UPSC-CMS 2017

Q: The external opening of branchial fistula is present in :

Lower third of the neck. ***Lower third of the neck*** - The external opening of a branchial fistula is typically found in the **lower third of the anterolateral neck**, anterior to the sternocleidomastoid muscle [1]. - This location corresponds to the embryological remnants of the second branchial cleft failing to close completely. *Middle third of the neck* - While other branchial anomalies might present in the middle third, the classic external opening of a **branchial fistula** is usually lower [1]. - Cysts (branchial cleft cysts) are more commonly found in the middle third [1]. *Upper third of the neck* - Anomalies in the upper third of the neck are less common for an external branchial fistula opening. - This region is more associated with anomalies of the first branchial cleft [1]. *Suprasternal notch* - The suprasternal notch is located at the base of the neck, and while cysts can occur in this area (e.g., cervicomediastinal thymic cysts), it is not the typical site for a **branchial fistula** opening. - This location is often associated with abnormalities of thyroid development or other midline defects. [Practice more UPSC-CMS 2017 questions on OnCourse]

Q: A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from:

Carcinoma head of pancreas. A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from: ***Carcinoma head of pancreas*** - The classic triad of **painless progressive jaundice**, **weight loss**, and a **palpable, non-tender gallbladder** (Courvoisier's sign) strongly indicates carcinoma of the head of the pancreas due to obstruction of the common bile duct [1]. - The high serum bilirubin value further supports a severe obstructive process, typical of a pancreatic head mass compressing the bile duct [1]. *Carcinoma stomach* - Carcinoma of the stomach typically presents with upper abdominal pain, dyspepsia, early satiety, and weight loss, but **jaundice is rare** unless there is extensive metastasis to the liver or porta hepatis. - It usually does not directly lead to **obstructive jaundice** with a palpable gallbladder, as the tumor's location is remote from the common bile duct. *Choledocholithiasis* - While choledocholithiasis can cause obstructive jaundice, it is often associated with **pain** (biliary colic) and fluctuating jaundice rather than the painless, progressive pattern described. - A gallbladder obstructed by a stone would typically be **tender** if inflamed, or decompressed if the obstruction is intermittent, rather than smooth and non-tender due to chronic distal obstruction. *Klatskin tumour* - A Klatskin tumor (hilar cholangiocarcinoma) causes obstructive jaundice, but it typically obstructs the bile ducts above the cystic duct insertion, meaning the **gallbladder would usually be decompressed and non-palpable** [2]. - These tumors often present with **jaundice and itching**, but the presence of a palpable gallbladder makes a pancreatic head mass more likely [2]. [Practice more UPSC-CMS 2017 questions on OnCourse]

Q: Which of the following is NOT true regarding ‘Renal Carbuncle’?

It is a type of renal tuberculosis. A **renal carbuncle** is essentially a **renal abscess** caused by bacterial infection, typically *Staphylococcus aureus* or *Escherichia coli*, not *Mycobacterium tuberculosis*. Renal tuberculosis manifests differently, often with **sterile pyuria** and granulomatous inflammation, and is not synonymous with a carbuncle. Patients with **diabetes mellitus** are at an increased risk of developing bacterial infections, including **renal carbuncles**, due to impaired immune function and glucose-rich urine. Poorly controlled diabetes is a significant **predisposing factor** for severe renal infections. **Intravenous drug users** are at higher risk of bloodstream infections, including **septic emboli** that can disseminate to the kidneys and form renal carbuncles. **Skin contaminants** and unsterile injection practices can introduce bacteria into the bloodstream that eventually localize in renal tissue. A **renal carbuncle** is defined as a focal collection of **pus** and necrotic tissue within the renal parenchyma, essentially a **renal abscess**. It results from the **hematogenous spread** of bacteria or, less commonly, from an ascending urinary tract infection [1]. [Practice more UPSC-CMS 2017 questions on OnCourse]

Q: An eight year old male child complains of severe pain in right testis. The most probable diagnosis is

Torsion of right testis. ***Torsion of right testis*** - **Testicular torsion** typically presents with sudden onset **severe unilateral testicular pain** in pre-pubertal boys, as described. - This condition is an emergency requiring prompt surgical intervention to preserve testicular viability, making it the most probable diagnosis for severe pain in a child's testis. *Acute epididymo-orchitis* - While causing testicular pain, **epididymo-orchitis** typically has a more gradual onset and is often associated with symptoms like **fever** and **dysuria**, which are not mentioned. - It usually occurs in older adolescents or adults and is less common in an 8-year-old without predisposing factors like a urinary tract infection. *Strangulated Inguinal hernia* - A **strangulated inguinal hernia** would present with an acutely painful, irreducible groin or scrotal swelling, often accompanied by signs of **bowel obstruction**. - While it can cause pain radiating to the testis, primary severe testicular pain without a palpable groin mass points away from this diagnosis. *Undescended testis* - An **undescended testis** (cryptorchidism) is a condition where the testis has not descended into the scrotum; it typically presents as an empty scrotum or a palpable mass in the inguinal canal. - It is usually **painless** unless undergoing torsion or developing malignancy, and severe acute pain as the primary symptom would be unusual for an uncomplicated undescended testis. [Practice more UPSC-CMS 2017 questions on OnCourse]

Q: Which one of the following statements is NOT correct regarding Gastroschisis?

It is a ruptured exomphalos. ***It is a ruptured exomphalos*** - This statement is incorrect because **gastroschisis** and **exomphalos (omphalocele)** are distinct congenital abdominal wall defects, and gastroschisis is not a ruptured form of exomphalos. - Gastroschisis involves a **full-thickness abdominal wall defect** with direct extrusion of bowel, while exomphalos involves herniation of abdominal contents into the base of the umbilical cord, covered by a membrane. *Gut has herniated through a defect to right of umbilicus* - Gastroschisis is typically characterized by a **paraumbilical defect**, almost always located to the **right of the umbilical cord**. - This anatomical location is a key differentiator from exomphalos, where the defect is at the central umbilical ring. *Normally limited to midgut* - The herniated contents in gastroschisis are predominantly the **small bowel (midgut)**, though other organs like the large bowel, stomach, or liver can occasionally be involved. - The limited involvement of other organs is a differentiating factor from an exomphalos, which can contain a wider array of abdominal viscera. *There is no covering membrane* - A defining feature of gastroschisis is the **absence of a peritoneal sac or covering membrane** over the herniated intestines. - This lack of protection exposes the bowel to amniotic fluid, leading to inflammation and a thickened, matted appearance of the bowel loops. [Practice more UPSC-CMS 2017 questions on OnCourse]

115 Previous Year Questions with Answers & Explanations

115

Questions

Subjects

All (115)Anatomy (4)Anesthesiology (1)Biochemistry (1)Community Medicine (36)Dermatology (2)Internal Medicine (8)Microbiology (2)Obstetrics and Gynecology (26)Ophthalmology (2)Pathology (4)Pediatrics (1)Pharmacology (3)Physiology (2)Surgery (23)

Anatomy

1 questions

The external opening of branchial fistula is present in :

Internal Medicine

2 questions

A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from:

Which of the following is NOT true regarding ‘Renal Carbuncle’?

UPSC-CMS 2017 - Internal Medicine UPSC-CMS Practice Questions and MCQs

Question 1: A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from:

A. Carcinoma head of pancreas (Correct Answer)
B. Carcinoma stomach
C. Choledocholithiasis
D. Klatskin tumour

Explanation: A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from: ***Carcinoma head of pancreas*** - The classic triad of **painless progressive jaundice**, **weight loss**, and a **palpable, non-tender gallbladder** (Courvoisier's sign) strongly indicates carcinoma of the head of the pancreas due to obstruction of the common bile duct [1]. - The high serum bilirubin value further supports a severe obstructive process, typical of a pancreatic head mass compressing the bile duct [1]. *Carcinoma stomach* - Carcinoma of the stomach typically presents with upper abdominal pain, dyspepsia, early satiety, and weight loss, but **jaundice is rare** unless there is extensive metastasis to the liver or porta hepatis. - It usually does not directly lead to **obstructive jaundice** with a palpable gallbladder, as the tumor's location is remote from the common bile duct. *Choledocholithiasis* - While choledocholithiasis can cause obstructive jaundice, it is often associated with **pain** (biliary colic) and fluctuating jaundice rather than the painless, progressive pattern described. - A gallbladder obstructed by a stone would typically be **tender** if inflamed, or decompressed if the obstruction is intermittent, rather than smooth and non-tender due to chronic distal obstruction. *Klatskin tumour* - A Klatskin tumor (hilar cholangiocarcinoma) causes obstructive jaundice, but it typically obstructs the bile ducts above the cystic duct insertion, meaning the **gallbladder would usually be decompressed and non-palpable** [2]. - These tumors often present with **jaundice and itching**, but the presence of a palpable gallbladder makes a pancreatic head mass more likely [2].

Question 2: Which of the following is NOT true regarding ‘Renal Carbuncle’?

A. It occurs in diabetic patient
B. It occurs in intravenous drug abusers
C. It is a type of renal tuberculosis (Correct Answer)
D. It is an abscess in renal parenchyma

Explanation: A **renal carbuncle** is essentially a **renal abscess** caused by bacterial infection, typically *Staphylococcus aureus* or *Escherichia coli*, not *Mycobacterium tuberculosis*. Renal tuberculosis manifests differently, often with **sterile pyuria** and granulomatous inflammation, and is not synonymous with a carbuncle. Patients with **diabetes mellitus** are at an increased risk of developing bacterial infections, including **renal carbuncles**, due to impaired immune function and glucose-rich urine. Poorly controlled diabetes is a significant **predisposing factor** for severe renal infections. **Intravenous drug users** are at higher risk of bloodstream infections, including **septic emboli** that can disseminate to the kidneys and form renal carbuncles. **Skin contaminants** and unsterile injection practices can introduce bacteria into the bloodstream that eventually localize in renal tissue. A **renal carbuncle** is defined as a focal collection of **pus** and necrotic tissue within the renal parenchyma, essentially a **renal abscess**. It results from the **hematogenous spread** of bacteria or, less commonly, from an ascending urinary tract infection [1].

Surgery

7 questions

An eight year old male child complains of severe pain in right testis. The most probable diagnosis is

Which one of the following statements is NOT correct regarding Gastroschisis?

Heineke‐Mikulicz operation is done for:

A 32 year old female underwent laparoscopic cholecystectomy which was difficult. On her second post operative day, she develops jaundice. Her LFT parameters show serum bilirubin 6.8 mg/dL; direct bilirubin 5.6 and indirect bilirubin 1.2 mg/dL; and serum alkaline phosphatase 1226 IU/L. She is most likely suffering from obstructive jaundice due to:

A 23-year-old male riding his motorcycle meets with a road accident. He is tachypnoeic with HR 110/min and BP 112/74 mmHg. On examination, he appears pale and has tenderness over the left side of chest with dullness to percussion. There is slight mediastinal shift to the opposite side. Abdominal examination is unremarkable. Most probably he is suffering from:

Mondor’s disease is

Anderson‐Hynes operation is performed for:

UPSC-CMS 2017 - Surgery UPSC-CMS Practice Questions and MCQs

Question 1: An eight year old male child complains of severe pain in right testis. The most probable diagnosis is

A. Acute epididymo-orchitis
B. Torsion of right testis (Correct Answer)
C. Strangulated Inguinal hernia
D. Undescended testis

Explanation: ***Torsion of right testis*** - **Testicular torsion** typically presents with sudden onset **severe unilateral testicular pain** in pre-pubertal boys, as described. - This condition is an emergency requiring prompt surgical intervention to preserve testicular viability, making it the most probable diagnosis for severe pain in a child's testis. *Acute epididymo-orchitis* - While causing testicular pain, **epididymo-orchitis** typically has a more gradual onset and is often associated with symptoms like **fever** and **dysuria**, which are not mentioned. - It usually occurs in older adolescents or adults and is less common in an 8-year-old without predisposing factors like a urinary tract infection. *Strangulated Inguinal hernia* - A **strangulated inguinal hernia** would present with an acutely painful, irreducible groin or scrotal swelling, often accompanied by signs of **bowel obstruction**. - While it can cause pain radiating to the testis, primary severe testicular pain without a palpable groin mass points away from this diagnosis. *Undescended testis* - An **undescended testis** (cryptorchidism) is a condition where the testis has not descended into the scrotum; it typically presents as an empty scrotum or a palpable mass in the inguinal canal. - It is usually **painless** unless undergoing torsion or developing malignancy, and severe acute pain as the primary symptom would be unusual for an uncomplicated undescended testis.

Question 2: Which one of the following statements is NOT correct regarding Gastroschisis?

A. Gut has herniated through a defect to right of umbilicus
B. Normally limited to midgut
C. It is a ruptured exomphalos (Correct Answer)
D. There is no covering membrane

Explanation: ***It is a ruptured exomphalos*** - This statement is incorrect because **gastroschisis** and **exomphalos (omphalocele)** are distinct congenital abdominal wall defects, and gastroschisis is not a ruptured form of exomphalos. - Gastroschisis involves a **full-thickness abdominal wall defect** with direct extrusion of bowel, while exomphalos involves herniation of abdominal contents into the base of the umbilical cord, covered by a membrane. *Gut has herniated through a defect to right of umbilicus* - Gastroschisis is typically characterized by a **paraumbilical defect**, almost always located to the **right of the umbilical cord**. - This anatomical location is a key differentiator from exomphalos, where the defect is at the central umbilical ring. *Normally limited to midgut* - The herniated contents in gastroschisis are predominantly the **small bowel (midgut)**, though other organs like the large bowel, stomach, or liver can occasionally be involved. - The limited involvement of other organs is a differentiating factor from an exomphalos, which can contain a wider array of abdominal viscera. *There is no covering membrane* - A defining feature of gastroschisis is the **absence of a peritoneal sac or covering membrane** over the herniated intestines. - This lack of protection exposes the bowel to amniotic fluid, leading to inflammation and a thickened, matted appearance of the bowel loops.

Question 3: Heineke‐Mikulicz operation is done for:

A. Pyloric stenosis (Correct Answer)
B. Ureteric stricture
C. Urethral stricture
D. Stricture common bile duct

Explanation: ***Pyloric stenosis*** - The Heineke-Mikulicz pyloroplasty is a surgical procedure specifically designed to relieve obstruction in cases of **pyloric stenosis**. - This operation involves a **longitudinal incision** of the pylorus followed by a **transverse closure**, effectively widening the pyloric channel. *Ureteric stricture* - Ureteric strictures are typically treated with procedures like **ureteroplasty** (e.g., using a Foley Y-V plasty for ureteropelvic junction obstruction) or ureteral stenting, not the Heineke-Mikulicz operation. - The Heineke-Mikulicz technique is not anatomically or functionally suitable for the repair of a ureter, which is a muscular tube with distinct functions. *Urethral stricture* - Urethral strictures are managed by **urethroplasty**, which includes various techniques such as excision and primary anastomosis, or augmentation using grafts (e.g., buccal mucosa). - The Heineke-Mikulicz technique is not employed for the treatment of urethral strictures, which have different anatomical and surgical considerations. *Stricture common bile duct* - Common bile duct strictures are usually treated with procedures like **choledochoduodenostomy** or **choledochojejunostomy** (bile duct bypass) or endoscopic techniques like balloon dilation and stent placement. - The Heineke-Mikulicz operation is a pyloroplasty that is not applicable to the common bile duct, given its different anatomical location and physiological role.

Question 4: A 32 year old female underwent laparoscopic cholecystectomy which was difficult. On her second post operative day, she develops jaundice. Her LFT parameters show serum bilirubin 6.8 mg/dL; direct bilirubin 5.6 and indirect bilirubin 1.2 mg/dL; and serum alkaline phosphatase 1226 IU/L. She is most likely suffering from obstructive jaundice due to:

A. Hepatocellular carcinoma
B. Carcinoma gallbladder
C. Carcinoma head of pancreas
D. Bile duct injury (Correct Answer)

Explanation: ***Bile duct injury*** - The patient developed jaundice two days after a "difficult" laparoscopic cholecystectomy, which is a common context for **iatrogenic bile duct injury**. - The lab results show **predominantly direct (conjugated) hyperbilirubinemia** and a significantly **elevated alkaline phosphatase**, highly indicative of extrahepatic **obstructive jaundice**. *Hepatocellular carcinoma* - This is unlikely given the **acute onset of jaundice** two days post-surgery; hepatocellular carcinoma typically presents with a more ** insidious onset** and features of chronic liver disease. - While it can cause obstructive jaundice, it is usually due to large masses compressing bile ducts or tumor thrombus in the portal vein, which doesn't fit the immediate postoperative timing. *Carcinoma gallbladder* - Gallbladder carcinoma can cause obstructive jaundice by invading or compressing the bile ducts, but it usually presents with more **chronic symptoms** and is rare in a 32-year-old. - The acute onset immediately following surgery makes an **iatrogenic cause** much more probable than a newly diagnosed cancer. *Carcinoma head of pancreas* - Pancreatic head carcinoma causes **obstructive jaundice** by compressing the common bile duct, but similar to other cancers, it presents more chronically with **weight loss**, **abdominal pain**, and potentially **pancreatitis**. - An acute presentation **post-cholecystectomy** in a young patient is not typical for this diagnosis.

Question 5: A 23-year-old male riding his motorcycle meets with a road accident. He is tachypnoeic with HR 110/min and BP 112/74 mmHg. On examination, he appears pale and has tenderness over the left side of chest with dullness to percussion. There is slight mediastinal shift to the opposite side. Abdominal examination is unremarkable. Most probably he is suffering from:

A. Tension pneumothorax
B. Subcutaneous emphysema
C. Haemothorax (Correct Answer)
D. Tracheal rupture

Explanation: **Haemothorax** - **Dullness to percussion** on the left side of the chest, combined with symptoms of **hypovolemia** (pale, HR 110/min, BP 112/74 mmHg), strongly suggests blood accumulation in the pleural space. - **Slight mediastinal shift** to the opposite side is consistent with a large volume of blood pushing the mediastinum, though it's typically more pronounced in tension pneumothorax. *Tension pneumothorax* - Characterized by **hyperresonance** to percussion, not dullness, as air accumulates in the pleural space. - Would present with marked **tracheal deviation**, **severe respiratory distress**, and often severe hypotension due to impaired cardiac output. *Subcutaneous emphysema* - Identified by **crepitus** (crackling sensation) on palpation due to air in the subcutaneous tissues. - While it can be associated with chest trauma, it does not explain the dullness to percussion or the systemic signs of blood loss. *Tracheal rupture* - Typically presents with **severe subcutaneous emphysema**, **dyspnea**, **hoarseness**, and possibly a **pneumomediastinum**. - Does not directly cause dullness to percussion in the pleural space or explain the significant signs of blood loss.

Question 6: Mondor’s disease is

A. Multiple breast cysts
B. Eczema of nipple and areola
C. Thrombophlebitis of superficial veins of breast (Correct Answer)
D. Lymphangitis of mammary lymphatics

Explanation: ***Thrombophlebitis of superficial veins of breast*** - Mondor's disease is characterized by **thrombophlebitis**, which is inflammation and clotting, of the **superficial veins of the breast** and sometimes the chest wall. - It often manifests as a **palpable, tender cord-like structure** under the skin. *Multiple breast cysts* - This condition involves the presence of **fluid-filled sacs** within the breast tissue, which can be palpable but do not present as a classic cord-like structure. - Cysts are typically smooth, mobile, and can fluctuate in size with the **menstrual cycle**, unlike Mondor's disease. *Eczema by nipple and areola* - This refers to an **inflammatory skin condition** affecting the **nipple and areola**, characterized by redness, itching, scaling, and sometimes oozing. - It is a **dermatological issue** and does not involve vascular clotting or a palpable cord. *Lymphangitis of mammary lymphatics* - **Lymphangitis** is the inflammation of **lymphatic vessels**, often presenting as red streaks and tenderness. - While it can affect the breast, it involves the **lymphatic system** rather than the superficial venous system and would not typically present as a thrombosed vessel.

Question 7: Anderson‐Hynes operation is performed for:

A. Pseudo-pancreatic cyst
B. Achalasia cardia
C. Pelvi-ureteric junction obstruction (Correct Answer)
D. Pyloric stenosis

Explanation: ***Pelvi-ureteric junction obstruction*** - The **Anderson-Hynes pyeloplasty** is a widely used surgical procedure to correct obstruction at the **pelvi-ureteric junction (PUJ)**. - This operation involves **resecting the stenotic (narrowed) or obstructed part of the renal pelvis and ureter** and then rejoining the healthy segments to restore normal urine flow. *Pseudo-pancreatic cyst* - Management of a **pseudopancreatic cyst** typically involves percutaneous drainage, endoscopic transmural drainage, or surgical cyst-gastrostomy or cyst-jejunostomy. - The **Anderson-Hynes operation** is not indicated for this condition, which is a complication of pancreatitis. *Achalasia cardia* - **Achalasia cardia** is a disorder of esophageal motility, primarily treated with procedures like **Heller myotomy** (surgical cutting of the lower esophageal sphincter muscle) or pneumatic dilation. - The **Anderson-Hynes procedure** is entirely unrelated to the esophagus or its disorders. *Pyloric stenosis* - **Pyloric stenosis** in infants is generally treated with a **Ramstedt pyloromyotomy**, which involves surgically incising the hypertrophied pyloric muscle without opening the mucosa. - This condition involves the stomach outlet, and therefore, the **Anderson-Hynes operation** is not relevant.