Community Medicine
1 questionsThe most common site for nosocomial (hospital acquired) infection is:
UPSC-CMS 2016 - Community Medicine UPSC-CMS Practice Questions and MCQs
Question 21: The most common site for nosocomial (hospital acquired) infection is:
- A. Surgical site
- B. Blood stream
- C. Respiratory tract
- D. Urinary tract (Correct Answer)
Explanation: ***Urinary tract*** - **Urinary tract infections (UTIs)** are the most frequently acquired nosocomial infections, often associated with **urinary catheterization**. - Catheter-associated UTIs (CAUTIs) account for a significant percentage of all healthcare-associated infections. *Surgical site* - **Surgical site infections (SSIs)** are a common type of nosocomial infection, but they are less frequent than UTIs overall. - SSIs are highly dependent on the type of surgery, duration, and patient risk factors. *Blood stream* - **Bloodstream infections (BSIs)**, including central line-associated bloodstream infections (CLABSIs), are serious nosocomial infections. - While they carry high morbidity and mortality, their overall incidence is lower than that of UTIs. *Respiratory tract* - **Respiratory tract infections**, particularly **ventilator-associated pneumonia (VAP)**, are significant nosocomial concerns. - However, they are not as common as UTIs when considering all types of healthcare settings and patient populations.
Internal Medicine
3 questionsThe ideal temperature to store the whole blood in blood-bank is
Glasgow coma scale (GCS) score ranges between:
Consider the following statements: Haemophilia A (haemophilia) and Haemophilia B (christmas disease) 1. are variants of the same disease process 2. are due to congenital deficiency of factor VIII and factor IX respectively 3. both are sex linked characteristics and transmitted by asymptomatic females 4. can occur both in males and females Select the correct answer using the code given below:
UPSC-CMS 2016 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 21: The ideal temperature to store the whole blood in blood-bank is
- A. -4°C
- B. 8°C
- C. 4°C (Correct Answer)
- D. 0°C
Explanation: ***4°C*** - Whole blood is typically stored at **1 to 6°C**, with **4°C** being the optimal compromise to preserve red blood cell viability and minimize bacterial growth [1]. - This temperature range allows for a standard storage duration of **21 to 42 days**, depending on the anticoagulant-preservative solution used [1]. *-4°C* - Temperatures below freezing point (**0°C**) would cause **hemolysis** due to ice crystal formation within the red blood cells, making the blood unsuitable for transfusion. - While frozen storage is used for specific blood components (e.g., cryopreserved red blood cells or plasma), it requires different protocols and cryoprotectants. *8°C* - Storing whole blood at **8°C** is above the recommended range and would significantly decrease the storage time due to increased metabolic activity and **bacterial proliferation**. - This temperature also leads to a faster decline in **red blood cell viability** and function. *0°C* - Storing whole blood at **0°C** is at the freezing point of water and close to the freezing point of blood, which can lead to initial **ice crystal formation** and subsequent hemolysis. - Although it's within the recommended 1-6°C range, maintaining exactly 0°C without fluctuations into freezing territory is challenging and poses a risk to blood quality [1].
Question 22: Glasgow coma scale (GCS) score ranges between:
- A. 1 and 15
- B. 2 and 15
- C. 3 and 15 (Correct Answer)
- D. 0 and 15
Explanation: **3 and 15** * The **Glasgow Coma Scale (GCS)** is a neurological scale that aims to give a reliable and objective way of recording the conscious state of a person [2]. * A score of **3 represents the lowest possible level of consciousness**, indicating a severe injury [1], while **15 represents full consciousness** [1]. * *1 and 15* * The GCS assesses three components: **eye opening, verbal response, and motor response** [2]. Each component has a minimum score of 1. * Therefore, a total score of 1 is not possible as the minimum score for any individual component is 1, and there are three components. * *2 and 15* * The lowest possible score for any single component in the GCS is 1 (e.g., no eye opening, no verbal response, no motor response). * With three components, the sum of the minimum scores (1+1+1) is 3, making a total score of 2 impossible. * *0 and 15* * The GCS is designed with a minimum score of 1 for each of its three categories. * A score of 0 is not used in the GCS scoring system; the lowest possible score for any component is 1, even in an unresponsive state.
Question 23: Consider the following statements: Haemophilia A (haemophilia) and Haemophilia B (christmas disease) 1. are variants of the same disease process 2. are due to congenital deficiency of factor VIII and factor IX respectively 3. both are sex linked characteristics and transmitted by asymptomatic females 4. can occur both in males and females Select the correct answer using the code given below:
- A. 1, 2 and 4
- B. 2 and 3 (Correct Answer)
- C. 2 only
- D. 3 only
Explanation: ***2 and 3*** - Hemophilia A is caused by a deficiency of **Factor VIII**, and Hemophilia B is caused by a deficiency of **Factor IX** [1]. These are distinct but clinically similar genetic disorders of the coagulation cascade. - Both hemophilia A and B are **X-linked recessive disorders**, meaning they predominantly affect males and are transmitted by asymptomatic female carriers [2]. *1, 2 and 4* - While both hemophilia A and B result in similar bleeding phenotypes, they are due to deficiencies in different **coagulation factors** (Factor VIII and Factor IX, respectively), making them distinct diseases, not variants of the same process [2]. - While hemophilia mainly affects males, a female can be affected if she inherits two affected X chromosomes (one from each parent) or has **Turner syndrome** (XO) with an affected X chromosome, but this is extremely rare. *2 only* - This option correctly identifies the specific factor deficiencies for Hemophilia A (**Factor VIII**) and Hemophilia B (**Factor IX**) [1]. - However, it omits the crucial aspect of their **sex-linked inheritance** and transmission by asymptomatic females, which is a fundamental characteristic of both conditions [2]. *3 only* - This option correctly states that both hemophilia A and B are **sex-linked characteristics** and are transmitted by **asymptomatic females** [2]. - However, it fails to mention the specific deficient factors (Factor VIII and Factor IX), which is key to understanding the underlying pathology of these two distinct disorders.
Pediatrics
1 questionsWhat is the most common cause of intestinal obstruction in neonates?
UPSC-CMS 2016 - Pediatrics UPSC-CMS Practice Questions and MCQs
Question 21: What is the most common cause of intestinal obstruction in neonates?
- A. Volvulus neonatorium
- B. Duodenal atresia (Correct Answer)
- C. Hirschsprung's disease
- D. Meconium ileus
Explanation: ***Duodenal atresia*** - **Duodenal atresia** is one of the **most common causes of intestinal obstruction** in neonates, accounting for approximately 30-40% of all neonatal intestinal obstructions. - It is a **congenital malformation** where the duodenum is completely blocked, leading to the characteristic **"double-bubble" sign** on X-ray (one bubble in the stomach and one in the proximal duodenum). - Strongly associated with **Down syndrome** (30% of cases) and **polyhydramnios** during pregnancy. - Presents with **bilious vomiting** within the first 24-48 hours of life. *Meconium ileus* - **Meconium ileus** accounts for only **10-15%** of neonatal intestinal obstruction cases. - It is strongly associated with **cystic fibrosis** (90% of meconium ileus cases have CF), with approximately 10-20% of CF newborns presenting with meconium ileus. - Caused by thick, inspissated meconium obstructing the terminal ileum. *Hirschsprung's disease* - **Hirschsprung's disease** causes functional obstruction due to **absence of ganglion cells** in the distal bowel (aganglionic segment). - Accounts for **15-20%** of neonatal intestinal obstruction cases. - Typically presents with **delayed passage of meconium** (>48 hours), abdominal distension, and bilious vomiting. *Volvulus neonatorium* - **Volvulus neonatorium** involves twisting of the intestine, often due to **intestinal malrotation**, leading to obstruction and vascular compromise. - Accounts for **10-15%** of cases and presents as a surgical emergency with bilious vomiting and potential bowel ischemia.
Pharmacology
1 questionsMatch List-I with List-II and select the correct answer using the code given below the Lists:
UPSC-CMS 2016 - Pharmacology UPSC-CMS Practice Questions and MCQs
Question 21: Match List-I with List-II and select the correct answer using the code given below the Lists:
- A. A→3 B→4 C→2 D→1
- B. A→4 B→3 C→2 D→1
- C. A→4 B→3 C→1 D→2
- D. A→3 B→4 C→1 D→2 (Correct Answer)
Explanation: ***A→3 B→4 C→1 D→2*** - This option correctly matches each anticancer drug to its characteristic adverse effect: **Cisplatinum (A)** with **tubular necrosis (3)**, **Adriamycin (B)** with **cardiomyopathy (4)**, **Bleomycin (C)** with **pulmonary fibrosis (1)**, and **Cyclophosphamide (D)** with **haemorrhagic cystitis (2)**. - These drug-toxicity associations are clinically important for monitoring and managing patients on chemotherapy. *A→3 B→4 C→2 D→1* - This option incorrectly matches Bleomycin with haemorrhagic cystitis (should be pulmonary fibrosis) and Cyclophosphamide with pulmonary fibrosis (should be haemorrhagic cystitis). - While Cisplatinum and Adriamycin are correctly paired, the last two associations are reversed. *A→4 B→3 C→2 D→1* - This option incorrectly matches Cisplatinum with cardiomyopathy (should be tubular necrosis) and Adriamycin with tubular necrosis (should be cardiomyopathy). - Additionally, Bleomycin and Cyclophosphamide complications are also incorrectly paired. *A→4 B→3 C→1 D→2* - This option incorrectly swaps the complications for Cisplatinum and Adriamycin: Cisplatinum is matched with cardiomyopathy (should be tubular necrosis) and Adriamycin with tubular necrosis (should be cardiomyopathy). - While Bleomycin and Cyclophosphamide are correctly paired with their respective complications, the first two associations are incorrect.
Surgery
4 questionsBisgaard treatment refers to that of:
The most common cause of intestinal obstruction is:
A 30 year old lady sustained chest injury in an accident and presented with massive haemothorax on right side. Tube thoracostomy drained 1800 ml of blood. What is the most appropriate treatment?
In a case of obstructed hernia, strangulation is suggested by which of the following? 1. Presence of shock 2. Pain is never completely absent 3. Localised tenderness is associated with rebound tenderness 4. Pain persists despite conservative management 5. An external hernia becomes tense, tender, irreducible, with recent increase in size Select the correct answer using the code given below:
UPSC-CMS 2016 - Surgery UPSC-CMS Practice Questions and MCQs
Question 21: Bisgaard treatment refers to that of:
- A. An ischaemic ulcer
- B. Venous ulcer (Correct Answer)
- C. An in-growing toe nail
- D. Ruptured tendo achillis
Explanation: ***Venous ulcer*** - **Bisgaard treatment** is a historical surgical technique specifically developed for the management of **chronic venous ulcers**. - This treatment aims to improve venous return and reduce venous hypertension by surgically addressing incompetent perforator veins and superficial venous reflux. *An ischaemic ulcer* - **Ischaemic ulcers** are caused by arterial insufficiency and require interventions to improve arterial blood flow, such as revascularization. - Bisgaard treatment is not appropriate for ischaemic ulcers as it does not address the underlying **arterial occlusive disease**. *An in-growing toe nail* - An **ingrown toenail** is a common podiatric condition typically treated with local procedures like nail avulsion or matrixectomy. - Bisgaard treatment is a complex vascular surgical procedure and bears no relevance to the treatment of an ingrown toenail. *Ruptured tendo achillis* - A **ruptured Achilles tendon** is an orthopaedic injury that requires surgical repair or conservative management involving immobilization. - Bisgaard treatment is exclusively for venous ulcer disease and has no role in the management of tendon injuries.
Question 22: The most common cause of intestinal obstruction is:
- A. Inflammatory abdominal conditions
- B. Bands and adhesions (Correct Answer)
- C. Obstructed hernia
- D. Gastrointestinal malignancy
Explanation: ***Bands and adhesions*** - **Post-surgical adhesions** are the most common cause of small bowel obstruction, often forming after abdominal surgeries due to tissue healing. - These fibrous bands can **constrict or kink** the bowel, leading to a mechanical blockage. *Inflammatory abdominal conditions* - Conditions like **Crohn's disease** or **diverticulitis** can cause obstruction, but they are less frequent than adhesions as a primary cause. - Obstruction due to inflammation often involves **strictures** or inflammation-induced narrowing of the lumen. *Obstructed hernia* - **Hernias** (inguinal, femoral, umbilical, incisional) can become obstructed or strangulated, causing acute obstruction. - While a significant cause, the overall incidence is lower than that of adhesions, especially looking at all cases of intestinal obstruction. *Gastrointestinal malignancy* - **Colorectal cancer** is a common cause of large bowel obstruction, and other GI malignancies can cause small bowel obstruction. - Malignancy-related obstructions typically involve **tumor growth** causing luminal narrowing, but adhesions remain the leading cause overall.
Question 23: A 30 year old lady sustained chest injury in an accident and presented with massive haemothorax on right side. Tube thoracostomy drained 1800 ml of blood. What is the most appropriate treatment?
- A. Clamp the chest tube to cause the tamponade
- B. Put one more chest tube
- C. Resuscitation and prepare for urgent thoracotomy (Correct Answer)
- D. Correction of hypovolemic shock
Explanation: ***Resuscitation and prepare for urgent thoracotomy*** - A **massive hemothorax**, defined as draining >1500 ml of blood initially or >200 ml/hour for 2-4 hours, indicates significant ongoing bleeding requiring surgical intervention. - Urgent **thoracotomy** is necessary to identify and control the source of hemorrhage in such cases. *Clamp the chest tube to cause the tamponade* - Clamping the chest tube in a massive hemothorax can lead to **cardiac tamponade** or worsening **respiratory distress** by trapping blood in the pleural space. - This action would dangerously increase **intrathoracic pressure** and is contraindicated as it prevents proper drainage and exacerbates hypovolemic shock. *Put one more chest tube* - While additional chest tubes might be considered for inadequate drainage in certain situations, a massive hemothorax (1800 ml) signifies a major vascular injury, making multiple tubes insufficient to control the bleeding. - The priority is to stop the bleeding surgically, not just to drain more blood, which would only accelerate **exsanguination**. *Correction of hypovolemic shock* - **Resuscitation** is a critical initial step, but it is not the definitive treatment for a massive hemothorax with ongoing bleeding. - Without addressing the source of the bleeding via **thoracotomy**, simply managing the **hypovolemic shock** would be futile as the patient would continue to bleed out.
Question 24: In a case of obstructed hernia, strangulation is suggested by which of the following? 1. Presence of shock 2. Pain is never completely absent 3. Localised tenderness is associated with rebound tenderness 4. Pain persists despite conservative management 5. An external hernia becomes tense, tender, irreducible, with recent increase in size Select the correct answer using the code given below:
- A. 1, 2, 3, 4 and 5 (Correct Answer)
- B. 1, 2, 4 and 5 only
- C. 1, 2, 3, 4 only
- D. 1, 3 and 5 only
Explanation: ***1, 2, 3, 4 and 5*** - All listed options (presence of **shock**, persistent pain, **localized and rebound tenderness**, failure of conservative management, and a **tense, tender, irreducible hernia** with recent size increase) are classic indicators of **hernia strangulation**. - **Strangulation** is a surgical emergency where the blood supply to the herniated tissue is compromised, leading to **ischemia** and potential **necrosis**, requiring immediate intervention. *1, 2, 4 and 5 only* - This option incorrectly omits **localized tenderness associated with rebound tenderness**, which is a crucial sign of peritoneal irritation and impending or established strangulation. - While other signs are accurate, the absence of this specific finding makes the option incomplete for a comprehensive understanding of strangulation. *1, 2, 3, 4 only* - This option misses the critical clinical sign of an **external hernia becoming tense, tender, irreducible, with a recent increase in size**, which is a direct and often visible sign of strangulation. - The physical examination findings of the hernia itself are paramount in diagnosing strangulation. *1, 3 and 5 only* - This option omits two significant indicators: **pain is never completely absent** (implying continuous, severe pain) and **pain persists despite conservative management**. - Continuous pain and refractoriness to treatment highlight the progressive and severe nature of strangulation.