Internal Medicine
2 questionsMondor’s disease is:
Which one of the following regarding Pancreatic effusion is correct?
UPSC-CMS 2018 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 111: Mondor’s disease is:
- A. Named after the scientist who first coined the term “Actinomycosis of Breast”
- B. Thrombophlebitis of superficial veins of the breast and anterior chest wall (Correct Answer)
- C. Other name for tuberculosis of breast
- D. Rare type of chronic intramammary abscess
Explanation: ***Thrombophlebitis of superficial veins of the breast and anterior chest wall*** - **Mondor's disease** is characterized by inflammation and thrombosis of the superficial veins, most commonly affecting the breast and anterior chest wall. - It typically manifests as a sensitive, cord-like structure under the skin, often associated with a recent trauma, surgery, or inflammation. *Named after the scientist who first coined the term “Actinomycosis of Breast”* - Mondor’s disease is named after **Henri Mondor**, who described this clinical condition in 1939. - He did not specifically coin the term "Actinomycosis of Breast," which is a separate bacterial infection. *Other name for tuberculosis of breast* - **Tuberculosis of the breast** is a rare infectious disease caused by *Mycobacterium tuberculosis*, leading to granulomatous inflammation. - Mondor's disease is a non-infectious thrombophlebitis, distinct from infectious conditions like tuberculosis. *Rare type of chronic intramammary abscess* - A **chronic intramammary abscess** is a localized collection of pus within the breast tissue, usually due to bacterial infection. - Mondor's disease involves inflammation of blood vessels and thrombosis, not pus formation or abscess development.
Question 112: Which one of the following regarding Pancreatic effusion is correct?
- A. Pancreatic stenting is to be done
- B. Free fluid collection in Pleural cavity
- C. Percutaneous drainage under image guidance is indicated for symptomatic effusions (Correct Answer)
- D. Never associated with abdominal collection
Explanation: ***Percutaneous drainage under image guidance is indicated for symptomatic effusions*** - For **symptomatic pancreatic effusions**, particularly those causing pain, infection, or organ compression, percutaneous drainage offers an effective and less invasive management option. - This procedure is typically performed under **ultrasound or CT guidance** to ensure accurate placement of the drainage catheter, minimizing complications. *Pancreatic stenting is to be done* - **Pancreatic stenting** is primarily indicated for managing pancreatic duct strictures or leaks, often in the context of chronic pancreatitis or postsurgical complications. - It is not a direct treatment for a pancreatic effusion itself, which is a collection of fluid outside the ductal system. *Free fluid collection in Pleural cavity* - Pancreatic effusion refers to the **leakage of pancreatic fluid** into the abdominal cavity, typically surrounding the pancreas or in the peritoneum. - While pancreatic diseases can sometimes lead to **pleural effusions** (fluid in the chest cavity) due to translocation of fluid through the diaphragm, a pancreatic effusion itself is defined as an abdominal collection. *Never associated with abdominal collection* - This statement is incorrect as a **pancreatic effusion is by definition an abdominal collection** of fluid originating from the pancreas. - These collections can arise from disruptions in the pancreatic duct or parenchyma, leading to the accumulation of pancreatic enzymes, fluid, and debris in the peripancreatic region or elsewhere within the abdomen.
Orthopaedics
1 questionsWhich one of the following bones is affected in Keinbock's disease?
UPSC-CMS 2018 - Orthopaedics UPSC-CMS Practice Questions and MCQs
Question 111: Which one of the following bones is affected in Keinbock's disease?
- A. Lunate bone (Correct Answer)
- B. Capitellum of the humerus
- C. Metatarsal
- D. Navicular bone
Explanation: ***Lunate bone*** - Kienbock's disease is an **avascular necrosis** of the **lunate bone** in the wrist, leading to its collapse and fragmentation over time. - This condition is often associated with repetitive trauma, negative ulnar variance, and altered blood supply to the lunate. *Capitellum of the humerus* - Avascular necrosis of the capitellum is known as **Panner's disease**, which is distinct from Kienbock's disease. - Panner's disease primarily affects children and adolescents, often due to repetitive throwing or overhead activities. *Metatarsal* - Avascular necrosis of the metatarsal heads is seen in conditions like **Freiberg's disease**, which typically affects the second metatarsal. - This condition presents with forefoot pain and differs significantly in location and affected bone from Kienbock's disease. *Navicular bone* - Avascular necrosis of the tarsal navicular bone is referred to as **Kohler's disease**, predominantly appearing in young children. - This condition affects the foot and is not related to the wrist pathologies seen in Kienbock's disease.
Radiology
1 questionsIndications of computed tomography after head injury include all EXCEPT:
UPSC-CMS 2018 - Radiology UPSC-CMS Practice Questions and MCQs
Question 111: Indications of computed tomography after head injury include all EXCEPT:
- A. Open depressed fracture
- B. Glasgow Coma Scale < 13 at any point
- C. Amnesia > 30 minutes
- D. Mild head injury in a 50 year old man (Correct Answer)
Explanation: ***Mild head injury in a 50-year-old man*** - This is not an absolute indication for CT scanning after head injury, especially if the patient is **neurologically intact** (GCS 15) and has no other high-risk features. - While age **> 65 years** is considered a risk factor in some guidelines (Canadian CT Head Rule), age 50 alone does not warrant CT in mild head injury (GCS 13-15) without additional warning signs. - CT would be indicated if this patient had **other risk factors** such as loss of consciousness, amnesia, vomiting, anticoagulation use, or dangerous mechanism of injury. *Open depressed fracture* - This is a **high-risk feature** indicating a severe head injury and potential for **intracranial injury** or infection, requiring immediate imaging. - CT is essential to assess the extent of **bone depression**, foreign bodies, and associated brain injury. *Glasgow Coma Scale < 13 at any point* - A GCS score below 13 signifies a **moderate to severe head injury** and is a critical indication for immediate CT to evaluate for significant intracranial pathology. - This level of altered consciousness suggests a **potential for life-threatening brain injury** that must be rapidly identified. *Amnesia > 30 minutes* - **Post-traumatic amnesia (PTA)** lasting longer than 30 minutes is a recognized risk factor for **intracranial injury**, even in patients with otherwise normal GCS scores. - It indicates a more significant impact on brain function and warrants a CT scan to rule out **structural lesions** per NICE and Canadian CT Head Rules.
Surgery
5 questionsIn postoperative care the long term risks after Bariatric Surgery include all EXCEPT:
Hilton's method of Incision and drainage of abscess has the advantage of:
Sengstaken-Blakemore tube is used to control bleeding in:
Which one of the following regarding management of acute wounds is NOT true?
Risk Scoring System which can be used postoperatively is:
UPSC-CMS 2018 - Surgery UPSC-CMS Practice Questions and MCQs
Question 111: In postoperative care the long term risks after Bariatric Surgery include all EXCEPT:
- A. Vitamin and Micronutrient depletion syndromes
- B. Weight regain
- C. Deep Vein Thrombosis (Correct Answer)
- D. Protein Calorie Malnutrition
Explanation: ***Deep Vein Thrombosis*** - Deep Vein Thrombosis (DVT) is a significant **short-term (early) complication** of bariatric surgery, primarily in the **immediate postoperative period**, due to immobility and hypercoagulability. - While prophylaxis is crucial, DVT is not typically considered a **long-term risk** that persists for years after surgery. *Vitamin and Micronutrient depletion syndromes* - Bariatric surgery procedures, especially those involving malabsorption (e.g., Roux-en-Y gastric bypass), can lead to chronic deficiencies in **fat-soluble vitamins (A, D, E, K)**, **B12**, **iron**, and **calcium** due to altered absorption. - These depletion syndromes are a well-documented **long-term risk** requiring lifelong supplementation and monitoring. *Weight regain* - Despite initial significant weight loss, a substantial number of patients experience some degree of **weight regain** in the long term, typically peaking 2-5 years post-surgery. - This is a common and critical **long-term risk** that often necessitates ongoing lifestyle modifications and monitoring. *Protein Calorie Malnutrition* - Certain bariatric procedures (e.g., biliopancreatic diversion with duodenal switch) can lead to severe **malabsorption of protein and calories**, resulting in protein-calorie malnutrition (PCM). - PCM is a serious and persistent **long-term risk** that requires careful dietary management and sometimes additional medical interventions.
Question 112: Hilton's method of Incision and drainage of abscess has the advantage of:
- A. Avoids injury to underlying vessels and nerves (Correct Answer)
- B. Complete drainage of pus
- C. Heals without scar
- D. Provides irrigation
Explanation: ***Avoids injury to underlying vessels and nerves*** - Hilton's method involves blunt dissection with an artery forceps once the skin incision is made, allowing the surgeon to **feel important structures** and push them aside. - This technique is particularly useful in areas with **numerous neurovascular bundles**, such as the axilla or neck, minimizing the risk of iatrogenic damage. *Complete drainage of pus* - While Hilton's method facilitates drainage, it doesn't inherently guarantee **complete drainage** more than other proper incision and drainage techniques. - The effectiveness of drainage primarily depends on the **size and location of the incision** relative to the abscess cavity. *Heals without scar* - Any surgical incision, including those made using Hilton's method, will result in some degree of **scar formation**. - The method prioritizes safety over cosmetic outcomes, and the nature of the scar depends on **wound healing** and **surgical closure**. *Provides irrigation* - Irrigation is a separate step often performed after the incision and drainage to **flush out debris** and reduce bacterial load. - Hilton's method itself is a technique for making the incision and gaining access to the abscess, not for **intraoperative irrigation**.
Question 113: Sengstaken-Blakemore tube is used to control bleeding in:
- A. Duodenal ulcer bleed
- B. Renal trauma
- C. Bleeding varices (Correct Answer)
- D. Splenic injury in portal hypertension
Explanation: ***Bleeding varices*** - The **Sengstaken-Blakemore tube** is specifically designed with gastric and esophageal balloons to apply direct pressure and tamponade actively bleeding **esophageal** or **gastric varices**. - This device is a temporary measure used to control life-threatening hemorrhage from varices secondary to **portal hypertension** when endoscopic therapies are unsuccessful or unavailable. *Duodenal ulcer bleed* - Bleeding from a duodenal ulcer is typically managed with **endoscopic intervention** (e.g., clipping, injection, cautery) or **surgical repair**. - A Sengstaken-Blakemore tube is not suitable for controlling duodenal bleeds as it cannot reach or apply pressure to the bleeding site in the **duodenum**. *Renal trauma* - Renal trauma causes bleeding within or around the **kidney**, which is usually managed conservatively, with embolization of bleeding vessels, or surgically (e.g., nephrectomy). - The Sengstaken-Blakemore tube is an **upper gastrointestinal device** and has no role in managing bleeding from renal injuries. *Splenic injury in portal hypertension* - Splenic injury with bleeding in the context of portal hypertension typically requires **splenectomy** or **splenic artery embolization**. - While portal hypertension can be a contributing factor, the tube is not designed to control bleeding originating from a **damaged spleen**.
Question 114: Which one of the following regarding management of acute wounds is NOT true?
- A. Wounds should be examined, taking into consideration site and structures damaged
- B. Bleeding wounds should be elevated and a pressure pad applied
- C. The whole patient should be examined according to ATLS principles
- D. Clamps should be used to stop all bleeding vessels (Correct Answer)
Explanation: ***Clamps should be used to stop all bleeding vessels*** - While **hemostasis** is crucial, using clamps on *all* bleeding vessels, especially small ones, is generally discouraged as it can cause **tissue damage** and may not be necessary for effective bleeding control in many acute wound settings. - The primary initial goal is to achieve **hemostasis** safely, often through direct pressure, elevation, and pressure dressings, before more invasive measures. *Wounds should be examined, taking into consideration site and structures damaged* - A thorough examination is fundamental to identify the **extent of the injury**, including potential damage to underlying structures like nerves, tendons, vessels, or joints. - This assessment guides the appropriate cleaning, debridement, and repair strategies to optimize **healing and function**. *Bleeding wounds should be elevated and a pressure pad applied* - **Elevation** helps reduce hydrostatic pressure, thereby decreasing blood flow to the injured area. - Applying **direct pressure** with a pressure pad is the most immediate and effective method for controlling venous and capillary bleeding, and often arterial bleeding as well. *The whole patient should be examined according to ATLS principles* - The **Advanced Trauma Life Support (ATLS)** principles prioritize a systematic approach to trauma care, starting with the primary survey (ABCDE) to identify and manage life-threatening injuries. - This ensures that hidden or more critical injuries are not missed amidst the focus on the visible wound, maintaining a **holistic view** of the patient's condition.
Question 115: Risk Scoring System which can be used postoperatively is:
- A. ASA American Society of Anaesthesiologist
- B. MET Metabolic Equivalent Task
- C. POSSUM Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity (Correct Answer)
- D. RCRI Revised Cardiac Risk Index
Explanation: ***POSSUM (Physiologic and Operative Severity Score for enUmeration of Mortality and Morbidity)*** - **POSSUM** is a risk scoring system specifically designed to predict **postoperative mortality and morbidity** based on physiological and operative factors. - It includes both **preoperative physiological variables** and **intraoperative findings** to provide a comprehensive risk assessment after surgery. *ASA (American Society of Anesthesiologists)* - The **ASA physical status classification system** is used to assess a patient's **preoperative health status** and predict anesthetic risk, not directly postoperative outcomes. - It is determined **before surgery** to categorize patients into different classes based on their overall health and presence of co-morbidities. *MET (Metabolic Equivalent Task)* - **METs** are a measure of **exercise capacity** and reflect a person's functional status, often used in preoperative cardiac risk assessment. - They are used to gauge a patient's ability to perform physical tasks, not as a direct predictor of postoperative complications. *RCRI (Revised Cardiac Risk Index)* - The **RCRI** is used to predict the risk of **major cardiac events** in patients undergoing non-cardiac surgery. - It is primarily a **preoperative tool** focused on cardiac risks, not a general predictor of all postoperative morbidity and mortality.