UPSC-CMS 2024 Practice Questions

Q: Which of the following are correct for managing hypertrophic scars? 1. Silicone gel sheeting 2. Intralesional steroid injections 3. Vitamin A gel applications 4. Laser treatment Select the answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** - **Silicone gel sheeting**, **intralesional steroid injections**, and **laser treatment** are all established and effective methods for managing hypertrophic scars. - Silicone gel helps to hydrate the scar, reduce collagen synthesis, and decrease itching, while steroids reduce inflammation and collagen production, and lasers can help to improve scar texture and color. *1, 3 and 4* - This option incorrectly includes **Vitamin A gel applications** as a primary treatment. While retinoids can have some skin benefits, they are not a first-line or well-established treatment for hypertrophic scars. - **Silicone gel sheeting** and **laser treatment** are indeed effective, but the inclusion of Vitamin A makes this option less accurate. *1, 2 and 3* - This option also incorrectly includes **Vitamin A gel applications**. While **silicone gel sheeting** and **intralesional steroid injections** are effective, Vitamin A is not a standard treatment for hypertrophic scars. - The primary methods for managing hypertrophic scars focus on reducing collagen production and inflammation, which Vitamin A gel does not effectively address in this context. *2, 3 and 4* - This option correctly includes **intralesional steroid injections** and **laser treatment**, but it again incorrectly includes **Vitamin A gel applications** and omits **silicone gel sheeting**, which is a widely recommended and often first-line treatment. - Omitting **silicone gel sheeting** significantly weakens the effectiveness of this combination as a comprehensive management strategy.

Q: Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)? 1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria. 2. It is same as bacteraemia. 3. It results in Multiple Organ Dysfunction Syndrome (MODS). 4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - **SIRS** can be caused by the release of **lipopolysaccharide endotoxin** from the cell wall of dying **Gram-negative bacteria** like *E. coli*, triggering a systemic inflammatory response [1]. - One of the major complications of **SIRS** is the progression to **Multiple Organ Dysfunction Syndrome (MODS)**, where organs begin to fail due to uncontrolled inflammation [1]. - A component of the **SIRS criteria** is a white blood cell count greater than 12 x 10^9/L or less than 4 x 10^9/L, or the presence of more than 10% immature band forms [1]. *2, 3 and 4* - **Bacteremia** refers specifically to the presence of **viable bacteria** in the bloodstream, while **SIRS** is a broader inflammatory response that can be triggered by various causes (infectious or non-infectious). - While bacteremia can lead to SIRS, SIRS can also occur without bacteremia (e.g., pancreatitis, trauma). *1, 2 and 3* - **Bacteremia** is not the same as SIRS; bacteremia is a potential cause of SIRS, but SIRS can arise from non-infectious conditions as well. - The presence of bacteria in the blood (bacteremia) is a specific finding, whereas SIRS describes a *syndrome* of systemic inflammation. *1, 2 and 4* - This option incorrectly states that **SIRS is the same as bacteremia**, which it is not. - Also, while bacteremia can lead to SIRS, **MODS** is a crucial and often fatal consequence of advanced SIRS, which is omitted in this option.

Q: The best measure of organ perfusion and the best monitor of adequacy of shock therapy is

urine output. ***urine output*** - **Urine output** is a direct and sensitive indicator of **renal blood flow** and, consequently, overall organ perfusion [1]. Adequate urine production (typically >0.5 mL/kg/hr) signifies that the kidneys are being sufficiently perfused, which generally correlates with adequate perfusion of other vital organs. - In the context of shock, improved urine output following therapy indicates effective restoration of **circulating blood volume** and microcirculation, making it an excellent monitor for treatment adequacy. *restoring blood pressure/pulse vital parameters* - While restoring **blood pressure** and **pulse** is a critical goal in shock management, these parameters alone do not always reflect true tissue perfusion [1]. A patient can have normalized blood pressure due to **vasoconstriction** while still experiencing inadequate microcirculatory flow and cellular hypoxia. - These vital signs are systemic indicators, and while essential, they don't provide the same granular insight into **organ-level perfusion** as urine output. *central venous pressure* - **Central venous pressure (CVP)** primarily reflects the **right heart's filling pressure** and overall intravascular volume status [1]. While CVP helps guide fluid resuscitation, it is not a direct measure of organ perfusion. - CVP can be influenced by various factors, including **cardiac function** and **intrathoracic pressure**, and a "normal" CVP does not guarantee adequate perfusion to all organs [1]. *pulmonary wedge pressure* - **Pulmonary wedge pressure (PWP)**, also known as pulmonary artery occlusion pressure, reflects the **left atrial pressure** and serves as an indicator of left ventricular preload [1]. - While PWP is useful in assessing **cardiac function** and guiding fluid management in specific types of shock [1] (e.g., cardiogenic shock), it is not a primary measure of global organ perfusion or a universal monitor for adequacy of shock therapy.

Q: Consider the following : 1. Pain relief 2. Prevention of infection 3. Anaesthesia 4. Restoration of anatomy Which of the features given above are priorities for fracture treatment?

1, 3 and 4. **1, 3 and 4** - **Priorities in fracture treatment** always include alleviating pain, which can be severe and debilitating. - **Restoration of normal anatomy** is crucial for proper healing and optimal function of the fractured limb. - **Anesthesia** is often required to facilitate reduction and fixation of a fracture, as well as to manage pain during the procedure. *2, 3 and 4* - While **anesthesia** and **restoration of anatomy** are priorities, **prevention of infection** is primarily a concern for **open fractures** or surgical interventions. - **Pain relief** is a fundamental and immediate concern in all fracture cases, which is omitted in this option. *1, 2 and 3* - **Pain relief** and **anesthesia** are critical, and **prevention of infection** is important, but this option neglects the essential goal of **restoring anatomical alignment**. - **Restoring anatomy** directly impacts the long-term functional outcome and is a major goal of fracture management. *1, 2 and 4* - This option correctly identifies **pain relief**, **prevention of infection**, and **restoration of anatomy** as important. - However, it overlooks the immediate necessity of **anesthesia** to effectively manage pain during treatment procedures and allow for fracture reduction.

Q: Hangman's fracture is

traumatic spondylolisthesis of axis vertebra (C2). ***traumatic spondylolisthesis of axis vertebra (C2)*** - A Hangman's fracture is a specific type of **traumatic spondylolisthesis** involving the **C2 (axis) vertebra**. - It results from bilateral fractures of the **pars interarticularis** of C2, often due to hyperextension and distractive forces. *traumatic spondylolisthesis of atlas vertebra (C1)* - A fracture of the atlas (C1) is typically called a **Jefferson fracture**, not a Hangman's fracture. - A Jefferson fracture usually involves ruptures of facets or arches, often caused by **axial loading**. *traumatic spondylolisthesis of lumbar vertebra (L1)* - **Spondylolisthesis** can occur in the lumbar spine, but it most commonly affects L5-S1 or L4-L5, and is usually a **fatigue fracture** not a traumatic spondylolisthesis. - Fractures in the lumbar region have different causes and clinical implications than cervical fractures, and are not termed a Hangman's fracture. *traumatic spondylolisthesis of thoracic vertebra (T1)* - While traumatic spine fractures can occur in the **thoracic spine**, spondylolisthesis is much less common due to the rib cage's stabilizing effect. - Fractures in this region are distinctly different from the characteristic C2 pars interarticularis fracture of a Hangman's fracture.

Q: Which of the following are approximate daily requirements of the common electrolytes in an adult? 1. Sodium 50-90 mM/day 2. Calcium 25-30 mM/day 3. Potassium 90 mM/day 4. Magnesium 15-17 mM/day Select the correct answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - The approximate daily requirements for **sodium** are indeed within the range of **50-90 mM/day** (typical maintenance: 1-2 mEq/kg/day) - **Potassium** is around **90 mM/day** (typical maintenance: 1 mEq/kg/day or ~70 mEq/day) - **Magnesium** is typically **15-17 mM/day** (typical maintenance: 0.2-0.3 mEq/kg/day or ~7-10 mM/day) - These values are essential for maintaining proper physiological functions, including fluid balance, nerve impulse transmission, and muscle contraction *2, 3 and 4* - This option incorrectly includes the daily requirement for **calcium** as **25-30 mM/day**, which is approximately **3-4 times higher** than the typical maintenance requirement - Actual adult calcium requirement is approximately **0.1-0.2 mEq/kg/day** or **3.5-7 mM/day** - While potassium and magnesium values are close to accurate, the calcium value makes this option incorrect *1, 2 and 3* - This option incorrectly states the daily requirement for **calcium** as **25-30 mM/day** - The value of **25-30 mM/day** appears to confuse dietary calcium intake (1000-1200 mg/day ≈ 25-30 mmol) with maintenance electrolyte requirements - Although sodium and potassium requirements are correctly stated, the error in calcium makes this choice incorrect *1, 2 and 4* - This combination is incorrect because it includes the inaccurate daily requirement for **calcium** as **25-30 mM/day** - While sodium and magnesium requirements are generally accurate, the inclusion of the incorrect calcium value (should be ~3.5-7 mM/day) invalidates this option

Q: Distributive shock is described by which of the following patterns of cardiovascular responses? 1. Vasodilation 2. Reduced peripheral vascular resistance 3. Inadequate 'afterload' 4. Low cardiac output Select the correct answer using the code given below.

1, 2 and 3. ***1, 2 and 3*** - Distributive shock is characterized by **widespread vasodilation** (1), leading to a significant **reduction in peripheral vascular resistance/SVR** (2). - The reduced vascular resistance causes **inadequate afterload** (3) on the heart, as afterload is determined by SVR. - Cardiac output is typically **normal or elevated** in early distributive shock as the heart compensates for the low SVR, so statement 4 is NOT characteristic. - Classic examples include septic shock, anaphylactic shock, and neurogenic shock. *1, 2 and 4* - While **vasodilation** (1) and **reduced peripheral vascular resistance** (2) are correct, **low cardiac output** (4) is NOT a defining feature of distributive shock. - In distributive shock, cardiac output is often elevated in the hyperdynamic phase as the heart compensates for decreased SVR. - Low cardiac output is more characteristic of cardiogenic or hypovolemic shock. *1, 3 and 4* - **Vasodilation** (1) and **inadequate afterload** (3) are correct features, but **low cardiac output** (4) is incorrect. - Distributive shock typically presents with normal or increased cardiac output, not decreased. - This combination incorrectly includes low CO while missing the reduced peripheral vascular resistance (2). *2, 3 and 4* - **Reduced peripheral vascular resistance** (2) and **inadequate afterload** (3) are correct, but this option misses the fundamental mechanism of **vasodilation** (1). - Additionally, **low cardiac output** (4) is not a defining characteristic of distributive shock. - Without mentioning vasodilation, the underlying pathophysiology is incomplete.

Q: A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?

Acidosis with pH < 7.32. ***Acidosis with pH < 7.32*** - This represents **severe metabolic acidosis** and is a specific, measurable component of the **"lethal triad"** (acidosis, hypothermia, coagulopathy) that mandates damage control surgery. - pH < 7.32 (or < 7.2 in some protocols) is a **defined threshold** that indicates severe physiological derangement requiring abbreviated surgery. - Severe acidosis impairs **cardiac contractility**, **enzyme function**, and **coagulation cascade**, making prolonged definitive repair dangerous. - This specific laboratory value provides clear, objective criteria for the surgical decision. *Blood pressure < 100 mm Hg* - While **hypotension** indicates shock and requires aggressive resuscitation, blood pressure < 100 mmHg alone is not a specific criterion for damage control surgery. - Damage control is indicated by the **lethal triad** components, not by blood pressure thresholds alone. - Many trauma patients with BP 1.5, PT > 16-19 seconds, platelets < 50,000) that would make it a definitive, measurable criterion. - In contrast to the specific pH threshold given in option A, "coagulopathy" as stated here is less precise for decision-making. *Hypothermia < 36 °C* - While hypothermia is the third component of the "lethal triad," the typical threshold for damage control surgery is **core temperature < 35°C** (or < 34°C in most trauma protocols). - Hypothermia < 36°C represents only **mild hypothermia** and is not generally considered an absolute indication for abbreviated surgery. - More severe hypothermia (< 34-35°C) would be required to trigger damage control protocols.

Q: A 30-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates

fracture of the skull base. ***fracture of the skull base*** - A bruise over the mastoid process, known as **Battle's sign**, is a classic indicator of a **basilar skull fracture**. It signifies extravasation of blood from fracture lines in the skull base, typically involving the **temporal bone**. - This sign develops several hours to days after the injury as blood tracks subcutaneously, indicating severe trauma given the patient's altered consciousness. *injury to the external auditory meatus* - While head trauma can cause injury to the **external auditory meatus (EAM)**, a bruise over the mastoid process specifically points to deeper bone involvement, not just the EAM. - Injuries to the EAM might present with bleeding from the ear canal or local pain, but a mastoid bruise suggests a more extensive underlying fracture. *fracture of mastoid process* - Although Battle's sign is located on the mastoid process, it primarily indicates a fracture of the **skull base** (often involving the temporal bone, which includes the mastoid). - A fracture limited to the mastoid process itself might not necessarily cause the characteristic diffuse bruising pattern associated with Battle's sign, which results from blood tracking from deeper structures. *soft tissue injury to the neck* - A bruise over the mastoid process is anatomically distinct from the neck and does not directly indicate a **soft tissue injury to the neck**. - While neck injuries can accompany head trauma, Battle's sign is specific to a **cranial fracture**.

Q: A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the

WHO surgical safety checklist. **WHO surgical safety checklist** - The questions about patient identity, procedure site, and anticipated critical events are key components of the **"Sign In"** and **"Time Out"** sections of the **WHO Surgical Safety Checklist**. - This checklist is designed to improve **patient safety** by ensuring communication and adherence to essential steps before, during, and after surgery, thereby reducing surgical errors. *nurses safety checklist* - While nurses play a crucial role in patient safety, there isn't a universally recognized "nurses safety checklist" that specifically encompasses these exact comprehensive surgical verification steps. - The comprehensive framework described, with its specific questions, aligns more closely with the broader, interdisciplinary **WHO Surgical Safety Checklist**. *universal precautions checklist* - **Universal precautions** focus on preventing the transmission of bloodborne pathogens and other infectious agents by treating all bodily fluids as potentially infectious. - This checklist primarily addresses **infection control** measures and does not cover patient identification, surgical site verification, or critical event anticipation. *MCI patient safety checklist* - A "MCI patient safety checklist" is not a widely recognized or standardized medical safety protocol. - The scenario describes a standard, internationally adopted set of safety checks specifically for surgical procedures, which is the **WHO Surgical Safety Checklist**.

Question 1

Which of the following are correct for managing hypertrophic scars?

1. Silicone gel sheeting
2. Intralesional steroid injections
3. Vitamin A gel applications
4. Laser treatment Select the answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 2

Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)?

1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria.
2. It is same as bacteraemia.
3. It results in Multiple Organ Dysfunction Syndrome (MODS).
4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 3

The best measure of organ perfusion and the best monitor of adequacy of shock therapy is

Accepted Answer

urine output

Answer

restoring blood pressure/pulse vital parameters

Answer

central venous pressure

Answer

pulmonary wedge pressure

Question 4

Consider the following :

1. Pain relief
2. Prevention of infection
3. Anaesthesia
4. Restoration of anatomy Which of the features given above are priorities for fracture treatment?

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 5

Hangman's fracture is

Accepted Answer

traumatic spondylolisthesis of axis vertebra (C2)

Answer

traumatic spondylolisthesis of atlas vertebra (C1)

Answer

traumatic spondylolisthesis of lumbar vertebra (L1)

Answer

traumatic spondylolisthesis of thoracic vertebra (T1)

Question 6

Which of the following are approximate daily requirements of the common electrolytes in an adult?

1. Sodium 50-90 mM/day
2. Calcium 25-30 mM/day
3. Potassium 90 mM/day
4. Magnesium 15-17 mM/day

Select the correct answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 7

Distributive shock is described by which of the following patterns of cardiovascular responses?

1. Vasodilation
2. Reduced peripheral vascular resistance
3. Inadequate 'afterload'
4. Low cardiac output

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 8

A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?

Accepted Answer

Acidosis with pH < 7.32

Answer

Blood pressure < 100 mm Hg

Answer

Coagulopathy

Answer

Hypothermia < 36 °C

Question 9

A 30-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates

Accepted Answer

fracture of the skull base

Answer

injury to the external auditory meatus

Answer

fracture of mastoid process

Answer

soft tissue injury to the neck

Question 10

A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the

Accepted Answer

WHO surgical safety checklist

Answer

nurses safety checklist

Answer

universal precautions checklist

Answer

MCI patient safety checklist

UPSC-CMS 2024

Dermatology

Internal Medicine

Orthopaedics

Physiology

Surgery