Anatomy
1 questionsThe pancreas is supplied by all of the following arteries except
UPSC-CMS 2012 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 11: The pancreas is supplied by all of the following arteries except
- A. Splenic
- B. Common hepatic
- C. Left gastric (Correct Answer)
- D. Superior mesenteric
Explanation: ***Left gastric*** - The **left gastric artery** primarily supplies the lesser curvature of the stomach and the abdominal esophagus. - It does not directly supply the pancreas; pancreatic blood supply originates from branches of the splenic, common hepatic, and superior mesenteric arteries. *Splenic* - The **splenic artery** gives rise to multiple branches that supply the pancreas, including the great pancreatic artery, dorsal pancreatic artery, and caudal pancreatic arteries. - These branches are crucial for the blood supply to the body and tail of the pancreas. *Common hepatic* - The **common hepatic artery** gives rise to the gastroduodenal artery, which further branches into the anterior and posterior superior pancreaticoduodenal arteries. - These arteries supply the head of the pancreas and the duodenum. *Superior mesenteric* - The **superior mesenteric artery** gives rise to the inferior pancreaticoduodenal arteries (anterior and posterior branches). - These arteries anastomose with the superior pancreaticoduodenal arteries to supply the head of the pancreas and the uncinate process.
Internal Medicine
1 questionsThe Ranson prognostic criteria used at the time of admission in acute pancreatitis include all of the following except
UPSC-CMS 2012 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 11: The Ranson prognostic criteria used at the time of admission in acute pancreatitis include all of the following except
- A. Blood glucose more than 200 mg/100 mL
- B. WBC count more than 16,000/mm3
- C. Serum calcium < 2.0 mmol/L (Correct Answer)
- D. Age more than 55 years
Explanation: ***Serum calcium < 2.0 mmol/L*** - This option refers to a low serum calcium level, which is part of the **Ranson criteria measured 48 hours after admission**, not at admission. - The initial Ranson criteria (on admission) focus on demographic and immediate lab results. *Blood glucose more than 200 mg/100 mL* - An elevated **blood glucose > 200 mg/100 mL** is one of the five Ranson criteria assessed at the time of admission. - High glucose indicates significant physiological stress and typically a more severe illness. *WBC count more than 16,000/mm3* - An elevated **white blood cell count > 16,000/mm3** is one of the Ranson criteria assessed at admission. - This indicates a significant inflammatory response, suggesting severe pancreatitis. *Age more than 55 years* - **Age > 55 years** is one of the Ranson criteria assessed at the time of admission [1]. - Older age is a recognized risk factor for more severe outcomes in acute pancreatitis [1].
Microbiology
1 questionsAll of the following organisms are involved in post-splenectomy sepsis except
UPSC-CMS 2012 - Microbiology UPSC-CMS Practice Questions and MCQs
Question 11: All of the following organisms are involved in post-splenectomy sepsis except
- A. Staphylococcus aureus (Correct Answer)
- B. Neisseria meningitidis
- C. Haemophilus influenzae
- D. Streptococcus pneumoniae
Explanation: ***Staphylococcus aureus*** - While *Staphylococcus aureus* can cause various infections, it is **not typically considered a primary encapsulated organism** for which the spleen's filtering function is critical, and therefore, it is **less commonly implicated in overwhelming post-splenectomy infection (OPSI)** compared to encapsulated bacteria. - The risk of OPSI is significantly higher with **encapsulated bacteria** due to the spleen's role in clearing these pathogens. *Neisseria meningitidis* - *Neisseria meningitidis* is an **encapsulated bacterium** and a well-known cause of **meningitis and sepsis**, particularly in individuals with **asplenia**. - The **spleen plays a crucial role in filtering encapsulated organisms** from the bloodstream, making asplenic individuals highly susceptible. *Haemophilus influenzae* - **Encapsulated strains** of *Haemophilus influenzae* (especially type b) are a significant cause of invasive infections in asplenic patients, including **meningitis and epiglottitis**. - The **lack of splenic immune function** impairs the body's ability to clear these bacteria. *Streptococcus pneumoniae* - *Streptococcus pneumoniae* is the **most common cause of OPSI** (overwhelming post-splenectomy infection) due to its **polysaccharide capsule**. - The spleen is essential for **opsonization and phagocytosis** of encapsulated bacteria, a function lost post-splenectomy.
Pathology
1 questionsWhich of the following breast cancers is most often bilateral ?
UPSC-CMS 2012 - Pathology UPSC-CMS Practice Questions and MCQs
Question 11: Which of the following breast cancers is most often bilateral ?
- A. Lobular carcinoma of the breast (Correct Answer)
- B. Medullary carcinoma of the breast
- C. Ductal carcinoma of the breast
- D. Colloid carcinoma of the breast
Explanation: ***Lobular carcinoma of the breast*** - **Invasive lobular carcinoma (ILC)** is the breast cancer subtype most frequently associated with **bilateral disease**, occurring in 5% to 28% of cases. [1] - This higher rate of bilaterality is partly due to the diffuse growth pattern of lobular carcinoma, which can make it more challenging to detect and may lead to synchronous or metachronous involvement of both breasts. [1] *Medullary carcinoma of the breast* - **Medullary carcinoma** is a rare and often well-circumscribed type of breast cancer that typically presents as a solitary mass and is not characteristically bilateral. [1] - It has a generally better prognosis than other invasive ductal carcinomas and is often associated with a BRCA1 mutation. [1] *Ductal carcinoma of the breast* - **Invasive ductal carcinoma (IDC)**, also known as no special type (NST), is the most common form of breast cancer, but it is less frequently bilateral than lobular carcinoma. [1] - While bilateral IDC can occur, it is a less defining characteristic compared to ILC. *Colloid carcinoma of the breast* - **Colloid (mucinous) carcinoma** is a distinct and relatively rare subtype of invasive ductal carcinoma, characterized by tumor cells floating in pools of mucin. - It usually presents as a solitary mass and is not known for a higher incidence of bilaterality. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-456.
Surgery
6 questionsIn which one of the following is Branham's sign positive?
The structures removed in radical neck dissection include: 1. Sternocleidomastoid muscle 2. Submandibular gland 3. Internal jugular vein 4. Accessory nerve
The inflammatory breast carcinoma is staged as
Splenectomy is indicated in all of the following conditions, except
Which one of the following statements is true regarding "injection sclerotherapy" for haemorrhoids ?
Which one of the following nerves is vulnerable to injury while conducting an appendicectomy through the McBurney's incision ?
UPSC-CMS 2012 - Surgery UPSC-CMS Practice Questions and MCQs
Question 11: In which one of the following is Branham's sign positive?
- A. Arterial stenosis
- B. Arteriovenous fistula (Correct Answer)
- C. Deep vein thrombosis
- D. Arterial aneurysm
Explanation: ***Arteriovenous fistula*** - **Branham's sign**, also known as Nicoladoni-Branham's sign, is characterized by a **sudden decrease in heart rate** upon compression of an arteriovenous fistula. - This occurs because *compression of the fistula increases systemic vascular resistance, leading to improved venous return and a reflex bradycardia* via vagal stimulation. *Arterial stenosis* - **Arterial stenosis** involves narrowing of an artery and does not typically present with Branham's sign. - While it may cause a **bruit** or **reduced pulse**, compressing the stenotic vessel would not lead to an immediate change in heart rate. *Deep vein thrombosis* - **Deep vein thrombosis (DVT)** is a blood clot in a deep vein, causing pain and swelling, but it is not associated with Branham's sign. - Compression in the area of a DVT would likely worsen pain or dislodge the clot, not alter heart rate in this manner. *Arterial aneurysm* - An **arterial aneurysm** is a localized bulging of an artery wall, which can pulsate but generally does not elicit Branham's sign upon compression. - Compressing an aneurysm could be dangerous and would not result in the reflex bradycardia seen with an arteriovenous fistula.
Question 12: The structures removed in radical neck dissection include: 1. Sternocleidomastoid muscle 2. Submandibular gland 3. Internal jugular vein 4. Accessory nerve
- A. 1 and 2 only
- B. 1 and 3 only
- C. 2 and 4 only
- D. 1, 2, 3 and 4 (Correct Answer)
Explanation: ***1, 2, 3 and 4*** - A **radical neck dissection** involves the removal of the **sternocleidomastoid muscle**, **internal jugular vein**, and **spinal accessory nerve (cranial nerve XI)**, along with all cervical lymph node groups from levels I to V, and the submandibular gland. - This extensive procedure is designed to achieve complete tumor clearance, particularly in cases of advanced head and neck cancers with suspected or confirmed nodal metastases. *1 and 2 only* - This option is incomplete as a radical neck dissection targets more structures than just the **sternocleidomastoid muscle** and **submandibular gland**. - While these two structures are removed, the procedure also extensively addresses major neurovascular structures and lymph nodes to ensure comprehensive cancer eradication. *1 and 3 only* - This option is incomplete because a radical neck dissection also involves the removal of the **submandibular gland** and the **accessory nerve**, in addition to the sternocleidomastoid muscle and internal jugular vein. - The goal is to clear all potential pathways of cancer spread in the neck. *2 and 4 only* - This option is incorrect as it omits other key structures removed in a radical neck dissection, such as the **sternocleidomastoid muscle** and the **internal jugular vein**. - These structures are critical components of the surgical field to adequately remove all affected tissues.
Question 13: The inflammatory breast carcinoma is staged as
- A. T4d (Correct Answer)
- B. T4c
- C. T1a
- D. T1b
Explanation: ***T4d*** - **Inflammatory breast carcinoma** is by definition a **T4d tumor** in the TNM staging system, regardless of tumor size. - This designation reflects the aggressive nature and characteristic features of erythema and edema involving a substantial portion of the breast. *T4c* - **T4c** refers to either **T4a** (chest wall invasion) and **T4b** (ulceration, edema, or skin nodules) combined. - While these can be features of advanced breast cancer, they do not specifically define inflammatory breast carcinoma. *T1a* - **T1a** describes a tumor size of **greater than 0.5 cm but not more than 1 cm** in greatest dimension. - Inflammatory breast carcinoma is not staged based on tumor size in this manner due to its diffuse nature. *T1b* - **T1b** describes a tumor size of **greater than 1 cm but not more than 2 cm** in greatest dimension. - Inflammatory breast carcinoma is characterized by diffuse involvement of the breast skin and does not fit into typical size-based T categories like T1b.
Question 14: Splenectomy is indicated in all of the following conditions, except
- A. Hydatid cyst of the spleen (Correct Answer)
- B. Hereditary spherocytosis
- C. Idiopathic thrombocytopenic purpura
- D. Myelofibrosis
Explanation: ***Hydatid cyst of the spleen*** - **Splenectomy** is generally **NOT indicated** as first-line treatment for uncomplicated **hydatid cysts** of the spleen. - The primary concern is the **risk of spillage of cyst contents**, which can lead to **anaphylactic shock** or **disseminated echinococcosis** (secondary hydatid disease). - **Conservative organ-preserving approaches** are strongly preferred, including **PAIR** (Puncture, Aspiration, Injection, Reaspiration, and Drainage) or **pericystectomy** (removing cyst with its pericyst while preserving spleen). - Splenectomy may only be considered in complicated cases (rupture, secondary infection, or inability to preserve spleen tissue), but it is NOT a routine indication. *Hereditary spherocytosis* - **Splenectomy** is the **definitive treatment** for **hereditary spherocytosis** to reduce hemolysis and alleviate symptoms like anemia, jaundice, and splenomegaly. - The spleen is the primary site of destruction of the abnormally shaped red blood cells, so its removal significantly prolongs red blood cell lifespan. - Typically performed after age 5-6 years to reduce infection risk. *Idiopathic thrombocytopenic purpura* - **Splenectomy** is indicated in cases of **chronic refractory ITP** that do not respond to medical therapy (e.g., corticosteroids, IVIG, rituximab). - The spleen is the primary site of **platelet destruction** and **autoantibody production** against platelets in ITP. - Splenectomy achieves remission in approximately 60-70% of patients with chronic ITP. *Myelofibrosis* - **Splenectomy** may be indicated in **myelofibrosis** for severe, symptomatic **splenomegaly** causing debilitating pain, early satiety, cachexia, or mechanical complications. - Also indicated for refractory cytopenias requiring frequent transfusions or severe portal hypertension. - It can alleviate pressure symptoms and reduce the metabolic demands of a massively enlarged spleen, improving quality of life.
Question 15: Which one of the following statements is true regarding "injection sclerotherapy" for haemorrhoids ?
- A. Injection of sclerosant is made above the dentate line (pectinate line) (Correct Answer)
- B. Sclerotherapy is the treatment of choice for the prolapsed haemorrhoids
- C. In patients with haemorrhoids at 3 o'clock, 7 o'clock and 11 o'clock positions, the injection is made in the sitting position
- D. Sclerotherapy is the ideal treatment for acute external haemorrhoids
Explanation: ***Injection of sclerosant is made above the dentate line (pectinate line)*** - Sclerotherapy involves injecting a **sclerosing agent** into the submucosa of internal hemorrhoids, specifically where they are **rich in blood vessels** and above the **pain-sensitive dentate line** to minimize discomfort. - Injecting above the dentate line helps to **avoid pain receptors** and induce fibrosis, which reduces blood flow and shrinks the hemorrhoid. *Sclerotherapy is the treatment of choice for the prolapsed haemorrhoids* - **Sclerotherapy** is generally effective for **Grade I and II internal hemorrhoids** that bleed but may not prolapse or prolapse only minimally. - For **prolapsed hemorrhoids (Grade III and IV)**, band ligation, excisional hemorrhoidectomy, or other surgical interventions are typically more effective. *In patients with haemorrhoids at 3 o'clock, 7 o'clock and 11 o'clock positions, the injection is made in the sitting position* - Injections for hemorrhoids are typically performed in the **left lateral (Sims') position** or **lithotomy position**, which provides optimal exposure and patient comfort. - The **sitting position** is not used for this procedure due to poor access and difficulty in maintaining a stable posture for the injection. *Sclerotherapy is the ideal treatment for acute external haemorrhoids* - **Sclerotherapy** is contraindicated for **external hemorrhoids** because they lie below the dentate line and are highly sensitive to pain. - Acute external hemorrhoids, especially if thrombosed, are usually managed with **excision of the thrombus** or conservative measures, not sclerotherapy.
Question 16: Which one of the following nerves is vulnerable to injury while conducting an appendicectomy through the McBurney's incision ?
- A. Subcostal nerve
- B. Ilio-inguinal nerve (Correct Answer)
- C. Lateral cutaneous nerve of the thigh
- D. Genitofemoral nerve
Explanation: ***Ilio-inguinal nerve*** - The **ilio-inguinal nerve** runs anterior to the **quadratus lumborum muscle** and enters the **transversus abdominis muscle**, lying between it and the internal oblique muscle. It is especially vulnerable at the lateral edge of the **rectus abdominis.** - **McBurney's incision**, which is an **oblique incision** in the **right lower quadrant**, may damage the ilioinguinal nerve as it exits the deep inguinal ring. *Subcostal nerve* - The **subcostal nerve** is the ventral ramus of **T12**, and it runs inferior to the **12th rib**. - It usually lies significantly superior to the **McBurney’s incision** site, making injury unlikely during this specific procedure. *Lateral cutaneous nerve of the thigh* - The **lateral cutaneous nerve of the thigh** arises from the **lumbar plexus (L2-L3)** and innervates the skin of the lateral thigh. - It traverses near the **anterior superior iliac spine**, which is not typically within the primary field of a **McBurney’s incision**. *Genitofemoral nerve* - The **genitofemoral nerve** originates from the **L1 and L2 spinal nerves** and descends retroperitoneally. - It is located deep and medial to the region of **McBurney’s incision**, making direct injury during this superficial abdominal incision less probable.