UPSC-CMS 2023 Practice Questions

Q: The best position to palpate the minimal enlargement of spleen is :

Supine with lower limbs extended. ***Supine with lower limbs extended*** - This position allows for optimal relaxation of the abdominal muscles, making it easier to **palpate the spleen** as it descends during inspiration. - In a supine position, the examiner can effectively use techniques like the **hooking method** or palpation from the right side of the patient to detect minimal splenic enlargement. *Bimanual palpation in supine position* - While bimanual palpation is useful for organs like the kidneys, it is generally less effective for detecting minimal splenic enlargement compared to other specialized techniques. - The goal is to feel the spleen as it descends, which is better achieved with precise contact during inspiration rather than a bimanual 'capture'. *Palpation of left subcostal area in right lateral decubitus position* - The **right lateral decubitus position** (Lieper's or Opeczky's position) is indeed used to make a slightly enlarged spleen more prominent by shifting it anteriorly and inferiorly. - However, while helpful for a potentially palpable spleen, the combined supine position with relaxed abdominal muscles can be overall more sensitive for **minimal enlargement** when initially assessing. *Palpation of left subcostal area in knee-elbow position* - The knee-elbow position is primarily used for rectal or vaginal examinations and is not suitable for abdominal palpation, especially for organs like the spleen. - It would make abdominal muscle contraction more likely, hindering effective palpation of the left subcostal area.

Q: Which one of the following is a cause of exudative ascites ?

Peritoneal malignancy. ***Peritoneal malignancy*** - **Malignant cells** can directly or indirectly increase capillary permeability and fluid production within the peritoneal cavity. - This leads to a **high protein content** in the ascitic fluid, characteristic of exudate [1]. *Nephrotic syndrome* - Causes **transudative ascites** due to severe **hypoalbuminemia**, leading to decreased plasma oncotic pressure [1]. - The liver is healthy, and there is no direct inflammation or increased capillary permeability in the peritoneum. *Portal vein thrombosis* - Results in **increased hydrostatic pressure** within the portal circulation, leading to the transudation of fluid into the peritoneal cavity. - The ascitic fluid typically has a **low protein content** as it's a transudate, not an exudate [1]. *Congestive cardiac failure* - Leads to **increased systemic venous pressure** and consequently elevated hepatic sinusoidal and splanchnic capillary pressures [1]. - This causes **transudative ascites** with low protein content due to passive fluid leakage rather than inflammation or direct vascular damage [1].

Q: Which of the following are seen in Normal pressure hydrocephalus ? 1. Hearing loss 2. Gait disturbance 3. Incontinence 4. Cognitive decline Select the correct answer using the code given below :

2, 3 and 4. ***2, 3 and 4*** - This option correctly identifies the **Hakim-Adams triad** of Normal pressure hydrocephalus: **gait disturbance**, **urinary incontinence**, and **cognitive decline**. - The classic mnemonic "**wet, wobbly, and wacky**" describes these three cardinal features - incontinence (wet), gait instability (wobbly), and cognitive impairment (wacky). *3 and 4 only* - This option only includes **incontinence** and **cognitive decline**, missing the crucial **gait disturbance** component of the triad. - **Gait apraxia** is often the earliest and most prominent feature of NPH, making this option incomplete. *1, 2 and 3* - **Hearing loss** is not a feature of Normal pressure hydrocephalus and is incorrectly included in this option. - While it correctly includes **gait disturbance** and **incontinence**, the presence of hearing loss makes this choice inaccurate. *1, 2 and 4* - **Hearing loss** is not associated with NPH and represents a major error in this option. - Though **gait disturbance** and **cognitive decline** are correct features, including hearing loss eliminates this as a valid choice.

Q: Which of the following are included in the classical clinical presentation of pericardial tamponade ?

Muffled heart sounds. ***Muffled heart sounds*** - Pericardial tamponade involves an accumulation of fluid in the **pericardial sac**, which dampens sound transmission and results in **muffled heart sounds** [1]. - This is a key component of **Beck's triad**, indicating compromised cardiac filling. *Collapsed neck veins* - In pericardial tamponade, there is a significant increase in **intrapericardial pressure**, which impedes venous return to the heart [1]. - This typically leads to **distended neck veins** (elevated jugular venous pressure), not collapsed ones. *Tachycardia* - While **tachycardia** can be present as a compensatory mechanism due to reduced cardiac output in tamponade, it is a non-specific finding. - It is not considered part of the **classical Beck's triad**, which specifically focuses on the triad of muffled heart sounds, hypotension, and elevated jugular venous pressure. ***Decreased arterial pressure*** - The increased intrapericardial pressure in tamponade severely restricts **ventricular filling**, leading to a reduction in stroke volume and subsequently **decreased cardiac output** [1], [2]. - This reduction in cardiac output manifests as systemic **hypotension** (decreased arterial pressure), which is a critical finding in tamponade.

Q: Which of the following are the functions of larynx ? 1. Fixation of the chest 2. Aids in swallowing of food 3. Phonation 4. Respiration Select the correct answer using the code given below :

All of the above (1, 2, 3 and 4). ***All of the above (1, 2, 3 and 4)*** - The larynx performs **all four functions** listed in the question. - **Respiration**: The larynx serves as a vital conduit for airflow. The posterior cricoarytenoid muscles actively abduct the vocal cords during inspiration, and the larynx regulates airflow through glottic opening and closure. - **Phonation**: The vocal cords housed within the larynx vibrate to produce sound, making this the primary organ of voice production. - **Aids in swallowing**: During deglutition, the larynx elevates and the epiglottis closes the laryngeal inlet to prevent aspiration of food into the trachea. - **Chest fixation**: The larynx closes the glottis during the Valsalva maneuver, creating a closed air column that stabilizes the chest for activities like lifting, coughing, defecation, and parturition. *1, 2 and 3* - This option incorrectly excludes **respiration**, which is a fundamental function of the larynx as part of the conducting airways. - The larynx is not merely a passive tube but actively regulates airflow through intrinsic muscle activity. *2, 3 and 4* - While these are all valid laryngeal functions, this option incorrectly excludes **chest fixation**, which is accomplished through glottic closure during the Valsalva maneuver. *1, 3 and 4* - This option incorrectly excludes the larynx's role in **aiding swallowing** through laryngeal elevation and airway protection during deglutition.

Q: Which one of the following statements is correct regarding eFAST in trauma? 1. It is a technique to assess free fluid in abdominal cavity, thoracic cavity, and pericardium. 2. It is a technique to assess free fluid in pelvic cavity. 3. It is a technique to assess free fluid in pleural cavity. Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - The **eFAST exam (extended Focused Assessment with Sonography for Trauma)** evaluates multiple areas for **free fluid**, including the abdominal cavity, thoracic cavity (pleural effusions), and pericardium (pericardial effusions). - It also includes specific views for the **pelvic cavity** (pouch of Douglas) to detect free fluid, which is highly relevant in trauma settings. *1 and 2 only* - This option misses the crucial component of assessing the **pleural cavity** for free fluid (hemothorax), which is an integral part of the **eFAST protocol**. - While it correctly includes the abdominal and pelvic cavities, the exclusion of the thoracic cavity (pleural) makes it incomplete. *2 and 3 only* - This option incorrectly omits the assessment of the **abdominal cavity**, which is a primary and essential part of any FAST or eFAST exam to identify intra-abdominal hemorrhage. - The abdominal cavity includes views of the **hepatorenal space (Morison's pouch)**, **splenorenal space**, and **suprapubic window**. *1 and 3 only* - This option incorrectly excludes the specific assessment of the **pelvic cavity**, which is routinely included in the eFAST exam, particularly in trauma, to identify dependent pooling of free fluid. - While it correctly includes the abdominal and thoracic cavities, the absence of the pelvic cavity assessment makes it incomplete.

Q: A Sengstaken-Blakemore tube is used for the management of :

Variceal bleeding. ***Variceal bleeding*** - A **Sengstaken-Blakemore tube** is specifically designed with gastric and esophageal balloons to apply direct pressure and tamponade **bleeding esophageal varices**, a common complication of portal hypertension. - It is utilized as a temporary measure to control severe hemorrhage when endoscopic interventions fail or are unavailable. *Corrosive poisoning* - Management of corrosive poisoning focuses on **supportive care**, pain management, and preventing further injury; a Sengstaken-Blakemore tube is not indicated. - Using such a tube could potentially worsen esophageal damage or perforation in corrosive injuries. *Tension pneumothorax* - A tension pneumothorax is a **thoracic emergency** requiring immediate **needle decompression** or chest tube insertion. - A Sengstaken-Blakemore tube is an upper gastrointestinal device and has no role in managing pulmonary conditions. *Asphyxia* - Asphyxia involves a lack of oxygen and is managed by establishing an **open airway**, providing ventilation, and addressing the underlying cause. - A Sengstaken-Blakemore tube is irrelevant to the treatment of asphyxia.

Q: A young 28-year-old male was operated for duodenal ulcer perforation peritonitis. After having recovered well for five days, he developed high fever with chills and symptoms of toxemia. He developed right shoulder tip pain and intractable hiccoughs. The most likely diagnosis is :

Subphrenic abscess. ***Subphrenic abscess*** - The development of **high fever with chills**, **toxemia**, **right shoulder tip pain**, and **intractable hiccups** following a duodenal ulcer perforation repair strongly suggests a subphrenic abscess. - **Diaphragmatic irritation** by the abscess causes referred shoulder pain (due to phrenic nerve irritation) and hiccups. *Right lobe liver abscess* - While a liver abscess can cause fever and chills, **shoulder tip pain** and **hiccups** are less typical compared to a subphrenic abscess, unless the abscess is very superficial and irritating the diaphragm. - A liver abscess often presents with **right upper quadrant pain** and hepatomegaly, which are not mentioned. *Surgical site infection* - A surgical site infection would typically manifest with **localized pain**, **redness**, **swelling**, and possibly **pus discharge** at the incision site, rather than referred shoulder pain or intractable hiccups. - While it can cause fever and toxemia, the specific constellation of symptoms points away from a superficial wound infection. *Postoperative peritonitis* - Postoperative peritonitis would present with more generalized **abdominal pain**, **distension**, **tenderness**, and potentially signs of evolving **sepsis** or **organ dysfunction**. - While it can cause fever and toxemia, the distinct symptoms of **shoulder tip pain** and **hiccups** are less characteristic of diffuse peritonitis.

Q: In seat belt syndrome the most common site of bleeding is from :

Mesentery. ***Mesentery*** - In **seat belt syndrome**, the **mesentery** is the **most common site of bleeding** due to the unique mechanism of injury. - Sudden deceleration causes **shearing forces** at fixed points where the small bowel and mesentery are compressed against the posterior abdominal wall and spine by the lap belt. - This results in **mesenteric tears**, **hematomas**, and **vascular injuries** (mesenteric vessels are particularly vulnerable), leading to significant intra-abdominal hemorrhage. - **Mesenteric injury** occurs in approximately **20-30%** of seat belt syndrome cases, making it the predominant source of bleeding. *Bowel* - While **bowel injuries** (perforation, transection, intramural hematoma) do occur in seat belt syndrome and are clinically significant, they are typically **second in frequency** to mesenteric injuries. - Bowel perforation occurs in about 15-20% of cases and may present with delayed symptoms. - The bowel injury often occurs in conjunction with mesenteric tears due to the same deceleration mechanism. *Spleen* - Splenic injury is less commonly associated with the specific compression mechanism of seat belt syndrome. - The spleen is more typically injured in direct blunt trauma to the left upper quadrant from side impacts or direct blows. - Not the characteristic injury pattern seen with lap belt restraint. *Liver* - Liver injuries are more often associated with direct forceful impacts to the right upper quadrant or generalized severe blunt abdominal trauma. - The typical seat belt mechanism with lap belt compression does not preferentially injure the liver. - Less common in the classical seat belt syndrome presentation.

Q: A 47-year-old man comes to Surgery OPD with history of recurrent episodes of UTI. He gives history of the urine being frothy and occasionally having bubbles. The probable diagnosis is :

Colovesical fistula. ***Colovesical fistula*** - The presence of **pneumaturia (gas/bubbles in urine)** and **frothy urine** is pathognomonic of colovesical fistula, indicating abnormal communication between the colon and bladder with gas passage from bowel to bladder. - **Recurrent UTIs** occur in >50% of cases due to constant contamination of the bladder with fecal bacteria. - Other features include **fecaluria** (fecal matter in urine) - though less common than pneumaturia. - Most commonly caused by diverticular disease (65%), followed by colorectal cancer and Crohn's disease. *Tubercular cystitis* - While it can cause recurrent UTIs and bladder irritation, it does not typically present with **pneumaturia** or frothy urine. - Presents with sterile pyuria, dysuria, hematuria, and frequency. - Diagnosis requires identification of *Mycobacterium tuberculosis* in urine culture or bladder biopsy. *Urethrocutaneous fistula* - This involves an abnormal communication between the urethra and the skin, leading to urine leakage onto the skin surface. - Does not cause gas to enter the bladder or result in **pneumaturia**. - May cause recurrent UTIs if fistula leads to inadequate bladder emptying, but not the presenting features. *Anaerobic bacterial infection* - Although anaerobic bacteria can cause UTIs, they do not produce sufficient gas to cause **pneumaturia** without an underlying anatomical defect. - **Pneumaturia** is a mechanical sign indicating an abnormal connection with a gas-containing organ (colon), not merely infection.

Question 1

The best position to palpate the minimal enlargement of spleen is :

Accepted Answer

Supine with lower limbs extended

Answer

Bimanual palpation in supine position

Answer

Palpation of left subcostal area in right lateral decubitus position

Answer

Palpation of left subcostal area in knee-elbow position

Question 2

Which one of the following is a cause of exudative ascites ?

Accepted Answer

Peritoneal malignancy

Answer

Nephrotic syndrome

Answer

Portal vein thrombosis

Answer

Congestive cardiac failure

Question 3

Which of the following are seen in Normal pressure hydrocephalus ?

1. Hearing loss
2. Gait disturbance
3. Incontinence
4. Cognitive decline

Select the correct answer using the code given below :

Accepted Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

3 and 4 only

Question 4

Which of the following are included in the classical clinical presentation of pericardial tamponade ?

Accepted Answer

Muffled heart sounds

Answer

Collapsed neck veins

Answer

Tachycardia

Question 5

Which of the following are the functions of larynx ?

1. Fixation of the chest
2. Aids in swallowing of food
3. Phonation
4. Respiration

Select the correct answer using the code given below :

Accepted Answer

All of the above (1, 2, 3 and 4)

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 6

Which one of the following statements is correct regarding eFAST in trauma?

1. It is a technique to assess free fluid in abdominal cavity, thoracic cavity, and pericardium.
2. It is a technique to assess free fluid in pelvic cavity.
3. It is a technique to assess free fluid in pleural cavity.

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 and 3 only

Question 7

A Sengstaken-Blakemore tube is used for the management of :

Accepted Answer

Variceal bleeding

Answer

Corrosive poisoning

Answer

Tension pneumothorax

Answer

Asphyxia

Question 8

A young 28-year-old male was operated for duodenal ulcer perforation peritonitis. After having recovered well for five days, he developed high fever with chills and symptoms of toxemia. He developed right shoulder tip pain and intractable hiccoughs. The most likely diagnosis is :

Accepted Answer

Subphrenic abscess

Answer

Right lobe liver abscess

Answer

Surgical site infection

Answer

Postoperative peritonitis

Question 9

In seat belt syndrome the most common site of bleeding is from :

Accepted Answer

Mesentery

Answer

Bowel

Answer

Spleen

Answer

Liver

Question 10

A 47-year-old man comes to Surgery OPD with history of recurrent episodes of UTI. He gives history of the urine being frothy and occasionally having bubbles. The probable diagnosis is :

Accepted Answer

Colovesical fistula

Answer

Tubercular cystitis

Answer

Urethrocutaneous fistula

Answer

Anaerobic bacterial infection

UPSC-CMS 2023

General Medicine

Internal Medicine

Physiology

Radiology

Surgery