Internal Medicine
3 questionsIn a head injury victim, which of the following is the most common initial manifestation of an increasing intra-cranial pressure?
The complications of prolonged parenteral hyperalimentation may include the following except
The "Subclavian steal syndrome" occurs due to
UPSC-CMS 2023 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 31: In a head injury victim, which of the following is the most common initial manifestation of an increasing intra-cranial pressure?
- A. Change in the consciousness level (Correct Answer)
- B. Ipsilateral pupillary dilatation
- C. Contralateral pupillary dilatation
- D. Hemiparesis
Explanation: ***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.
Question 32: The complications of prolonged parenteral hyperalimentation may include the following except
- A. Hyperosmolar acidosis
- B. Hyperammonaemia
- C. Hyperphosphataemia (Correct Answer)
- D. Cholestatic jaundice
Explanation: ***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.
Question 33: The "Subclavian steal syndrome" occurs due to
- A. Occlusion/stenosis of the carotid artery
- B. Occlusion/stenosis of the vertebral artery
- C. Occlusion of the subclavian artery proximal to origin of vertebral artery (Correct Answer)
- D. Occlusion of the subclavian artery distal to origin of vertebral artery
Explanation: ***Occlusion of the subclavian artery proximal to origin of vertebral artery*** - Subclavian steal syndrome occurs due to severe **stenosis or occlusion of the subclavian artery** **proximal** to the origin of the vertebral artery. - This causes **retrograde flow** in the vertebral artery to supply the arm, "stealing" blood from the vertebrobasilar circulation and potentially leading to **cerebral ischemic symptoms** when the arm is exercised. *Occlusion/stenosis of the carotid artery* - This typically causes symptoms related to **cerebral ischemia** (e.g., stroke, transient ischemic attacks) affecting the anterior circulation, not "stealing" from the vertebrobasilar system [1]. - Carotid artery disease leads to reduced blood flow to the **brain's anterior circulation**, without directly affecting subclavian-vertebral artery dynamics in the same way [1]. *Occlusion/stenosis of the vertebral artery* - Unilateral vertebral artery occlusion or stenosis can cause **vertebrobasilar insufficiency** symptoms but typically does not lead to retrograde flow from the contralateral vertebral artery down the ipsilateral vertebral artery to supply the arm. - It would primarily impair blood supply to the **posterior circulation of the brain** rather than causing blood to be diverted from the brain to the arm [1]. *Occlusion of the subclavian artery distal to origin of vertebral artery* - If the subclavian artery is occluded **distal** to the origin of the vertebral artery, blood flow to the arm is reduced, but the **vertebral artery flow remains antegrade** and supplies the brain. - There would be no "steal" phenomenon because the vertebral artery is not called upon to provide collateral flow to the arm; its natural path to the brain remains undisturbed in terms of competition with the subclavian artery for arm supply.
Obstetrics and Gynecology
2 questionsWhich of the following hormones is the best indicator of maternal-fetal placental unit?
During a normal pregnancy, the changes occurring in the urinary tract include the following except
UPSC-CMS 2023 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 31: Which of the following hormones is the best indicator of maternal-fetal placental unit?
- A. Progesterone
- B. Estriol (Correct Answer)
- C. Human placental lactogen
- D. Prolactin
Explanation: ***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.
Question 32: During a normal pregnancy, the changes occurring in the urinary tract include the following except
- A. Hypertonicity of the ureteric smooth muscle (Correct Answer)
- B. Dilatation of the ureters
- C. Elevation and thickening of the trigone
- D. Increase in the Glomerular filtration rate
Explanation: ***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.
Pediatrics
1 questionsConsider 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?
UPSC-CMS 2023 - Pediatrics UPSC-CMS Practice Questions and MCQs
Question 31: 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?
- A. 1, 2 and 4 only (Correct Answer)
- B. 3 only
- C. 2, 3 and 4 only
- D. 1 and 2 only
Explanation: ***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.
Physiology
1 questionsStored blood which has been preserved in a blood bank is deficient in which of the following coagulation factors?
UPSC-CMS 2023 - Physiology UPSC-CMS Practice Questions and MCQs
Question 31: Stored blood which has been preserved in a blood bank is deficient in which of the following coagulation factors?
- A. IX and X
- B. II and VII
- C. V and VIII (Correct Answer)
- D. II only
Explanation: ***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.
Surgery
3 questionsThe following statements regarding Meckel's diverticulum in adults are true except
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?
Regarding laparoscopic cholecystectomy, which of the following statements is correct?
UPSC-CMS 2023 - Surgery UPSC-CMS Practice Questions and MCQs
Question 31: The following statements regarding Meckel's diverticulum in adults are true except
- A. It usually presents on the mesenteric border of small intestine (Correct Answer)
- B. Bleeding is a common complication
- C. Incidental removal is often recommended in younger patients with risk factors
- D. It is a remnant of omphalomesenteric duct
Explanation: ***It usually presents on the mesenteric border of small intestine*** - Meckel's diverticulum is a **true diverticulum** arising from the **anti-mesenteric border** of the ileum, typically 2 feet from the ileocecal valve. - Its mesenteric positioning would be highly atypical and contradict its embryological origin as a remnant of the **vitelline duct**. - This statement is **FALSE** - it arises from the anti-mesenteric border, making it the correct answer to this "except" question. *Bleeding is a common complication* - **Bleeding** is indeed a common complication in adults, often due to **ectopic gastric mucosa** (present in ~50% of cases) within the diverticulum causing ulceration. - This complication can manifest as **painless rectal bleeding**. - This statement is **TRUE**. *Incidental removal is often recommended in younger patients with risk factors* - Current evidence-based guidelines recommend **selective removal** based on risk factors including age <50 years, palpable abnormalities (thickening, nodularity), narrow neck, length >2cm, or presence of bands. - In younger patients with risk factors, the lifetime risk of complications justifies prophylactic removal. - In older adults or those without risk factors, the morbidity of resection may outweigh the lifetime risk of complications. - This statement is **TRUE**. *It is a remnant of omphalomesenteric duct* - Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, representing a persistent portion of the **embryonic vitelline (omphalomesenteric) duct**. - This duct normally connects the fetal midgut to the yolk sac and should completely regress by the 7th week of gestation. - This statement is **TRUE**.
Question 32: 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?
- A. 2, 3 and 4 only
- B. 1, 2, 3 and 4
- C. 1, 2 and 3 only (Correct Answer)
- D. 1 and 2 only
Explanation: ***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 33: Regarding laparoscopic cholecystectomy, which of the following statements is correct?
- A. It is primarily done for cholecystitis in the third trimester of pregnancy
- B. It is associated with higher rate of bile duct injuries than open cholecystectomy (Correct Answer)
- C. It is safer than open cholecystectomy in patients with cardiorespiratory disease
- D. It is contraindicated in acute cholecystitis
Explanation: ***It is associated with higher rate of bile duct injuries than open cholecystectomy*** - **Historically**, laparoscopic cholecystectomy has been associated with a **higher rate of bile duct injuries** (0.4-0.6%) compared to open cholecystectomy (0.1-0.2%), particularly during the **learning curve period** in the 1990s. - Contributing factors include **limited visualization**, **altered anatomy** in acute inflammation, **reliance on 2D imaging**, and **misidentification of anatomic structures**. - Bile duct injuries, such as **common bile duct (CBD) laceration** or **transection**, can lead to significant morbidity. - **Note**: With increased surgeon experience and adoption of the **critical view of safety** technique, these rates have decreased, though the risk remains slightly higher than open surgery in some studies. *It is primarily done for cholecystitis in the third trimester of pregnancy* - **Laparoscopic cholecystectomy** during pregnancy is generally considered safe for symptomatic **gallstone disease**, with the **second trimester** being the optimal time for surgery. - In the **third trimester**, surgical considerations like **increased uterine size**, technical difficulty, and **fetal well-being** make laparoscopic surgery more challenging, and it is usually **deferred until after delivery** unless an emergency. - The primary indication for **cholecystectomy** is symptomatic gallstones or complications like **acute cholecystitis**, not specifically third trimester pregnancy. *It is safer than open cholecystectomy in patients with cardiorespiratory disease* - While **laparoscopic cholecystectomy** is generally associated with **less postoperative pain**, **reduced pulmonary complications**, and **faster recovery**, it involves **pneumoperitoneum** (CO2 insufflation), which increases intra-abdominal pressure. - **Pneumoperitoneum** can cause **decreased venous return**, **increased systemic vascular resistance**, **hypercarbia**, and **decreased lung compliance**, which may stress patients with severe **cardiorespiratory disease**. - The safety profile depends on individual patient factors, severity of cardiorespiratory disease, and anesthetic management. In many cases, the benefits of minimally invasive surgery outweigh the risks, but careful patient selection is essential. *It is contraindicated in acute cholecystitis* - This is **incorrect**. **Laparoscopic cholecystectomy** is the **gold standard treatment** for acute cholecystitis. - **Early laparoscopic cholecystectomy** (within **72 hours** of symptom onset) is preferred as it reduces complications, shortens hospital stay, and has better outcomes compared to delayed surgery. - Acute cholecystitis is an **indication**, not a **contraindication** for laparoscopic approach.