Anatomy
2 questionsAll of the following cranial nerves pass through the jugular foramen except :
Which of the following ligaments contains splenic artery?
UPSC-CMS 2013 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 11: All of the following cranial nerves pass through the jugular foramen except :
- A. Vagus
- B. Hypoglossal (Correct Answer)
- C. Glossopharyngeal
- D. Spinal accessory
Explanation: ***Hypoglossal*** - The **hypoglossal nerve (CN XII)** exits the skull through the **hypoglossal canal**, not the jugular foramen. - Its primary function is to innervate the intrinsic and extrinsic muscles of the **tongue**. *Vagus* - The **vagus nerve (CN X)** is one of the three cranial nerves that traverse the **jugular foramen**. - It has extensive innervation, including parasympathetic supply to the **heart, lungs, and most of the gastrointestinal tract**. *Glossopharyngeal* - The **glossopharyngeal nerve (CN IX)** exits the skull via the **jugular foramen**. - It is responsible for **taste sensation** from the posterior one-third of the tongue and motor innervation to the **stylopharyngeus muscle**. *Spinal accessory* - The **spinal accessory nerve (CN XI)** passes through the **jugular foramen** after entering the cranial cavity through the foramen magnum. - It innervate the **sternocleidomastoid** and **trapezius muscles**, responsible for head and shoulder movements.
Question 12: Which of the following ligaments contains splenic artery?
- A. Spleno-colic ligament
- B. Spleno-renal ligament (Correct Answer)
- C. Spleno-phrenic ligament
- D. Gastro-splenic ligament
Explanation: ***Spleno-renal ligament*** - The **splenic artery**, a branch of the **celiac trunk**, runs along the **superior border of the pancreas** and then travels within the **spleno-renal (lienorenal) ligament** to reach the hilum of the spleen. - This ligament connects the **spleen to the left kidney** and also contains the **splenic vein** and the **tail of the pancreas** [1], . - The splenic artery is the primary vessel within this ligament. *Spleno-colic ligament* - This ligament connects the **spleen to the transverse colon** and does not contain the splenic artery [1], . - It primarily functions to stabilize the spleen's position relative to the colon. *Spleno-phrenic ligament* - This ligament connects the **spleen to the diaphragm** and is part of the suspensory ligaments of the spleen. - It does not contain major vessels like the splenic artery but may contain small accessory splenic vessels. *Gastro-splenic ligament* - This ligament connects the **spleen to the greater curvature of the stomach**. - It contains the **short gastric arteries** and the **left gastroepiploic vessels**, which are **branches of the splenic artery**, but not the main splenic artery itself [1], .
Internal Medicine
2 questionsDeep vein thrombosis of calf is best managed by :
To differentiate pancreatic ascites from ascites secondary to cirrhosis of the liver, the most important test is :
UPSC-CMS 2013 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 11: Deep vein thrombosis of calf is best managed by :
- A. active physiotherapy
- B. anticoagulants (Correct Answer)
- C. thrombolysis
- D. surgical venous thrombectomy
Explanation: ***Anticoagulants*** - **Anticoagulation** therapy is the cornerstone of DVT management, preventing clot extension and reducing the risk of **pulmonary embolism** [1]. - Medications like **heparin**, **low molecular weight heparin**, or **direct oral anticoagulants (DOACs)** are commonly used [1]. *active physiotherapy* - While physical activity can prevent DVT, it is generally **contraindicated in acute DVT** due to the risk of dislodging the clot. - Mobilization is introduced gradually once anticoagulation is therapeutic and the risk of **embolization** is reduced. *thrombolysis* - **Thrombolysis** (clot dissolution) is usually reserved for **proximal, extensive DVT** [1] or DVT with **limb-threatening ischemia** [2]. - It carries a **higher risk of bleeding** compared to anticoagulation and is not typically necessary for isolated calf DVT [2]. *surgical venous thrombectomy* - **Surgical thrombectomy** is rarely performed for DVT and is generally reserved for **massive iliocaval thrombosis** with severe limb threat. - It is an **invasive procedure** with significant risks and is not indicated for typical calf DVT.
Question 12: To differentiate pancreatic ascites from ascites secondary to cirrhosis of the liver, the most important test is :
- A. Abdominal ultrasound
- B. Endoscopic retrograde cholangio pancreatography (ERCP)
- C. Computed tomogram (CT) scan
- D. Abdominal paracentesis (Correct Answer)
Explanation: ***Abdominal paracentesis*** - This procedure involves analyzing the **ascitic fluid**, which is crucial for distinguishing between pancreatic ascites and cirrhosis-related ascites [1]. - In **pancreatic ascites**, the fluid will have a very high **amylase** content and often a high protein level (>2.5 g/dL), whereas in **cirrhosis**, the amylase is typically normal and the protein is usually low (<2.5 g/dL) [1]. *Abdominal ultrasound* - While useful for detecting ascites and underlying liver disease (cirrhosis), it cannot definitively determine the **cause of ascites** or the specific content of the ascitic fluid [2]. - Ultrasound can visualize the pancreas but cannot reliably differentiate pancreatic ascites from other causes without **fluid analysis**. *Endoscopic retrograde cholangiopancreatography (ERCP)* - This is an **invasive procedure** primarily used for diagnosing and treating disorders of the bile ducts and pancreatic duct, such as strictures or stones. - It is not the most important or initial test for differentiating the cause of ascites, as its main role is in identifying **ductal leaks** that might lead to pancreatic ascites, rather than direct fluid analysis. *Computed tomogram (CT) scan* - CT can confirm the presence of ascites, evaluate the **pancreas** for inflammation or pseudocysts, and assess the **liver** for signs of cirrhosis [2]. - However, like ultrasound, a CT scan cannot provide the definitive **biochemical analysis** of the ascitic fluid that is necessary to distinguish pancreatic ascites from other causes.
Pediatrics
1 questionsMost common cause of intestinal obstruction in childhood is:
UPSC-CMS 2013 - Pediatrics UPSC-CMS Practice Questions and MCQs
Question 11: Most common cause of intestinal obstruction in childhood is:
- A. Mucoviscidosis
- B. Hirschsprung's disease
- C. Intussusception (Correct Answer)
- D. Volvulus
Explanation: ***Intussusception*** - **Intussusception** is the most common cause of intestinal obstruction in children between **3 months and 6 years** of age, particularly in infants. - It involves the telescoping of one segment of the intestine into an adjacent segment, leading to obstruction and potentially **ischemia**. *Mucoviscidosis* - **Mucoviscidosis**, or **cystic fibrosis**, can cause intestinal obstruction in newborns due to **meconium ileus**, but it is less common across the entire childhood period than intussusception. - While it is a significant cause of intestinal issues, its prevalence as the *most common overall cause* of obstruction in childhood is lower. *Hirschsprung's disease* - **Hirschsprung's disease** is a congenital absence of **ganglion cells** in the distal bowel, leading to functional obstruction, primarily in **neonates** and infants. - While an important cause of obstruction in early life, its overall incidence is less than intussusception, especially when considering the broader childhood age range. *Volvulus* - **Volvulus** is the twisting of a section of the intestine around its mesentery, which can occur at any age but is less frequent than intussusception in childhood. - It often presents as an acute surgical emergency with severe symptoms, but it is not the *most common* cause of obstruction across childhood.
Surgery
5 questionsThe most common early sign of increasing intracranial pressure in the victim of head injury is :
Surgical treatment for a 40-years old lady with 3 x 3 cm. papillary carcinoma thyroid with level III enlarged lymph nodes is :
Splenectomy is best indicated for :
A retained stone in CBD (common bile duct) diagnosed by T-tube cholangiogram is best treated by :
All of the following statements regarding gallstones are true except :
UPSC-CMS 2013 - Surgery UPSC-CMS Practice Questions and MCQs
Question 11: The most common early sign of increasing intracranial pressure in the victim of head injury is :
- A. Change of level of consciousness (Correct Answer)
- B. Contralateral pupillary dilation
- C. Ipsilateral pupillary dilatation
- D. Hemiparesis
Explanation: ***Change of level of consciousness*** - A **deterioration in the level of consciousness** is often the earliest and most sensitive indicator of increasing intracranial pressure (ICP) following a head injury. - This change can manifest as **confusion, lethargy, drowsiness, or difficulty arousing** the patient. *Contralateral pupillary dilation* - **Contralateral pupillary dilation** typically occurs later in the progression of increased ICP, often indicating brainstem compression. - This sign suggests a more advanced and severe stage of brain herniation. *Ipsilateral pupillary dilatation* - **Ipsilateral pupillary dilation** is a classic sign of **uncal herniation**, which occurs as increased ICP pushes the temporal lobe. - While a critical sign, it is generally not the earliest indicator and suggests significant mass effect on the oculomotor nerve. *Hemiparesis* - **Hemiparesis**, or weakness on one side of the body, is a **focal neurological deficit** that can result from direct brain injury or compression. - It usually appears later than changes in the level of consciousness and may not be the initial symptom of rising ICP, especially if the pressure increase is diffuse.
Question 12: Surgical treatment for a 40-years old lady with 3 x 3 cm. papillary carcinoma thyroid with level III enlarged lymph nodes is :
- A. Total thyroidectomy with radical neck dissection
- B. Total thyroidectomy with post-operative radio-iodine ablation
- C. Total thyroidectomy with excision of involved nodes
- D. Total thyroidectomy with functional neck dissection (Correct Answer)
Explanation: ***Total thyroidectomy with functional neck dissection*** - For **papillary thyroid carcinoma** with **level III lymph node involvement**, the standard approach is **total thyroidectomy** with **therapeutic lateral neck dissection** (functional/modified radical neck dissection). - **Level III nodes** are part of the **lateral compartment** (levels II-IV), requiring formal **compartment-oriented dissection** rather than selective node excision for adequate oncological clearance. *Total thyroidectomy with excision of involved nodes* - **"Excision of involved nodes"** is not standard terminology in thyroid surgery and **"berry-picking"** individual nodes is generally not recommended for therapeutic purposes. - **Compartment-oriented dissection** is preferred over selective node removal as it provides better oncological outcomes and staging accuracy. *Total thyroidectomy with radical neck dissection* - **Radical neck dissection** involves removal of cervical lymph node levels I-V along with the **sternocleidomastoid muscle**, **internal jugular vein**, and **spinal accessory nerve**. - This extensive procedure is reserved for cases with **extensive extranodal extension** or when these structures are directly involved, causing significant morbidity. *Total thyroidectomy with post-operative radio-iodine ablation* - **Radioiodine ablation** is an **adjuvant therapy** used after thyroidectomy to destroy remaining thyroid tissue and microscopic disease. - This option doesn't address the **surgical management** of enlarged lymph nodes, which is specifically what the question asks about.
Question 13: Splenectomy is best indicated for :
- A. Cirrhosis liver with portal hypertension
- B. Sickle cell disease
- C. Hereditary spherocytosis (Correct Answer)
- D. Gaucher's disease
Explanation: ***Hereditary spherocytosis*** - Splenectomy is a curative treatment for **hereditary spherocytosis** as it removes the primary site of red blood cell destruction. - It alleviates **anemia** and prevents complications such as **gallstones** by reducing hemolysis. *Cirrhosis liver with portal hypertension* - In cirrhosis with **portal hypertension**, splenectomy is generally not the primary treatment and may even worsen portal hypertension in some cases. - Management focuses on treating the underlying **liver disease** and its complications, such as **variceal bleeding**. *Sickle cell disease* - Splenectomy is generally avoided in **sickle cell disease** due to the increased risk of **overwhelming post-splenectomy sepsis** and other complications. - The primary approach is supportive care to manage crises, pain, and prevent infections. *Gaucher's disease* - **Gaucher's disease** involves the accumulation of glucocerebroside in various organs, including the spleen, often leading to **splenomegaly**. - Treatment primarily involves **enzyme replacement therapy (ERT)** and substrate reduction therapy, with splenectomy reserved for rare cases of severe symptoms unresponsive to medical therapy.
Question 14: A retained stone in CBD (common bile duct) diagnosed by T-tube cholangiogram is best treated by :
- A. Endoscopic papillotomy (Correct Answer)
- B. Re-exploration of common bile duct
- C. Extra corporeal shock wave lithotripsy
- D. Dissolution therapy
Explanation: ***Endoscopic papillotomy*** - This procedure, typically performed via an **ERCP**, allows for the removal of **retained common bile duct stones** in a less invasive manner than re-exploration. - It involves incising the **sphincter of Oddi** to facilitate stone extraction or spontaneous passage, especially when a **T-tube** is already in place, making access easier. *Re-exploration of common bile duct* - This is a more invasive surgical procedure with higher risks compared to endoscopic approaches. - Re-exploration is generally reserved for cases where **endoscopic techniques fail** or where there are specific contraindications to endoscopy. *Extra corporeal shock wave lithotripsy* - **ESWL** is primarily used for **kidney stones** and sometimes for large pancreatic or gallbladder stones that are difficult to access endoscopically. - Its effectiveness in fragmenting **CBD stones**, especially when a T-tube is present, is limited, and fragments may still obstruct the duct. *Dissolution therapy* - This therapy involves administering **ursodeoxycholic acid** to dissolve cholesterol stones. - It is a **slow process** and is generally ineffective for pigmented stones or for promptly resolving symptomatic or **obstructive retained CBD stones**.
Question 15: All of the following statements regarding gallstones are true except :
- A. They can cause intestinal obstruction
- B. They are mostly radio opaque (Correct Answer)
- C. They can lead to acute cholangitis by slipping into the common bile duct
- D. Mixed stones are the commonest type
Explanation: ***They are mostly radio opaque*** - Only about **10-20% of gallstones** are sufficiently calcified to be visible on a plain abdominal radiograph. - The majority of gallstones, especially **cholesterol stones**, are radiolucent and are best visualized by ultrasound. *They can cause intestinal obstruction* - This statement is true. A large gallstone can erode through the gallbladder wall into the small intestine, typically the duodenum, leading to a gallstone ileus. - **Gallstone ileus** is a rare form of mechanical bowel obstruction caused by a gallstone impaction, usually in the terminal ileum. *They can lead to acute cholangitis by slipping into the common bile duct* - This statement is true. Gallstones can migrate from the gallbladder into the **common bile duct (CBD)**, obstructing bile flow and leading to **choledocholithiasis**. - Obstruction of the CBD by gallstones, especially with superimposed bacterial infection, can cause **acute cholangitis**. *Mixed stones are the commonest type* - This statement is true. **Mixed gallstones**, which contain a combination of cholesterol, calcium salts, and bilirubin, are the most prevalent type of gallstones. - Pure cholesterol stones and pure pigment stones (black or brown) are less common than mixed stones.