UPSC-CMS 2018 Practice Questions

Q: Normal anatomical narrowings of the ureter are present in all EXCEPT:

Crossing the abdominal aorta. ***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**.

Q: Antro-choanal polyp always arises from:

Maxillary sinus. ***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.

Q: Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?

It always presents with haematuria. ***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.

Q: Mainstay of an accurate diagnosis of pancreatic injury following blunt abdominal trauma is:

Computed Tomogram. ***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.

Q: Which one of the following is NOT a surgical modality for management of femoral hernia?

The canal ring narrowing operation (Lytle’s). ***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.

Q: “Triangle of Doom” dissected and seen during Laparoscopic inguinal hernia repair is bounded by all EXCEPT:

Peritoneal fold. ***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.

Q: Paralytic ileus is a type of:

Adynamic obstruction. ***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.

Q: Indication of Coronary artery bypass grafting (CABG) is:

Triple vessel disease. ***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.

Question 1

Normal anatomical narrowings of the ureter are present in all EXCEPT:

Accepted Answer

Crossing the abdominal aorta

Answer

Ureteropelvic junction

Answer

Entering bladder wall

Answer

Ureteric orifice

Question 2

Antro-choanal polyp always arises from:

Accepted Answer

Maxillary sinus

Answer

Posterior end of the septum

Answer

Nasopharynx

Answer

Posterior ethmoidal cells

Question 3

Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?

Accepted Answer

It always presents with haematuria

Answer

It may be associated with Pyrexia of unknown origin

Answer

Renal vein extention may embolize to lungs

Answer

It is also called Grawitz tumour

Question 4

Mainstay of an accurate diagnosis of pancreatic injury following blunt abdominal trauma is:

Accepted Answer

Computed Tomogram

Answer

USG abdomen

Answer

MRI abdomen

Answer

Diagnostic peritoneal lavage

Question 5

Pancreatic pseudocysts developing complications are best managed by?

Accepted Answer

Surgery

Answer

Conservative treatment

Answer

Radiologically guided interventions

Answer

External drainage

Question 6

Which one of the following regarding absorbable meshes is NOT true?

Accepted Answer

They show very good results as collagen deposition is maximum

Answer

They are made of polyglycolic acid fibre

Answer

They are used to buttress sutured repair

Answer

They are used in temporary abdominal wall closure

Question 7

Which one of the following is NOT a surgical modality for management of femoral hernia?

Accepted Answer

The canal ring narrowing operation (Lytle’s)

Answer

Lotheissen's (Inguinal) operation

Answer

The low approach (Lockwood)

Answer

The high approach (Mc Evedy)

Question 8

“Triangle of Doom” dissected and seen during Laparoscopic inguinal hernia repair is bounded by all EXCEPT:

Accepted Answer

Peritoneal fold

Answer

Vas deferens

Answer

Gonadal vessels

Answer

Cord structures

Question 9

Paralytic ileus is a type of:

Accepted Answer

Adynamic obstruction

Answer

Inflammatory obstruction

Answer

Drug induced obstruction

Answer

Dynamic obstruction

Question 10

Indication of Coronary artery bypass grafting (CABG) is:

Accepted Answer

Triple vessel disease

Answer

More than 70% stenosis of proximal left anterior interventricular artery

Answer

More than 50% stenosis of critical left main stem

Answer

Deranged Stress Echocardiography report

UPSC-CMS 2018

Anatomy

ENT

Internal Medicine

Surgery