UPSC-CMS 2013 Practice Questions

Q: Femoral hernias are more common in females because :

femoral canal is wide. ***femoral canal is wide*** - Females tend to have a **wider pelvis** to accommodate childbirth, which consequently leads to a proportionally wider and shorter femoral canal. - A wider femoral canal provides less structural support, making it easier for abdominal contents to herniate through the **femoral ring** [1]. *femoral canal is long* - The length of the femoral canal is not the primary factor influencing the predisposition to femoral hernias in females. - A longer canal might theoretically offer more resistance to herniation if its diameter were consistent. *ligaments of femoral canal neck are weak* - While ligamentous laxity can contribute to hernia formation, the primary anatomical reason for the increased incidence in females is the **wider canal**, not inherently weaker ligaments specific to the femoral canal neck. - The **inguinal ligament** forms the anterior boundary of the femoral ring, and its integrity is important, but its weakness isn't the direct cause of female predisposition. *weakness of posterior inguinal wall* - Weakness of the posterior inguinal wall is more directly associated with **direct inguinal hernias**, which are distinct from femoral hernias [1]. - Femoral hernias protrude below the inguinal ligament, through the femoral canal, rather than through the inguinal canal itself.

Q: Donovan bodies are associated with :

Granuloma inguinale. ***Granuloma inguinale*** - **Donovan bodies** are characteristic intracellular inclusions found within macrophages in tissue samples from patients with **granuloma inguinale**, also known as **donovanosis**. - These bodies are the causative organism, *Klebsiella granulomatis*, encapsulated within phagosomes, and appear as safety pin-shaped structures. *Gonorrhoea* - This sexually transmitted infection is caused by **Neisseria gonorrhoeae**, a Gram-negative diplococcus. - Diagnosis is typically based on identifying the organism in smears or cultures, not by Donovan bodies. *Chlamydia trachomatis infection* - **Chlamydia trachomatis** is an obligate intracellular bacterium that causes various infections, including cervicitis, urethritis, and lymphogranuloma venereum. - While it causes inclusion bodies within host cells, these are distinct from Donovan bodies and are known as **chlamydial inclusion bodies**. *Herpes genitalis* - This is a viral infection caused by the **herpes simplex virus (HSV)** type 1 or 2. - Diagnosis involves viral culture, PCR, or the identification of **Tzanck cells** (multinucleated giant cells) in vesicular fluid, not Donovan bodies.

Q: Pelvic abscess can present with all symptoms except:

bleeding rectum. ***bleeding rectum*** - A **bleeding rectum** is not a typical presentation of a pelvic abscess. It might suggest other conditions like hemorrhoids, colorectal cancer, or inflammatory bowel disease. - Pelvic abscesses are collections of pus in the pelvic cavity, and while they can cause various gastrointestinal symptoms due to local inflammation and pressure, direct rectal bleeding is generally not among them. *pain abdomen* - **Abdominal pain** is a very common symptom of a pelvic abscess, often localized to the lower abdomen. - This pain is caused by inflammation, pressure, and irritation of surrounding organs and tissues. *diarrhea with mucus discharge* - A pelvic abscess can cause irritation to the adjacent **bowel segments**, leading to changes in bowel habits such as diarrhea. - The presence of **mucus discharge** can also be a sign of bowel irritation or inflammation, which can occur secondary to a nearby abscess. *fever* - **Fever** is a classic systemic sign of infection and inflammation, and thus is almost always present in patients with an abscess, including a pelvic abscess. - The body's inflammatory response to the infection typically elevates body temperature.

Q: The most common ocular lesion peculiar to HIV infection in early stage is :

Soft exudates in retina. ***Soft exudates in retina*** - **Soft exudates**, also known as **cotton wool spots**, are the most common early ocular manifestation in HIV infection. - They represent ischemia of the nerve fiber layer due to microvascular occlusion and do not generally affect vision significantly. *Retinal necroses* - **Retinal necroses**, such as those seen in **progressive outer retinal necrosis (PORN)** or **acute retinal necrosis (ARN)**, are typically severe and rapidly progressive. - They are usually associated with advanced HIV infection (low CD4 count) and viral etiologies like **CMV retinitis** or **VZV**, not early stage HIV. *Retinal hemorrhages* - **Retinal hemorrhages** can occur in HIV, but they are often associated with systemic conditions like **thrombocytopenia** or **anemia**, or advanced opportunistic infections. - They are not considered the *most common* lesion peculiar to early HIV itself. *Kaposi's sarcoma* - **Kaposi's sarcoma** is a vascular tumor caused by **HHV-8 infection** and is associated with advanced immunosuppression in HIV. - While it can affect the conjunctiva or eyelids, primary intraocular involvement is rare and typically presents in later stages, not early HIV.

Q: The commonest complication of fracture of clavicle is :

malunion. ***malunion*** - **Malunion** is the most frequent complication following a clavicle fracture, meaning the bone heals in an anatomically incorrect or deformed position. - This often results in a palpable bump or cosmetic deformity, and can occasionally cause functional impairment. *non union* - **Non-union** occurs when the fracture fails to heal completely, leaving a persistent gap between the bone fragments. - While possible, it is less common than malunion in clavicle fractures, especially with appropriate management. *avascular necrosis* - **Avascular necrosis** is rare in clavicle fractures because the clavicle has a rich blood supply. - It typically affects bones with precarious blood supply, such as the femoral head or scaphoid. *Neurovascular injury* - **Neurovascular injury** involving the subclavian vessels or brachial plexus is a serious but relatively rare complication of clavicle fractures. - While possible, especially with displaced fractures, it is not the most common adverse outcome.

Q: Pregnancy is characterized by the following physiological changes except :

Decreased glomerular filtration rate. ***Decreased glomerular filtration rate*** - During **pregnancy**, there is a significant **increase in glomerular filtration rate (GFR)**, typically by 30-50%, due to increased renal blood flow and vasodilation. - A decreased GFR would be an abnormal finding, indicating renal dysfunction, not a normal physiological change of pregnancy. *Dilatation of ureters* - **Physiological hydronephrosis** and **utereral dilation** are common in pregnancy, primarily due to the relaxed smooth muscle effects of **progesterone** and mechanical compression by the gravid uterus. - This dilation occurs as early as the first trimester and can persist until after delivery. *Delayed gastric emptying time* - **Progesterone** acts as a smooth muscle relaxant, leading to decreased gastrointestinal motility and a **delayed gastric emptying time** during pregnancy. - This can contribute to common pregnancy symptoms like **nausea, vomiting**, and **heartburn**. *Increased tidal volume* - **Tidal volume (TV)** increases during pregnancy, primarily driven by hormonal changes, specifically **progesterone**. - This increase in TV leads to a greater minute ventilation, helping to meet the increased oxygen demands of both the mother and the fetus.

Q: Consider the following statements in respect of prostatic carcinoma : 1. Most originate from peripheral zone 2. Prostatic needle biopsy is better performed under trans rectal ultrasound 3. Prostate specific antigen is the specific test 4. L.H.R.H. analogues are used as medical treatment for metastatic disease Which of the statements given above is/are correct ?

1, 2 and 4. ***1, 2 and 4*** - **Most prostatic carcinomas originate from the peripheral zone** (approximately 70%), making this statement correct. This zone is palpable on digital rectal examination. - **Prostatic needle biopsy is indeed better performed under transrectal ultrasound (TRUS) guidance**, which allows for targeted and accurate sampling of suspicious areas. - **LHRH (Luteinizing Hormone-Releasing Hormone) analogues are a cornerstone of medical treatment for metastatic prostate cancer** as they suppress testosterone production, which fuels tumor growth. *1 and 3* - While statement 1 is correct (most prostate cancers originate from the peripheral zone), **prostate-specific antigen (PSA) is not a specific test** for prostate cancer. - **Elevated PSA can be caused by various conditions** such as benign prostatic hyperplasia (BPH), prostatitis, and even normal aging, making it a marker for prostate health rather than a definitive diagnostic test for cancer. *1 and 2 only* - Statements 1 and 2 are correct individually, but this option **incorrectly excludes statement 4**, which is also correct regarding the use of LHRH analogues in metastatic disease. - Therefore, this option is incomplete as it misses a true statement about prostate cancer management. *2, 3 and 4* - This option is incorrect because **statement 3 regarding PSA being a specific test is false**. - While PSA is used for screening and monitoring, its lack of specificity means it cannot definitively diagnose cancer.

Q: Regarding varicocele, all of the following are true except :

Varicosity of cremasteric veins. ***Varicosity of cremasteric veins*** - A varicocele is specifically the **dilation of the pampiniform plexus** of testicular veins, not the cremasteric veins. - The cremasteric veins are a separate venous system, and their varicosity is not what defines a varicocele. *May lead to infertility* - Varicoceles can **impair spermatogenesis** due to increased scrotal temperature and reflux of adrenal/renal metabolites, leading to reduced sperm count and motility. - This is a well-established complication and a common cause of **male factor infertility**. *Left side is affected usually* - The left side is more commonly affected because the **left testicular vein drains into the left renal vein** at a perpendicular angle, leading to higher hydrostatic pressure and a longer course. - The right testicular vein drains directly into the inferior vena cava (IVC) at an acute angle, which is less prone to reflux and dilation. *Feels like a bag of worms* - The characteristic palpation of a varicocele is described as a **"bag of worms"** due to the palpable dilated and tortuous veins within the pampiniform plexus. - This sensation is a key diagnostic clinical finding on physical examination.

Q: The most frequent complication of fracture pelvis is injury to :

membranous urethra. ***membranous urethra*** - The membranous (posterior) urethra is the **most frequently injured genitourinary structure** in pelvic fractures, occurring in **10-20% of major pelvic fractures** in males. - It is particularly vulnerable due to its **relatively fixed position** between the urogenital diaphragm and prostate, making it susceptible to shearing forces during anteroposterior compression or straddle-type injuries. - **Associated with pubic rami fractures and diastasis of the pubic symphysis** - the "pie in the sky" bladder sign on cystography suggests associated posterior urethral injury. - Clinical signs include **blood at the urethral meatus, high-riding prostate, and inability to void**. *urinary bladder* - Bladder injury occurs in approximately **5-10% of pelvic fractures**, making it less common than posterior urethral injuries. - Can present as **intraperitoneal rupture** (dome injury from increased intravesical pressure) or **extraperitoneal rupture** (base injury from bone fragments). - More common with pubic rami fractures, but still **less frequent than urethral injury overall**. *penile urethra* - Injury to the penile (anterior) urethra is **rarely associated with pelvic fractures** as it is mobile and not in direct proximity to pelvic bones. - More commonly injured by **straddle injuries, instrumentation, or direct penile trauma**. *rectum* - Rectal injury is a **rare complication** occurring in less than 1-5% of pelvic fractures. - Typically seen with **open pelvic fractures, open-book fractures with severe displacement**, or penetrating injuries where sharp bone fragments lacerate the rectum. - Much less common than genitourinary injuries.

Q: Burns involving the head and neck region are particularly dangerous because :

There may be thermal damage to the respiratory passage. ***There may be thermal damage to the respiratory passage*** - Burns to the **head and neck** often indicate exposure to heat or flame around the face, increasing the risk of inhaling hot air, smoke, or toxic fumes. - This can lead to **thermal damage** to the upper and lower **respiratory passages**, causing edema, airway obstruction, and acute respiratory distress. *Face is a very vascular area* - While the face is indeed **vascular**, this property primarily impacts **healing time** (often faster due to good blood supply) and the potential for swelling, but does not inherently make burns in this region "particularly dangerous" in the immediate, life-threatening sense compared to airway compromise. - The vascularity itself doesn't directly cause a unique danger that surpasses the risk of **airway obstruction** or systemic complications. *Renal failure is more frequent* - **Acute renal failure** can be a complication of severe burns due to hypovolemia, rhabdomyolysis, or sepsis, but it is not specific to burns of the head and neck region. - It is a systemic complication related to the overall burn severity and total body surface area (TBSA) involved, rather than the specific anatomical location of the burn. *Blood loss may be more severe* - Significant **blood loss** is not typically a direct primary concern in burn injuries unless there are associated trauma or very deep burns to highly vascular areas. - While fluid shifts in burns can be massive, initial blood loss is not the defining factor that makes head and neck burns particularly dangerous from a life-threatening perspective.

Question 1

Femoral hernias are more common in females because :

Accepted Answer

femoral canal is wide

Answer

femoral canal is long

Answer

ligaments of femoral canal neck are weak

Answer

weakness of posterior inguinal wall

Question 2

Donovan bodies are associated with :

Accepted Answer

Granuloma inguinale

Answer

Gonorrhoea

Answer

Chlamydia trachomatis infection

Answer

Herpes genitalis

Question 3

Pelvic abscess can present with all symptoms except:

Accepted Answer

bleeding rectum

Answer

pain abdomen

Answer

diarrhea with mucus discharge

Answer

fever

Question 4

The most common ocular lesion peculiar to HIV infection in early stage is :

Accepted Answer

Soft exudates in retina

Answer

Retinal necroses

Answer

Retinal hemorrhages

Answer

Kaposi's sarcoma

Question 5

The commonest complication of fracture of clavicle is :

Accepted Answer

malunion

Answer

non union

Answer

avascular necrosis

Answer

Neurovascular injury

Question 6

Pregnancy is characterized by the following physiological changes except :

Accepted Answer

Decreased glomerular filtration rate

Answer

Dilatation of ureters

Answer

Delayed gastric emptying time

Answer

Increased tidal volume

Question 7

Consider the following statements in respect of prostatic carcinoma :

1. Most originate from peripheral zone
2. Prostatic needle biopsy is better performed under trans rectal ultrasound
3. Prostate specific antigen is the specific test
4. L.H.R.H. analogues are used as medical treatment for metastatic disease Which of the statements given above is/are correct ?

Accepted Answer

1, 2 and 4

Answer

1 and 3

Answer

1 and 2 only

Answer

2, 3 and 4

Question 8

Regarding varicocele, all of the following are true except :

Accepted Answer

Varicosity of cremasteric veins

Answer

May lead to infertility

Answer

Left side is affected usually

Answer

Feels like a bag of worms

Question 9

The most frequent complication of fracture pelvis is injury to :

Accepted Answer

membranous urethra

Answer

penile urethra

Answer

rectum

Answer

urinary bladder

Question 10

Burns involving the head and neck region are particularly dangerous because :

Accepted Answer

There may be thermal damage to the respiratory passage

Answer

Face is a very vascular area

Answer

Renal failure is more frequent

Answer

Blood loss may be more severe

UPSC-CMS 2013

Anatomy

Microbiology

Obstetrics and Gynecology

Ophthalmology

Orthopaedics

Physiology

Surgery