Anatomy
1 questionsWhich of the following regarding blood supply of rectum is NOT true?
UPSC-CMS 2018 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 81: Which of the following regarding blood supply of rectum is NOT true?
- A. Superior rectal artery is a direct continuation of Inferior mesenteric artery
- B. Inferior rectal artery arises from internal pudendal artery
- C. Middle rectal artery arises from external iliac artery and passes through the lateral ligaments into rectum (Correct Answer)
- D. Inferior rectal artery traverses the Alcock’s canal into rectum
Explanation: ***Middle rectal artery arises from external iliac artery and passes through the lateral ligaments into rectum*** - This statement is **FALSE** (making it the correct answer for this "NOT true" question) - The middle rectal artery actually arises from the **internal iliac artery**, not the external iliac artery [1] - It does correctly pass through the lateral ligaments of the rectum to supply the middle and lower parts of the rectum *Superior rectal artery is a direct continuation of Inferior mesenteric artery* - This statement is TRUE - The superior rectal artery is indeed the direct continuation of the inferior mesenteric artery [1] - It supplies the superior part of the rectum *Inferior rectal artery arises from internal pudendal artery* - This statement is TRUE - The inferior rectal artery is a branch of the internal pudendal artery [1] - It supplies the anal canal and perianal skin *Inferior rectal artery traverses the Alcock's canal into rectum* - This statement is TRUE - The inferior rectal artery traverses Alcock's canal (pudendal canal) along with the internal pudendal vessels and pudendal nerve [1] - Upon exiting Alcock's canal, it branches to supply the anal region
Internal Medicine
2 questionsA 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:
Patients with phlebographically confirmed deep vein thrombosis of the calf:
UPSC-CMS 2018 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 81: A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:
- A. Sepsis syndrome
- B. Systemic inflammatory response syndrome (Correct Answer)
- C. Multisystem organ failure (MSOF)
- D. Wound infection
Explanation: ***Systemic inflammatory response syndrome*** - The patient's presentation with **tachycardia** (pulse 106/min), **tachypnea** (respiratory rate 26/min), and **leukocytosis** (TLC 14000/µL) meets at least two criteria for **Systemic Inflammatory Response Syndrome (SIRS)** following a significant surgical stressor. - SIRS is a generalized inflammatory response to various insults, including major surgery, trauma, and infection, occurring in the absence of a confirmed infection. *Sepsis syndrome* - **Sepsis syndrome** is defined as SIRS with a **confirmed or suspected infectious source**. While the patient had a bowel injury, there is no definitive evidence of active infection provided (e.g., positive cultures, purulent discharge). - Although the bowel injury could lead to infection, the current information only confirms a systemic inflammatory response, not necessarily a microbial cause. *Multisystem organ failure (MSOF)* - **Multisystem organ failure (MSOF)** involves the failure of two or more organ systems. While the patient has elevated **BUN** and **creatinine**, indicating **acute kidney injury**, there's no evidence of failure in other systems required to diagnose MSOF. - MSOF is a more severe progression of SIRS or sepsis, characterized by severe organ dysfunction, which is not fully met by the current presentation. *Wound infection* - **Wound infection** is a localized infection and would typically present with signs like **erythema**, **purulent discharge**, **tenderness**, or **warmth** at the surgical site. None of these specific local signs are mentioned. - While a wound infection could be a potential source of SIRS or sepsis, the clinical picture provided describes a systemic response rather than a localized one.
Question 82: Patients with phlebographically confirmed deep vein thrombosis of the calf:
- A. can expect asymptomatic recovery if treated promptly with anticoagulant
- B. are at risk for significant pulmonary embolism (Correct Answer)
- C. may be effectively treated with low-dose heparin
- D. may be effectively treated with pneumatic compression stockings
Explanation: ***are at risk for significant pulmonary embolism*** - While calf DVT is often considered less severe than proximal DVT, it still carries a definite risk of extending proximally [1] and subsequently leading to **pulmonary embolism (PE)**, especially if untreated. - Approximately **10-20% of calf DVTs extend proximally**, increasing the risk of potentially fatal PE. *can expect asymptomatic recovery if treated promptly with anticoagulant* - Even with prompt anticoagulant treatment, a significant percentage of patients with DVT experience **post-thrombotic syndrome (PTS)**, characterized by pain, swelling, and skin changes. - While anticoagulants [2] prevent clot extension and PE, they do not guarantee an **asymptomatic recovery** or fully prevent long-term sequelae. *may be effectively treated with low-dose heparin* - **Low-dose heparin** is typically used for DVT prophylaxis, not for treating acute DVT. - Treatment of acute DVT, including calf DVT, requires **therapeutic anticoagulation** with unfractionated heparin, low molecular weight heparin, or oral anticoagulants [2] to prevent clot propagation and embolism. *may be effectively treated with pneumatic compression stockings* - **Pneumatic compression stockings** are primarily used for DVT prevention in high-risk patients, especially post-surgery. - They are not a primary treatment for an **established acute DVT**, where anticoagulation is the cornerstone of therapy to prevent complications.
Obstetrics and Gynecology
1 questionsA 47 year old post menopausal lady was on adjuvant hormonal treatment with Tamoxifen for 3 years for Carcinoma Breast. She came to Outpatient Department with history of passing blood clots per vagina. She is probably suffering from:
UPSC-CMS 2018 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 81: A 47 year old post menopausal lady was on adjuvant hormonal treatment with Tamoxifen for 3 years for Carcinoma Breast. She came to Outpatient Department with history of passing blood clots per vagina. She is probably suffering from:
- A. Uterine fibroid
- B. Carcinoma Endometrium (Correct Answer)
- C. Carcinoma Vagina
- D. Carcinoma Vulva
Explanation: ***Carcinoma Endometrium*** - **Tamoxifen** acts as an **estrogen agonist** in the endometrium, increasing the risk of **endometrial hyperplasia** and **carcinoma**. - Postmenopausal vaginal bleeding or passing blood clots is a significant warning sign for **endometrial cancer**. *Uterine fibroid* - While fibroids can cause abnormal uterine bleeding, they are less likely to cause sudden, significant bleeding with clots in a **postmenopausal woman** on Tamoxifen without other symptoms. - Tamoxifen is not a direct cause of uterine fibroid development or enlargement. *Carcinoma Vagina* - **Vaginal carcinoma** is rarer than endometrial carcinoma and typically presents with a **vaginal mass** or bleeding with intercourse, not usually significant clotting in this context. - Tamoxifen is not directly linked to an increased risk of primary vaginal carcinoma. *Carcinoma Vulva* - **Vulvar carcinoma** presents as a **lesion** or **sore on the vulva** and symptoms like itching, pain, or bleeding from the lesion itself, not typically as vaginal blood clots. - The use of Tamoxifen does not significantly increase the risk of vulvar carcinoma.
Pathology
1 questionsFine Needle Aspiration Cytology (FNAC) is NOT conclusive in which one of the following thyroid swellings?
UPSC-CMS 2018 - Pathology UPSC-CMS Practice Questions and MCQs
Question 81: Fine Needle Aspiration Cytology (FNAC) is NOT conclusive in which one of the following thyroid swellings?
- A. Papillary carcinoma thyroid
- B. Follicular carcinoma thyroid (Correct Answer)
- C. Thyroiditis
- D. Medullary carcinoma thyroid
Explanation: ***Follicular carcinoma thyroid*** - FNAC cannot definitively distinguish between a **follicular adenoma** and a **follicular carcinoma** [1]. - This is because the diagnosis of follicular carcinoma relies on the presence of **capsular invasion** or **vascular invasion**, which can only be assessed on **histopathological examination** of the resected specimen, not cytology [1]. *Papillary carcinoma thyroid* - FNAC is highly effective in diagnosing papillary carcinoma due to characteristic **nuclear features** such as **Orphan Annie eye nuclei**, nuclear grooves, and intranuclear inclusions [3]. - These distinct cytological findings allow for a confident diagnosis without needing to assess invasion [3]. *Thyroiditis* - FNAC is typically conclusive for diagnosing various forms of thyroiditis (e.g., Hashimoto's thyroiditis, subacute thyroiditis). - It identifies characteristic inflammatory cells, giant cells, and changes in follicular cells consistent with the diagnosis. *Medullary carcinoma thyroid* - Medullary thyroid carcinoma can be reliably diagnosed by FNAC due to its characteristic **polygonal or spindle-shaped cells**, **amyloid deposition**, and presence of **calcitonin** in the aspirate [2]. - Immunocytochemical staining for calcitonin further confirms the diagnosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1100-1101. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099.
Pharmacology
1 questionsHerceptin (Trastuzumab) is an immunotherapeutic agent used in the treatment of:
UPSC-CMS 2018 - Pharmacology UPSC-CMS Practice Questions and MCQs
Question 81: Herceptin (Trastuzumab) is an immunotherapeutic agent used in the treatment of:
- A. Carcinoma rectum
- B. Ovarian malignancy
- C. Carcinoma breast (Correct Answer)
- D. Carcinoma prostate
Explanation: ***Carcinoma breast*** - **Herceptin (Trastuzumab)** is a monoclonal antibody that targets the **HER2 receptor**, which is overexpressed in a significant subset of breast cancers. - Its use is specifically indicated for **HER2-positive breast cancer**, where it helps to inhibit cancer cell growth and proliferation. *Carcinoma rectum* - Treatment for **colorectal cancer** (including rectal carcinoma) typically involves surgery, chemotherapy (e.g., 5-fluorouracil), and radiation, with targeted therapies like cetuximab or bevacizumab for specific mutations. - **HER2 overexpression** is rare in colorectal cancer and Trastuzumab is not a standard treatment. *Ovarian malignancy* - Treatment for **ovarian cancer** usually involves surgery and platinum-based chemotherapy (e.g., carboplatin, paclitaxel), and sometimes bevacizumab. - While HER2 can be expressed in some ovarian cancers, it is not a primary therapeutic target, and **Trastuzumab is not routinely used** for this malignancy. *Carcinoma prostate* - **Prostate cancer** treatment primarily involves hormone therapy, radiation, chemotherapy (e.g., docetaxel), and targeted agents for specific mutations (e.g., PARP inhibitors). - HER2 is not a significant driver of prostate cancer growth, and **Trastuzumab is not indicated** for its treatment.
Surgery
4 questionsFollowing are the factors for increased risk of wound infection EXCEPT:
A 22 year old young man came with history of occasional bleeding per rectum. On colonoscopy, numerous sessile polyps were seen in descending and sigmoid colon. On family history his elder brother was operated for thyroid malignancy. The young man should be advised:
Gastric conduit after oesophageal resection is based upon:
A 70 year old male having comorbidities presents with benign appearing parotid tumour. The best option is:
UPSC-CMS 2018 - Surgery UPSC-CMS Practice Questions and MCQs
Question 81: Following are the factors for increased risk of wound infection EXCEPT:
- A. Good blood supply (Correct Answer)
- B. Metabolic diseases (diabetes, uraemia)
- C. Immunosuppression
- D. Malnutrition
Explanation: ***Good blood supply*** - A **robust blood supply** is crucial for wound healing as it delivers **oxygen, nutrients, and immune cells** to the injured site, actively preventing infection. - Good perfusion means that the tissues can effectively **clear bacteria** and support the local immune response, thereby **decreasing the risk** of wound infection. *Metabolic diseases (diabetes, uraemia)* - **Diabetes** impairs wound healing through mechanisms like **peripheral neuropathy**, **vasculopathy**, and compromised immune function, greatly increasing infection risk. - **Uraemia** in kidney failure leads to a buildup of toxins that can **suppress the immune system** and impair cellular function, making patients more susceptible to infections. *Immunosuppression* - **Immunosuppression**, whether due to chronic illness, medications (e.g., corticosteroids), or immunodeficiency, significantly **weakens the body's defense mechanisms**. - A compromised immune system is less able to **identify, target, and eliminate invading pathogens**, leading to a higher incidence of wound infections. *Malnutrition* - **Malnutrition**, particularly deficiencies in protein, vitamin C, and zinc, can severely **impair collagen synthesis**, immune function, and overall tissue repair. - Inadequate nutritional status hinders the body's ability to **mount an effective immune response** and regenerate tissues, creating an environment ripe for infection.
Question 82: A 22 year old young man came with history of occasional bleeding per rectum. On colonoscopy, numerous sessile polyps were seen in descending and sigmoid colon. On family history his elder brother was operated for thyroid malignancy. The young man should be advised:
- A. Prophylactic anterior resection
- B. Prophylactic panproctocolectomy (Correct Answer)
- C. Surveillance colonoscopy every 6 months
- D. Colonoscopic removal of all polyps
Explanation: ***Prophylactic panproctocolectomy*** - This patient presents with multiple sessile polyps in the descending and sigmoid colon, along with a family history of **thyroid malignancy** in his brother. This constellation of findings is highly suggestive of **Familial Adenomatous Polyposis (FAP)**, specifically **Gardner syndrome**, which is a variant of FAP associated with extracolonic manifestations like thyroid tumors. - Due to the high risk of **colorectal cancer** development in FAP (nearly 100% by age 40 without intervention), **prophylactic panproctocolectomy** is the recommended treatment to prevent progression to malignancy. *Prophylactic anterior resection* - An anterior resection typically involves removing only a segment of the colon, which would be insufficient for a patient with FAP, as polyps can develop throughout the entire colon and rectum. - This procedure would leave a significant portion of the colon at risk for **neoplastic transformation**, necessitating further surgeries or intense surveillance. *Surveillance colonoscopy every 6 months* - While surveillance is crucial in risk assessment, for diagnosed FAP, particularly with symptomatic polyps and a family history suggestive of a syndrome, surveillance alone is inadequate due to the **high and inevitable risk of cancer**. - Delaying definitive surgical intervention would expose the patient to a very high probability of developing **colorectal carcinoma**. *Colonoscopic removal of all polyps* - Given the presence of **numerous sessile polyps**, endoscopic polypectomy would be impractical, incomplete, and would likely miss microscopic or nascent lesions. - This approach offers only temporary management and does not address the underlying genetic predisposition to continuous polyp formation and high malignancy risk.
Question 83: Gastric conduit after oesophageal resection is based upon:
- A. Short gastric vessels and Vasa brevia
- B. Right Gastroepiploic artery (Correct Answer)
- C. Left gastric artery
- D. Right gastric artery
Explanation: ***Right Gastroepiploic artery*** - The **right gastroepiploic artery** is the primary arterial supply preserved when fashioning a gastric conduit for esophageal replacement. - This artery provides the main blood supply to the **greater curvature of the stomach**, which forms the basis of the conduit, ensuring its viability. *Short gastric vessels and Vasa brevia* - The **short gastric vessels** are typically ligated and divided during gastric conduit creation to mobilize the stomach for upward transposition. - These vessels supply the fundus and upper part of the greater curvature, which are often either resected or lose their primary blood supply, making them unsuitable as the sole basis for the conduit. *Left gastric artery* - The **left gastric artery** is usually ligated during oesophageal resection to facilitate gastric mobilization and conduit creation. - It supplies the lesser curvature and upper part of the stomach, but its division is necessary to free the stomach for transposition into the chest or neck. *Right gastric artery* - The **right gastric artery** supplies the lesser curvature of the stomach and is often ligated or preserved with care, but it is not the primary vessel relied upon for the blood supply of the gastric conduit. - Its contribution to the overall conduit's blood supply is secondary to the robust flow from the right gastroepiploic artery.
Question 84: A 70 year old male having comorbidities presents with benign appearing parotid tumour. The best option is:
- A. Tumour enucleation
- B. Radio therapy
- C. Aspiration biopsy confirmation
- D. Superficial Parotidectomy (Correct Answer)
Explanation: ***Superficial Parotidectomy*** - This is the **standard surgical treatment** for benign parotid tumors, even in elderly patients with comorbidities, as it offers the best balance of **low recurrence risk** and **preservation of facial nerve function**. - The procedure removes the superficial lobe of the parotid gland, where most benign tumors are located, and allows for **intraoperative facial nerve monitoring**. *Tumour enucleation* - This procedure has a **higher risk of tumor recurrence** as it does not remove a cuff of healthy tissue around the tumor. - It also has a greater chance of **facial nerve injury** due to the lack of clear dissection planes. *Radio therapy* - Radiotherapy is generally reserved for **malignant parotid tumors** or as an adjuvant therapy after incomplete resection of high-grade malignancies. - It carries risks of **xerostomia**, radiation-induced fibrosis, and potential secondary malignancies, making it less suitable for benign conditions. *Aspiration biopsy confirmation* - While an aspiration biopsy (Fine Needle Aspiration Cytology, FNAC) is crucial for **preoperative diagnosis**, it is not a treatment option. - It helps in planning the definitive surgical approach but does not address the tumor itself.