Internal Medicine
5 questionsAmong the following sites, which is the most common location for development of pressure sores in debilitated patients?
Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?
Which of the following is the LEAST invasive initial treatment option for achalasia? 1. Botulinum toxin 2. Beta blockers 3. Pneumatic dilation 4. Heller's myotomy
Which of the following statements regarding peptic ulcers are correct? 1. Duodenal ulcers are more common as compared to gastric ulcers. 2. Helicobacter pylori and NSAIDs are most common causative agents. 3. Bleeding is the most common complication associated with posterior duodenal ulcer.
Which of the following statements are correct with regard to Budd-Chiari syndrome? 1. Venous drainage of liver is occluded by hepatic vein thrombosis. 2. It most commonly affects the young males. 3. It is associated with protein C, protein S and antithrombin III deficiency. 4. Abdominal discomfort and ascites are the most common features associated with acute thrombosis.
UPSC-CMS 2022 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 21: Among the following sites, which is the most common location for development of pressure sores in debilitated patients?
- A. heel (Correct Answer)
- B. greater trochanter
- C. ischium
- D. occiput
Explanation: Heel - The heels are a common location due to the localized pressure, especially in supine or chair-bound individuals, and are a high-risk area for developing pressure ulcers because they often bear a significant portion of body weight. [1] - The bone prominence and lack of subcutaneous fat make the skin over the heel particularly vulnerable to ischemia and tissue damage from sustained pressure. [1] Greater trochanter - The greater trochanter is a common site for pressure sore development, especially in individuals positioned in a lateral recumbent position. - However, it typically ranks second or third after the sacrum and heels in overall incidence for most debilitated patients. Ischium - The ischium is a high-risk area for pressure sores, particularly in patients who spend prolonged periods sitting. - While significant in seated patients, it is not the most common site generally across all debilitated patients and various positions. Occiput - The occiput is a risk area for pressure sores, especially in patients who are critically ill, intubated, or lying supine for extended periods. - While it is a significant concern for certain patient populations, it is generally less common than the heels or sacrum for pressure ulcer development in the broad category of debilitated patients.
Question 22: Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?
- A. Primary sclerosing cholangitis
- B. Arthropathy (Correct Answer)
- C. Pyoderma gangrenosum
- D. Amyloidosis
Explanation: **Arthropathy** - **Peripheral arthropathy**, particularly **Type 1 (pauciarticular)**, is directly linked to **Crohn's disease activity**, meaning flares in bowel disease often coincide with flares in joint symptoms. - This form of arthritis typically affects large joints, is transient, and resolves with successful treatment of the underlying intestinal inflammation. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a serious extraintestinal manifestation often associated with Crohn's disease but is **not directly correlated with its activity**. - Its progression is independent of whether the intestinal inflammation is well-controlled. *Pyoderma gangrenosum* - **Pyoderma gangrenosum** is a skin manifestation that can occur in patients with Crohn's disease, but its activity often **does not parallel the severity of the bowel disease**. - While it can be debilitating, effective treatment of Crohn's disease may not always lead to remission of pyoderma gangrenosum. *Amyloidosis* - **Amyloidosis**, specifically **AA amyloidosis**, is a rare but severe complication of chronic inflammatory diseases like Crohn's, resulting from long-term inflammation. - While prolonged, uncontrolled disease activity increases the risk, the **amyloidosis itself does not fluctuate with day-to-day or short-term changes in Crohn's disease activity**.
Question 23: Which of the following is the LEAST invasive initial treatment option for achalasia? 1. Botulinum toxin 2. Beta blockers 3. Pneumatic dilation 4. Heller's myotomy
- A. 3. Pneumatic dilation
- B. 4. Heller's myotomy
- C. 2. Beta blockers (Correct Answer)
- D. 1. Botulinum toxin
Explanation: ***Beta blockers*** - This is incorrect as **beta blockers** are not a recognized treatment for achalasia. - Achalasia management focuses on reducing **lower esophageal sphincter (LES)** pressure, which beta blockers do not achieve [1]. *Pneumatic dilation* - While less invasive than surgery, **pneumatic dilation** involves stretching the LES using a balloon, which carries risks such as perforation [2]. - It is generally considered a more invasive intervention than endoscopic injection therapies, and not initial treatment [2]. *Heller's myotomy* - This is a **surgical procedure** to cut the muscle fibers of the LES, making it the most invasive option among those listed [2]. - It is typically reserved for cases where less invasive treatments have failed or for patients who prefer a more definitive, long-term solution. *Botulinum toxin* - **Botulinum toxin** injection into the LES is a less invasive endoscopic procedure [2]. - It temporarily relaxes the LES by inhibiting acetylcholine release, though its effects are not permanent and repeated injections may be necessary [2].
Question 24: Which of the following statements regarding peptic ulcers are correct? 1. Duodenal ulcers are more common as compared to gastric ulcers. 2. Helicobacter pylori and NSAIDs are most common causative agents. 3. Bleeding is the most common complication associated with posterior duodenal ulcer.
- A. 2 and 3 only
- B. 1, 2 and 3
- C. 1 and 2 only (Correct Answer)
- D. 1 and 3 only
Explanation: ***1 and 2 only*** - **Duodenal ulcers** are significantly more common than gastric ulcers, with a ratio of about 4:1 [1]. - The two primary causes of peptic ulcers are infection with **_Helicobacter pylori_** and the use of **non-steroidal anti-inflammatory drugs (NSAIDs)** [1]. *2 and 3 only* - While _**H. pylori**_ and **NSAIDs** are indeed the most common causes, the statement incorrectly assumes that bleeding is the most common complication associated with **posterior duodenal ulcers**, when the most common complication of all peptic ulcers is **hemorrhage** but it is more specifically associated with posterior duodenal ulcers due to proximity to the **gastroduodenal artery**. - Hence, the second and third statements are individually correct, but the first statement which says duodenal ulcers are more common then gastric ulcers is also correct. *1, 2 and 3* - While statements 1 and 2 are correct individually, statement 3, which attributes bleeding as the most common complication specifically to posterior duodenal ulcers, is correct because posterior duodenal ulcers are particularly prone to bleeding due to the proximity of the **gastroduodenal artery** [1]. - Thus, all three statements are individually correct, but the combination chosen is redundant. *1 and 3 only* - This option is flawed because it omits statement 2, which correctly identifies **_H. pylori_** and **NSAIDs** as the primary causes of peptic ulcers [1]. - Although posterior duodenal ulcers are associated with bleeding, statement 3 is not complete enough without the inclusion of statement 2.
Question 25: Which of the following statements are correct with regard to Budd-Chiari syndrome? 1. Venous drainage of liver is occluded by hepatic vein thrombosis. 2. It most commonly affects the young males. 3. It is associated with protein C, protein S and antithrombin III deficiency. 4. Abdominal discomfort and ascites are the most common features associated with acute thrombosis.
- A. 1, 2 and 3
- B. 1, 2 and 4
- C. 2, 3 and 4
- D. 1, 3 and 4 (Correct Answer)
Explanation: ***1, 3 and 4*** - **Budd-Chiari syndrome** is characterized by the **occlusion of hepatic venous outflow**, typically due to **thrombosis** in the hepatic veins or inferior vena cava [1]. - It is frequently associated with **hypercoagulable states**, including deficiencies of **protein C, protein S, and antithrombin III**, and commonly presents acutely with **abdominal discomfort, ascites**, and hepatomegaly due to acute thrombosis [1], [2]. *1, 2 and 3* - This option is incorrect because Budd-Chiari syndrome does not most commonly affect young males; it has a variable incidence and can affect both sexes, often in their early adulthood or middle age. - While venous drainage occlusion and association with hypercoagulable states are correct, the demographic statement renders this option partially incorrect. *1, 2 and 4* - This option is incorrect because the statement that Budd-Chiari syndrome most commonly affects young males is not accurate; it has a broader demographic distribution. - The other points regarding venous occlusion and clinical features are correct, but the demographic inaccuracy makes this option incorrect. *2, 3 and 4* - This option is incorrect because statement 2, claiming that Budd-Chiari syndrome most commonly affects young males, is not consistently true. - While deficiencies like protein C, protein S, and antithrombin III, as well as symptoms like abdominal discomfort and ascites, are indeed associated, the demographic claim invalidates this choice.
Pathology
2 questionsThe maximum tensile strength that a wound can reach after healing is complete, in comparison to normal skin, is
Which one of the following is correct regarding Gastrointestinal Stromal Tumour (GIST)?
UPSC-CMS 2022 - Pathology UPSC-CMS Practice Questions and MCQs
Question 21: The maximum tensile strength that a wound can reach after healing is complete, in comparison to normal skin, is
- A. 60%–80% (Correct Answer)
- B. 30%–50%
- C. 20%–30%
- D. 50%–60%
Explanation: ***60%–80%*** - A fully healed wound, after complete maturation (typically **3 months**), achieves approximately **70–80%** of the **tensile strength** of normal unwounded skin [1]. - This is the **maximum tensile strength** that can be attained despite ongoing **collagen remodeling** and cross-linking [1]. - The strength never reaches 100% because scar tissue has a different collagen architecture compared to normal tissue, with **Type I collagen** replacing the original dermis but in a less organized pattern. *50%–60%* - This range underestimates the final tensile strength achieved by completely healed wounds. - At approximately **6 weeks**, wounds may be at this strength level, but further maturation increases strength to 70–80% [1]. *20%–30%* - This represents the tensile strength at an **early stage** of wound healing (around 3 weeks). - By the time healing is **complete**, the tensile strength is substantially higher than this range. *30%–50%* - This range also underestimates the maximum tensile strength of fully healed wounds. - While this may represent intermediate stages of healing, the final mature scar achieves greater strength approaching 70–80%. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 119-121.
Question 22: Which one of the following is correct regarding Gastrointestinal Stromal Tumour (GIST)?
- A. The male to female ratio is 9 : 1.
- B. 50% arise from stomach. (Correct Answer)
- C. Lymphatic spread is seen commonly.
- D. It arises from epithelial layer.
Explanation: ***50% arise from stomach.*** - The stomach is the most common primary site for GISTs, accounting for approximately **50-60% of cases**. [1] - Other common sites include the small intestine (25-30%), colon/rectum (5%), and esophagus (<5%). *The male to female ratio is 9 : 1.* - GISTs show **no significant gender predominance**, with the male-to-female ratio being roughly 1:1. - While some gastrointestinal cancers have gender disparities, GISTs affect both sexes almost equally. *Lymphatic spread is seen commonly.* - GISTs rarely spread via the **lymphatic system**; lymphatic metastases are uncommon. - The primary routes of GIST metastasis are **hematogenous** spread, commonly to the liver, and direct seeding within the peritoneal cavity. *It arises from epithelial layer.* - GISTs are **mesenchymal tumors**, specifically believed to originate from the **interstitial cells of Cajal** or their precursor cells. [1] - These cells are found in the muscularis propria layer of the gastrointestinal tract, not the epithelial layer. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 782-784.
Surgery
3 questionsWhich of the following is NOT included in Grade II acute cholecystitis as per 'Tokyo Consensus Guidelines for Severity'? 1. Elevated white cell count (> 18000/mm3) 2. Renal dysfunction 3. Duration > 72 hours 4. Marked local inflammation
Which of the following is the FIRST step in triple assessment of breast lumps? 1. Clinical assessment 2. Radiological assessment 3. Histopathological assessment 4. Sentinel lymph node biopsy
Which of the following is the MOST reliable intraoperative feature of viable small bowel? 1. Visible peristalsis 2. Flabby intestinal musculature 3. Shiny appearance of small bowel wall 4. Visible pulsation in the mesenteric artery
UPSC-CMS 2022 - Surgery UPSC-CMS Practice Questions and MCQs
Question 21: Which of the following is NOT included in Grade II acute cholecystitis as per 'Tokyo Consensus Guidelines for Severity'? 1. Elevated white cell count (> 18000/mm3) 2. Renal dysfunction 3. Duration > 72 hours 4. Marked local inflammation
- A. 2. Renal dysfunction (Correct Answer)
- B. 4. Marked local inflammation
- C. 3. Duration > 72 hours
- D. 1. Elevated white cell count (> 18000/mm3)
Explanation: ***2. Renal dysfunction*** - **Renal dysfunction** is a criterion for **Grade III (severe)** acute cholecystitis, NOT Grade II, indicating systemic organ failure. - This represents a critical systemic complication requiring intensive care, distinct from the moderate severity markers of Grade II. *1. Elevated white cell count (> 18000/mm3)* - An elevated white blood cell count *greater than 18,000/mm³* **IS** a criterion for **Grade II (moderate)** acute cholecystitis. - This reflects a substantial systemic inflammatory response, categorizing it as a moderate severity finding. *3. Duration > 72 hours* - A duration of symptoms *greater than 72 hours* **IS** a defining criterion for **Grade II (moderate)** acute cholecystitis according to the **Tokyo Guidelines for severity assessment**. - This indicates a more prolonged inflammatory process, often associated with increased local complications. *4. Marked local inflammation* - **Marked local inflammation** **IS** a characteristic of **Grade II (moderate)** acute cholecystitis. - This criterion includes conditions such as pericholecystic abscess, hepatic abscess, gangrenous cholecystitis, or biliary peritonitis, indicating significant local complications.
Question 22: Which of the following is the FIRST step in triple assessment of breast lumps? 1. Clinical assessment 2. Radiological assessment 3. Histopathological assessment 4. Sentinel lymph node biopsy
- A. Radiological assessment
- B. Sentinel lymph node biopsy
- C. Histopathological assessment
- D. Clinical assessment (Correct Answer)
Explanation: ***Clinical assessment*** - The **first step** in triple assessment involves taking a thorough history and performing a physical examination to identify concerning features of a breast lump. - This step helps to guide the subsequent radiological and histopathological investigations. *Radiological assessment* - This is the **second step** of triple assessment and typically involves mammography, ultrasound, or MRI to characterize the lump's features and extent. - It provides imaging information but does not precede the initial clinical evaluation. *Histopathological assessment* - This is the **third step**, involving a biopsy (fine needle aspiration, core needle biopsy) to obtain tissue for microscopic examination and definitive diagnosis. - While crucial for diagnosis, it follows both clinical and radiological assessments in the triple assessment pathway. *Sentinel lymph node biopsy* - This procedure is performed to determine if **cancer cells have spread** to the regional lymph nodes, typically after a confirmed diagnosis of breast cancer. - It is not part of the initial diagnostic triple assessment for a breast lump but rather a staging procedure.
Question 23: Which of the following is the MOST reliable intraoperative feature of viable small bowel? 1. Visible peristalsis 2. Flabby intestinal musculature 3. Shiny appearance of small bowel wall 4. Visible pulsation in the mesenteric artery
- A. 3. Shiny appearance of small bowel wall
- B. 2. Flabby intestinal musculature
- C. 4. Visible pulsation in the mesenteric artery
- D. 1. Visible peristalsis (Correct Answer)
Explanation: ***Visible peristalsis*** - The presence of **visible peristalsis** is the **MOST reliable indicator** of viable small bowel, demonstrating preserved neuromuscular function and tissue vitality. - Among the classical "3 Ps" of bowel viability (Peristalsis, Pulsation, Pink color), **peristalsis is the most direct indicator** as it confirms functional integrity of the bowel wall itself. - This indicates that the muscle layers of the intestine (longitudinal and circular) are functioning properly with intact innervation. *Shiny appearance of small bowel wall* - A **shiny serosa** is indeed a feature of viable bowel, indicating healthy, well-perfused tissue with an intact mesenteric surface. - However, it is a **less specific indicator** compared to peristalsis, as the appearance can be subjective and may not directly correlate with functional viability. *Visible pulsation in the mesenteric artery* - **Visible pulsation** in the mesenteric artery is one of the classical signs of viability and indicates blood flow to the vessel. - However, arterial pulsation alone **does not guarantee adequate tissue perfusion** or venous drainage, and ischemia can still occur despite pulsatile flow (e.g., venous thrombosis). - Peristalsis is more reliable as it confirms both adequate perfusion AND functional integrity. *Flabby intestinal musculature* - **Flabby intestinal musculature** indicates **non-viable bowel** with loss of tone, suggesting ischemia or necrosis. - Viable bowel typically feels **turgid and elastic** with good tone, not flabby.