Anatomy
2 questionsWhich of the following are probable sites for Ectopic pancreas? 1. Submucosa of the stomach and duodenum 2. Liver 3. Small bowel mesentery 4. Splenic hilum
Which one of the following statements regarding Cantlie's line is correct?
UPSC-CMS 2021 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 21: Which of the following are probable sites for Ectopic pancreas? 1. Submucosa of the stomach and duodenum 2. Liver 3. Small bowel mesentery 4. Splenic hilum
- A. 1, 2 and 4
- B. 2, 3 and 4
- C. 1, 3 and 4
- D. 1, 2 and 3 (Correct Answer)
Explanation: Correct: 1, 2 and 3 - The **submucosa of the stomach and duodenum** is the most common site for ectopic pancreatic tissue (25-40% of cases). - Ectopic pancreas can also be found in the **liver** and **small bowel mesentery**, though less frequently than in the upper gastrointestinal tract. - These three locations represent the well-recognized probable sites for ectopic pancreatic tissue. *Incorrect: 1, 2 and 4* - This option incorrectly includes the **splenic hilum**, which is not a recognized typical site for ectopic pancreas. - While ectopic pancreatic tissue can occur in various abdominal locations, the splenic hilum is not among the probable sites. *Incorrect: 2, 3 and 4* - This option omits the **submucosa of the stomach and duodenum**, which is the most frequent site for ectopic pancreas. - This makes the option incomplete as it misses the primary location for this condition. *Incorrect: 1, 3 and 4* - This option omits the **liver** as a probable site for ectopic pancreatic tissue. - While the liver is less common than the stomach or duodenum, it is a recognized location for ectopic pancreas.
Question 22: Which one of the following statements regarding Cantlie's line is correct?
- A. Runs between gall bladder fossa and right hepatic vein
- B. Runs between gall bladder fossa and middle hepatic vein (Correct Answer)
- C. Runs between gall bladder fossa and right branch of portal vein
- D. Runs between gall bladder fossa and left branch of portal vein
Explanation: ***Runs between gall bladder fossa and middle hepatic vein*** - **Cantlie's line** is an imaginary plane that divides the **functional left and right lobes of the liver** [1]. - This line extends from the **gallbladder fossa anteriorly** to the groove for the **inferior vena cava posteriorly**, functionally aligned with the **middle hepatic vein** [1], [3]. *Runs between gall bladder fossa and right hepatic vein* - The **right hepatic vein** typically lies further to the right, dividing the **right anterior and right posterior segments** of the liver [3]. - Cantlie's line is specifically defined by the **major fissure** where the **middle hepatic vein** resides [1]. *Runs between gall bladder fossa and right branch of portal vein* - The **portal vein branches** are located deeper within the liver parenchyma and indicate segmental anatomy rather than the primary functional division [1], [2]. - Cantlie's line is defined by the **major fissure (middle hepatic vein)**, not a portal vein branch [1]. *Runs between gall bladder fossa and left branch of portal vein* - The **left portal vein branch** supplies the functional left lobe and is not involved in defining the primary plane between the functional right and left lobes [1]. - This anatomical landmark relates to the **middle hepatic vein** and the **gallbladder fossa** [1].
Anesthesiology
1 questionsWhich one of the following is a Nephrotoxic anaesthetic agent ?
UPSC-CMS 2021 - Anesthesiology UPSC-CMS Practice Questions and MCQs
Question 21: Which one of the following is a Nephrotoxic anaesthetic agent ?
- A. Nitrous oxide
- B. Halothane
- C. Methoxyflurane (Correct Answer)
- D. Isoflurane
Explanation: ***Methoxyflurane*** - **Methoxyflurane** is an inhaled anesthetic that can cause dose-dependent **nephrotoxicity** due to the metabolic release of **fluoride ions**. - Its use is limited due to the risk of **renal dysfunction**, including **high-output renal failure**, especially with prolonged administration or high concentrations. *Nitrous oxide* - **Nitrous oxide** is an inhaled anesthetic known for its analgesic properties and low solubility, leading to rapid onset and offset. - It does not typically cause **direct organ toxicity** like nephrotoxicity, though prolonged exposure can affect bone marrow. *Halothane* - **Halothane** is an older inhaled anesthetic associated with **hepatotoxicity** (halothane hepatitis) in some susceptible individuals. - While it can cause liver damage, it is not primarily known for causing **nephrotoxicity**. *Isoflurane* - **Isoflurane** is a commonly used inhaled anesthetic known for its relatively stable cardiovascular effects and low metabolic degradation. - It is generally considered to have a **good safety profile** with minimal organ toxicity, including the kidneys.
Pharmacology
1 questionsWhich of the following statements regarding the composition of common crystalloid solutions is correct ?
UPSC-CMS 2021 - Pharmacology UPSC-CMS Practice Questions and MCQs
Question 21: Which of the following statements regarding the composition of common crystalloid solutions is correct ?
- A. Normal saline contains 154 mEq/L of Na+ (Correct Answer)
- B. Hartmann's solution contains 120 mEq/L of Cl-
- C. Hartmann's solution contains 140 mEq/L of Na+
- D. Normal saline contains 140 mEq/L of Cl-
Explanation: ***Normal saline contains 154 mEq/L of Na+*** - Normal saline (0.9% NaCl) contains **154 mEq/L of both Na+ and Cl-**, making this statement factually correct. - This makes normal saline **hypernatremic and hyperchloremic** compared to plasma (which has ~140 mEq/L Na+ and ~103 mEq/L Cl-). - Normal saline is useful for correcting **hyponatremia** and for significant volume expansion, but large volumes can cause **hyperchloremic metabolic acidosis**. *Hartmann's solution contains 140 mEq/L of Na+* - Hartmann's solution (Lactated Ringer's) actually contains approximately **130 mEq/L of Na+**, not 140 mEq/L. - The sodium content is designed to be closer to that of **plasma**, making it a more physiologically balanced solution. *Hartmann's solution contains 120 mEq/L of Cl-* - Hartmann's solution contains approximately **109-110 mEq/L of Cl-**, not 120 mEq/L. - This **lower chloride content** compared to normal saline, along with the presence of lactate (28 mEq/L), contributes to a reduced risk of hyperchloremic metabolic acidosis. - The lactate is metabolized to bicarbonate, providing a mild alkalinizing effect. *Normal saline contains 140 mEq/L of Cl-* - Normal saline contains **154 mEq/L of Cl-**, not 140 mEq/L. - Its high chloride content can lead to **hyperchloremic metabolic acidosis** with large-volume administration.
Radiology
1 questionsPositron Emission Tomography (PET) used in Preoperative staging of Gastro Oesophageal tumours is to detect
UPSC-CMS 2021 - Radiology UPSC-CMS Practice Questions and MCQs
Question 21: Positron Emission Tomography (PET) used in Preoperative staging of Gastro Oesophageal tumours is to detect
- A. Local spread
- B. Lymph node status
- C. Extension into stomach
- D. Distant metastatic disease (Correct Answer)
Explanation: ***Distant metastatic disease*** - **PET scans** are highly sensitive for detecting metabolically active lesions, making them excellent for identifying **distant metastases** in organs such as the liver, lungs, and bone, which significantly impacts surgical planning. - Identifying **distant metastatic disease** with PET helps in determining if the patient is a candidate for curative surgery or if palliative treatment is more appropriate. *Local spread* - While PET can show increased metabolic activity in the primary tumor, its resolution is often insufficient to precisely delineate the **local extent** of tumor invasion into adjacent tissues, which is better evaluated by **endoscopic ultrasound (EUS)** or **CT scan**. - Assessing local invasion is crucial for determining resectability, but PET's primary role isn't detailed local staging. *Lymph node status* - **PET scans** can detect metabolically active lymph nodes, but they have limitations in differentiating between inflammatory and malignant nodes, especially for very small metastases, leading to potential false positives or negatives. - **Endoscopic ultrasound (EUS)** with fine-needle aspiration (FNA) is generally considered superior for accurate regional **lymph node staging** in gastroesophageal cancer. *Extension into stomach* - The precise **intramural extension** of the tumor within the esophagus and into the stomach is often difficult to determine accurately with PET due to its relatively poor spatial resolution compared to other imaging modalities like **endoscopic ultrasound (EUS)** and **CT**. - **Endoscopic assessment** directly visualizes the tumor and can determine its macroscopic extent into the stomach more precisely than PET.
Surgery
5 questionsA 45 year old female patient presents with a painless firm abdominal swelling of size 10 x 8 cm near the umbilicus. The swelling is reducible and shows no fixation to deeper structures. The most probable clinical diagnosis in this patient is
In Pringle Manoeuvre, clamping includes which of the following? 1. Common Bile Duct 2. Hepatic artery 3. Portal vein 4. Inferior Vena Cava
A patient with suspected head injury is brought to the emergency following road traffic accident. At the time of examination, patient is conscious with GCS 14/15 and stable vitals. There is bleeding from right ear and CSF leak from nose. Bruising is present behind the right ear. The most probable clinical diagnosis in this patient is
Which of the following are correct about ectopic ureters? 1. They are more common in males 2. They drain the upper pole of the kidney 3. They are associated with duplex ureter 4. They may cause incontinence
A patient of road traffic accident presents to the emergency with increasing restlessness and difficulty in breathing. The respiratory rate is 26 breaths/minute; there are distended neck veins; trachea is deviated to the right side with hyper-resonant note and absence of breath sounds on the left side. Which of the following statements are correct? 1. The most probable clinical diagnosis is left tension pneumothorax 2. Immediate chest decompression using wide bore cannula in left 2nd intercostal space is to be done 3. Immediate chest X-ray should be done to confirm the clinical diagnosis 4. Definitive chest tube insertion in left fifth intercostal space should be done
UPSC-CMS 2021 - Surgery UPSC-CMS Practice Questions and MCQs
Question 21: A 45 year old female patient presents with a painless firm abdominal swelling of size 10 x 8 cm near the umbilicus. The swelling is reducible and shows no fixation to deeper structures. The most probable clinical diagnosis in this patient is
- A. Incisional hernia
- B. Umbilical hernia (Correct Answer)
- C. Inguinal hernia
- D. Femoral hernia
Explanation: ***Umbilical hernia*** - An **umbilical hernia** presents as a swelling near the umbilicus, is often **painless**, and tends to be **reducible**, especially in adults where it can be acquired. - The patient's age and the location and characteristics of the swelling (painless, firm, reducible, unfixed near the umbilicus) are highly consistent with an umbilical hernia, which commonly affects middle-aged women. *Incisional hernia* - An **incisional hernia** develops at the site of a previous surgical incision, which is not mentioned in the patient's history. - While it can be reducible, its location near the umbilicus without a history of abdominal surgery makes it less likely than an umbilical hernia. *Inguinal hernia* - An **inguinal hernia** occurs in the **groin region**, above the inguinal ligament, and not typically near the umbilicus. - While also often **reducible**, its anatomical location differentiates it from the described swelling. *Femoral hernia* - A **femoral hernia** presents as a swelling in the **upper thigh**, inferior to the inguinal ligament, and is more common in women. - The described swelling's location near the umbilicus rules out a femoral hernia.
Question 22: In Pringle Manoeuvre, clamping includes which of the following? 1. Common Bile Duct 2. Hepatic artery 3. Portal vein 4. Inferior Vena Cava
- A. 2, 3 and 4
- B. 1, 2 and 3 (Correct Answer)
- C. 1, 3 and 4
- D. 1, 2 and 4
Explanation: ***1, 2 and 3*** - The **Pringle maneuver** involves clamping structures within the **hepatoduodenal ligament** to temporarily control bleeding from the liver. - The three main structures within the hepatoduodenal ligament that are clamped are the **hepatic artery**, the **portal vein**, and the **common bile duct**. *2, 3 and 4* - This option incorrectly includes the **inferior vena cava (IVC)**, which is not part of the hepatoduodenal ligament and therefore not clamped during a standard Pringle maneuver. - Clamping the IVC would lead to severe hemodynamic instability and is not a part of this routine surgical maneuver. *1, 3 and 4* - This option incorrectly includes the **inferior vena cava (IVC)**, which is not clamped during the Pringle maneuver. - It also omits the **hepatic artery**, a major blood supply to the liver, which must be clamped along with the portal vein to effectively reduce hepatic blood flow. *1, 2 and 4* - This option incorrectly includes the **inferior vena cava (IVC)**, which is located posterior to the liver and not within the hepatoduodenal ligament. - It also omits the **portal vein**, which contributes to the majority of the liver's blood supply and is crucial to occlude during the Pringle maneuver to control bleeding effectively.
Question 23: A patient with suspected head injury is brought to the emergency following road traffic accident. At the time of examination, patient is conscious with GCS 14/15 and stable vitals. There is bleeding from right ear and CSF leak from nose. Bruising is present behind the right ear. The most probable clinical diagnosis in this patient is
- A. Extradural haematoma
- B. Fracture of the base of skull (Correct Answer)
- C. Cerebral concussion
- D. Traumatic subarachnoid haemorrhage
Explanation: ***Fracture of the base of skull*** - The combination of **bleeding from the ear (otorrhagia)**, **CSF leak from the nose (rhinorrhea)**, and **bruising behind the ear (Battle's sign)** are classic indicators of a **basilar skull fracture**. - These signs suggest a breach in the bone separating the brain from the external environment, often involving the **temporal bone** or the **anterior cranial fossa**. *Extradural haematoma* - This typically presents with a **lucid interval** followed by rapid neurological deterioration due to arterial bleeding, which is not suggested by the stable GCS of 14/15. - While it can be associated with skull fractures, the specific signs of **CSF leak** and **Battle's sign** point more directly to a basilar fracture. *Cerebral concussion* - A concussion involves a transient disturbance of brain function without macrostructural damage, characterized by symptoms like confusion, dizziness, and memory problems. - It does not involve **CSF leaks**, **otorrhagia**, or **Battle's sign**, which are indicative of a more severe structural injury. *Traumatic subarachnoid haemorrhage* - This involves bleeding into the **subarachnoid space**, typically causing a **sudden severe headache**, nuchal rigidity, and altered consciousness. - It does not directly explain **otorrhagia**, **rhinorrhea**, or **Battle's sign**, which are specific to a breach in the skull base.
Question 24: Which of the following are correct about ectopic ureters? 1. They are more common in males 2. They drain the upper pole of the kidney 3. They are associated with duplex ureter 4. They may cause incontinence
- A. 1, 3 and 4
- B. 1, 2 and 3
- C. 2, 3 and 4 (Correct Answer)
- D. 1, 2 and 4
Explanation: ***2, 3 and 4*** - Ectopic ureters primarily drain the **upper pole** of a **duplicated kidney** and are nearly always associated with some degree of renal dysplasia. - They are commonly associated with **duplex ureters** and can cause **incontinence**, especially in females, as they often bypass the bladder sphincter. *1, 3 and 4* - This option is incorrect because ectopic ureters are **more common in females** than males, particularly symptomatic cases involving incontinence. - While they are associated with duplex ureters and incontinence, the statement about being more common in males is inaccurate. *1, 2 and 3* - This option is incorrect because ectopic ureters are **more prevalent in females** and are a significant cause of continuous urinary incontinence in this population. - While they drain the upper pole and are associated with duplex ureters, the claim of being more common in males is false. *1, 2 and 4* - This option is incorrect as ectopic ureters are typically found more often in **females** and are a recognized cause of **incontinence** in affected individuals. - Although they drain the upper pole and may cause incontinence, the assertion that they are more common in males is inaccurate.
Question 25: A patient of road traffic accident presents to the emergency with increasing restlessness and difficulty in breathing. The respiratory rate is 26 breaths/minute; there are distended neck veins; trachea is deviated to the right side with hyper-resonant note and absence of breath sounds on the left side. Which of the following statements are correct? 1. The most probable clinical diagnosis is left tension pneumothorax 2. Immediate chest decompression using wide bore cannula in left 2nd intercostal space is to be done 3. Immediate chest X-ray should be done to confirm the clinical diagnosis 4. Definitive chest tube insertion in left fifth intercostal space should be done
- A. 2, 3 and 4
- B. 1, 2 and 4 (Correct Answer)
- C. 1, 2 and 3
- D. 1, 3 and 4
Explanation: ***1, 2 and 4*** - The clinical presentation with **increasing restlessness**, **difficulty in breathing**, **distended neck veins**, **tracheal deviation away from the affected side** (to the right for a left-sided collection), **hyper-resonant note**, and **absent breath sounds on the left** is pathognomonic for **left tension pneumothorax** (Statement 1 is correct). - **Immediate needle decompression** with a wide-bore cannula in the **2nd intercostal space** along the mid-clavicular line on the affected side is a **life-saving intervention** that must be performed immediately (Statement 2 is correct). - After needle decompression, **definitive chest tube insertion** in the **5th intercostal space** (mid-axillary line) should be performed (Statement 4 is correct). - Statement 3 is **incorrect** because tension pneumothorax is a **clinical diagnosis** requiring immediate treatment without delaying for imaging, which could be fatal. *2, 3 and 4* - This combination is incorrect because Statement 3 is wrong. - **Immediate chest X-ray should NOT be done** for suspected tension pneumothorax as it is a **clinical emergency** requiring immediate decompression without delay for imaging. - Statement 1 (the correct diagnosis) is also missing from this option. *1, 2 and 3* - This combination is incorrect because Statement 3 is wrong. - **Delaying treatment to obtain imaging** can be **fatal** due to cardiovascular collapse from mediastinal shift and impaired venous return. - Statement 4 (definitive chest tube insertion) is also missing from this option. *1, 3 and 4* - This combination is incorrect because Statement 3 is wrong. - The diagnosis is **clinical**, and treatment (needle decompression - Statement 2) should be initiated immediately to prevent hemodynamic compromise and death. - Statement 2 (immediate needle decompression) is also missing from this option.