UPSC-CMS 2012 Practice Questions

Q: The most typical clinical presentation of a retinoblastoma is

White reflex in pupil. ***White reflex in pupil*** - The most typical clinical presentation of retinoblastoma is **leukocoria**, or a **white reflex in the pupil**, which occurs when the tumor reflects light. - This symptom is often noticed by parents in photographs (the "cat's eye reflex") or during routine examinations. *Severe pain in the eye* - While retinoblastoma can cause pain in advanced stages, especially with increased **intraocular pressure** or inflammation, it is not the initial or most typical presenting symptom. - **Early retinoblastoma** is usually asymptomatic in terms of pain. *Loss of vision* - Vision loss can occur with retinoblastoma, particularly if the tumor affects the **macula** or becomes large, but it is often detected later than leukocoria. - Young children may not be able to articulate **vision changes**, making leukocoria a more apparent early sign. *Proptosis* - **Proptosis (bulging of the eye)** is an advanced sign of retinoblastoma, indicating significant tumor growth and extension beyond the globe. - It suggests **orbital involvement**, which is characteristic of more aggressive or late-stage disease rather than an initial presentation.

Q: The normal range of intraocular pressure (in mmHg) is

10-20. ***10-20*** - The **normal range for intraocular pressure (IOP)** is generally accepted to be between **10 and 20 mmHg**. - Maintaining IOP within this range is crucial for optimal eye health, as deviations can indicate conditions like **glaucoma** or **ocular hypotony**. *15-25* - While 15 mmHg falls within the normal range, **25 mmHg is considered elevated** and potentially indicative of **ocular hypertension** or **glaucoma**. - Sustained pressures above 20-21 mmHg raise concern for **optic nerve damage**. *20-30* - Both 20 mmHg and 30 mmHg are generally considered to be at the **upper end or above the normal range** of IOP. - Pressures in this range significantly increase the **risk of developing glaucoma** and require further evaluation. *5-15* - While 5 mmHg is generally considered low, **15 mmHg is within the normal range**. - An IOP of 5 mmHg or lower for an extended period could indicate **ocular hypotony**, which can lead to various visual problems.

Q: Avascular necrosis may develop in the following fractures except

Fracture of the calcaneum. ***Fracture of the calcaneum*** - The **calcaneum** (heel bone) has a rich and robust blood supply from multiple arteries, making it highly resistant to avascular necrosis (AVN) even after significant fractures. - While calcaneal fractures can lead to other complications like **subtalar arthritis** or wound issues, AVN is exceedingly rare due to its excellent vascularity. *Fracture of the talus* - The **talus** has a precarious blood supply, primarily from branches off the dorsalis pedis artery, peroneal artery, and posterior tibial artery, which enter at specific non-articular areas. - Fractures, especially those involving the **talus neck**, can disrupt these vital vascular channels, frequently leading to **avascular necrosis** of the talar body. *Subcapital fracture of the femoral neck* - **Subcapital fractures** occur within the hip joint capsule and often disrupt the **retinacular arteries** (medial and lateral circumflex femoral arteries), which are the main blood supply to the femoral head. - This interruption of blood flow to the femoral head is a very common cause of **avascular necrosis**, particularly in displaced fractures. *Fracture of the scaphoid* - The **scaphoid bone** has a unique blood supply where arteries typically enter the distal pole and travel proximally. - A fracture, especially in the **waist** or **proximal pole**, can easily disrupt this retrograde blood flow, leading to a high incidence of **avascular necrosis** in the proximal fragment.

Q: Which one of the following statements regarding seminoma testis is correct ?

It is the most common type of testicular cancer. ***It is the most common type of testicular cancer*** - **Seminoma** accounts for approximately **50% of all germ cell tumors** of the testis, making it the most common type [1]. - It typically affects men between the ages of **30 and 40 years**. *It frequently metastasizes to the liver and bones* - While seminoma can metastasize, its most common sites of spread are the **retroperitoneal lymph nodes** first, then distant sites like the lungs [2]. - Metastasis to the **liver and bones** is less frequent, especially in earlier stages. *Its five-year survival rates approach 50 per cent* - **Seminoma** generally has an **excellent prognosis**, with 5-year survival rates ranging from **95% for localized disease** to about 70-80% for metastatic disease [1]. - A 50% survival rate is significantly lower than actual outcomes for seminoma. *It does not respond to radiation* - **Seminoma is highly radiosensitive**, making radiation therapy a cornerstone of treatment for localized disease and regional lymph node involvement. - This characteristic distinguishes it from non-seminomatous germ cell tumors, which are generally less responsive to radiation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-984. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-512.

Q: What is the most appropriate surgical procedure for duodenal atresia?

Duodenoduodenostomy. ***Duodenoduodenostomy*** - This procedure involves **reconnecting the two ends of the duodenum** after resecting the atretic (blocked) segment. - It is specifically designed to bypass the obstruction caused by **duodenal atresia**, restoring normal intestinal continuity. *Ramstedt's operation* - This procedure is a **pyloromyotomy** performed for **pyloric stenosis**, where the thickened muscle of the pylorus is incised, not for duodenal atresia. - It addresses a narrowing at the exit of the stomach, not an obstruction within the small intestine itself. *Duodenojejunostomy* - This involves connecting the **duodenum to the jejunum**, typically used when a large segment of the duodenum is affected or there is a need to bypass a pathological area. - While technically feasible, **duodenoduodenostomy is preferred for isolated duodenal atresia** due to its more anatomical reconstruction. *Gastroduodenostomy* - This procedure connects the **stomach to the duodenum**, primarily performed after a partial gastrectomy (e.g., Billroth I) or for gastric outlet obstruction. - It is **not indicated for duodenal atresia**, as it does not address the congenital blockage within the duodenum.

Q: All of the following signs are considered in Alvarado score for acute appendicitis except

Rectal tenderness. ***Rectal tenderness*** - While rectal tenderness can be a sign of appendicitis, it is **not included in the Alvarado score**. The Alvarado score focuses on more direct indicators of peritoneal irritation and systemic response. - The score is composed of symptoms like **migratory right iliac fossa pain**, anorexia, nausea/vomiting, and signs like right iliac fossa tenderness, rebound tenderness, elevated temperature, leukocytosis and shift to the left. *Elevated temperature* - An **elevated body temperature** (fever) is a recognized component of the Alvarado score, indicating a systemic inflammatory response. - This sign contributes one point to the total score. *Rebound tenderness* - **Rebound tenderness** in the right lower quadrant is a crucial sign of peritoneal irritation and is explicitly included in the Alvarado score. - This clinical finding contributes one point to the total score. *Right iliac fossa tenderness* - **Tenderness in the right iliac fossa** (RLQ tenderness) is a primary clinical sign of appendicitis and is a significant component of the Alvarado score. - This sign contributes two points to the total score, reflecting its importance.

Q: A 30-year-old patient developed haematuria following a blunt injury to the abdomen. The patient is haemodynamically stable. However, the ultrasonographic examination reveals a perirenal collection which measures 4 x 4 cm. The patient is best managed by

Nonoperative management. ***Nonoperative management*** - The patient is **haemodynamically stable** with a contained, relatively small **perirenal collection (4x4 cm)**, indicating that the bleeding is likely self-limiting. - **Conservative management** involving observation, bed rest, and serial imaging is the standard approach for most blunt renal injuries in stable patients. *Percutaneous nephrostomy and drainage of the haematoma* - This approach is generally reserved for patients with significant **urinary extravasation**, **infected collections**, or ongoing bleeding despite conservative measures, which are not described here. - Draining a sterile haematoma without addressing the source of bleeding can also pose a risk of infection without clear benefit in a stable patient. *Renal angiography and embolisation of the bleeding vessel* - **Angioembolization** is typically indicated for patients with **persistent active bleeding** despite conservative management, or for those who become **haemodynamically unstable**. - In a stable patient with a contained haematoma, this invasive procedure is not the initial best step. *Immediate laparotomy and repair of the renal injury* - **Laparotomy** and surgical repair are indicated for **haemodynamically unstable patients**, large or expanding retroperitoneal haematomas, or injuries involving the renal pedicle or major collecting system. - Given the **haemodynamic stability** and contained haematoma, immediate surgery is overly aggressive and unnecessary.

Q: Inhalation injury most commonly results in which of the following to the bronchial tree?

Chemical burn to the bronchial tree. ***Correct: Chemical burn to the bronchial tree*** - Inhalation injuries predominantly involve **toxic gases and chemicals** (carbon monoxide, cyanide, aldehydes, acids) produced during fires, which cause **chemical burns** to the bronchial tree - The bronchial mucosa is highly susceptible to chemical irritants, leading to **mucosal inflammation, edema, sloughing, and bronchospasm** - Chemical injury to the tracheobronchial tree is the **hallmark of significant inhalation injury** - Clinical features include wheezing, carbonaceous sputum, and progressive respiratory distress *Incorrect: Thermal burn to the bronchial tree and lungs* - **Thermal burns rarely extend beyond the larynx** to the lower airways due to the **efficient heat dissipation** by the upper airway structures - The high heat capacity of the upper airway mucosa and cooling effect of inspired air protect the bronchial tree and lungs from direct thermal injury - Exception: superheated steam can occasionally reach lower airways, but this is uncommon *Incorrect: Chemical burn to the lungs* - While chemical irritants can reach the alveoli and cause **secondary pneumonitis or ARDS**, the question specifically asks about the **bronchial tree** - The **primary site of chemical injury** from inhalation is the airway (bronchial tree), not the pulmonary parenchyma - Lung injury is typically a delayed complication rather than the immediate result *Incorrect: Thermal burn to the upper airway* - Thermal injury primarily affects the **supraglottic structures** (nasopharynx, oropharynx, larynx), not the bronchial tree - While thermal burns to the upper airway are common in inhalation injury, the question asks specifically about the **bronchial tree** - Upper airway thermal injury and lower airway chemical injury are distinct components of inhalation injury

Q: A patient is diagnosed to have a Stage T3a carcinoma of the prostate. Clinically, this implies

Extraprostatic extension through the prostatic capsule. ***Extraprostatic extension through the prostatic capsule*** - **T3a prostate cancer** indicates **extraprostatic extension** of the tumor, meaning it has grown beyond the boundaries of the prostate capsule [1]. - This stage specifically denotes microscopic or macroscopic extension through the capsule but without involvement of seminal vesicles or other adjacent structures [1]. *Involvement of the pelvic wall* - **Pelvic wall involvement** signifies a more advanced stage, typically **T4**, where the tumor has invaded adjacent organs or structures beyond the seminal vesicles. - This description goes beyond the definition of a T3a tumor, which is contained within the immediate periprostatic tissue. *Involvement of the seminal vesicles* - **Seminal vesicle invasion** is classified as **T3b** in the TNM staging system for prostate cancer, differentiating it from T3a [1]. - T3a specifically excludes seminal vesicle involvement, focusing solely on extraprostatic extension [1]. *Involvement of both the lobes but the disease is limited to within the prostatic capsule* - **Involvement of both lobes** while remaining within the prostatic capsule is characteristic of a **T2c** stage prostate cancer. - T3a implies extension *beyond* the capsule, which contradicts the statement that the disease is limited to within it.

Question 1

The most typical clinical presentation of a retinoblastoma is

Accepted Answer

White reflex in pupil

Answer

Severe pain in the eye

Answer

Loss of vision

Answer

Proptosis

Question 2

The normal range of intraocular pressure (in mmHg) is

Accepted Answer

10-20

Answer

15-25

Answer

20-30

Answer

5-15

Question 3

Avascular necrosis may develop in the following fractures except

Accepted Answer

Fracture of the calcaneum

Answer

Fracture of the talus

Answer

Subcapital fracture of the femoral neck

Answer

Fracture of the scaphoid

Question 4

Which one of the following statements regarding seminoma testis is correct ?

Accepted Answer

It is the most common type of testicular cancer

Answer

It frequently metastasizes to the liver and bones

Answer

Its five-year survival rates approach 50 per cent

Answer

It does not respond to radiation

Question 5

A truck driver hit his chest against the steering wheel and sustained multiple rib fractures. His vitals are stable; however, the injured side of the chest shows paradoxical movement. The chest X-ray shows no evidence of haemothorax or pneumothorax but there is a large pulmonary contusion. The most appropriate treatment will be

Accepted Answer

Immediate operative stabilisation

Answer

Insertion of an intrathoracic drain

Answer

Stabilisation of fractured ribs with towel clips

Answer

Tracheostomy, mechanical ventilation and positive end-expiratory pressure ventilation

Question 6

What is the most appropriate surgical procedure for duodenal atresia?

Accepted Answer

Duodenoduodenostomy

Answer

Ramstedt's operation

Answer

Duodenojejunostomy

Answer

Gastroduodenostomy

Question 7

All of the following signs are considered in Alvarado score for acute appendicitis except

Accepted Answer

Rectal tenderness

Answer

Elevated temperature

Answer

Rebound tenderness

Answer

Right iliac fossa tenderness

Question 8

A 30-year-old patient developed haematuria following a blunt injury to the abdomen. The patient is haemodynamically stable. However, the ultrasonographic examination reveals a perirenal collection which measures 4 x 4 cm. The patient is best managed by

Accepted Answer

Nonoperative management

Answer

Percutaneous nephrostomy and drainage of the haematoma

Answer

Renal angiography and embolisation of the bleeding vessel

Answer

Immediate laparotomy and repair of the renal injury

Question 9

Inhalation injury most commonly results in which of the following to the bronchial tree?

Accepted Answer

Chemical burn to the bronchial tree

Answer

Thermal burn to the bronchial tree and lungs

Answer

Chemical burn to the lungs

Answer

Thermal burn to the upper airway

Question 10

A patient is diagnosed to have a Stage T3a carcinoma of the prostate. Clinically, this implies

Accepted Answer

Extraprostatic extension through the prostatic capsule

Answer

Involvement of the pelvic wall

Answer

Involvement of the seminal vesicles

Answer

Involvement of both the lobes but the disease is limited to within the prostatic capsule

UPSC-CMS 2012

Ophthalmology

Orthopaedics

Pathology

Surgery