UPSC-CMS 2020 Practice Questions

Q: Which one of the following cranial nerves does NOT supply the external ear?

Cranial nerve VI. ***Cranial nerve VI*** - Cranial nerve VI, the **abducens nerve**, solely innervates the **lateral rectus muscle** of the eye, responsible for eye abduction. - It has no known role in the sensory or motor innervation of the external ear. *Cranial nerve V* - The **auriculotemporal nerve**, a branch of the **mandibular division of the trigeminal nerve (V3)**, provides sensory innervation to the anterior aspect of the external ear and the temporomandibular joint. - Therefore, cranial nerve V contributes to the innervation of the external ear. *Cranial nerve IX* - The **glossopharyngeal nerve (IX)** contributes to the innervation of the external ear through its **auricular branch**, which supplies a small area of skin near the external auditory meatus. - This provides some sensory input from the external ear. *Cranial nerve VII* - The **facial nerve (VII)** supplies motor innervation to the **auricular muscles** and provides sensory innervation to a small area of the concha via the **nervus intermedius**. - Its involvement is evident in various reflexes and sensations related to the ear.

Q: Rapid Sequence Induction is indicated in:

Emergency surgery for intestinal obstruction. ***Emergency surgery for intestinal obstruction*** - Rapid Sequence Induction (RSI) is indicated in situations where there is a high risk of **pulmonary aspiration** of gastric contents, such as in **intestinal obstruction**, due to a full stomach or impaired gastric emptying. - The goal of RSI is to achieve rapid intubation while minimizing the risk of aspiration by using a specific sequence of medications and techniques (e.g., cricoid pressure). *Cardiopulmonary bypass surgery* - This is an **elective procedure** where patients are typically fasted and have time for a thorough pre-operative assessment and standard induction. - While significant, it does not inherently carry the same immediate high risk of aspiration as an emergency with a full stomach. *Elective open hernia surgery* - This is an **elective procedure** where the patient can be properly fasted, significantly reducing the risk of a full stomach. - A standard, controlled anesthetic induction is generally preferred, allowing for gradual intubation and ventilation. *Elective laparoscopic surgery* - Similar to elective open surgery, patients undergoing **elective laparoscopic procedures** are properly fasted. - The primary concern in laparoscopic surgery is often related to pneumoperitoneum and its effects, rather than a high aspiration risk during induction if fasting guidelines are followed.

Q: The most common site for osteosarcoma is:

Distal femur. ***Distal femur*** - The **distal femur** is the most frequent site of involvement for **osteosarcoma**, accounting for approximately 40% of all cases [1]. - This region, along with the proximal tibia and proximal humerus, constitutes the most common locations for this primary malignant bone tumor [1]. *Proximal humerus* - While the **proximal humerus** is a common site for osteosarcoma, it is less frequent than the distal femur [1]. - It ranks third in incidence after the distal femur and proximal tibia [1]. *Proximal femur* - The **proximal femur** can be affected by osteosarcoma, but it is a relatively less common site compared to the distal femur. - Osteosarcomas tend to occur around the **growth plates** of long bones [1]. *Distal humerus* - The **distal humerus** is an uncommon site for the development of osteosarcoma. - It is much less frequently involved than the other major long bone metaphyses. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1200-1202.

Q: The term mid-line shift is associated with:

Head injury. **Head injury** - **Mid-line shift** refers to the displacement of the brain's central structures, such as the septum pellucidum or pineal gland, from their normal position due to a **mass effect** from a lesion like a hematoma or edema following a head injury. - This displacement is a critical sign of increased **intracranial pressure** and can lead to herniation syndromes, indicating a severe and life-threatening condition. *Chest injury* - Chest injuries typically involve structures within the thorax, such as the lungs, heart, or rib cage. - While a tension pneumothorax can cause a **mediastinal shift** (displacement of the trachea and heart), this is distinct from a "mid-line shift" which specifically describes brain structures. *Abdominal injury* - Abdominal injuries usually affect organs like the liver, spleen, or intestines. - These injuries can cause significant internal bleeding or organ damage but do not directly lead to a "mid-line shift" of brain structures. *Limb injury* - Limb injuries involve damage to bones, muscles, ligaments, or blood vessels in the extremities. - These injuries are localized to the limbs and are not associated with any form of intracranial shift or increased intracranial pressure.

Q: Which one of the following is NOT the strength of ultrasound as a diagnostic modality?

Short learning curve. ***Short learning curve*** - While ultrasound is widely used, developing proficiency requires **extensive training** and **experience**, especially for complex evaluations. - The interpretation of ultrasound images is highly **operator-dependent**, and mastering proper technique and recognizing subtle findings demands a significant learning investment. *No radiation* - Ultrasound uses **sound waves** to generate images, meaning it does not expose patients to **ionizing radiation**. - This makes it a safer option for repeated studies, pregnant patients, and pediatric populations compared to modalities like X-rays or CT scans. *Inexpensive* - Ultrasound machines are generally **less expensive** to purchase and maintain compared to MRI or CT scanners. - The procedure itself is also typically **less costly** than other advanced imaging techniques, making it more accessible. *Allows dynamic studies to be done* - Ultrasound can capture images in **real-time**, allowing clinicians to observe organ movement, blood flow, and tissue changes during various maneuvers. - This capability is crucial for assessing joint stability, vascular patency, and the mobility of masses or fluid collections.

Q: Left Internal Mammary Artery (LIMA) has become the conduit of choice for Left Anterior Descending (LAD) artery during coronary artery bypass grafting because:

Long term patency rates are superior (>90% at 10 years). ***Long term patency rates are superior (>90% at 10 years)*** - The superior **long-term patency rates** (over 90% at 10 years) of the **Left Internal Mammary Artery (LIMA)** when anastomosed to the **Left Anterior Descending (LAD) artery** are the primary reason for it being the conduit of choice. - This excellent patency is attributed to its **endothelial** properties and **resistance to atherosclerosis**, contributing to improved patient outcomes and survival. *Atherosclerosis is never seen in this vessel* - While the LIMA is significantly **more resistant to atherosclerosis** compared to saphenous veins, it is not entirely immune. - Atherosclerosis can still occur in the LIMA, though it is far less common and less severe than in other graft conduits. *It is very easy to harvest* - Harvesting the LIMA requires a skilled surgical technique and is **not considered "very easy."** - It involves careful dissection to preserve the conduit's integrity and includes potential complications like **sternal wound infections** due to altered blood supply. *It is close to LAD* - While the anatomical proximity of the LIMA to the LAD is a favorable factor, making the anastomosis geographically convenient, it is **not the primary reason** for its widespread use. - The primary driving factor is the superior long-term patency, which directly impacts patient morbidity and mortality.

Q: A 50-year old male with significant smoking history presented in the surgical emergency with sudden severe breathlessness. Chest X-ray shows right sided Pneumothorax. The appropriate management requires:

Right chest drain of size 8-14 Fr. ***Right chest drain of size 8-14 Fr*** - A **chest drain (thoracostomy tube)** is indicated for spontaneous pneumothorax, especially in symptomatic patients like this one, to allow trapped air to escape and the lung to re-expand. - A **small-bore catheter (8-14 Fr)** is generally preferred for primary spontaneous pneumothorax due to comparable efficacy to large-bore tubes but with less pain and fewer complications. *Mechanical ventilation* - **Mechanical ventilation** is not the primary treatment for pneumothorax; it may be needed if the patient develops respiratory failure despite chest drain insertion or if there's a tension pneumothorax causing hemodynamic instability. - Initiating mechanical ventilation without addressing the underlying pneumothorax can worsen the situation by increasing **intrathoracic pressure**. *Aspiration of air with 16-18 G cannula* - **Needle aspiration** with a 16-18G cannula is typically reserved for initial management of a **stable, small primary spontaneous pneumothorax** (< 2 cm apex-to-cupola distance), or as a temporary measure for tension pneumothorax. - For a symptomatic patient with a significant pneumothorax, a **chest drain** offers more definitive and sustained air removal compared to needle aspiration. *Oxygen by face mask* - Administering **oxygen by face mask** is an supportive measure and it can accelerate resorption of air, but it does not resolve the pneumothorax itself by evacuating the trapped air. - While oxygen therapy is important, it is **insufficient as the sole treatment** for a symptomatic pneumothorax that requires active air removal.

Q: Which one of the following statements regarding Felon is NOT correct?

It is a painless condition. ***It is a painless condition*** - A **felon** is an abscess within the distal phalanx (fingertip) confined by fibrous septa, making it an extremely **painful** and tense infection due to increased pressure. - The severe pain is a hallmark symptom, distinguishing it from a painless condition, and is caused by the pus accumulating in a confined space. *It is common in diabetics* - **Felons** (and other soft tissue infections) are indeed more common in individuals with **diabetes mellitus** due to impaired immune function and compromised circulation. - This makes diabetics more susceptible to infections and can also lead to more severe outcomes. *Incision and drainage is the treatment of choice* - For a **felon**, **surgical incision and drainage** is the primary treatment to relieve pressure, evacuate pus, and prevent serious complications like osteomyelitis or necrosis. - This procedure typically involves a longitudinal or hockey-stick incision to access the infected compartment. *There is infection of the finger tip between specialised fibrous septa* - A **felon** is an infection, typically bacterial, located in the closed compartments of the fingertip's distal pulp, which are separated by **fibrous septa**. - These septa connect the skin to the periosteum, creating multiple small, enclosed spaces that can become acutely infected and filled with pus.

Q: Which of the following statements regarding lymphoedema following breast cancer treatment are correct? 1. Incidence has decreased due to rarely combined therapy of axillary LN dissection and radiotherapy 2. Precipitating cause like LN metastasis is a major determinant 3. The condition is often painful 4. Oedematous limb is susceptible to bacterial infection Select the correct answer using the code given below:

1, 2 and 4. ***Correct: 1, 2 and 4*** **Statement 1 is correct:** The incidence of post-treatment lymphoedema has decreased primarily due to the shift from routine **axillary lymph node dissection (ALND)** to **sentinel lymph node biopsy (SLNB)**. The combined therapy of ALND and radiotherapy, historically a major risk factor, is now rarely used, significantly reducing lymphoedema incidence. **Statement 2 is correct:** The presence of **lymph node metastases** is a major precipitating factor as it necessitates more extensive surgery (ALND) and/or radiation therapy, increasing the risk of lymphatic damage and subsequent lymphoedema. **Statement 4 is correct:** The oedematous limb has impaired lymphatic drainage leading to reduced immune surveillance and skin changes, making it highly **susceptible to bacterial infections** like cellulitis and erysipelas. *Statement 3 is incorrect:* Lymphoedema itself is typically **not acutely painful** but may cause a feeling of heaviness, tightness, or discomfort. Pain usually indicates complications such as bacterial infection (cellulitis), not the lymphoedema itself. Therefore, statements 1, 2, and 4 are correct, making option **"1, 2 and 4"** the correct answer.

Question 1

Which one of the following cranial nerves does NOT supply the external ear?

Accepted Answer

Cranial nerve VI

Answer

Cranial nerve V

Answer

Cranial nerve IX

Answer

Cranial nerve VII

Question 2

Rapid Sequence Induction is indicated in:

Accepted Answer

Emergency surgery for intestinal obstruction

Answer

Cardiopulmonary bypass surgery

Answer

Elective open hernia surgery

Answer

Elective laparoscopic surgery

Question 3

Which one of the following statements about Compartment Syndrome is NOT correct?

Accepted Answer

Pain is on active movement but not on passive movement of muscles

Answer

Fasciotomy is the treatment of choice

Answer

It is commonest in a closed fracture

Answer

Volkmann's Ischaemic contracture is a late complication

Question 4

The most common site for osteosarcoma is:

Accepted Answer

Distal femur

Answer

Proximal humerus

Answer

Proximal femur

Answer

Distal humerus

Question 5

The term mid-line shift is associated with:

Accepted Answer

Head injury

Answer

Chest injury

Answer

Abdominal injury

Answer

Limb injury

Question 6

Which one of the following is NOT the strength of ultrasound as a diagnostic modality?

Accepted Answer

Short learning curve

Answer

No radiation

Answer

Inexpensive

Answer

Allows dynamic studies to be done

Question 7

Left Internal Mammary Artery (LIMA) has become the conduit of choice for Left Anterior Descending (LAD) artery during coronary artery bypass grafting because:

Accepted Answer

Long term patency rates are superior (>90% at 10 years)

Answer

Atherosclerosis is never seen in this vessel

Answer

It is very easy to harvest

Answer

It is close to LAD

Question 8

A 50-year old male with significant smoking history presented in the surgical emergency with sudden severe breathlessness. Chest X-ray shows right sided Pneumothorax. The appropriate management requires:

Accepted Answer

Right chest drain of size 8-14 Fr

Answer

Mechanical ventilation

Answer

Aspiration of air with 16-18 G cannula

Answer

Oxygen by face mask

Question 9

Which one of the following statements regarding Felon is NOT correct?

Accepted Answer

It is a painless condition

Answer

It is common in diabetics

Answer

Incision and drainage is the treatment of choice

Answer

There is infection of the finger tip between specialised fibrous septa

Question 10

Which of the following statements regarding lymphoedema following breast cancer treatment are correct?

1. Incidence has decreased due to rarely combined therapy of axillary LN dissection and radiotherapy
2. Precipitating cause like LN metastasis is a major determinant
3. The condition is often painful
4. Oedematous limb is susceptible to bacterial infection

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

UPSC-CMS 2020

Anatomy

Anesthesiology

Orthopaedics

Pathology

Radiology

Surgery