Anatomy
1 questionsNormal anatomical narrowings of the ureter are present in all EXCEPT:
UPSC-CMS 2018 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 91: Normal anatomical narrowings of the ureter are present in all EXCEPT:
- A. Ureteropelvic junction
- B. Entering bladder wall
- C. Ureteric orifice
- D. Crossing the abdominal aorta (Correct Answer)
Explanation: ***Crossing the abdominal aorta*** - The ureter passes anterior to the **abdominal aorta** but this location does not represent a physiological narrowing. - While it's an anatomical relationship, it does not impede urine flow in the same manner as the other listed narrowings. *Ureteropelvic junction* - This is a well-known site of **physiological narrowing** where the renal pelvis funnels into the ureter. - It is a common site for **calculi (kidney stones)** to lodge due to its constricted lumen. *Entering bladder wall* - The ureter traverses the **wall of the bladder** obliquely, creating another physiological narrowing. - This anatomical arrangement acts as a **ureterovesical valve**, preventing vesicoureteral reflux. *Ureteric orifice* - The ureteric orifice, where the ureter opens into the bladder, is the **narrowest point** in the ureter. - This final constriction can also be a site of **stone impaction**.
ENT
1 questionsAntro-choanal polyp always arises from:
UPSC-CMS 2018 - ENT UPSC-CMS Practice Questions and MCQs
Question 91: Antro-choanal polyp always arises from:
- A. Posterior end of the septum
- B. Nasopharynx
- C. Maxillary sinus (Correct Answer)
- D. Posterior ethmoidal cells
Explanation: ***Maxillary sinus*** - An **antro-choanal polyp** (ACP) characteristically originates from the **mucosa of the maxillary sinus**, typically protruding through the ostium into the nasal cavity. - The name "antro-choanal" itself signifies its origin in the **antrum** (maxillary sinus) and its extension to the **choana** (posterior nasal aperture). *Posterior end of the septum* - Polyps do not typically arise from the **septum**; nasal polyps more commonly originate from the lateral nasal wall or paranasal sinuses. - The septum is primarily composed of cartilage and bone and does not have the same mucociliary lining susceptible to polyp formation as the sinuses. *Nasopharynx* - While an antro-choanal polyp may extend into the **nasopharynx**, it does not originate there. - The nasopharynx is a common endpoint for the polyp's growth, but its actual point of attachment is in the maxillary sinus. *Posterior ethmoidal cells* - Polyps can arise from **ethmoidal cells** (ethmoidal polyps), but these are distinct from antro-choanal polyps and do not typically grow to occupy the choana. - Ethmoidal polyps are usually multiple and bilateral, whereas antro-choanal polyps are typically solitary and unilateral.
Internal Medicine
1 questionsWhich one of the following is NOT correct regarding Adenocarcinoma of the kidney ?
UPSC-CMS 2018 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 91: Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?
- A. It may be associated with Pyrexia of unknown origin
- B. It always presents with haematuria (Correct Answer)
- C. Renal vein extention may embolize to lungs
- D. It is also called Grawitz tumour
Explanation: ***It always presents with haematuria*** - This statement is incorrect because **renal cell carcinoma** (adenocarcinoma of the kidney) often remains asymptomatic until a late stage, meaning **hematuria** is not always present, especially in early disease [1]. - While hematuria is a common symptom in later stages, occurring in about 60% of cases, its absence does not rule out the diagnosis, and many tumors are found incidentally [1]. *It may be associated with Pyrexia of unknown origin* - **Renal cell carcinoma** can produce various paraneoplastic syndromes, including **pyrexia of unknown origin (PUO)** [2]. - The tumor may release **pyrogenic cytokines** that lead to unexplained fever, making this a recognized systemic manifestation. *Renal vein extention may embolize to lungs* - **Renal cell carcinoma** has a propensity to invade the **renal vein** and extend into the inferior vena cava. - Tumor thrombi can then break off and travel to the lungs, resulting in **pulmonary embolism** of tumor cells or even macroscopic tumor emboli. *It is also called Grawitz tumour* - **Grawitz tumor** is an older, historical term used to refer to **renal cell carcinoma**, particularly the clear cell subtype. - This name originated from Paul Grawitz, who first described the tumor's histological features.
Surgery
7 questionsMainstay of an accurate diagnosis of pancreatic injury following blunt abdominal trauma is:
Pancreatic pseudocysts developing complications are best managed by?
Which one of the following regarding absorbable meshes is NOT true?
Which one of the following is NOT a surgical modality for management of femoral hernia?
“Triangle of Doom” dissected and seen during Laparoscopic inguinal hernia repair is bounded by all EXCEPT:
Paralytic ileus is a type of:
Indication of Coronary artery bypass grafting (CABG) is:
UPSC-CMS 2018 - Surgery UPSC-CMS Practice Questions and MCQs
Question 91: Mainstay of an accurate diagnosis of pancreatic injury following blunt abdominal trauma is:
- A. USG abdomen
- B. MRI abdomen
- C. Computed Tomogram (Correct Answer)
- D. Diagnostic peritoneal lavage
Explanation: ***Computed Tomogram*** - **CT scan** is the **imaging modality of choice** for evaluating solid organ injuries, including the pancreas, following blunt abdominal trauma due to its rapid acquisition and high resolution. - It effectively identifies signs of pancreatic injury such as **lacerations**, **hematoma**, **peripancreatic fluid**, and **transection of the pancreatic duct**. *USG abdomen* - **Ultrasound** has limited utility in diagnosing pancreatic injury due to the gland's **retroperitoneal location** and frequent overlying bowel gas obfuscating views. - While useful for rapid assessment of free fluid, it is **not sensitive enough** to reliably detect subtle pancreatic parenchymal damage. *MRI abdomen* - **MRI** provides excellent soft tissue contrast but is typically **time-consuming** and less accessible than CT in acute trauma settings, making it impractical for initial evaluation. - It may be used for **further characterization** of an injury, especially ductal involvement, if CT findings are equivocal or in stable patients. *Diagnostic peritoneal lavage* - **Diagnostic peritoneal lavage (DPL)** is primarily used to detect **hemoperitoneum** or rupture of hollow viscous organs, but it is **not specific for pancreatic injury**. - A positive DPL can indicate intra-abdominal injury but doesn't localize the source, and it has largely been replaced by focused assessment with sonography for trauma (FAST) and CT scans.
Question 92: Pancreatic pseudocysts developing complications are best managed by?
- A. Conservative treatment
- B. Surgery (Correct Answer)
- C. Radiologically guided interventions
- D. External drainage
Explanation: ***Surgery*** - When pancreatic pseudocysts develop **complications** (infection, hemorrhage, rupture, gastric outlet/biliary obstruction), definitive management is required. - Surgical internal drainage procedures (**cyst-gastrostomy**, **cyst-jejunostomy**, or **cyst-duodenostomy**) provide durable treatment by creating a permanent communication between the mature pseudocyst and the GI tract. - Surgery is particularly indicated when the pseudocyst has a **mature wall (>6 weeks)**, is **large (>6 cm)**, or when endoscopic approaches are not feasible or have failed. - While endoscopic drainage (EUS-guided) is increasingly used as first-line therapy, surgery remains the gold standard for complicated pseudocysts requiring definitive management, especially with complex anatomy or failed minimally invasive approaches. *Conservative treatment* - Conservative management with observation, pain control, and nutritional support is appropriate only for **asymptomatic, small (<6 cm)**, and **uncomplicated pseudocysts** with high likelihood of spontaneous resolution. - Once complications develop, conservative treatment is **inadequate** and poses risks of further deterioration. *Radiologically guided interventions* - Percutaneous drainage may be used for **infected pseudocysts** or as a temporizing measure, but carries high risk of **external fistula formation** (25-50%) and **recurrence**. - Does not provide internal drainage and is generally less effective than surgical or endoscopic internal drainage for complicated pseudocysts. - Not considered definitive management when complications are present. *External drainage* - External percutaneous catheter drainage is primarily a **temporizing measure** for critically ill patients or infected pseudocysts not amenable to other approaches. - High risk of **pancreaticocutaneous fistula** formation and does not address the underlying pancreatic duct communication. - Requires subsequent definitive management in most cases; not appropriate as primary treatment for complicated pseudocysts.
Question 93: Which one of the following regarding absorbable meshes is NOT true?
- A. They show very good results as collagen deposition is maximum (Correct Answer)
- B. They are made of polyglycolic acid fibre
- C. They are used to buttress sutured repair
- D. They are used in temporary abdominal wall closure
Explanation: ***They show very good results as collagen deposition is maximum*** - Absorbable meshes are **resorbed by the body** over time, leading to less collagen deposition compared to non-absorbable meshes, which provide a permanent scaffold for tissue integration. - While they can be useful in certain situations, the statement implies **superior results due to maximum collagen deposition**, which is contradictory to their nature and purpose in situations where permanent reinforcement is needed. *They are made of polyglycolic acid fibre* - Many absorbable meshes, such as **Dexon** and **Vicryl**, are indeed made from synthetic polymers like **polyglycolic acid (PGA)** or polylactic acid (PLA). - These materials are designed to be **hydrolyzed and absorbed** by the body. *They are used to buttress sutured repair* - Absorbable meshes can be used to **reinforce a primary suture line** in contaminated fields or when there is concern for tissue breakdown. - They provide **temporary support** while the native tissue heals. *They are used in temporary abdominal wall closure* - In cases of **abdominal compartment syndrome** or severe contamination, absorbable meshes may be used for **temporary closure** of the abdominal wall. - This allows for staged repair and reduces the risk of infection often associated with permanent meshes in these scenarios.
Question 94: Which one of the following is NOT a surgical modality for management of femoral hernia?
- A. The canal ring narrowing operation (Lytle’s) (Correct Answer)
- B. Lotheissen's (Inguinal) operation
- C. The low approach (Lockwood)
- D. The high approach (Mc Evedy)
Explanation: ***The canal ring narrowing operation (Lytle’s)*** - The **Lytle's operation** is a technique primarily used for the repair of **inguinal hernias**, specifically to reinforce the posterior wall of the inguinal canal, not for femoral hernias. - It involves repairing the **transversalis fascia** and strengthening the deep inguinal ring area. *Lotheissen's (Inguinal) operation* - This approach involves reducing the **femoral hernia sac** from above and repairing the defect through an **inguinal incision**. - It allows for exploration of the **inguinal canal** and is often used in cases of difficulty reducing the hernia or when a concomitant inguinal hernia is suspected. *The low approach (Lockwood)* - The **Lockwood operation** involves approaching the femoral hernia directly from **below the inguinal ligament** through a groin crease incision. - This method is straightforward for simple, uncomplicated femoral hernias. *The high approach (Mc Evedy)* - The **McEvedy approach** involves a **vertical incision** made above the inguinal ligament, providing excellent access to the **preperitoneal space** and the femoral canal. - This approach is particularly useful for **strangulated femoral hernias** as it allows for better visualization of compromised bowel and wider repair of the defect.
Question 95: “Triangle of Doom” dissected and seen during Laparoscopic inguinal hernia repair is bounded by all EXCEPT:
- A. Vas deferens
- B. Gonadal vessels
- C. Cord structures
- D. Peritoneal fold (Correct Answer)
Explanation: ***Peritoneal fold*** - The "Triangle of Doom" is an important anatomical landmark in **laparoscopic inguinal hernia repair** that contains critical vascular structures vulnerable to injury. - The **peritoneal fold** does not form a boundary of the Triangle of Doom, making this the correct answer to the EXCEPT question. - The triangle lies in the preperitoneal space and is not bounded by peritoneal reflections. *Vas deferens* - The **vas deferens** forms the **medial boundary** of the Triangle of Doom. - It courses from the internal ring into the pelvis and is a crucial landmark during dissection. - Injury can result in **infertility**, particularly if bilateral damage occurs. *Gonadal vessels* - The **gonadal vessels (testicular/ovarian vessels)** form the **lateral boundary** of the Triangle of Doom. - These vessels run parallel to the vas deferens and are at risk during lateral dissection. - The triangle's base is formed by the **iliac vessels** (external iliac artery and vein). *Cord structures* - The **cord structures** (including vas deferens and gonadal vessels) pass through or form the boundaries of the Triangle of Doom. - Within this triangle lie the **external iliac artery and vein** and the **femoral branch of the genitofemoral nerve**. - **Clinical significance**: Inadvertent stapling or dissection in this area can cause life-threatening **vascular injury** or nerve damage. **Note**: This should not be confused with the "Triangle of Pain" which is bounded laterally by the **inferior epigastric artery** and contains the lateral femoral cutaneous nerve and femoral branch of genitofemoral nerve.
Question 96: Paralytic ileus is a type of:
- A. Inflammatory obstruction
- B. Drug induced obstruction
- C. Adynamic obstruction (Correct Answer)
- D. Dynamic obstruction
Explanation: ***Adynamic obstruction*** - **Paralytic ileus** is characterized by the absence of normal peristaltic movement of the bowel, leading to a functional or **adynamic obstruction** without a physical blockage. - This condition often results from factors like **abdominal surgery**, electrolyte imbalances, or certain medications, which disrupt neural control over intestinal motility. *Inflammatory obstruction* - An **inflammatory obstruction** implies a physical blockage or narrowing of the bowel lumen due to inflammation, such as in **Crohn's disease** or diverticulitis. - While inflammation can contribute to ileus, the primary mechanism of paralytic ileus is a lack of motility, not a physical inflammatory mass blocking the lumen. *Drug-induced obstruction* - While certain drugs, such as **opioids** or **anticholinergics**, can *cause* paralytic ileus by reducing gut motility, the term "drug-induced obstruction" is typically used when the drug directly creates a physical obstruction. - In the context of ileus, drugs induce a *functional* impairment rather than a physical **luminal blockage**. *Dynamic obstruction* - **Dynamic obstruction** refers to a *physical blockage* of the bowel, such as a **volvulus**, **intussusception**, or an **hernia**, where the bowel is actively trying to overcome the obstruction (hence "dynamic"). - In contrast, paralytic ileus involves a *lack* of active bowel movement, classifying it as an adynamic, rather than dynamic, obstruction.
Question 97: Indication of Coronary artery bypass grafting (CABG) is:
- A. More than 70% stenosis of proximal left anterior interventricular artery
- B. More than 50% stenosis of critical left main stem
- C. Deranged Stress Echocardiography report
- D. Triple vessel disease (Correct Answer)
Explanation: ***Triple vessel disease*** - **Triple vessel disease** (significant stenosis in all three major coronary arteries: LAD, LCx, and RCA) is a **Class I indication for CABG** with the highest level of evidence. - CABG provides **superior long-term outcomes** compared to PCI in triple vessel disease, with better survival rates, reduced need for repeat revascularization, and more complete revascularization. - This is particularly true in patients with **diabetes** or **reduced LV function**. *More than 70% stenosis of proximal left anterior interventricular artery* - While **proximal LAD stenosis >70%** can be treated with CABG (Class IIa indication), it is often managed successfully with **PCI** (drug-eluting stents). - The choice between CABG and PCI for isolated proximal LAD disease depends on anatomy, patient comorbidities, and surgical risk factors. *More than 50% stenosis of critical left main stem* - **Left main coronary artery stenosis >50%** is actually a **Class I indication for CABG** per ACC/AHA and ESC/EACTS guidelines. - However, in the context of this question comparing multiple scenarios, **triple vessel disease** represents a more universally accepted and broader indication with the strongest evidence base for CABG superiority over PCI. - Modern guidelines do allow PCI for selected left main cases (low SYNTAX score, ostial/shaft lesions), whereas triple vessel disease more consistently favors CABG. *Deranged Stress Echocardiography report* - A **positive stress echocardiography** indicates inducible myocardial ischemia but is a **diagnostic finding**, not a specific indication for the revascularization method. - Further evaluation with **coronary angiography** is required to determine the anatomical extent of CAD and guide the choice between CABG, PCI, or medical management.