ENT
1 questionsWhich one of the following regarding Nasal polyps is NOT true?
UPSC-CMS 2018 - ENT UPSC-CMS Practice Questions and MCQs
Question 101: Which one of the following regarding Nasal polyps is NOT true?
- A. Nasal polyps are very painful to touch (Correct Answer)
- B. Meningocele must be excluded in children with polyps
- C. Bleeding polyp may indicate malignancy
- D. Simple polyps are bilateral
Explanation: ***Nasal polyps are very painful to touch*** * **Nasal polyps** are typically **painless** and soft to the touch, as they are edematous mucosal outgrowths. * Pain associated with **nasal polyps** usually indicates a secondary complication such as **infection** or, rarely, **malignancy**, rather than the polyps themselves. * *Meningocele must be excluded in children with polyps* * **Meningoceles** or **encephalocele** are important considerations in children presenting with **nasal masses**, as they represent a protrusion of brain tissue or meninges and resemble polyps. * Their exclusion is critical due to the risk of **meningitis** during surgical intervention if misdiagnosed as routine polyps. * *Bleeding polyp may indicate malignancy* * While polyps are generally not prone to bleeding, the presence of **unilateral**, **bleeding**, or **friable polyps** raises suspicion for **malignancy**, such as **nasopharyngeal carcinoma** or **sinonasal cancers**. * Any atypical presentation, especially with ulceration or persistent epistaxis, warrants **biopsy** and further investigation. * *Simple polyps are bilateral* * **Simple inflammatory polyps** (e.g., from **chronic rhinosinusitis** with nasal polyps) are most commonly found **bilaterally**. * Unilateral polyps or masses, especially in adults, should prompt suspicion for other causes, including **neoplasms**.
Internal Medicine
1 questionsGenetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:
UPSC-CMS 2018 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 101: Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:
- A. Marfan’s syndrome
- B. Adult polycystic kidney
- C. Neurofibromatosis Type II (Correct Answer)
- D. Fibromuscular dysplasia
Explanation: ***Neurofibrofomatosis Type II*** - This condition is primarily associated with **central nervous system tumors** like **vestibular schwannomas** and **meningiomas**, not Berry aneurysms [2]. - While it affects the nervous system, its vascular manifestations are typically different from those predisposing to aneurysms. *Marfan’s syndrome* - Patients with Marfan's syndrome have **fragile connective tissue** due to a defect in **fibrillin-1**, which can weaken arterial walls. - This weakness increases the risk of **aortic aneurysms** and dissections, and can also predispose to intracranial aneurysms like Berry aneurysms. *Adult polycystic kidney* - This **autosomal dominant** disorder is characterized by the formation of **cysts in the kidneys**, but also has systemic manifestations [1]. - There is a well-established association between **autosomal dominant polycystic kidney disease (ADPKD)** and an increased incidence of **Berry aneurysms**. *Fibromuscular dysplasia* - This condition involves **abnormal cellular development** in the **arterial walls**, leading to areas of narrowing and enlargement. - It commonly affects the **renal arteries** and **carotid arteries**, and is also a known risk factor for the development of **intracranial aneurysms**, including Berry aneurysms.
Physiology
1 questionsWhich one of the following factors is NOT involved in the pathogenesis of Systemic inflammatory response syndrome (SIRS)?
UPSC-CMS 2018 - Physiology UPSC-CMS Practice Questions and MCQs
Question 101: Which one of the following factors is NOT involved in the pathogenesis of Systemic inflammatory response syndrome (SIRS)?
- A. Free radical production
- B. Increased cytokine production
- C. Abnormal nitric oxide synthesis
- D. Microvascular occlusion (Correct Answer)
Explanation: ***Microvascular occlusion*** - While microvascular occlusion (including microthrombi formation) does occur in SIRS, it is generally considered a **secondary phenomenon or consequence** rather than a **primary initiating pathogenic mechanism**. - It develops as a result of **endothelial dysfunction, platelet activation, and coagulation cascade activation** triggered by the primary inflammatory mediators. - More characteristically associated with **disseminated intravascular coagulation (DIC)**, which is a complication of severe SIRS/sepsis rather than an initiating factor. - The primary pathogenic drivers initiate the cascade, while microvascular occlusion represents a downstream effect contributing to organ dysfunction. *Free radical production* - **Free radicals** (reactive oxygen species and reactive nitrogen species) are directly produced by activated inflammatory cells and damaged tissues. - They cause **oxidative stress**, leading to direct cellular damage, lipid peroxidation, and increased vascular permeability. - Free radical production is a **key pathogenic mechanism** amplifying the inflammatory response and tissue injury in SIRS. *Increased cytokine production* - **Pro-inflammatory cytokines** (TNF-α, IL-1, IL-6, IL-8) are the **central mediators** of SIRS pathogenesis. - They are released early in response to inflammatory stimuli (infection, trauma, burns, pancreatitis). - These cytokines trigger the **systemic inflammatory cascade**, causing fever, vasodilation, capillary leak, leukocyte activation, and acute phase response. - Represent the **primary pathogenic mechanism** driving SIRS. *Abnormal nitric oxide synthesis* - **Excessive nitric oxide (NO) production** by inducible nitric oxide synthase (iNOS) is a **direct pathogenic mechanism** in SIRS. - Leads to **inappropriate vasodilation**, contributing to the **distributive shock** and **refractory hypotension** seen in severe SIRS and septic shock. - NO also impairs vascular responsiveness to vasoconstrictors and contributes to **myocardial depression**. - This abnormal synthesis is a **primary factor** in the hemodynamic instability of SIRS.
Radiology
1 questionsRadiologic views used for fracture Mandible (body and Ramus) are all EXCEPT:
UPSC-CMS 2018 - Radiology UPSC-CMS Practice Questions and MCQs
Question 101: Radiologic views used for fracture Mandible (body and Ramus) are all EXCEPT:
- A. Lower occlusal
- B. Submentovertex (Correct Answer)
- C. Lateral obliques
- D. Orthopantomogram
Explanation: ***Submentovertex*** - The **Submentovertex (SMV) view** is primarily used to assess the **zygomatic arches**, base of the skull, and sphenoid sinuses, not typically for mandibular body or ramus fractures. - While it can provide some information about the medial aspects of the mandible, it offers **limited structural detail** crucial for diagnosing fractures in the body and ramus. *Lower occlusal* - **Lower occlusal films** are useful for visualizing the **anterior mandible**, including the symphysis and parasymphysis regions, and the lingual aspect of the body. - They can provide detailed views of these specific areas but are not the primary view for comprehensive assessment of the entire body or ramus. *Lateral obliques* - **Lateral oblique views** are highly effective for visualizing the **body, angle, and ramus** of the mandible, providing a good representation of these regions without superimposition from the contralateral side. - This projection allows for assessment of fracture displacement and angulation in the lateral and postero-lateral aspects of the mandible. *Orthopantomogram* - An **Orthopantomogram (OPG)**, also known as a panoramic radiograph, provides a comprehensive view of the **entire mandible** and maxilla on a single film. - It is an excellent screening tool for identifying fractures in the **condyle, ramus, angle, body, and symphysis** of the mandible due to its broad coverage.
Surgery
6 questionsWhich one of the following regarding abdominal pediatric surgery is correct?
Allen's test is used in cardiac surgery for:
In a lateral facial wound, if facial nerve injury is suspected, it should be:
Mallory-Weiss tear causing haematemesis is seen over:
Sleeve Gastrectomy done for Morbid obesity is a:
Pre-operative Nutrition Screening in a patient with morbid obesity planned for Gastric Bypass includes all EXCEPT:
UPSC-CMS 2018 - Surgery UPSC-CMS Practice Questions and MCQs
Question 101: Which one of the following regarding abdominal pediatric surgery is correct?
- A. Transverse abdominal incision is always used
- B. Bowel must be always anastomosed in double layer
- C. Skin over abdomen can never be closed with subcuticular sutures
- D. Incision can be closed with absorbable suture (Correct Answer)
Explanation: ***Incision can be closed with absorbable suture*** - **Absorbable sutures** are commonly used in pediatric abdominal surgery for closing deeper layers and sometimes skin, as they degrade over time and do not require removal. - This is particularly beneficial in children to avoid the trauma and discomfort of suture removal and to promote good cosmetic outcomes. *Transverse abdominal incision is always used* - While **transverse incisions** are often preferred in pediatric abdominal surgery for their good cosmetic results and lower incidence of incisional hernias, they are not *always* used. - Other incisions, such as **vertical midline incisions**, may be utilized depending on the surgical exposure required, the specific pathology, or the surgeon's preference. *Bowel must be always anastomosed in double layer* - **Bowel anastomoses** in pediatric surgery can be performed using either a **single-layer** or **double-layer** technique. - The choice depends on surgeon preference, the specific bowel segment involved, and the patient's condition, with both methods demonstrating comparable outcomes in many situations. *Skin over abdomen can never be closed with subcuticular sutures* - **Subcuticular sutures** are frequently used for skin closure in pediatric abdominal surgery, especially for their excellent cosmetic results and to avoid external suture removal. - This technique places the suture material under the skin surface, minimizing scarring and being well-suited for a child's healing skin.
Question 102: Allen's test is used in cardiac surgery for:
- A. To select finger prick for blood glucose estimation
- B. To check warmth of hands
- C. When radial artery harvest is planned (Correct Answer)
- D. For evaluation of AV fistula
Explanation: ***When radial artery harvest is planned*** - **Allen's test** is performed to assess the patency of the **ulnar artery** and ensure adequate collateral circulation to the hand before harvesting the radial artery. - A positive test (indicating good collateral flow) is crucial to prevent **hand ischemia** if the radial artery is removed. *To select finger prick for blood glucose estimation* - Finger prick sites for **blood glucose estimation** are chosen based on adequate capillary blood flow and patient comfort, not by Allen's test. - Allen's test is specifically for evaluating **arterial patency** and collateral circulation, which is irrelevant for routine fingersticks. *To check warmth of hands* - Checking the **warmth of hands** is a basic clinical assessment for peripheral perfusion but does not involve Allen's test. - Allen's test is a dynamic test of **vascular competence**, not a static thermal assessment. *For evaluation of AV fistula* - **AV fistula evaluation** involves assessing patency, thrill, and bruit, and is typically done using physical examination and Doppler ultrasound. - Allen's test is not used for this purpose, as it assesses **collateral arterial flow** to a digit, not the patency of an arteriovenous connection.
Question 103: In a lateral facial wound, if facial nerve injury is suspected, it should be:
- A. Left alone
- B. Secondary repair using microscope gives best result
- C. Skin and subcutaneous flaps to be raised to cover the cut ends
- D. Primary repair should be attempted (Correct Answer)
Explanation: ***Primary repair should be attempted*** - **Early surgical repair** of facial nerve injuries, ideally within the first 72 hours, offers the best chance for **functional recovery**. - **Primary repair** involves direct reapproximation and meticulous suturing of the severed nerve ends under magnification. *Left alone* - Leaving a suspected facial nerve injury untreated can lead to **permanent facial paralysis** and significant functional and aesthetic deficits. - The facial nerve has a limited capacity for spontaneous regeneration, especially after a **complete transection**. *Secondary repair using microscope gives best result* - While microscopic techniques are crucial for nerve repair, **secondary repair** (performed weeks or months after the injury) generally yields poorer outcomes compared to primary repair. - **Scar tissue formation** and **nerve end retraction** make secondary repair more challenging and less effective. *Skin and subcutaneous flaps to be raised to cover the cut ends* - This approach addresses wound closure but **does not repair the underlying nerve injury**, leading to persistent motor deficits. - Covering the nerve ends without repair would still result in **facial paralysis** as the nerve fibers cannot reconnect across the gap.
Question 104: Mallory-Weiss tear causing haematemesis is seen over:
- A. Oesophagus
- B. Gastroesophageal junction (Correct Answer)
- C. Anterior wall of stomach
- D. Fundus of stomach
Explanation: ***Gastroesophageal junction*** - Mallory-Weiss tears are **linear mucosal lacerations** typically located at the **gastroesophageal junction**, where the esophagus meets the stomach. - These tears are caused by sudden increases in **intra-abdominal pressure**, often due to forceful retching or vomiting, leading to bleeding. *Oesophagus* - While located close, Mallory-Weiss tears are specifically at the **junction**, not generally throughout the esophageal body. - **Esophageal varices** are a more common cause of hematemesis originating from the esophagus itself, distinct from Mallory-Weiss tears. *Anterior wall of stomach* - Tears in the anterior wall of the stomach are less common and typically associated with other conditions like **ulcers** or **trauma**, not the characteristic forceful vomiting seen in Mallory-Weiss syndrome. - The unique anatomical stress at the **gastroesophageal junction** during retching makes it the preferred site for Mallory-Weiss lacerations. *Fundus of stomach* - Tears in the fundus are rare in the context of Mallory-Weiss syndrome; the fundus is usually affected by other conditions such as **gastric ulcers** or **gastric varices**. - The biomechanical forces that cause Mallory-Weiss tears are concentrated where the **esophageal and gastric mucosa meet**, not primarily in the fundus.
Question 105: Sleeve Gastrectomy done for Morbid obesity is a:
- A. Restrictive procedure (Correct Answer)
- B. Mildly restrictive and mainly malabsorptive
- C. Reversible procedure
- D. Malabsorptive procedure only
Explanation: ***Restrictive procedure (Correct Answer)*** - A **sleeve gastrectomy** involves removing a large portion of the stomach (approximately 75-80%), leaving a banana-shaped "sleeve," which significantly **reduces stomach volume**. - This reduction in volume **restricts** the amount of food a patient can consume at one time, leading to early satiety and weight loss. - It is classified as a **purely restrictive** bariatric procedure. *Mildly restrictive and mainly malabsorptive* - While there is some malabsorption due to faster gastric emptying, the primary mechanism of weight loss in sleeve gastrectomy is **restriction**, not malabsorption. - Procedures like **Roux-en-Y gastric bypass** are considered both restrictive and malabsorptive. *Reversible procedure* - Sleeve gastrectomy involves the **irreversible removal** of a significant part of the stomach. - Unlike devices like the **adjustable gastric band**, it cannot be undone or reversed. *Malabsorptive procedure only* - Sleeve gastrectomy does not significantly alter the **intestinal tract** to cause malabsorption. - Procedures that are primarily **malabsorptive**, such as **biliopancreatic diversion with duodenal switch**, involve bypassing large sections of the small intestine.
Question 106: Pre-operative Nutrition Screening in a patient with morbid obesity planned for Gastric Bypass includes all EXCEPT:
- A. Serum Insulin (Correct Answer)
- B. Serum Vitamin B12
- C. Serum Calcium
- D. Serum Magnesium
Explanation: ***Serum Insulin*** - While relevant to **diabetes** and metabolic health, routine **pre-operative insulin screening** is not standard for gastric bypass. - Nutritional screening focuses on identifying and correcting deficiencies that could complicate surgery or post-operative recovery. *Serum Vitamin B12* - Patients undergoing **gastric bypass** are at high risk for **Vitamin B12 deficiency** due to altered absorption in the bypassed stomach and small intestine. - Pre-operative screening is essential to identify and replete deficiencies to prevent post-operative neurological complications. *Serum Calcium* - **Malabsorption of calcium** is a known risk after gastric bypass due to changes in the digestive tract. - Pre-operative **calcium levels** are crucial for bone health assessment and to guide supplementation strategies. *Serum Magnesium* - **Magnesium deficiency** can occur post-gastric bypass due to malabsorption. - Pre-operative screening helps to identify existing deficiencies, which can impact cardiac function and neuromuscular health.