UPSC-CMS 2014 Practice Questions

Q: Consider the following statements: Venacaval opening of the diaphragm, situated at the level of T8 transmits 1. inferior vena cava 2. vagus nerve 3. branches of the right phrenic nerve 4. thoracic duct Which of the statements given above are correct?

1 and 3. The **venacaval opening (caval hiatus)** is located at the level of **T8 vertebra** in the central tendon of the diaphragm. [1] **Statement 1: Inferior vena cava** ✓ - **CORRECT** - The inferior vena cava is the primary structure passing through the venacaval opening at T8. This opening is specifically designed to allow the IVC to pass from the abdomen into the thorax. **Statement 3: Branches of the right phrenic nerve** ✓ - **CORRECT** - The right phrenic nerve pierces the central tendon of the diaphragm near the venacaval opening. Some terminal branches of the right phrenic nerve pass through or adjacent to the caval opening to supply the inferior surface of the diaphragm [1]. *Statement 2: Vagus nerve* ✗ - *Incorrect* - The vagus nerves (anterior and posterior vagal trunks) pass through the **esophageal hiatus** at the level of **T10 vertebra**, not through the venacaval opening. [1] *Statement 4: Thoracic duct* ✗ - *Incorrect* - The thoracic duct passes through the **aortic hiatus** at the level of **T12 vertebra**, posterior to the diaphragm between the two crura. It does not pass through the venacaval opening. **Three major openings in the diaphragm:** - **T8** - Venacaval opening (IVC + right phrenic nerve branches) - **T10** - Esophageal hiatus (esophagus + vagus nerves) - **T12** - Aortic hiatus (aorta + thoracic duct + azygos vein) ***Therefore, statements 1 and 3 are correct.***

Q: Sprain of the ankle joint results from an injury to:

Anterior talofibular ligament. ***Anterior talofibular ligament*** - The **anterior talofibular ligament (ATFL)** is the **most commonly injured ligament** in ankle sprains, especially those resulting from **inversion injuries**. - It lies on the lateral aspect of the ankle and connects the **fibula to the talus**, stabilizing the **ankle joint** against anterior displacement and internal rotation of the talus. *Posterior talofibular ligament* - The **posterior talofibular ligament (PTFL)** is part of the lateral collateral ligament complex but is **rarely injured in isolation** or as the primary site in an ankle sprain. - It is typically involved only in **severe ankle sprains** with significant joint instability. *Deltoid ligament* - The **deltoid ligament** is located on the **medial side of the ankle** and is very strong, making it less prone to injury compared to the lateral ligaments. - Injury to the deltoid ligament usually occurs with **eversion injuries** of the ankle, which are less common than inversion injuries. *Spring Ligament* - The **spring ligament (plantar calcaneonavicular ligament)** supports the **medial longitudinal arch of the foot** and is not directly involved in stabilizing the ankle joint against sprains. - Injury to the spring ligament can lead to a **flatfoot deformity** but is not the primary cause of an ankle sprain.

Q: Consider the following structures in the femoral triangle: 1. Femoral canal 2. Femoral Nerve 3. Femoral artery 4. Femoral vein What is the correct sequence of the above from medial to lateral ?

1, 4, 3, 2. The correct order from medial to lateral within the femoral triangle is **Femoral canal (lymphatics)**, **Femoral vein**, **Femoral artery**, and **Femoral nerve**. A common mnemonic for this order is **NAVEL** read from lateral to medial: **N**erve, **A**rtery, **V**ein, **E**mpty space/**L**ymphatics (femoral canal). Therefore, from medial to lateral, the sequence is: Canal (1), Vein (4), Artery (3), Nerve (2). *1, 2, 3, 4* - This sequence incorrectly places the Femoral nerve (2) second from medial and the Femoral vein (4) most lateral, which contradicts the anatomical arrangement. The **Femoral nerve** is the most lateral structure, and the **Femoral canal** is the most medial component. *4, 3, 1, 2* - This order incorrectly positions the Femoral canal (1) second from lateral instead of being the most medial structure. The **Femoral canal** must be the most medial, followed by vein, artery, and nerve. *3, 4, 2, 1* - This sequence incorrectly places the **Femoral artery** as the most medial and the **Femoral canal** as the most lateral, which is completely reversed. The correct medial-to-lateral order is Canal (1), Vein (4), Artery (3), Nerve (2).

Q: A female patient aged 30 years with bilateral conductive deafness is wearing a hearing aid. What is the probable diagnosis?

Otosclerosis. ***Otosclerosis*** - **Otosclerosis** is a common cause of **conductive hearing loss** in young to middle-aged adults, often presenting bilaterally. - It involves abnormal bone remodeling in the **otic capsule**, primarily affecting the **stapes footplate**, which leads to fixation and impaired sound transmission. *Presbycusis* - **Presbycusis** is an **age-related sensorineural hearing loss** that typically affects older individuals, not a 30-year-old. - It is characterized by difficulty hearing high-frequency sounds, not conductive hearing loss. *Chronic suppurative otitis media* - **Chronic suppurative otitis media (CSOM)** involves a **perforated tympanic membrane** with chronic discharge and hearing loss. - While it causes conductive hearing loss, it is typically associated with a history of recurrent infections and ear discharge, which are not mentioned here. *Meniere's disease* - **Meniere's disease** is characterized by episodic **vertigo**, **tinnitus**, **fluctuating sensorineural hearing loss**, and aural fullness. - It causes sensorineural, not conductive, hearing loss and is associated with additional symptoms absent in this case.

Q: In diabetes mellitus the following findings are seen in ophthalmoscopy except:

Wet sponge haemorrhage. ***Wet sponge haemorrhage*** - **Wet sponge haemorrhage** is not a term typically used in the description of diabetic retinopathy or other retinal conditions found during ophthalmoscopy. - The appearance it suggests (diffuse, sponge-like bleeding) does not correlate with the characteristic hemorrhage types seen in diabetic retinopathy. - This is **not a recognized ophthalmologic finding** in diabetes mellitus. *Flame shaped haemorrhage* - **Flame-shaped haemorrhages** are superficial retinal hemorrhages in the nerve fiber layer, commonly seen in diabetic retinopathy as well as hypertensive retinopathy. - Their characteristic shape reflects the arrangement of nerve fibers in the retina. - These are seen in both non-proliferative and proliferative diabetic retinopathy. *Dot haemorrhage* - **Dot haemorrhages** are small, round hemorrhages located deeper in the retina (inner nuclear and outer plexiform layers). - These are a common early finding in diabetic retinopathy, often representing microaneurysms that have ruptured or deep intraretinal hemorrhages. - They indicate damage to retinal capillaries. *Microaneurysm* - **Microaneurysms** are the earliest and most characteristic clinical sign of diabetic retinopathy, appearing as small, red dots on the retina. - They represent focal outpouchings of retinal capillaries due to weakened vessel walls and pericyte loss. - Best visualized with fluorescein angiography but visible on ophthalmoscopy.

Q: An 8 year old girl sustained a fall on the outstretched right hand 6 hours ago and was treated with egg albumen bandages by a village bone setter. She presented with gross swelling of the right elbow and forearm. The first essential intervention in this case would be to

completely remove all encircling bandages.. ***completely remove all encircling bandages.*** - An 8-year-old with a fall on an outstretched hand and gross swelling of the elbow and forearm points to a **supracondylar fracture of the humerus**, which can lead to **compartment syndrome**. - **Tight bandages** (like egg albumen) will exacerbate swelling, impede venous return, and compromise arterial inflow, making their immediate removal essential to prevent **ischemia** and potential **nerve damage**. *elevate the right hand.* - While elevation helps reduce swelling, it is **secondary** to relieving any constricting external pressure caused by the bandages, which are the more immediate threat. - Elevating a limb with compromised circulation due to external compression would be insufficient and could delay proper management. *immerse the hand in warm water to increase the circulation.* - Immersing an injured limb in warm water can **increase swelling** and potentially aggravate bleeding into the tissues, which is counterproductive in a situation with suspected compartment syndrome. - This intervention would **worsen the clinical picture** and is inappropriate for acute trauma with significant swelling. *order urgent radiographs of both elbows.* - While radiographs are crucial for diagnosing the underlying fracture, they are **not the first essential intervention** in a limb with gross swelling and potential vascular compromise from tight bandages. - Addressing the immediate threat of **compartment syndrome** and relieving external compression takes priority over diagnostic imaging.

Q: The following nerves are blocked for repairing inguinal hernia by local anaesthetic except:

Femoral. ***Femoral*** - The **femoral nerve** primarily innervates the anterior thigh muscles and provides sensory supply to the anterior thigh and medial leg; its block is not typically required for **inguinal hernia repair**. - Blocking the femoral nerve would primarily affect **motor function** of the quadriceps and sensation in the distribution of the saphenous nerve, which is not the surgical field for an inguinal hernia. *Ilio-inguinal* - The **ilio-inguinal nerve** provides sensation to the inguinal region, scrotum/labia majora, and the medial aspect of the thigh, making its block essential for anesthesia during **inguinal hernia repair**. - It lies in the **inguinal canal** and is typically targeted with local anesthetic to cover the incision site and surgical area. *Genito femoral* - The **genitofemoral nerve** has both genital and femoral branches, providing sensation to the scrotum/labia majora and a small area of the femoral triangle, respectively, and is therefore often included in an **inguinal block**. - Its blockade helps to cover the sensory innervation of the **spermatic cord** and a portion of the inguinal region, contributing to effective pain control. *Ilio-hypogastric* - The **ilio-hypogastric nerve** provides sensory innervation to the suprapubic and gluteal regions, and its blockade is important for covering the **upper part of the surgical incision** for an inguinal hernia repair. - It runs parallel to the ilio-inguinal nerve and is often blocked concurrently to ensure **comprehensive analgesia** of the abdominal wall.

Q: Traumatic haemothorax is best managed by:

Intercostal tube drainage. ***Intercostal tube drainage*** - **Intercostal tube drainage** is the most effective initial management for traumatic haemothorax as it allows continuous evacuation of blood and re-expansion of the lung. - It helps in quantifying blood loss, preventing clot formation, and improving respiratory mechanics by reducing pleural space compression. *Use of streptokinase* - **Streptokinase** is a fibrinolytic agent used to break down clots, but its primary role is in established, organized haemothoraces (fibrothorax) and is not the acute management for traumatic haemothorax. - Administering streptokinase in acute bleeding can worsen haemorrhage and is contraindicated in the immediate post-traumatic period. *Open drainage* - **Open drainage**, typically via thoracotomy, is reserved for massive haemothorax (e.g., >1500 mL initially or >200 mL/hr for 2-4 hours) or ongoing severe bleeding that cannot be controlled by tube thoracostomy. - It is a more invasive procedure with higher risks and is not the first-line management for all traumatic haemothoraces. *Aspiration of blood from pleural cavity* - **Aspiration of blood from the pleural cavity** (thoracentesis) can be diagnostic but is often insufficient for adequately draining a traumatic haemothorax, especially if there is ongoing bleeding or significant clot formation. - It is often reserved for small, uncomplicated haemothoraces or for diagnostic purposes, not as the definitive management in trauma.

Q: The following operative procedure can result in neurogenic voiding dysfunction except:

Ureterolithotomy. **Ureterolithotomy** - This procedure involves removing kidney stones from the **ureter** and generally does not involve dissection near the pelvic nerves responsible for bladder function. - It is a **localized procedure** that avoids the extensive pelvic dissection associated with damage to the **autonomic nerves controlling voiding**. *Radical hysterectomy* - This procedure involves the removal of the **uterus, cervix, parametrium, and a portion of the vagina**, which frequently necessitates extensive dissection in the pelvic area. - The dissection can injure the **pelvic plexus nerves**, leading to neurogenic bladder dysfunction. *Abdominoperineal resection* - This surgery involves removing the **rectum and anus**, requiring extensive dissection through the pelvic floor. - This procedure carries a significant risk of damaging the **inferior hypogastric plexus and sacral nerves**, which are crucial for bladder control. *Retroperitoneal lymph node dissection* - This procedure involves dissecting lymph nodes in the **retroperitoneal space**, especially in cases of testicular cancer. - While primarily affecting ejaculation, extensive or misplaced dissection can also impact the **sympathetic and parasympathetic efferent nerves originating from the pelvic plexus** that contribute to bladder function.

Question 1

Consider the following statements: Venacaval opening of the diaphragm, situated at the level of T8 transmits

1. inferior vena cava 
2. vagus nerve 
3. branches of the right phrenic nerve 
4. thoracic duct Which of the statements given above are correct?

Accepted Answer

1 and 3

Answer

1 and 4

Answer

2 and 3

Answer

1 and 2

Question 2

Sprain of the ankle joint results from an injury to:

Accepted Answer

Anterior talofibular ligament

Answer

Posterior talofibular ligament

Answer

Deltoid ligament

Answer

Spring Ligament

Question 3

Consider the following structures in the femoral triangle:

1. Femoral canal
2. Femoral Nerve
3. Femoral artery
4. Femoral vein

What is the correct sequence of the above from medial to lateral ?

Accepted Answer

1, 4, 3, 2

Answer

1, 2, 3, 4

Answer

4, 3, 1, 2

Answer

3, 4, 2, 1

Question 4

A female patient aged 30 years with bilateral conductive deafness is wearing a hearing aid. What is the probable diagnosis?

Accepted Answer

Otosclerosis

Answer

Presbycusis

Answer

Chronic suppurative otitis media

Answer

Meniere’s disease

Question 5

In diabetes mellitus the following findings are seen in ophthalmoscopy except:

Accepted Answer

Wet sponge haemorrhage

Answer

Flame shaped haemorrhage

Answer

Dot haemorrhage

Answer

Microaneurysm

Question 6

An 8 year old girl sustained a fall on the outstretched right hand 6 hours ago and was treated with egg albumen bandages by a village bone setter. She presented with gross swelling of the right elbow and forearm. The first essential intervention in this case would be to

Accepted Answer

completely remove all encircling bandages.

Answer

elevate the right hand.

Answer

immerse the hand in warm water to increase the circulation.

Answer

order urgent radiographs of both elbows.

Question 7

The following nerves are blocked for repairing inguinal hernia by local anaesthetic except:

Accepted Answer

Femoral

Answer

Ilio-inguinal

Answer

Genito-femoral

Answer

Ilio-hypogastric

Question 8

Traumatic haemothorax is best managed by:

Accepted Answer

Intercostal tube drainage

Answer

Use of streptokinase

Answer

Open drainage

Answer

Aspiration of blood from pleural cavity

Question 9

Which of the following statements about mesh skin grafts is not correct?

Accepted Answer

They contract to the same degree as a grafted sheet of skin.

Answer

They allow egress of fluid collections under the graft.

Answer

They permit coverage of large areas.

Answer

They “take” satisfactorily on granulating bed.

Question 10

The following operative procedure can result in neurogenic voiding dysfunction except:

Accepted Answer

Ureterolithotomy

Answer

Radical hysterectomy

Answer

Abdominoperineal resection

Answer

Retroperitoneal lymph node dissection

UPSC-CMS 2014

Anatomy

ENT

Ophthalmology

Orthopaedics

Surgery