Anatomy
1 questionsThe inability to flex the index finger is a sign of
UPSC-CMS 2023 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 11: The inability to flex the index finger is a sign of
- A. Median nerve injury (Correct Answer)
- B. Radial nerve injury
- C. Ulnar nerve injury
- D. Dupuytren's contracture
Explanation: ***Median nerve injury*** - The **median nerve** innervates the **flexor digitorum superficialis** and the **flexor digitorum profundus** (radial half), which are responsible for flexing the index and middle fingers. [1] - Damage to this nerve at a high level (e.g., above the elbow) would impact these muscles, leading to an **inability to flex the index finger**. [1] *Radial nerve injury* - The **radial nerve** primarily innervates the **extensor muscles** of the arm and forearm. - Injury to this nerve would result in difficulty extending the wrist and fingers (e.g., **wrist drop**), not flexing them. *Ulnar nerve injury* - The **ulnar nerve** innervates the **flexor carpi ulnaris** and the **ulnar half of the flexor digitorum profundus** (ring and pinky finger). [1] - Damage would primarily affect the flexion of the ring and little fingers, as well as intrinsic hand muscles, leading to a **claw hand deformity**. *Dupuytren's contracture* - This condition involves **fibrosis and thickening of the palmar fascia**, causing the fingers (most commonly the ring and little fingers) to permanently flex towards the palm. - It is a **fibroproliferative disorder** of the hand, not a nerve injury, and typically affects flexibility in multiple fingers in a characteristic pattern, rather than a specific inability to flex one finger due to paralysis.
Internal Medicine
4 questionsThe following are the common features of Idiopathic Thrombocytopenic Purpura except
The prognostic indicators in a case of portal hypertension include: 1. Serum globulin 2. Serum albumin 3. Serum bilirubin 4. Ascites Select the correct answer using the code given below :
The following constitute the Saint's triad except
The most common site of skeletal metastases in carcinoma of the breast is
UPSC-CMS 2023 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 11: The following are the common features of Idiopathic Thrombocytopenic Purpura except
- A. Cutaneous ecchymoses
- B. Massive splenomegaly (Correct Answer)
- C. Thrombocytopenia
- D. Epistaxis
Explanation: ***Massive splenomegaly*** - Idiopathic Thrombocytopenic Purpura (ITP) typically involves only **mild to moderate splenomegaly**, if any, due to increased platelet destruction in the spleen [1]. **Massive splenomegaly** is not a characteristic feature. - **Massive splenomegaly** would suggest other conditions like chronic myeloid leukemia, myelofibrosis, or certain infectious diseases. *Cutaneous ecchymoses* - **Ecchymoses (bruising)** are a common symptom of ITP due to the low platelet count, leading to easier bleeding under the skin [2]. - These present as larger, purplish patches on the skin, indicating extravasated blood. *Thrombocytopenia* - **Thrombocytopenia** (low platelet count) is the hallmark and diagnostic criterion for ITP [1]. - The reduced number of platelets impairs the body's ability to form clots, leading to bleeding manifestations [2]. *Epistaxis* - **Epistaxis (nosebleeds)** is a common mucocutaneous bleeding symptom in ITP, reflecting the impaired primary hemostasis due to low platelet count [2]. - Bleeding from mucosal surfaces is typical in platelet disorders [2].
Question 12: The prognostic indicators in a case of portal hypertension include: 1. Serum globulin 2. Serum albumin 3. Serum bilirubin 4. Ascites Select the correct answer using the code given below :
- A. 2, 3 and 4 (Correct Answer)
- B. 3 and 4 only
- C. 1, 2 and 3
- D. 1 and 4 only
Explanation: ***2, 3 and 4*** - **Serum albumin**, **serum bilirubin**, and the presence of **ascites** are all key components of scoring systems like the **Child-Pugh score**, which is widely used to assess the severity and prognosis of **liver disease** and **portal hypertension** [1]. - **Low albumin** reflects impaired synthetic function, **high bilirubin** indicates impaired excretory function, and **ascites** points to decompensation, all contributing to a worse prognosis [2]. *3 and 4 only* - This option is incomplete as it correctly identifies **serum bilirubin** and **ascites**, but omits **serum albumin**, which is a crucial prognostic indicator reflecting the liver's synthetic capacity. - While bilirubin and ascites are important, excluding albumin underestimates the complexity of prognostic assessment in **portal hypertension**. *1, 2 and 3* - This option incorrectly includes **serum globulin** as a direct prognostic indicator in the context of standard scoring systems like Child-Pugh which focus on liver function and clinical complications. - While **globulins** can be elevated in chronic liver disease due to inflammation, they are not part of the primary prognostic criteria for **portal hypertension**. *1 and 4 only* - This option incorrectly includes **serum globulin** and excludes **serum albumin** and **serum bilirubin**, two critical markers of liver function. - Relying solely on globulin and ascites would provide an incomplete and inaccurate assessment of prognosis in a patient with **portal hypertension**.
Question 13: The following constitute the Saint's triad except
- A. Jaundice (Correct Answer)
- B. Colonic diverticulosis
- C. Gall stones
- D. Hiatus hernia
Explanation: ***Jaundice*** - **Jaundice** is not part of Saint's Triad, which describes a common co-occurrence of three specific conditions. - While **gallstones** can cause jaundice, jaundice itself is a symptom, not one of the conditions in the triad. *Colonic diverticulosis* - **Colonic diverticulosis** is one of the three components of Saint's Triad. - It refers to the presence of **diverticula** (small pouches) in the colon. *Gall stones* - **Gallstones** (cholelithiasis) are another key component of Saint's Triad. - This condition involves the formation of **hardened deposits** in the gallbladder. *Hiatus hernia* - **Hiatus hernia** is the third component of Saint's Triad [1]. - It occurs when part of the **stomach protrudes** through the diaphragm into the chest cavity [1].
Question 14: The most common site of skeletal metastases in carcinoma of the breast is
- A. Thoracic vertebrae (Correct Answer)
- B. Skull
- C. Pelvis
- D. Lumbar vertebrae
Explanation: ***Thoracic vertebrae*** - The **thoracic spine** is the most frequent site for skeletal metastases from breast carcinoma due to its rich vascular supply and proximity to the primary tumor. - Metastases can lead to **vertebral compression fractures**, spinal cord compression, and severe back pain. *Skull* - While the skull can be a site of bone metastases, it is **less common** as the primary site compared to the thoracic vertebrae. - Skull metastases often present as **punched-out lytic lesions** and can involve cranial nerves. *Pelvis* - The **pelvis** is a common site for bone metastases, but it is **not the most frequent** compared to the axial skeleton, particularly the thoracic spine. - Pelvic metastases can cause pain, fractures, and affect mobility. *Lumbar vertebrae* - The **lumbar spine** is a common site for metastases, but it is generally **less frequently involved** than the thoracic spine in breast cancer. - Lumbar metastases also carry a risk of spinal cord compression affecting the lower limbs.
Physiology
1 questionsThe removal of malarial parasites from the blood is called
UPSC-CMS 2023 - Physiology UPSC-CMS Practice Questions and MCQs
Question 11: The removal of malarial parasites from the blood is called
- A. Phagocytosis (Correct Answer)
- B. Binding
- C. Culling
- D. Sequestration
Explanation: ***Phagocytosis*** - **Phagocytosis** is the process by which specialized cells, such as **macrophages** and **neutrophils**, engulf and digest foreign particles, including malarial parasites in the blood. - This is a crucial immune mechanism for clearing infected red blood cells and free parasites from the body. - Phagocytosis occurs primarily in the **spleen, liver, and bone marrow**, where macrophages recognize and destroy parasitized RBCs. *Binding* - **Binding** refers to the initial attachment of parasites or infected cells to host cells or tissues. - While binding is a step in the parasitic lifecycle and influences sequestration, it is not the process of *removal* from the blood. *Culling* - **Culling** refers to the selective removal of damaged, aged, or parasitized red blood cells by the spleen. - In malaria, the spleen does "cull" infected RBCs through mechanical filtration and phagocytic clearance. - However, **phagocytosis** is the broader immunological term that describes the cellular mechanism of engulfment and destruction, making it the more appropriate general answer. *Sequestration* - **Sequestration** is the process by which malarial parasites (specifically *Plasmodium falciparum*) in infected red blood cells adhere to the endothelium of capillaries and venules, especially in vital organs. - This mechanism allows parasites to **avoid clearance** by the spleen, representing a process of *retention* or *hiding* rather than removal from the circulation.
Radiology
1 questionsAmong the following, which is the investigation of choice for evaluation of common bile duct (CBD)?
UPSC-CMS 2023 - Radiology UPSC-CMS Practice Questions and MCQs
Question 11: Among the following, which is the investigation of choice for evaluation of common bile duct (CBD)?
- A. CECT Abdomen
- B. MRCP (Correct Answer)
- C. HIDA scan
- D. Ultrasonography
Explanation: ***Correct: MRCP*** - **Magnetic Resonance Cholangiopancreatography (MRCP)** is the investigation of choice for comprehensive CBD evaluation - **Non-invasive technique** with high sensitivity (95%) and specificity (97%) for biliary pathology - **Provides detailed anatomical visualization** of the entire biliary tree without radiation or contrast agents - **Superior for detecting** CBD stones, strictures, and obstructions *Incorrect: CECT Abdomen* - Can visualize the CBD but provides less detailed luminal information compared to MRCP - More useful for assessing surrounding structures, tumor staging, and vascular involvement - Not the primary investigation of choice for biliary tree evaluation *Incorrect: HIDA scan* - Hepatobiliary Iminodiacetic Acid scan is a functional study that assesses gallbladder function and cystic duct patency - Tracks radioactive tracer flow but does not provide detailed anatomical imaging - Cannot visualize the cause of obstruction, making it unsuitable for primary CBD evaluation *Incorrect: Ultrasonography* - Initial screening modality that is readily available and non-invasive - Can detect CBD dilation and some stones but has limited sensitivity - Limited by bowel gas interference and operator dependency - Provides less detail than MRCP, especially for distal CBD segments
Surgery
3 questionsA 40-year old alcoholic male complains of acute pain in the epigastrium associated with vomiting for the last 10 days. On clinical examination, he is found to have a mass in the epigastrium. The most likely diagnosis is
In acute pancreatitis, surgery is indicated in which one of the following conditions?
Consider the following findings with reference to a diagnostic peritoneal lavage (DPL) in a case of abdominal trauma : 1. 10 ml of gross blood on aspiration 2. W.B.C. count more than 500/cu mm 3. Amylase level more than 175 IU/dL 4. R.B.C. count more than 100,000/cu mm The criteria for a positive DPL are :
UPSC-CMS 2023 - Surgery UPSC-CMS Practice Questions and MCQs
Question 11: A 40-year old alcoholic male complains of acute pain in the epigastrium associated with vomiting for the last 10 days. On clinical examination, he is found to have a mass in the epigastrium. The most likely diagnosis is
- A. Carcinoma of head of the pancreas
- B. Perforated peptic ulcer with sub-hepatic abscess
- C. Hepatoma in left lobe of liver
- D. Pancreatic pseudocyst (Correct Answer)
Explanation: **Pancreatic pseudocyst** - The presence of an **epigastric mass** in an **alcoholic male** with acute epigastric pain and vomiting for 10 days is highly suggestive of a pancreatic pseudocyst, which commonly develops after **acute pancreatitis**. - Pseudocysts are collections of **pancreatic fluid** encased by a non-epithelial inflammatory wall, often presenting as a palpable mass within days to weeks after an acute episode. - The **alcoholic history** and **acute presentation** strongly support this diagnosis. *Carcinoma of head of the pancreas* - While pancreatic carcinoma can cause epigastric pain, **vomiting** and an **acute course** over 10 days are less typical. - It is usually associated with **weight loss**, **jaundice** (if the head is involved), and a more insidious onset. *Perforated peptic ulcer with sub-hepatic abscess* - A perforated peptic ulcer presents with **sudden, severe epigastric pain** that rapidly worsens, often with signs of **peritonitis** and acute abdomen. - A sub-hepatic abscess would typically be accompanied by **fever**, **leukocytosis**, and signs of sepsis. *Hepatoma in left lobe of liver* - A hepatoma would usually present with a **liver mass**, potentially **jaundice**, weight loss, and abnormal liver function tests, rather than an acute onset of severe epigastric pain and vomiting. - The mass would typically be felt in the **right upper quadrant** or epigastrium, but the clinical picture does not align with an acute pancreatic process.
Question 12: In acute pancreatitis, surgery is indicated in which one of the following conditions?
- A. Infected pancreatic necrosis (Correct Answer)
- B. Acute pseudocyst
- C. Acute fluid collection
- D. Sterile pancreatic necrosis
Explanation: ***Infected pancreatic necrosis*** - **Infected pancreatic necrosis** is a severe complication of acute pancreatitis requiring surgical or percutaneous debridement (necrosectomy) to remove infected tissue and prevent sepsis. - The presence of infection in necrotic tissue significantly increases morbidity and mortality, making intervention crucial. *Acute pseudocyst* - An acute pseudocyst is usually managed conservatively and only requires intervention if it is **symptomatic**, rapidly expanding, or becomes infected. - Surgical drainage is typically reserved for large, symptomatic, or complicated pseudocysts that persist beyond 6 weeks. *Acute fluid collection* - **Acute fluid collections** are generally self-limiting and resolve without intervention. - They are typically asymptomatic and represent an early stage of fluid accumulation, often preceding pseudocyst formation. *Sterile pancreatic necrosis* - **Sterile pancreatic necrosis** is usually managed with supportive care, as surgical intervention in the absence of infection does not improve outcomes and may increase complications. - The key distinction is the absence of infection—surgery is indicated only when necrosis becomes infected.
Question 13: Consider the following findings with reference to a diagnostic peritoneal lavage (DPL) in a case of abdominal trauma : 1. 10 ml of gross blood on aspiration 2. W.B.C. count more than 500/cu mm 3. Amylase level more than 175 IU/dL 4. R.B.C. count more than 100,000/cu mm The criteria for a positive DPL are :
- A. 1 and 2 only
- B. 3 and 4 only
- C. 1, 2 and 3 only
- D. 1, 2, 3 and 4 (Correct Answer)
Explanation: ***1, 2, 3 and 4*** - A **positive DPL** is indicated by any of these findings: gross blood on aspiration (≥10 mL), WBC count >500/mm³, amylase level >175 IU/dL, or RBC count >100,000/mm³. - All four criteria listed are standard indicators for a positive DPL, suggesting significant intra-abdominal injury requiring further intervention. *1 and 2 only* - While **gross blood aspiration** and an **elevated WBC count** are indeed criteria for a positive DPL, this option is incomplete as it omits other critical indicators. - A **high amylase level** and **RBC count >100,000/mm³** are also definitive signs of a positive DPL. *3 and 4 only* - Although an **elevated amylase level** and a **high RBC count** are valid criteria, this option is insufficient because it excludes the important findings of gross blood aspiration and an elevated WBC count. - A comprehensive assessment requires considering **all definitive indicators** for a positive DPL. *1, 2 and 3 only* - This option includes gross blood aspiration, elevated WBC count, and elevated amylase level, which are all positive indicators. - However, it incorrectly excludes an **RBC count >100,000/mm³**, which is a crucial and widely accepted criterion for a positive DPL.