UPSC-CMS 2023 Practice Questions

Q: In a head injury victim, which of the following is the most common initial manifestation of an increasing intra-cranial pressure?

Change in the consciousness level. ***Change in the consciousness level*** - As **intracranial pressure (ICP)** rises due to brain swelling or hematoma, cerebral perfusion is compromised, leading to global brain dysfunction. [1] - This typically manifests first as **subtle changes in arousal**, attention, and orientation, rather than focal neurological deficits. [1] *Ipsilateral pupillary dilatation* - This is a later sign of increasing ICP, specifically indicating **uncal herniation** and compression of the **oculomotor nerve (CN III)**. [1], [2] - While concerning, it usually occurs after changes in consciousness have already been noted. *Contralateral pupillary dilatation* - This is an **atypical finding** in the context of increasing ICP and **unilateral mass effect**. - Pupillary changes due to uncal herniation are typically ipsilateral to the lesion. *Hemiparesis* - **Hemiparesis (weakness on one side of the body)** indicates focal brain compression or damage, often of the **corticospinal tract**. [2] - While it can occur with increasing ICP, it is usually preceded by or occurs concurrently with a decline in the level of consciousness, especially when ICP is rising broadly.

Q: The complications of prolonged parenteral hyperalimentation may include the following except

Hyperphosphataemia. ***Hyperphosphataemia*** - **Hypophosphatemia** is a common complication of prolonged parenteral hyperalimentation (TPN), particularly during refeeding syndrome, due to increased cellular uptake of phosphate for ATP synthesis [1]. - **Hyperphosphatemia** is rare in TPN unless there is significant renal impairment or excessive phosphate administration, which is usually avoided. *Hyperosmolar acidosis* - This can occur with total parenteral nutrition (TPN) if the **glucose load is too high** or if the patient has underlying impaired glucose tolerance [1]. - The high glucose acts as an **osmotic diuretic**, leading to dehydration and metabolic acidosis [1]. *Hyperammonaemia* - This is a potential complication, especially with **excessive amino acid administration** in patients with liver dysfunction or immature liver enzymes (e.g., neonates). - The inability to adequately metabolize ammonia can lead to **encephalopathy**. *Cholestatic jaundice* - Prolonged TPN is a recognized cause of **TPN-associated liver disease**, which can manifest as cholestatic jaundice. - The etiology is multifactorial, involving factors such as **lack of enteral stimulation**, hepatotoxic components in TPN solutions, and altered bile flow.

Q: Which of the following hormones is the best indicator of maternal-fetal placental unit?

Estriol. ***Estriol*** - **Estriol** is the **best indicator of the maternal-fetal placental unit** because its production requires the integrated function of **all three components**: - **Fetal adrenal glands** produce DHEA-S (dehydroepiandrosterone sulfate) - **Fetal liver** performs 16α-hydroxylation of DHEA-S - **Placenta** converts 16α-OH-DHEA-S to estriol through aromatization - Any dysfunction in the fetus, placenta, or their interaction will be reflected in **decreased estriol levels**, making it the most comprehensive indicator of the **complete fetoplacental unit**. - Clinically used to assess fetal well-being, especially in conditions like **placental insufficiency** or **fetal adrenal hypoplasia**. *Human placental lactogen* - **hPL** is solely produced by the **syncytiotrophoblast** of the placenta and reflects **placental mass** and function. - While it correlates with placental viability, it does **not require fetal contribution** and therefore only indicates **placental function alone**, not the integrated maternal-fetal-placental unit. - Useful for assessing placental sufficiency but less comprehensive than estriol for evaluating the complete unit. *Progesterone* - **Progesterone** is initially produced by the **corpus luteum** (first 8-10 weeks) and later by the **placenta**. - Essential for maintaining pregnancy through uterine relaxation and endometrial support, but its levels reflect **placental function** rather than the integrated fetal-placental unit. - Does not require fetal contribution for its synthesis. *Prolactin* - **Prolactin** is primarily produced by the **maternal anterior pituitary gland**, with smaller amounts from the decidua. - Involved in mammary gland development and lactation preparation but is **not a product of the fetoplacental unit**. - Does not indicate the functioning of the maternal-fetal placental unit.

Q: During a normal pregnancy, the changes occurring in the urinary tract include the following except

Hypertonicity of the ureteric smooth muscle. ***Hypertonicity of the ureteric smooth muscle*** - Ureteric smooth muscle actually exhibits **reduced tone** and **hypoactivity** during pregnancy due to the relaxing effects of **progesterone**. - This **hypoactivity** contributes to ureteral dilatation and urinary stasis, making **hypertonicity** an incorrect statement. *Dilatation of the ureters* - **Progesterone** causes relaxation of smooth muscle throughout the body, including the ureters, leading to their **dilatation** and hydronephrosis. - Mechanical compression of the ureters by the gravid uterus, especially the right ureter, also contributes to this dilatation. *Elevation and thickening of the trigone* - The increased vascularity and hormonal influences during pregnancy cause the bladder trigone to become **edematous and elevated**. - This anatomical change can make the trigone more prominent during cystoscopic examination. *Increase in the Glomerular filtration rate* - Renal blood flow and GFR **increase by 30-50%** during pregnancy, primarily due to increased cardiac output and renal vasodilation. - This physiological adaptation is crucial for excreting fetal and maternal waste products.

Q: Consider the following statements in respect of congenital hypertrophic pyloric stenosis: 1. The condition is more common in males. 2. The investigation of choice is ultrasonography. 3. Hypertrophy is maximal in the pre pyloric region. 4. Projectile vomiting is seen in this condition. Which of the statements given above are correct?

1, 2 and 4 only. ***1, 2 and 4 only*** - **Statement 1 is CORRECT**: Congenital hypertrophic pyloric stenosis (CHPS) is more common in males with a male-to-female ratio of approximately 4-5:1. - **Statement 2 is CORRECT**: Ultrasonography is the investigation of choice for CHPS, being non-invasive and accurate in measuring pyloric muscle thickness (>3 mm) and pyloric length (>15 mm). - **Statement 3 is INCORRECT**: The hypertrophy is maximal in the **pyloric muscle** (circular muscle layer of the pylorus), NOT in the pre-pyloric region. This is a key anatomical distinction. - **Statement 4 is CORRECT**: Projectile non-bilious vomiting typically occurring 30-60 minutes after feeding is the hallmark clinical presentation of CHPS. *3 only* - Incorrect because statement 3 is false (hypertrophy is in the pylorus, not pre-pyloric region), while statements 1, 2, and 4 are all true. *2, 3 and 4 only* - Incorrect because it includes statement 3, which is false. The maximal hypertrophy occurs in the **pyloric canal**, not the pre-pyloric region. *1 and 2 only* - Incomplete as it omits statement 4 about projectile vomiting, which is a cardinal feature of CHPS and is definitely correct.

Q: Stored blood which has been preserved in a blood bank is deficient in which of the following coagulation factors?

V and VIII. ***V and VIII*** - **Factors V and VIII** are **labile coagulation factors** that degrade quickly during blood storage, making them deficient in stored blood. - This lability is due to their protein structure, which is sensitive to breakdown at refrigerated temperatures over time. *IX and X* - **Factors IX and X** are relatively stable and **vitamin K-dependent factors** that maintain their activity well in stored blood. - They are not significantly depleted during standard blood bank storage periods. *II and VII* - **Factors II (prothrombin) and VII** are also **vitamin K-dependent factors** known for their stability in stored blood. - Their levels remain largely preserved for typical blood storage durations. *II only* - **Factor II (prothrombin)** is a **stable, vitamin K-dependent factor**, and its levels are well-preserved in stored blood. - Therefore, stating only factor II is deficient is incorrect, as it is one of the more stable factors.

Q: Consider the following statements : Branchial cysts : 1. are associated with tracks passing between the carotid bifurcation. 2. usually present in early adulthood. 3. occur along the lower one-third of the anterior border of the sternocleidomastoid muscle. 4. develop from the vestigial remnants of the fourth branchial cleft. Which of the statements given above are correct?

1, 2 and 3 only. ***1, 2 and 3 only*** - **Branchial cysts** (specifically **second branchial cleft cysts**) are frequently associated with a **sinus tract** that passes between the **internal and external carotid arteries** (carotid bifurcation) and opens into the tonsillar fossa. - They commonly present in **late childhood or early adulthood** as a slowly enlarging, painless mass, often located along the **anterior border of the sternocleidomastoid muscle**, typically at the junction of the upper two-thirds and lower one-third of the neck. *2, 3 and 4 only* - This option incorrectly states that branchial cysts develop from the **fourth branchial cleft**. Most common branchial cysts are derived from the **second branchial cleft** (accounting for >90% of cases). - While statements 2 and 3 are correct regarding presentation and location, the origin from the fourth branchial cleft is generally not applicable to the most prevalent type of branchial cyst. *1, 2, 3 and 4* - This option includes the incorrect statement that branchial cysts typically originate from the **fourth branchial cleft**. The vast majority (over 90-95%) of branchial cleft anomalies arise from the **second branchial cleft**. - While all other statements (1, 2, and 3) are characteristic of second branchial cleft cysts, the inclusion of the fourth branchial cleft origin makes this option incorrect. *1 and 2 only* - This option correctly identifies the association with tracks passing through the carotid bifurcation and presentation in early adulthood. - However, it omits the correct statement that branchial cysts typically occur along the **lower one-third of the anterior border of the sternocleidomastoid muscle**, which is a key anatomical location and an important clinical finding for diagnosis.

Question 1

In a head injury victim, which of the following is the most common initial manifestation of an increasing intra-cranial pressure?

Accepted Answer

Change in the consciousness level

Answer

Ipsilateral pupillary dilatation

Answer

Contralateral pupillary dilatation

Answer

Hemiparesis

Question 2

The complications of prolonged parenteral hyperalimentation may include the following except

Accepted Answer

Hyperphosphataemia

Answer

Hyperosmolar acidosis

Answer

Hyperammonaemia

Answer

Cholestatic jaundice

Question 3

The "Subclavian steal syndrome" occurs due to

Accepted Answer

Occlusion of the subclavian artery proximal to origin of vertebral artery

Answer

Occlusion/stenosis of the carotid artery

Answer

Occlusion/stenosis of the vertebral artery

Answer

Occlusion of the subclavian artery distal to origin of vertebral artery

Question 4

Which of the following hormones is the best indicator of maternal-fetal placental unit?

Accepted Answer

Estriol

Answer

Progesterone

Answer

Human placental lactogen

Answer

Prolactin

Question 5

During a normal pregnancy, the changes occurring in the urinary tract include the following except

Accepted Answer

Hypertonicity of the ureteric smooth muscle

Answer

Dilatation of the ureters

Answer

Elevation and thickening of the trigone

Answer

Increase in the Glomerular filtration rate

Question 6

Consider the following statements in respect of congenital hypertrophic pyloric stenosis:

1. The condition is more common in males.

2. The investigation of choice is ultrasonography.

3. Hypertrophy is maximal in the pre pyloric region.

4. Projectile vomiting is seen in this condition.
Which of the statements given above are correct?

Accepted Answer

1, 2 and 4 only

Answer

3 only

Answer

2, 3 and 4 only

Answer

1 and 2 only

Question 7

Stored blood which has been preserved in a blood bank is deficient in which of the following coagulation factors?

Accepted Answer

V and VIII

Answer

IX and X

Answer

II and VII

Answer

II only

Question 8

The following statements regarding Meckel's diverticulum in adults are true except

Accepted Answer

It usually presents on the mesenteric border of small intestine

Answer

Bleeding is a common complication

Answer

Incidental removal is often recommended in younger patients with risk factors

Answer

It is a remnant of omphalomesenteric duct

Question 9

Consider the following statements :

Branchial cysts :

1. are associated with tracks passing between the carotid bifurcation.
2. usually present in early adulthood.
3. occur along the lower one-third of the anterior border of the sternocleidomastoid muscle.
4. develop from the vestigial remnants of the fourth branchial cleft.

Which of the statements given above are correct?

Accepted Answer

1, 2 and 3 only

Answer

2, 3 and 4 only

Answer

1, 2, 3 and 4

Answer

1 and 2 only

Question 10

Regarding laparoscopic cholecystectomy, which of the following statements is correct?

Accepted Answer

It is associated with higher rate of bile duct injuries than open cholecystectomy

Answer

It is primarily done for cholecystitis in the third trimester of pregnancy

Answer

It is safer than open cholecystectomy in patients with cardiorespiratory disease

Answer

It is contraindicated in acute cholecystitis

UPSC-CMS 2023

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Physiology

Surgery