UPSC-CMS 2020 Practice Questions

Q: Which one of the following is NOT true of Pyoderma gangrenosum?

Cultures often show Gram positive Staphylococci. ***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.

Q: Which one of the following is NOT a complication of massive blood transfusion?

Hyperthermia. ***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]

Q: Which one of the following is NOT correct regarding MEN-1 syndrome?

It involves pineal gland. ***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.

Q: Which one of the following is NOT an electronic information site in surgery?

Surgical textbook. ***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.

Q: Kohler's disease is avascular necrosis of :

Navicular. ***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.

Q: Which one of the following is NOT a risk factor for development of venous thrombosis in surgical patients?

Male gender. ***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.

Q: Stage III "Pressure sore" is full thickness skin loss extending:

into subcutaneous tissue but not through fascia. ***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.

Q: 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:

Iatrogenic pneumothorax. ***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.

Q: Which of the following is NOT a tissue repair surgery for inguinal hernia repair?

Stoppa's repair. ***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.

Q: Which one of the following type of meshes is recommended for intraperitoneal use in abdominal wall hernia?

Tissue separating meshes. ***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.

Question 1

Which one of the following is NOT true of Pyoderma gangrenosum?

Accepted Answer

Cultures often show Gram positive Staphylococci

Answer

It is often secondary to heightened immunological reactivity from another disease process

Answer

Lesions generally respond to steroids

Answer

It is characterized by cutaneous ulceration with purple undermined edges

Question 2

Which one of the following is NOT a complication of massive blood transfusion?

Accepted Answer

Hyperthermia

Answer

Hyperkalemia

Answer

Hypocalcaemia

Answer

Coagulopathy

Question 3

Which one of the following is NOT correct regarding MEN-1 syndrome?

Accepted Answer

It involves pineal gland

Answer

It involves pancreas

Answer

It involves pituitary gland

Answer

It involves parathyroid glands

Question 4

Which one of the following is NOT an electronic information site in surgery?

Accepted Answer

Surgical textbook

Answer

Embase

Answer

Cochrane library

Answer

Pubmed

Question 5

Kohler's disease is avascular necrosis of :

Accepted Answer

Navicular

Answer

First metatarsal head

Answer

Capitellum of humerus

Answer

Lunate

Question 6

Which one of the following is NOT a risk factor for development of venous thrombosis in surgical patients?

Accepted Answer

Male gender

Answer

Age > 60 years

Answer

Obesity (BMI > 30 kg/m2 )

Answer

Pregnancy

Question 7

Stage III "Pressure sore" is full thickness skin loss extending:

Accepted Answer

into subcutaneous tissue but not through fascia

Answer

through subcutaneous tissue into fascia, muscles and bone

Answer

through subcutaneous tissue into fascia

Answer

through subcutaneous tissue into fascia and muscles

Question 8

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:

Accepted Answer

Iatrogenic pneumothorax

Answer

Tension pneumothorax

Answer

Spontaneous pneumothorax

Answer

Iatrogenic hemothorax

Question 9

Which of the following is NOT a tissue repair surgery for inguinal hernia repair?

Accepted Answer

Stoppa's repair

Answer

Bassini's repair

Answer

Shouldice repair

Answer

Desarda repair

Question 10

Which one of the following type of meshes is recommended for intraperitoneal use in abdominal wall hernia?

Accepted Answer

Tissue separating meshes

Answer

Absorbable meshes

Answer

Heavy weight, porous meshes

Answer

Light weight, porous meshes

UPSC-CMS 2020

Dermatology

Internal Medicine

Orthopaedics

Surgery