UPSC-CMS 2017 Practice Questions

Q: Which of the following is NOT considered as an indicator of adequate fluid resuscitation?

Respiratory rate. ***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.

Q: 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:

Pseudocyst pancreas. 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].

Q: Which of the following is NOT a symptom of atherosclerotic occlusive disease at the bifurcation of aorta (Leriche syndrome)?

Claudication of the calf. ***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].

Q: An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?

Gonorrhoea. ***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**.

Q: 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:

Retinal detachment. ***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.

Q: What is the most common malignant tumour of eyelid?

Basal cell cancer. ***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.

Q: Which of the following factors is labelled as cytokine in the pathogenesis of Systemic Inflammatory Response Syndrome (SIRS)?

Tumor necrosis factor. ***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.

Q: Pringle's manoeuvre is done to stop bleeding at:

Hepatoduodenal ligament. ***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.

Q: Vocal cord palsy after thyroid surgery is due to injury to:

Recurrent laryngeal nerve. ***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.

Question 1

Which of the following is NOT considered as an indicator of adequate fluid resuscitation?

Accepted Answer

Respiratory rate

Answer

Pulse

Answer

Urine output

Answer

Blood pressure

Question 2

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:

Accepted Answer

Pseudocyst pancreas

Answer

Cancer colon

Answer

Splenic cyst

Answer

Cancer stomach

Question 3

Which of the following is NOT a symptom of atherosclerotic occlusive disease at the bifurcation of aorta (Leriche syndrome)?

Accepted Answer

Claudication of the calf

Answer

Sexual impotence

Answer

Claudication of the buttock and thigh

Answer

Gangrene localised to the feet

Question 4

An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?

Accepted Answer

Gonorrhoea

Answer

Trichomoniasis

Answer

Syphilis

Answer

Candidiasis

Question 5

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:

Accepted Answer

Retinal detachment

Answer

Vitreous haemorrhage

Answer

Acute onset ptosis

Answer

Intracranial haemorrhage

Question 6

What is the most common malignant tumour of eyelid?

Accepted Answer

Basal cell cancer

Answer

Sebaceous gland carcinoma

Answer

Squamous cell carcinoma

Answer

Melanoma

Question 7

Which of the following factors is labelled as cytokine in the pathogenesis of Systemic Inflammatory Response Syndrome (SIRS)?

Accepted Answer

Tumor necrosis factor

Answer

Leukotrienes

Answer

Nitric oxide

Answer

Complements

Question 8

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?

Accepted Answer

CECT to stage disease

Answer

Surgery

Answer

Radiotherapy

Answer

Chemotherapy

Question 9

Pringle's manoeuvre is done to stop bleeding at:

Accepted Answer

Hepatoduodenal ligament

Answer

Splenic artery

Answer

Renal artery

Answer

Left gastric artery

Question 10

Vocal cord palsy after thyroid surgery is due to injury to:

Accepted Answer

Recurrent laryngeal nerve

Answer

Vagus nerve

Answer

Superior laryngeal nerve

Answer

Ansa cervicalis

UPSC-CMS 2017

Anesthesiology

Internal Medicine

Obstetrics and Gynecology

Ophthalmology

Pathology

Surgery