Dermatology
1 questionsWhich one of the following is NOT true of Pyoderma gangrenosum?
UPSC-CMS 2020 - Dermatology UPSC-CMS Practice Questions and MCQs
Question 31: Which one of the following is NOT true of Pyoderma gangrenosum?
- A. It is often secondary to heightened immunological reactivity from another disease process
- B. Cultures often show Gram positive Staphylococci (Correct Answer)
- C. Lesions generally respond to steroids
- D. It is characterized by cutaneous ulceration with purple undermined edges
Explanation: ***Cultures often show Gram positive Staphylococci*** - Pyoderma gangrenosum is a **sterile inflammatory dermatosis**, meaning that the ulcers are not caused by bacterial infection. - While secondary infection can occur, the primary lesion itself is **non-infectious**, and therefore, routine cultures of the ulcer base would typically be negative for primary pathogens like *Staphylococci*. *It is often secondary to heightened immunological reactivity from another disease process* - Pyoderma gangrenosum is well-known for its association with underlying systemic conditions, particularly **inflammatory bowel disease**, **rheumatoid arthritis**, and certain **hematologic malignancies**. - Its pathogenesis is thought to involve **dysregulated neutrophils** and an underlying autoimmune or autoinflammatory process. *Lesions generally respond to steroids* - **Corticosteroids** are the first-line treatment for Pyoderma gangrenosum, used to reduce inflammation and promote healing. - Both topical and systemic corticosteroids, such as **prednisone**, are effective in managing the condition. *It is characterized by cutaneous ulceration with purple undermined edges* - The classic presentation of Pyoderma gangrenosum is a rapidly evolving, painful, **necrotic ulcer** with a characteristic **violaceous (purple) undermined border**. - This distinctive appearance helps differentiate it from other types of skin ulcers.
Internal Medicine
3 questionsWhich one of the following is NOT a complication of massive blood transfusion?
Which one of the following is NOT correct regarding MEN-1 syndrome?
Which one of the following is NOT an electronic information site in surgery?
UPSC-CMS 2020 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 31: Which one of the following is NOT a complication of massive blood transfusion?
- A. Hyperthermia (Correct Answer)
- B. Hyperkalemia
- C. Hypocalcaemia
- D. Coagulopathy
Explanation: ***Hyperthermia*** - **Hypothermia** is a more common complication of massive blood transfusion due to the administration of large volumes of cold blood products. - While theoretical, hyperthermia in this context would be rare and not a direct complication of the blood components themselves, unless equipment malfunction or infection occurs. [1] *Hyperkalemia* - Stored red blood cells **leak potassium** as they age, leading to higher potassium levels in the transfusion product. - Rapid infusion of large volumes can overwhelm the body's compensatory mechanisms, resulting in **elevated serum potassium**. *Hypocalcaemia* - **Citrate**, an anticoagulant used in blood storage, binds to ionized calcium in the recipient's blood. - Massive transfusions can lead to significant citrate accumulation, causing a drop in **ionized calcium levels**. *Coagulopathy* - Massive transfusions dilute clotting factors and platelets, which are not proportionally replaced in standard transfusion protocols. - This dilution can lead to impaired **hemostasis** and increased bleeding tendencies. [1]
Question 32: Which one of the following is NOT correct regarding MEN-1 syndrome?
- A. It involves pancreas
- B. It involves pituitary gland
- C. It involves pineal gland (Correct Answer)
- D. It involves parathyroid glands
Explanation: ***It involves pineal gland*** - MEN-1 syndrome, also known as Wermer's syndrome, is characterized by tumors of the **parathyroid glands**, **pituitary gland**, and **pancreatic islet cells** [1]. - The **pineal gland** is not typically associated with MEN-1 syndrome. *It involves pancreas* - **Pancreatic islet cell tumors** are a hallmark of MEN-1, often leading to diseases like **Zollinger-Ellison syndrome** (gastrinomas) or insulinomas [1]. - These tumors can cause significant endocrine dysfunction due to excessive hormone production [1]. *It involves pituitary gland* - **Pituitary adenomas**, particularly prolactinomas, are a common manifestation of MEN-1 syndrome [1]. - They can cause symptoms related to hormone excess (e.g., galactorrhea) or mass effects (e.g., visual disturbances) [1]. *It involves parathyroid glands* - **Hyperparathyroidism** due to parathyroid adenomas or hyperplasia is the most common manifestation of MEN-1 syndrome, affecting nearly all patients [2]. - This leads to elevated **calcium levels** and can cause symptoms like kidney stones, bone pain, and fatigue.
Question 33: Which one of the following is NOT an electronic information site in surgery?
- A. Embase
- B. Cochrane library
- C. Pubmed
- D. Surgical textbook (Correct Answer)
Explanation: ***Surgical textbook*** - A surgical textbook is a **physical or digital book** containing detailed information on surgical procedures, principles, and concepts. It is a traditional source of information, not an electronic information site. - While it provides valuable knowledge, it does not function as an **online database** or search engine for current medical literature. *Embase* - **Embase** is a comprehensive biomedical and pharmacological database, used for searching medical literature and evidence. - It contains a vast amount of information, including **articles, conference abstracts**, and drug-related data, making it an electronic information site. *Cochrane library* - The **Cochrane Library** is a collection of databases that contain different types of high-quality, independent evidence to inform healthcare decision-making. - It is particularly known for its **systematic reviews and meta-analyses**, making it a key electronic information site for evidence-based medicine. *Pubmed* - **PubMed** is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. - It is one of the most widely used **electronic information sites** for medical literature searches by healthcare professionals and researchers.
Orthopaedics
1 questionsKohler's disease is avascular necrosis of :
UPSC-CMS 2020 - Orthopaedics UPSC-CMS Practice Questions and MCQs
Question 31: Kohler's disease is avascular necrosis of :
- A. Navicular (Correct Answer)
- B. First metatarsal head
- C. Capitellum of humerus
- D. Lunate
Explanation: ***Navicular*** - **Kohler's disease** specifically refers to **osteochondrosis** or **avascular necrosis** of the **navicular bone** in the foot. - It primarily affects **children** and is characterized by pain and tenderness over the medial aspect of the foot. *First metatarsal head* - Avascular necrosis of the first metatarsal head is known as **Freiberg's infraction**. - This condition typically affects **adolescent girls** and causes pain in the forefoot, especially during weight-bearing. *Capitellum of humerus* - Avascular necrosis of the capitellum of the humerus is called **Panner's disease**. - It is an **osteochondrosis** that primarily affects **young athletes** involved in repetitive overhead activities, leading to elbow pain and stiffness. *Lunate* - Avascular necrosis of the lunate bone in the wrist is known as **Kienbock's disease**. - This condition typically affects **adults** and is associated with wrist pain, stiffness, and weakness.
Surgery
5 questionsWhich one of the following is NOT a risk factor for development of venous thrombosis in surgical patients?
Stage III "Pressure sore" is full thickness skin loss extending:
During subclavian vein puncture in a surgical ward suddenly a patient developed severe breathlessness. On auscultation breath sound was absent and the ipsilateral chest was tympanitic on percussion. The probable diagnosis is:
Which of the following is NOT a tissue repair surgery for inguinal hernia repair?
Which one of the following type of meshes is recommended for intraperitoneal use in abdominal wall hernia?
UPSC-CMS 2020 - Surgery UPSC-CMS Practice Questions and MCQs
Question 31: Which one of the following is NOT a risk factor for development of venous thrombosis in surgical patients?
- A. Male gender (Correct Answer)
- B. Age > 60 years
- C. Obesity (BMI > 30 kg/m2 )
- D. Pregnancy
Explanation: ***Male gender*** - While there may be slight differences in **VTE incidence** between sexes, male gender is **not considered an independent risk factor** for venous thrombosis in surgical patients; rather, other comorbidities or specific surgical procedures are more influential. - Risk factors like **age, obesity, and pregnancy** are well-established and significantly increase the risk of thrombosis, unlike male gender. *Age > 60 years* - **Advancing age** is a significant risk factor for venous thrombosis due to age-related changes in coagulation factors, endothelial function, and reduced mobility. - Older patients undergoing surgery have a higher likelihood of developing **deep vein thrombosis (DVT)** and **pulmonary embolism (PE)**. *Obesity (BMI > 30 kg/m2)* - **Obesity** is a well-established risk factor for venous thrombosis due to chronic inflammation, endothelial dysfunction, and increased procoagulant factors. - Obese surgical patients have a higher risk of **VTE** compared to those with a normal BMI. *Pregnancy* - **Pregnancy** is a hypercoagulable state due to hormonal changes, increased coagulation factors, and venous stasis, significantly increasing the risk of venous thrombosis. - The risk of VTE is elevated throughout pregnancy and the **postpartum period**, especially after surgical interventions like Cesarean sections.
Question 32: Stage III "Pressure sore" is full thickness skin loss extending:
- A. through subcutaneous tissue into fascia, muscles and bone
- B. into subcutaneous tissue but not through fascia (Correct Answer)
- C. through subcutaneous tissue into fascia
- D. through subcutaneous tissue into fascia and muscles
Explanation: ***into subcutaneous tissue but not through fascia*** - A **Stage III pressure ulcer** involves **full-thickness skin loss** with damage or necrosis of **subcutaneous tissue** that may extend down to, but **NOT through**, the underlying fascia. - The ulcer presents as a **deep crater** with or without undermining of adjacent tissue, slough, or eschar. - **Muscle, tendon, and bone are NOT visible or directly palpable** in Stage III ulcers. *through subcutaneous tissue into fascia* - This description is **too deep** for Stage III; fascia penetration indicates **Stage IV**. - Stage III extends **to** the fascia but does **not penetrate through** it. *through subcutaneous tissue into fascia and muscles* - This is the definition of a **Stage IV pressure ulcer**, not Stage III. - **Muscle exposure** indicates full-thickness tissue loss beyond the subcutaneous layer and signifies Stage IV. *through subcutaneous tissue into fascia, muscles and bone* - This is also **Stage IV** (most severe form with bone, tendon, or muscle exposure). - **Bone exposure** is pathognomonic of Stage IV pressure ulcers and never occurs in Stage III.
Question 33: During subclavian vein puncture in a surgical ward suddenly a patient developed severe breathlessness. On auscultation breath sound was absent and the ipsilateral chest was tympanitic on percussion. The probable diagnosis is:
- A. Iatrogenic pneumothorax (Correct Answer)
- B. Tension pneumothorax
- C. Spontaneous pneumothorax
- D. Iatrogenic hemothorax
Explanation: ***Iatrogenic pneumothorax*** - The sudden onset of breathlessness after **subclavian vein puncture** points towards an iatrogenic cause due to accidental pleural injury. - **Absent breath sounds** and **tympanitic percussion** on the ipsilateral side are classic signs of air in the pleural space. *Tension pneumothorax* - While it shares features of pneumothorax, **tension pneumothorax** would typically present with **tracheal deviation**, severe hypotension, and signs of cardiovascular collapse due to mediastinal shift. - The description lacks these critical signs of hemodynamic instability and significant mediastinal compression. *Spontaneous pneumothorax* - **Spontaneous pneumothorax** occurs without any preceding trauma or medical procedure, usually due to rupture of subpleural blebs. - The history of a recent **subclavian vein puncture** makes an iatrogenic cause much more likely than a spontaneous event. *Iatrogenic hemothorax* - **Iatrogenic hemothorax** would also be a complication of subclavian vein puncture, but it would present with **dullness to percussion** instead of tympany, and signs of hypovolemic shock if severe. - The **tympanitic percussion** directly indicates the presence of air, not blood, in the pleural cavity.
Question 34: Which of the following is NOT a tissue repair surgery for inguinal hernia repair?
- A. Bassini's repair
- B. Shouldice repair
- C. Stoppa's repair (Correct Answer)
- D. Desarda repair
Explanation: ***Stoppa's repair*** - Stoppa's repair is a type of **giant prosthetic reinforcement of the visceral sac (GPRVS)**, which involves placing a large sheet of **synthetic mesh** in the preperitoneal space to buttress the entire myopectineal orifice. - This technique is primarily a **mesh repair** and thus not considered a pure tissue repair method. *Bassini's repair* - This is a classic **tissue repair** method where the conjoint tendon is sutured to the inguinal ligament, reinforcing the posterior wall of the inguinal canal. - It involves using the patient's own tissues without the implantation of synthetic mesh. *Shouldice repair* - Considered a gold standard among **tissue repairs**, it involves a multi-layered reconstruction of the posterior wall of the inguinal canal by approximating the transversalis fascia, conjoint tendon, and iliopubic tract. - The Shouldice repair also avoids the use of mesh. *Desarda repair* - This is a newer **tissue repair** method that utilizes a strip of the external oblique aponeurosis to create a new posterior wall for the inguinal canal. - It is promoted as a tension-free repair that does not use foreign mesh materials.
Question 35: Which one of the following type of meshes is recommended for intraperitoneal use in abdominal wall hernia?
- A. Absorbable meshes
- B. Heavy weight, porous meshes
- C. Light weight, porous meshes
- D. Tissue separating meshes (Correct Answer)
Explanation: ***Correct: Tissue separating meshes*** - These meshes are designed with a **non-adherent barrier** on one side to prevent visceral adhesions when placed intraperitoneally. - They are essential for intraperitoneal hernia repair to avoid complications like **bowel obstruction** or **fistula formation**. - Examples include **Parietex Composite, Proceed, and Composix** meshes. *Incorrect: Light weight, porous meshes* - While generally preferred for tension-free repair due to reduced foreign body reaction, they **lack an anti-adhesive barrier** for intraperitoneal use. - Their direct contact with abdominal viscera can lead to **adhesion formation**, which is a significant complication. *Incorrect: Absorbable meshes* - These meshes are intended for temporary support and are eventually broken down and absorbed by the body. - Their complete absorption means they **do not provide long-term reinforcement** or prevent hernia recurrence, which is crucial for permanent repair. *Incorrect: Heavy weight, porous meshes* - These meshes are associated with a **higher foreign body reaction**, leading to more inflammation, pain, and mesh contraction. - They also **lack the necessary anti-adhesive coating** for safe intraperitoneal placement, increasing the risk of visceral adhesions.