - Oesophageal manometry is the **gold standard** for diagnosing motility disorders by directly measuring the pressure activity and coordination of oesophageal muscle contractions and sphincter function [1]. - It provides **physiologic data** critical for identifying conditions like achalasia, diffuse oesophageal spasm, and ineffective oesophageal motility; high-resolution manometry specifically allows for the accurate classification of these abnormalities [1]. *Barium meal* - A barium meal provides **structural and morphological information** and can show gross motility abnormalities, but it does not quantitatively measure pressure or coordination of contractions [1]. - It is often used as a **screening tool** and can suggest motility disorders, but manometry is needed for definitive diagnosis [1]. *Endoscopy* - Endoscopy is primarily used to visualize the **mucosa** and lumen of the oesophagus, stomach, and duodenum to rule out structural abnormalities like strictures, masses, or inflammation [1, 5]. - While it can indirectly reveal some motility issues (e.g., retained food in achalasia), it does not directly assess the **functional contractile activity** of the oesophageal muscle [1]. *Radiography* - General radiography (X-rays) of the chest or abdomen is primarily used to evaluate **gross anatomical structures** or identify abnormalities like pneumomediastinum or foreign bodies [2]. - It has **limited utility** for evaluating specific oesophageal motility disorders, unlike specialized imaging with contrast (barium swallow) or functional studies (manometry) [1, 4].

Q: Consider the following statements : Systemic Inflammatory Response Syndrome is characterised by 1. Temperature either above 38°C or below 36°C. 2. Heart rate less than 80/minute. 3. Tachypnoea > 20/min. 4. Leucocyte count > 4 x 109/L. Which of the statements given above are correct ?

3, 4 and 1. ***3, 4 and 1*** - **SIRS criteria** include a temperature above 38°C or below 36°C [1], and tachypnea with a respiratory rate greater than 20 breaths/minute. - Additionally, a white blood cell count greater than 12,000 cells/mm³ (12 x 10⁹/L) or less than 4,000 cells/mm³ (4 x 10⁹/L), or the presence of more than 10% immature band forms, are part of the criteria. *1 and 3* - This option correctly identifies **temperature** [1] and **tachypnea** as SIRS criteria but omits the leukocyte count, which is also a key component. - It is an incomplete set of correct criteria, missing one crucial element. *1, 4, 3 and 2* - This option incorrectly states a heart rate **less than 80/minute** as a SIRS criterion; the correct criterion for SIRS is a heart rate **greater than 90/minute**. - While it includes other correct criteria, the inclusion of an incorrect heart rate makes this option wrong. *2, 4 and 3* - This option incorrectly states a heart rate **less than 80/minute** as a SIRS criterion. The correct criterion for SIRS is a heart rate **greater than 90/minute**. - It also misses the **temperature** criterion, which is a fundamental component of SIRS [1].

Q: Which one of the following organisms is not associated with synergistic gangrene?

Escherichia. ***Escherichia*** - ***Escherichia coli* is NOT associated with classic synergistic gangrene** (Meleney's gangrene). - While *E. coli* causes many infections (UTIs, peritonitis, wound infections), it is **not a typical organism** in the polymicrobial synergistic gangrene described by Meleney. - Synergistic gangrene specifically involves **aerobic and microaerophilic organisms** working in combination, which is not the typical pattern for *E. coli* infections. *Staphylococcus* - ***Staphylococcus aureus* is a classic component of synergistic gangrene** (Meleney's gangrene). - Typically works in synergy with **microaerophilic streptococci** to cause progressive necrotizing infection. - *S. aureus* creates conditions that allow **anaerobic and microaerophilic organisms** to proliferate. *Clostridium* - ***Clostridium* species are associated with necrotizing soft tissue infections**, particularly gas gangrene (*C. perfringens*). - While gas gangrene differs from classic Meleney's synergistic gangrene, clostridial infections can occur in **polymicrobial settings** with synergistic tissue destruction. - They produce powerful **exotoxins** (alpha toxin, collagenase) causing rapid necrosis and gas formation. *Peptostreptococcus* - ***Peptostreptococcus* species are frequently isolated from synergistic gangrene**. - These **anaerobic gram-positive cocci** are key components of polymicrobial necrotizing infections. - They create an **anaerobic environment** that promotes tissue necrosis and allows other organisms to thrive.

Q: Clinical signs and symptoms in tetanus are a result of

Exotoxins fixed to nerve endings. ***Exotoxins fixed to nerve endings*** - Tetanus symptoms are caused by **tetanospasmin**, an exotoxin produced by *Clostridium tetani*, which undergoes **retrograde axonal transport** from peripheral nerve terminals to the CNS. - The toxin **irreversibly binds** to presynaptic terminals of **inhibitory interneurons** (Renshaw cells) in the spinal cord, blocking the release of **glycine and GABA**. - This results in **unopposed excitatory impulses** to motor neurons, causing **spastic paralysis** and characteristic muscle rigidity. *Circulating exotoxins* - While tetanospasmin circulates after production at the wound site, it must **bind to nerve tissue** and reach the CNS to exert its pathogenic effects. - Systemic circulation acts as a transport mechanism; the clinical manifestations result from toxin **fixation at neural synapses**, not from circulating toxin. *Endotoxins* - **Endotoxins** are lipopolysaccharides (LPS) found in the outer membrane of gram-negative bacteria. - *Clostridium tetani* is a **gram-positive, spore-forming anaerobic bacillus** that does not produce endotoxins. - Endotoxins play no role in tetanus pathogenesis. *Both endotoxins and exotoxins* - This option is incorrect because *Clostridium tetani* does **not produce endotoxins**. - The clinical manifestations of tetanus are **exclusively due to tetanospasmin**, an exotoxin that acts by blocking inhibitory neurotransmission in the CNS.

Q: O2 (Oxygen) dissociation curve is shifted to right in the following except

Metabolic alkalosis. ***Metabolic alkalosis*** - A shift to the **right** on the oxygen dissociation curve indicates **decreased affinity** for oxygen, promoting oxygen release to tissues. - In **metabolic alkalosis**, the blood pH is elevated, which **increases hemoglobin's affinity for oxygen**, leading to a **left shift** in the curve. *Hypercapnia* - **Hypercapnia** (increased PCO2) decreases blood pH, reducing hemoglobin's affinity for oxygen via the **Bohr effect**, resulting in a **right shift**. - This facilitates oxygen release to tissues where CO2 production is high. *Rise in temperature* - An increase in **body temperature** weakens the binding of oxygen to hemoglobin, causing a **right shift** in the oxygen dissociation curve. - This is beneficial during exercise, when active tissues generate heat and require more oxygen. *Raised 2, 3 DPG level* - **2,3-bisphosphoglycerate (2,3-BPG)** binds to deoxygenated hemoglobin, stabilizing its T-state and **reducing its affinity for oxygen**, causing a **right shift**. - This is a key adaptation to chronic hypoxia, enhancing oxygen delivery to tissues.

Q: The following statements are correct about burst abdomen (abdominal dehiscence) except

Second dehiscence is very common. ***Second dehiscence is very common*** - This statement is incorrect. While **dehiscence** can recur, it is not considered "very common" after proper surgical repair and addressing risk factors. - The overall incidence of **abdominal dehiscence** ranges from 0.5% to 3%, and subsequent dehiscence, though possible, is less frequent than the initial event due to stricter prophylactic measures and more careful wound closure techniques. *Manage with nasogastric aspiration and intravenous fluids* - This is a crucial initial step for managing **burst abdomen**, as it helps to decompress the gastrointestinal tract and prevent vomiting. - **Intravenous fluids** are essential for maintaining hydration and electrolyte balance, especially if the patient is experiencing fluid loss through the exposed wound. *Cover the wound with sterile towel and perform emergency surgery* - Covering the exposed viscera with a **sterile, saline-soaked towel** is vital to prevent desiccation, infection, and further injury to the bowel. - **Emergency surgery** is necessary to debride the wound, inspect the abdominal contents, and perform a secure secondary closure of the abdominal wall layers. *Peak incidence is between 6th and 8th post operative day* - This timeframe is consistent with the typical healing progression of surgical wounds, where the tensile strength of the wound is still relatively low before collagen deposition is complete. - Factors like **infection**, **increased intra-abdominal pressure**, and poor nutritional status can contribute to wound breakdown during this critical period.

Q: A patient presents to the emergency department with pain and distension of abdomen and absolute constipation. What is the investigation of choice ?

Plain X-ray abdomen (Erect). ***Plain X-ray abdomen (Erect)*** - An erect plain X-ray of the abdomen is the initial and often diagnostic investigation for **bowel obstruction**, revealing **dilated bowel loops** and **air-fluid levels**. - It helps confirm the presence of obstruction and can sometimes indicate its location and severity, though it does not provide information about the cause. *Ultrasonography* - While ultrasound can detect **bowel dilation** and **peristalsis**, it is limited in visualizing the entire bowel and cannot reliably differentiate between various causes of obstruction. - It is more useful for assessing **extraluminal pathology** or **fluid collections** but less effective as a primary diagnostic tool for bowel obstruction. *Barium meal follow-through* - This study involves oral **barium administration** and serial X-rays to visualize the small bowel, but it is **contraindicated** in suspected bowel obstruction due to the risk of exacerbating the obstruction or causing **barium impaction**. - Its primary role is in evaluating chronic or partial obstructions, or malabsorption, not acute presentations with complete obstruction. *Colonoscopy* - **Colonoscopy** is an invasive procedure primarily used for diagnosis and treatment of **colonic pathology**, such as polyps, strictures, or bleeding. - It is **contraindicated** in acute, complete bowel obstruction due to the risk of **perforation** and is not the initial diagnostic choice for acute abdominal pain and absolute constipation.

Q: What is the investigation of choice in a patient with blunt abdominal trauma with hematuria ?

Contrast enhanced computed tomography. ***Contrast enhanced computed tomography*** - **Ureteral and renal injuries** are best evaluated using **CT with intravenous contrast**, which offers detailed anatomical information. - In cases of **blunt abdominal trauma with hematuria**, **CT with contrast** is the imaging modality of choice to assess for injuries to the urinary tract. *Ultrasonography of abdomen* - While useful in some abdominal injuries, **ultrasonography** does not provide sufficient detail for precise evaluation of the **renal parenchyma, collecting system, or ureteral integrity** in trauma. - It is often used as an initial screening tool but less effective than CT for confirming and staging urinary tract injuries. *Intravenous urogram* - An **intravenous urogram (IVU)** can identify some urinary tract injuries but is **less sensitive and specific** than modern CT scans. - It also provides **less anatomical detail** of associated soft tissue and vascular injuries compared to CT. *Retrograde urogram* - A **retrograde urogram** primarily visualizes the **lower urinary tract** (ureters and bladder) by injecting contrast directly into the ureters. - It is **invasive** and not the first-line investigation for **blunt abdominal trauma with hematuria**, especially for evaluating the kidneys themselves.

Q: Which one of the following is the treatment of choice in a child with inguinal hernia ?

Herniotomy alone. ***Herniotomy alone*** - In children, an **inguinal hernia** is typically an **indirect hernia** resulting from a persistent **patent processus vaginalis**. - **Herniotomy alone** (ligation and excision of the hernia sac) is sufficient because the posterior wall of the inguinal canal is usually strong and does not require reinforcement. *Shouldice operation* - The **Shouldice operation** is a **fascial repair** technique involving multiple layers of the posterior inguinal wall. - It is primarily used in **adults** for direct inguinal hernias or recurrent hernias, where the posterior wall is weakened. *Lichtenstein repair* - The **Lichtenstein repair** is a **tension-free mesh repair** method commonly performed in adults. - It involves placing a prosthetic mesh to reinforce the posterior wall of the inguinal canal, which is unnecessary and potentially problematic in growing children. *Bassini's repair* - **Bassini's repair** is a **tissue-based repair** that involves approximating the conjoined tendon to the inguinal ligament. - Like other adult repair techniques, it is associated with higher tension and risks of recurrence in adults due to underlying tissue weakness, and is not suitable for the physiological anatomy of a pediatric inguinal hernia.

Question 1

The commonly seen depression deformity of the chest wall is known as

Accepted Answer

Pectus excavatum

Answer

Kyphosis

Answer

Pectus carinatum

Answer

Manubriosternal junction

Question 2

Motility disorders of the oesophagus are best diagnosed by

Accepted Answer

Manometry

Answer

Barium meal

Answer

Endoscopy

Answer

Radiography

Question 3

Consider the following statements : Systemic Inflammatory Response Syndrome is characterised by

1. Temperature either above 38°C or below 36°C.

2. Heart rate less than 80/minute.

3. Tachypnoea > 20/min.

4. Leucocyte count > 4 x 109/L. Which of the statements given above are correct ?

Accepted Answer

3, 4 and 1

Answer

1 and 3

Answer

1, 4, 3 and 2

Answer

2, 4 and 3

Question 4

Which one of the following organisms is not associated with synergistic gangrene?

Accepted Answer

Escherichia

Answer

Staphylococcus

Answer

Clostridium

Answer

Peptostreptococcus

Question 5

Clinical signs and symptoms in tetanus are a result of

Accepted Answer

Exotoxins fixed to nerve endings

Answer

Circulating exotoxins

Answer

Endotoxins

Answer

Both endotoxins and exotoxins

Question 6

O2 (Oxygen) dissociation curve is shifted to right in the following except

Accepted Answer

Metabolic alkalosis

Answer

Hypercapnia

Answer

Rise in temperature

Answer

Raised 2, 3 DPG level

Question 7

The following statements are correct about burst abdomen (abdominal dehiscence) except

Accepted Answer

Second dehiscence is very common

Answer

Manage with nasogastric aspiration and intravenous fluids

Answer

Cover the wound with sterile towel and perform emergency surgery

Answer

Peak incidence is between 6th and 8th post operative day

Question 8

A patient presents to the emergency department with pain and distension of abdomen and absolute constipation. What is the investigation of choice ?

Accepted Answer

Plain X-ray abdomen (Erect)

Answer

Ultrasonography

Answer

Barium meal follow-through

Answer

Colonoscopy

Question 9

What is the investigation of choice in a patient with blunt abdominal trauma with hematuria ?

Accepted Answer

Contrast enhanced computed tomography

Answer

Ultrasonography of abdomen

Answer

Intravenous urogram

Answer

Retrograde urogram

Question 10

Which one of the following is the treatment of choice in a child with inguinal hernia ?

Accepted Answer

Herniotomy alone

Answer

Shouldice operation

Answer

Lichtenstein repair

Answer

Bassini's repair

UPSC-CMS 2009

Anatomy

Internal Medicine

Microbiology

Physiology

Surgery