UPSC-CMS 2010 Practice Questions

Q: Dysphagia lusoria is a condition which results from

aberrant right subclavian artery. ***aberrant right subclavian artery*** - Dysphagia lusoria is specifically caused by compression of the **esophagus** by an **aberrant right subclavian artery** [2]. - This congenital anomaly involves the right subclavian artery arising from the distal aortic arch and passing behind the esophagus [2]. *oesophageal atresia* - **Oesophageal atresia** is a congenital condition where the esophagus ends in a blind pouch, preventing food from reaching the stomach [1]. - It usually presents in neonates with **vomiting** and **choking** during feeds, not progressive dysphagia in an adult [1]. *oesophageal web* - An **oesophageal web** is a thin, eccentric protrusion of normal esophageal tissue into the lumen, typically causing intermittent dysphagia to solids. - While it causes dysphagia, it is a structural abnormality within the esophageal lumen, not external compression. *corrosive stricture* - A **corrosive stricture** results from chemical burns to the esophagus, leading to scarring and narrowing of the lumen. - This is an acquired condition with a clear history of corrosive ingestion, unlike the congenital anomaly seen in dysphagia lusoria.

Q: The lungs are derived from an out-pouching of the primitive foregut during which period of intrauterine life?

4th week. ***4th week*** - The **respiratory diverticulum (lung bud)** appears as a ventral out-pouching from the **primitive foregut** at approximately **26-28 days** of development, which falls in the **4th week** of intrauterine life [1]. - This marks the beginning of the respiratory system's development, initiating the formation of the **larynx**, **trachea**, **bronchi**, and **lungs** [1]. - The lung bud forms from the foregut endoderm and subsequently divides into the **right and left bronchial buds**. *3rd week* - During the third week, **gastrulation** occurs with the formation of the three germ layers (ectoderm, mesoderm, endoderm). - The **primitive gut tube** begins to form toward the end of the third week through **lateral and cranio-caudal folding**, but the respiratory diverticulum has not yet appeared. - The lung bud out-pouching occurs later, around day 26-28 of the fourth week. *5th week* - By the fifth week, the **laryngotracheal tube** has separated from the foregut via the **tracheoesophageal septum**. - The main **bronchi** continue to elongate and branch into **secondary (lobar) bronchi**. - The initial formation of the lung bud precedes this developmental stage. *6th week* - By the sixth week, the **bronchial tree** undergoes further branching with the formation of **tertiary (segmental) bronchi**. - The **pseudoglandular stage** of lung development is underway, with continued airway differentiation. - This represents a later stage of respiratory development, well after the initial lung bud formation [1].

Q: What is the most common injury sustained due to fall on outstretched hand by a person aged 65 years?

Colles' fracture. ***Colles' fracture*** - A **Colles' fracture** is a common injury in older adults, particularly post-menopausal women, due to **osteoporosis** weakening the bones. - It involves a **distal radius fracture** with dorsal displacement of the distal fragment, occurring typically from a fall onto an **outstretched hand**. *Shoulder dislocation* - While shoulder dislocations can occur from falls, they are less common than wrist fractures in the elderly following a fall on an outstretched hand, especially given the prevalence of **osteoporosis**. - A shoulder dislocation typically involves the **humeral head** coming out of the glenoid fossa. *Fracture of metacarpals* - Metacarpal fractures can result from direct trauma to the hand or a fall, but they are generally less frequent than **distal radius fractures** in the elderly after a fall on an outstretched hand. - These fractures involve the bones within the hand itself and are often caused by **punching injuries** or direct impact. *Supracondylar fracture* - **Supracondylar fractures** are more common in children due to their bone structure and are typically associated with falls on an outstretched hand. - In adults, particularly the elderly, this type of fracture is much less common than a **Colles' fracture** following such a mechanism.

Q: Osteitis fibrosa cystica is a feature of

hyperparathyroidism. ***Correct: Hyperparathyroidism*** - **Osteitis fibrosa cystica** is a classic bone manifestation of **severe primary hyperparathyroidism**, resulting from excessive **parathyroid hormone (PTH)** [1]. - **PTH** causes increased bone resorption, leading to fibrous tissue replacement, cystic changes, and **brown tumors** (osteoclast-rich lesions with hemosiderin deposition) [1], [2]. - This represents advanced skeletal disease in hyperparathyroidism, though now rare due to early detection [1]. *Incorrect: Milk-alkali syndrome* - This syndrome is characterized by **hypercalcemia**, **metabolic alkalosis**, and **renal insufficiency** due to excessive intake of calcium and absorbable alkali. - It does not cause osteitis fibrosa cystica, which is a specific bone lesion requiring prolonged elevated **PTH**. *Incorrect: Rickets* - **Rickets** is a disorder primarily affecting children, characterized by defective bone mineralization leading to soft and weakened bones. - It is caused by **vitamin D deficiency** or resistance and manifests as bone deformities (bowing, rachitic rosary), not cystic bone lesions. *Incorrect: Hyperthyroidism* - **Hyperthyroidism** can lead to generalized **osteopenia** or **osteoporosis** due to increased bone turnover, but it does not cause osteitis fibrosa cystica. - The bone changes in hyperthyroidism are diffuse and distinct from the focal cystic lesions seen in excessive **PTH** activity. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1105-1106. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1194.

Q: A four-month-old baby has cleft lip and palate. How would you manage the baby?

Immediate repair of the lip. ***Immediate repair of the lip*** - A **cleft lip** is typically repaired around **3-6 months of age** ("Rule of 10s": 10 weeks old, 10 pounds weight, 10 g/dL hemoglobin), which aligns with the baby's age of four months, to facilitate feeding and encourage normal facial bone and dental development. - Early lip closure also aids in better **feeding**, improved **speech development**, and addressing initial aesthetic concerns. *Delayed repair of the lip and palate until pre-school age* - Delaying **lip repair** until pre-school age would negatively impact feeding, speech development, and psychosocial well-being, as well as potentially affecting facial growth. - **Palate repair** is generally performed between **9-18 months of age** to optimize speech development, not pre-school age. *Immediate repair of the lip and palate* - While **lip repair** can be done relatively early, **palate repair** is usually delayed until later (9-18 months) to allow for facial growth and to optimize speech outcomes. - Performing both immediately might pose greater surgical risks and interfere with the natural growth of the maxilla and skull base. *Delayed repair of the lip and palate until 2 years* - Delaying **lip repair** until 2 years is too late, as it significantly impacts feeding, speech development, and facial aesthetics during critical developmental periods. - While some **palate repairs** may occur up to 18 months, delaying beyond this, particularly for the lip, is not optimal for function or aesthetics.

Q: Which one of the following is a cyanotic congenital heart disease?

Tetralogy of Fallot. ***Tetralogy of Fallot*** - This condition is characterized by **four distinct heart defects** that result in **right-to-left shunting** of unoxygenated blood into the systemic circulation, leading to cyanosis. - The four defects are **ventricular septal defect**, **pulmonary stenosis**, **overriding aorta**, and **right ventricular hypertrophy**. *Patent ductus arteriosus* - This is an **acyanotic heart defect** where there is a persistent opening between the aorta and pulmonary artery, leading to a **left-to-right shunt**, increasing pulmonary blood flow. - It does not typically cause cyanosis unless there is severe pulmonary hypertension leading to shunt reversal (Eisenmenger syndrome). *Ventricular septal defect* - This is also primarily an **acyanotic heart defect** where a hole exists between the ventricles, causing a **left-to-right shunt** of oxygenated blood. - Cyanosis would only occur in severe cases with significant pulmonary hypertension and shunt reversal (Eisenmenger syndrome). *Atrial septal defect* - This is an **acyanotic heart defect** involving an opening between the atria, usually resulting in a **left-to-right shunt** of oxygenated blood into the right atrium. - It rarely causes cyanosis unless there are significant complications like pulmonary hypertension with shunt reversal.

Q: Dumping syndrome can occur after

Billroth-II operation. ***Billroth-II operation*** - This procedure involves a **gastrojejunostomy** where the stomach is connected directly to the jejunum, bypassing the duodenum. This design allows for rapid emptying of gastric contents into the small intestine. - The rapid transit of **hyperosmolar chyme** into the small bowel draws fluid into the lumen, leading to symptoms like abdominal pain, bloating, diarrhea, and vasomotor symptoms (e.g., palpitations, sweating) [1]. *Whipple's operation* - While it involves extensive gastrointestinal reconstruction, a **Whipple's operation** (pancreaticoduodenectomy) typically includes a gastrojejunostomy that is less prone to severe dumping than a Billroth II, as it often preserves a significant portion of the duodenum or creates a more controlled gastric outflow. - The primary aim of a Whipple is to resect the head of the pancreas, duodenum, gallbladder, and bile duct, with subsequent reconstruction involving multiple anastomoses, but usually not one specifically designed to rapidly empty into the jejunum without duodenal transit. *Nissen fundoplication* - This procedure is performed to treat **gastroesophageal reflux disease (GERD)** by wrapping the top of the stomach (fundus) around the lower esophagus to strengthen the lower esophageal sphincter. - It aims to prevent reflux, not to alter the rate of gastric emptying in a way that typically causes dumping syndrome. *Heller's operation* - **Heller's myotomy** is a surgical procedure to treat **achalasia**, a disorder where the lower esophageal sphincter fails to relax properly. It involves cutting the muscle fibers of the lower esophageal sphincter to facilitate the passage of food into the stomach. - This operation addresses a motility issue of the esophagus and generally does not affect gastric emptying in a manner that leads to dumping syndrome.

Q: With reference to Le Fort I fracture, consider the following statements : 1. Fracture line separates alveolus and palate from the facial skeleton. 2. Fracture line passes from the pyriform aperture. 3. Fracture line runs posteriorly to include pterygoid plates. 4. Fracture line passes through orbit. Which of the statements given above are correct?

1, 2 and 3. ***Correct Answer: 1, 2 and 3*** - A **Le Fort I fracture** (floating palate fracture) involves a horizontal fracture line separating the **maxillary alveolus and hard palate** from the rest of the facial skeleton, confirming statement 1. - The fracture path includes the **pyriform aperture** anteriorly (statement 2) and extends posteriorly to involve the **pterygoid plates of the sphenoid bone** (statement 3). - Statement 4 is **incorrect** because Le Fort I fractures do **not** involve the orbit; this is a low-level fracture below the orbital floor. *Incorrect: 1 and 2 only* - This option is incomplete as it omits statement 3, which is a defining characteristic of Le Fort I fractures. - The fracture **must** extend posteriorly to include the **pterygoid plates** to be classified as a Le Fort I. *Incorrect: 2, 3 and 4* - Statement 4 is incorrect for a Le Fort I fracture. - Le Fort I fractures are located **inferiorly** and do **not** involve the orbital floor or walls. - Orbital involvement is characteristic of **Le Fort II** (pyramidal fracture) or **Le Fort III** (craniofacial dysjunction) fractures. *Incorrect: 1 and 3 only* - This option omits statement 2, which accurately describes the involvement of the **pyriform aperture** in Le Fort I fractures. - The fracture line **consistently** passes through the pyriform aperture anteriorly as it traverses the lower maxilla.

Q: Consider the following conditions in blunt trauma of the chest : 1. Flail chest 2. Drainage of 1 litre of blood from the chest tube 3. Cardiac tamponade 4. Rupture of oesophagus Which of the above are the indications of emergency thoracotomy?

2, 3 and 4 only. ***Correct: 2, 3 and 4 only*** **Emergency thoracotomy indications in blunt chest trauma:** **Drainage of 1 litre of blood from chest tube (Massive Hemothorax):** - Definite indication for emergency thoracotomy - Standard criteria: >1500 mL initial drainage OR >200-300 mL/hr for 2-4 consecutive hours - 1 liter initially approaches the threshold and indicates ongoing hemorrhage requiring surgical control **Cardiac tamponade:** - Life-threatening condition requiring immediate intervention - Initial management may include pericardiocentesis, but if patient is in extremis or pericardiocentesis fails, emergency thoracotomy is indicated - In the setting of blunt trauma with hemodynamic instability, thoracotomy may be necessary for definitive repair **Rupture of oesophagus:** - Though rare in blunt trauma, when it occurs it requires surgical repair via thoracotomy - While not always an immediate "emergency" in the resuscitation bay, it does require urgent surgical intervention once diagnosed - Can lead to mediastinitis and requires thoracotomy for repair and debridement *Incorrect: Flail chest (Statement 1)* - **Flail chest is NOT an indication for emergency thoracotomy** - Management is primarily conservative: adequate analgesia, pulmonary toilet, and respiratory support - Surgical rib fixation (ORIF) may be considered in select cases but this is different from emergency thoracotomy for hemorrhage or cardiac injury - Flail chest does not require opening the chest cavity emergently; it's a chest wall injury managed supportively *Incorrect: 2 and 4 only* - Excludes cardiac tamponade, which is a critical indication for thoracotomy in unstable patients *Incorrect: 1, 2, 3 and 4* - Incorrectly includes flail chest, which is not an indication for emergency thoracotomy *Incorrect: 1, 2 and 3 only* - Incorrectly includes flail chest - Excludes esophageal rupture which does require surgical thoracotomy when diagnosed

Question 1

Dysphagia lusoria is a condition which results from

Accepted Answer

aberrant right subclavian artery

Answer

oesophageal atresia

Answer

oesophageal web

Answer

corrosive stricture

Question 2

The lungs are derived from an out-pouching of the primitive foregut during which period of intrauterine life?

Accepted Answer

4th week

Answer

3rd week

Answer

5th week

Answer

6th week

Question 3

What is the most common injury sustained due to fall on outstretched hand by a person aged 65 years?

Accepted Answer

Colles' fracture

Answer

Shoulder dislocation

Answer

Fracture of metacarpals

Answer

Supracondylar fracture

Question 4

Which one of the following is not a premalignant condition for colon cancer?

Accepted Answer

Sporadic hamartomatous polyps

Answer

Ulcerative colitis

Answer

Villous adenoma

Answer

Familial adenomatous polyposis coli

Question 5

Osteitis fibrosa cystica is a feature of

Accepted Answer

hyperparathyroidism

Answer

milk-alkali syndrome

Answer

rickets

Answer

hyperthyroidism

Question 6

A four-month-old baby has cleft lip and palate. How would you manage the baby?

Accepted Answer

Immediate repair of the lip

Answer

Delayed repair of the lip and palate until pre-school age

Answer

Immediate repair of the lip and palate

Answer

Delayed repair of the lip and palate until 2 years

Question 7

Which one of the following is a cyanotic congenital heart disease?

Accepted Answer

Tetralogy of Fallot

Answer

Patent ductus arteriosus

Answer

Ventricular septal defect

Answer

Atrial septal defect

Question 8

Dumping syndrome can occur after

Accepted Answer

Billroth-II operation

Answer

Whipple's operation

Answer

Nissen fundoplication

Answer

Heller's operation

Question 9

With reference to Le Fort I fracture, consider the following statements :

1. Fracture line separates alveolus and palate from the facial skeleton.

2. Fracture line passes from the pyriform aperture.

3. Fracture line runs posteriorly to include pterygoid plates.

4. Fracture line passes through orbit.
Which of the statements given above are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2, 3 and 4

Answer

1 and 3 only

Question 10

Consider the following conditions in blunt trauma of the chest :
1. Flail chest
2. Drainage of 1 litre of blood from the chest tube
3. Cardiac tamponade
4. Rupture of oesophagus
Which of the above are the indications of emergency thoracotomy?

Accepted Answer

2, 3 and 4 only

Answer

2 and 4 only

Answer

1, 2, 3 and 4

Answer

1, 2 and 3 only

UPSC-CMS 2010

Anatomy

Orthopaedics

Pathology

Pediatrics

Surgery