Anesthesiology
1 questionsWhich of the following is NOT considered as an indicator of adequate fluid resuscitation?
UPSC-CMS 2017 - Anesthesiology UPSC-CMS Practice Questions and MCQs
Question 31: Which of the following is NOT considered as an indicator of adequate fluid resuscitation?
- A. Pulse
- B. Respiratory rate (Correct Answer)
- C. Urine output
- D. Blood pressure
Explanation: ***Respiratory rate*** - While an *elevated respiratory rate* can indicate *hypovolemia* or other systemic stress, it is a **less specific** and less direct indicator of the adequacy of *fluid resuscitation* compared to *perfusion parameters*. - Changes in *respiratory rate* can be influenced by many factors such as *pain*, *anxiety*, *metabolic acidosis*, and primary *pulmonary issues*, making it less reliable for guiding *fluid therapy*. *Pulse* - A *decreasing pulse rate* and *improving pulse quality* (becoming stronger and less thready) are good indicators of **improved cardiac output** and *volume status* during *fluid resuscitation*. - A *persistently high* or *weak pulse* suggests ongoing *hypovolemia* or inadequate *fluid replacement*. *Urine output* - *Adequate urine output* (typically >0.5 mL/kg/hr in adults) is a critical indicator of **sufficient renal perfusion** and overall *systemic hydration*. - A *rising urine output* after *fluid administration* signifies that organs are receiving adequate blood flow and *fluid balance* is improving. *Blood pressure* - An *increasing blood pressure*, particularly improvement in *mean arterial pressure*, directly reflects **better systemic perfusion** and resolution of *hypotension* caused by *hypovolemia*. - Normalization of *blood pressure* indicates that the *circulatory volume* is adequate to maintain vital organ function.
Internal Medicine
2 questionsA 35 year old woman presented with a lump in her upper abdomen for two months which was slightly increasing. She also complained of early satiety. She gave a history of acute severe pain in upper abdomen for which she was admitted in hospital for 10 days, about three months ago. On examination, the mass was firm, smooth surfaced and not moving with respiration. She was most likely suffering from:
Which of the following is NOT a symptom of atherosclerotic occlusive disease at the bifurcation of aorta (Leriche syndrome)?
UPSC-CMS 2017 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 31: A 35 year old woman presented with a lump in her upper abdomen for two months which was slightly increasing. She also complained of early satiety. She gave a history of acute severe pain in upper abdomen for which she was admitted in hospital for 10 days, about three months ago. On examination, the mass was firm, smooth surfaced and not moving with respiration. She was most likely suffering from:
- A. Pseudocyst pancreas (Correct Answer)
- B. Cancer colon
- C. Splenic cyst
- D. Cancer stomach
Explanation: Pseudocyst pancreas - The history of **acute severe upper abdominal pain** followed by a progressively enlarging, firm, smooth-surfaced upper abdominal mass points strongly towards a pancreatic pseudocyst, a common complication of **pancreatitis** [1]. - **Early satiety** can occur due to the mass effect of the pseudocyst compressing the stomach [1]. *Cancer colon* - A rapidly growing upper abdominal mass is **not a typical presentation** of colon cancer, which usually presents with changes in bowel habits, rectal bleeding, or weight loss. - Colon cancer does not typically cause a history of **acute, severe generalized abdominal pain** preceding mass formation in this manner. *Splenic cyst* - While a splenic cyst could present as an abdominal mass, it is **less likely to follow a history of acute severe abdominal pain** (unless trauma-related). - A history of acute pancreatitis is a strong indicator away from a splenic cyst as the primary diagnosis [1]. *Cancer stomach* - Gastric cancer can present with early satiety and an upper abdominal mass, but the specific history of **acute severe pain followed by a mass** is less characteristic of gastric cancer's typical insidious onset. - The "firm, smooth surfaced, not moving with respiration" description, especially in the context of prior pancreatitis, is more aligned with a **pancreatic pseudocyst** [1].
Question 32: Which of the following is NOT a symptom of atherosclerotic occlusive disease at the bifurcation of aorta (Leriche syndrome)?
- A. Claudication of the calf (Correct Answer)
- B. Sexual impotence
- C. Claudication of the buttock and thigh
- D. Gangrene localised to the feet
Explanation: ***Claudication of the calf*** - In Leriche syndrome, the occlusion is at the **aortic bifurcation**, affecting blood flow to the iliac arteries and their branches, typically presenting with **buttock and thigh claudication** [1]. - **Calf claudication** alone is usually indicative of more distal occlusive disease, such as in the popliteal or tibial arteries, and not typically the primary or most characteristic symptom of Leriche syndrome [1]. *Sexual impotence* - **Atherosclerotic occlusive disease** at the aortic bifurcation often reduces blood flow to the internal iliac arteries, which supply the penile arteries. - This results in **erectile dysfunction** due to insufficient blood supply during erection, making sexual impotence a characteristic symptom of Leriche syndrome. *Claudication of the buttock and thigh* - The partial or complete blockage of the **aortic bifurcation** impairs blood flow to both common iliac arteries, leading to ischemia in the major muscle groups of the buttocks and thighs [1]. - This **ischemia** manifests as pain, cramping, or fatigue during exercise, which is relieved by rest, making it a classic symptom of Leriche syndrome [1]. *Gangrene localised to the feet* - Severe and chronic **ischemia** resulting from significant atherosclerotic occlusion at the aortic bifurcation can lead to critical limb ischemia, especially in the lower extremities [1]. - Reduced blood flow to the feet can cause tissue necrosis, ultimately leading to **gangrene**, particularly in advanced stages of Leriche syndrome [1].
Obstetrics and Gynecology
1 questionsAn infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?
UPSC-CMS 2017 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 31: An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?
- A. Trichomoniasis
- B. Gonorrhoea (Correct Answer)
- C. Syphilis
- D. Candidiasis
Explanation: ***Gonorrhoea*** - This presentation, including **yellow/green vaginal discharge**, a **Bartholin cyst**, and **proctitis**, is highly suggestive of **gonorrhoea**. - *Neisseria gonorrhoeae* can cause inflammation in these specific areas and is a known cause of **infertility** due to pelvic inflammatory disease. *Trichomoniasis* - Characterized by a **frothy, foul-smelling, yellow-green discharge** and often involves **cervical petechiae** (strawberry cervix). - While it causes vaginal discharge, **Bartholin cysts** and **proctitis** are not typical features. *Syphilis* - The primary stage presents as a **painless chancre**, secondary syphilis involves a **rash** and **lymphadenopathy**, and tertiary syphilis has severe organ involvement. - It does not typically present with the specific combination of **Bartholin cyst**, vaginal discharge, and **proctitis**. *Candidiasis* - Causes a **thick, white, "cottage cheese-like" discharge** associated with significant **pruritus** and **vaginal irritation**. - It does not typically lead to **Bartholin cysts** or **proctitis**.
Ophthalmology
2 questionsWhile working in a primary health centre, an elderly patient presents with a history of sudden loss of vision and curtain falling sensation in one eye. This symptom is highly suggestive that the patient has the following condition:
What is the most common malignant tumour of eyelid?
UPSC-CMS 2017 - Ophthalmology UPSC-CMS Practice Questions and MCQs
Question 31: While working in a primary health centre, an elderly patient presents with a history of sudden loss of vision and curtain falling sensation in one eye. This symptom is highly suggestive that the patient has the following condition:
- A. Retinal detachment (Correct Answer)
- B. Vitreous haemorrhage
- C. Acute onset ptosis
- D. Intracranial haemorrhage
Explanation: ***Retinal detachment*** - The classic description of **sudden loss of vision** accompanied by a **"curtain falling" sensation** is highly characteristic of **rhegmatogenous retinal detachment**. - This occurs when the **neurosensory retina** separates from the **retinal pigment epithelium**, often leading to a **progressive visual field defect** as the detachment spreads. - This is an **ophthalmic emergency** requiring urgent referral for surgical intervention. *Vitreous haemorrhage* - A **vitreous haemorrhage** typically causes sudden, painless decrease in vision, often described as **floaters**, cobwebs, or a diffuse haze. - While it can impair vision significantly, it does not usually present with the specific "curtain falling" sensation that indicates a progressive visual field loss from the periphery. *Acute onset ptosis* - **Ptosis** refers to the drooping of the upper eyelid and directly affects the field of vision by physically obstructing the eye. - While it causes a reduction in the visual field, it is a physical obstruction and not typically described as a "curtain falling" sensation within the eye itself. *Intracranial haemorrhage* - An **intracranial haemorrhage** can cause various neurological deficits, including visual disturbances like **hemianopia** or **homonymous defects**, depending on the location of the bleed. - However, sudden unilateral vision loss with a "curtain falling" sensation localized to one eye is not a typical direct initial presentation, which would suggest an ocular rather than a neurological cause.
Question 32: What is the most common malignant tumour of eyelid?
- A. Sebaceous gland carcinoma
- B. Squamous cell carcinoma
- C. Melanoma
- D. Basal cell cancer (Correct Answer)
Explanation: ***Basal cell cancer*** - **Basal cell carcinoma (BCC)** is by far the most common malignant tumor of the eyelid, accounting for approximately **90% of all eyelid malignancies**. - It typically appears as a **slow-growing nodule** with rolled borders, central ulceration, and telangiectasias, most commonly affecting the **lower eyelid and medial canthus**. - BCC is strongly associated with **chronic UV radiation exposure** and rarely metastasizes, but can cause significant local tissue destruction if untreated. *Sebaceous gland carcinoma* - **Sebaceous gland carcinoma** (also known as meibomian gland carcinoma) is a rare but aggressive malignant tumor arising from the sebaceous glands of the eyelid. - It accounts for approximately **1-5% of eyelid malignancies** and has a higher risk of metastasis compared to BCC. - More common in **Asian populations** and often masquerades as chronic blepharoconjunctivitis, leading to delayed diagnosis. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** is the **second most common** malignant eyelid tumor, accounting for approximately **5-10% of cases**. - It presents as a firm, erythematous nodule or plaque and has a higher metastatic potential than BCC. - Associated with **UV exposure, HPV infection**, and immunosuppression. *Melanoma* - **Melanoma** is a rare malignant tumor of the eyelid, accounting for less than **1% of eyelid malignancies**. - It arises from melanocytes and carries a significant risk of metastasis and mortality. - Presents as a pigmented lesion with irregular borders, but amelanotic variants can also occur.
Pathology
1 questionsWhich of the following factors is labelled as cytokine in the pathogenesis of Systemic Inflammatory Response Syndrome (SIRS)?
UPSC-CMS 2017 - Pathology UPSC-CMS Practice Questions and MCQs
Question 31: Which of the following factors is labelled as cytokine in the pathogenesis of Systemic Inflammatory Response Syndrome (SIRS)?
- A. Leukotrienes
- B. Nitric oxide
- C. Complements
- D. Tumor necrosis factor (Correct Answer)
Explanation: ***Tumor necrosis factor*** - **Tumor necrosis factor (TNF-α)** is a prominent pro-inflammatory cytokine and a key mediator in the pathogenesis of **Systemic Inflammatory Response Syndrome (SIRS)** [1]. - It plays a crucial role in initiating and amplifying the inflammatory cascade, leading to systemic effects like fever, increased vascular permeability, and tissue damage [1]. *Leukotrienes* - **Leukotrienes** are lipid mediators derived from arachidonic acid, involved in inflammation and allergic reactions [1]. - They are not classified as **cytokines**, which are protein signaling molecules [1]. *Nitric oxide* - **Nitric oxide (NO)** is a gaseous signaling molecule with various physiological roles, including vasodilation and neurotransmission. - While it contributes to the pathophysiology of SIRS, particularly in regulating vascular tone, it is not a **cytokine**. *Complements* - **Complements** are a system of plasma proteins that are part of the innate immune response, helping to clear pathogens [1]. - They participate in inflammation but are distinct from **cytokines**, which are regulatory proteins [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 93-101.
Surgery
3 questionsIn a 65 year old, double contrast barium enema shows cancer of colon with an apple core appearance. Colonoscopic biopsy shows adenocarcinoma. What will be the next step of management?
Pringle's manoeuvre is done to stop bleeding at:
Vocal cord palsy after thyroid surgery is due to injury to:
UPSC-CMS 2017 - Surgery UPSC-CMS Practice Questions and MCQs
Question 31: In a 65 year old, double contrast barium enema shows cancer of colon with an apple core appearance. Colonoscopic biopsy shows adenocarcinoma. What will be the next step of management?
- A. Surgery
- B. Radiotherapy
- C. Chemotherapy
- D. CECT to stage disease (Correct Answer)
Explanation: ***CECT to stage disease*** - **CECT (Contrast-Enhanced CT) of chest, abdomen, and pelvis is the essential next step** after histological confirmation of colon adenocarcinoma. - **Staging is mandatory** before any treatment decision to determine: - **Local extent** of tumor (T stage) - **Lymph node involvement** (N stage) - **Distant metastases** (M stage - liver, lungs, peritoneum) - **Resectability** and surgical planning - Even with the "apple core" appearance indicating an advanced primary tumor, **treatment decisions cannot be made without knowing the overall disease burden**. - **CEA (Carcinoembryonic Antigen) levels** are also typically obtained during staging. *Surgery* - **Surgical resection is the definitive treatment** for localized, resectable colon cancer and would be performed **after staging**, not before. - Surgery involves removing the tumor with adequate margins and regional lymphadenectomy. - However, **staging must precede surgery** to: - Determine if the disease is metastatic (which would change surgical approach) - Plan the extent of resection - Counsel the patient appropriately - Decide on neoadjuvant therapy if indicated - The "apple core" appearance suggests an advanced primary but does not indicate acute obstruction requiring emergency surgery in this stable patient who has already undergone barium enema and colonoscopy. *Chemotherapy* - **Chemotherapy** is typically given as: - **Adjuvant therapy** after surgery for stage III (node-positive) or high-risk stage II disease - **Palliative therapy** for metastatic (stage IV) disease - **Neoadjuvant therapy** is not standard for colon cancer (unlike rectal cancer) - Chemotherapy is not the immediate next step; staging and then surgery (if resectable) come first. *Radiotherapy* - **Radiotherapy has limited role in colon cancer** (unlike rectal cancer where it is commonly used). - It may be used for: - **Palliation** of symptoms (pain, bleeding) in advanced disease - Rare cases of **locally advanced unresectable disease** - It is not a primary treatment modality and is not the next step in this case.
Question 32: Pringle's manoeuvre is done to stop bleeding at:
- A. Hepatoduodenal ligament (Correct Answer)
- B. Splenic artery
- C. Renal artery
- D. Left gastric artery
Explanation: ***Hepatoduodenal ligament*** - **Pringle's manoeuvre** involves clamping the **hepatoduodenal ligament** to temporarily occlude the hepatic artery and portal vein, which are the main blood supply to the liver. - This maneuver is used during **liver surgery** to control or prevent bleeding from the liver parenchyma. *Splenic artery* - The **splenic artery** supplies the spleen and is not directly occluded by Pringle's manoeuvre. - Bleeding from the splenic artery would require direct clamping or **ligation** of that vessel, not compression of the hepatoduodenal ligament. *Renal artery* - The **renal artery** supplies the kidney and is located in the retroperitoneum, far from the liver and the hepatoduodenal ligament. - Pringle's manoeuvre has no effect on blood flow to the kidneys. *Left gastric artery* - The **left gastric artery** supplies the stomach and is a branch of the celiac trunk, which is proximal to the points of compression in Pringle's manoeuvre. - While it is part of the systemic circulation, Pringle's manoeuvre is specific to the blood supply entering the liver via the hepatoduodenal ligament, not individual gastric vessels.
Question 33: Vocal cord palsy after thyroid surgery is due to injury to:
- A. Vagus nerve
- B. Superior laryngeal nerve
- C. Recurrent laryngeal nerve (Correct Answer)
- D. Ansa cervicalis
Explanation: ***Recurrent laryngeal nerve*** - The **recurrent laryngeal nerves** innervate all intrinsic muscles of the larynx except the cricothyroid muscle, which are responsible for vocal cord movement. - Injury to this nerve during thyroid surgery leads to **vocal cord palsy**, causing hoarseness or aphonia. *Vagus nerve* - The **vagus nerve** is the main trunk from which the recurrent laryngeal nerve branches, but direct injury to the vagus itself is less common in thyroid surgery and would cause widespread symptoms beyond just vocal cord palsy. - Vagus nerve injury would also affect other structures in the neck, thorax, and abdomen, reflecting its broad autonomic and motor functions. *Superior laryngeal nerve* - The **superior laryngeal nerve** innervates the **cricothyroid muscle** (external branch) and provides sensation to the supraglottic larynx (internal branch). - Damage to this nerve causes changes in vocal pitch (due to paralysis of the cricothyroid muscle, which tenses the vocal cords) and problems with voice modulation, but not complete vocal cord paralysis. *Ansa cervicalis* - The **ansa cervicalis** innervates the infrahyoid muscles (strap muscles), which depress the hyoid bone and larynx. - Injury to the ansa cervicalis would affect neck movement and swallowing, but not directly cause vocal cord palsy.