UPSC-CMS 2013 Previous Year Questions Practice Questions

Q: The commonest site for thyroglossal cyst is :

Subhyoid. ***Subhyoid (Infrahyoid)*** - The **subhyoid (infrahyoid) region** is the most common location for thyroglossal cysts, accounting for **50-65% of cases**. - The thyroglossal duct passes through or is intimately related to the **body of the hyoid bone** during embryonic descent of the thyroid gland from the foramen cecum [1], [2]. - Cysts most frequently form **at or just below the level of the hyoid bone** in the midline neck. - These cysts characteristically **move upward with swallowing and tongue protrusion** due to their attachment to the hyoid bone. *Suprahyoid* - Suprahyoid cysts occur **above the hyoid bone** and account for approximately **20-25% of cases**. - While common, they are **less frequent than subhyoid cysts**. - These may present higher in the neck but still maintain the characteristic midline location. *Submentum* - The submental region is **anterior and superior to the hyoid bone** in the midline. - Thyroglossal cysts in this location are **uncommon** as the duct's path runs more posteriorly in relation to this space. - True submental cysts are rare and must be differentiated from dermoid cysts. *Foramen caecum* - This is the **embryological origin** of the thyroglossal duct at the base of the tongue [1], [2]. - Cysts at this location are called **lingual thyroglossal cysts** and are very rare (1-2% of cases) [1]. - They present as tongue base masses and can cause dysphagia or airway obstruction. [Practice more UPSC-CMS 2013 questions on OnCourse]

Q: Universal precautions to be followed by the surgical team include all of the following except :

Prophylactic antimicrobials. **Prophylactic antimicrobials** - **Prophylactic antimicrobials** are given to prevent surgical site infections and are not considered a part of **universal precautions** themselves. - Universal precautions are primarily focused on preventing the transmission of bloodborne pathogens through physical barriers. *Wearing boots* - **Wearing boots** or shoe covers is an important component of **universal precautions** in the operating room to protect against splashes and contamination from blood and body fluids. - They also help maintain a sterile environment by preventing the introduction of contaminants from street shoes. *Wearing double gloves* - **Wearing double gloves** offers an extra layer of protection against sharps injuries and potential exposure to blood and body fluids, especially during procedures with a higher risk of puncture. - This practice reinforces the **barrier protection** aspect of universal precautions. *Donning water repellent gown* - A **water-repellent gown** acts as a crucial barrier to protect the surgical team's skin and clothing from contamination with blood, body fluids, and other potentially infectious materials. - This aligns with the principle of **universal precautions** to minimize exposure risks. [Practice more UPSC-CMS 2013 questions on OnCourse]

Q: The clinical signs of brain-stem death include all of the following except:

Profound hypotension. **Profound hypotension** - While patients with brainstem death can be hemodynamically unstable, **profound hypotension** itself is not a defining diagnostic criterion for brainstem death. It is often a consequence of brainstem injury, but not a direct sign indicating loss of brainstem function. - The criteria for brainstem death focus on the irreversible cessation of all brainstem reflexes and the capacity for spontaneous respiration, not peripheral circulatory status. *Absence of spontaneous respiration* - The **apnea test**, demonstrating no respiratory efforts despite adequate CO2 stimulation, is a critical component of brainstem death diagnosis, indicating irreversible loss of brainstem respiratory centers. - This sign confirms the total and irreversible cessation of the brainstem's ability to maintain vital functions. *Absent oculo-vestibular reflex* - The absence of the **oculo-vestibular reflex** (cold caloric test) indicates irreversible damage to the brainstem nuclei responsible for eye movements and vestibular function. - This is a key diagnostic criterion demonstrating the loss of specific brainstem reflexes. *Absence of pharyngeal reflex* - The absence of the **pharyngeal reflex** (gag reflex) signifies the loss of cranial nerve IX and X function, which are mediated by the brainstem. - This confirms the irreversible cessation of a vital protective reflex regulated by the brainstem. [Practice more UPSC-CMS 2013 questions on OnCourse]

Q: Factors important in the formation of gall stones include all of the following except :

Gall bladder motility. ***Gall bladder motility*** - While factors like gallbladder **stasis** or **hypomotility** can *contribute* to gallstone formation by allowing bile to concentrate, normal gallbladder motility itself does not directly form stones. - Efficient gallbladder emptying helps prevent the supersaturation and precipitation of cholesterol and bilirubin that lead to stone formation [2]. *Obesity* - Obesity increases the **hepatic secretion of cholesterol**, leading to more cholesterol in the bile [1]. - This increased cholesterol can lead to **supersaturation** of bile, making it prone to forming cholesterol gallstones. *Cholesterol saturation in bile* - When bile contains more cholesterol than can be kept in solution by bile salts and phospholipids, it becomes **supersaturated** [3]. - This supersaturation is a primary driver for the **precipitation of cholesterol crystals**, which aggregate to form gallstones [1]. *The size of micelles* - Micelles are small aggregates of bile salts and phospholipids that solubilize cholesterol in bile [3]. - If the **micelle size is insufficient** or their number is reduced, they cannot adequately solubilize the cholesterol, leading to its precipitation and stone formation [3]. [Practice more UPSC-CMS 2013 questions on OnCourse]

Q: The complications of ascaris lumbricoides infestation include all of the following except :

peptic ulcer disease. ***Peptic ulcer disease*** - **Peptic ulcer disease** is not a commonly recognized direct complication of *Ascaris lumbricoides* infestation. - While *Ascaris* can cause gastrointestinal symptoms, it does not typically lead to the formation of peptic ulcers. *Lower gastrointestinal bleed* - Heavy worm burdens can cause irritation and inflammation of the intestinal lining, potentially leading to **mucosal erosions** and **lower gastrointestinal bleeding**. - In rare cases, worms might erode into blood vessels, contributing to bleeding. *Cholangitis and obstructive jaundice* - Adult worms can migrate from the small intestine into the **biliary tree**, obstructing bile flow and causing **cholangitis** or **obstructive jaundice**. - They can also enter the pancreatic duct, leading to **pancreatitis**. *Acute intestinal obstruction* - A large bolus of adult worms can form a tangled mass (bolus) within the small intestine, leading to **complete or partial acute intestinal obstruction**. - This is a serious surgical emergency, especially in children with heavy worm loads. [Practice more UPSC-CMS 2013 questions on OnCourse]

Question 1

The commonest site for thyroglossal cyst is :

Accepted Answer

Subhyoid

Answer

Submentum

Answer

Suprahyoid

Answer

Foramen caecum

Question 2

Universal precautions to be followed by the surgical team include all of the following except :

Accepted Answer

Prophylactic antimicrobials

Answer

Wearing boots

Answer

Wearing double gloves

Answer

Donning water repellent gown

Question 3

The clinical signs of brain-stem death include all of the following except:

Accepted Answer

Profound hypotension

Answer

Absence of spontaneous respiration

Answer

Absent oculo-vestibular reflex

Answer

Absence of pharyngeal reflex

Question 4

Factors important in the formation of gall stones include all of the following except :

Accepted Answer

Gall bladder motility

Answer

Obesity

Answer

The size of micelles

Answer

Cholesterol saturation in bile

Question 5

The complications of ascaris lumbricoides infestation include all of the following except :

Accepted Answer

peptic ulcer disease

Answer

lower gastro intestinal bleed

Answer

cholangitis and obstructive jaundice

Answer

acute intestinal obstruction

Question 6

Which one of the following fractures is most often complicated by fat embolism ?

Accepted Answer

Shaft of femur

Answer

Shaft of tibia

Answer

Supra condyler humerus

Answer

Lumbar vertebrae

Question 7

Non-cardiac causes of raised central venous pressure include all of the following except:

Accepted Answer

Hyper-volemia

Answer

Abdominal compartment syndrome

Answer

Positive pressure ventilation

Answer

Tension pneumothorax

Question 8

A 25-year-old patient has 5 x 5 cm amoebic abscess in right lobe of liver. He is febrile and has pain in right hypochondrium. His primary management would include:

Accepted Answer

Ultra-sound guided placement of pigtail catheter

Answer

Laparotomy and drainage

Answer

Administration of antibiotic and observation

Answer

Ultra-sound guided aspiration

Question 9

The surgical complications of typhoid fever include all of the following except :

Accepted Answer

Acute pancreatitis

Answer

Splenic abscess

Answer

Acute cholecystitis

Answer

Perforation peritonitis

Question 10

Treatment of choice for acute femoral artery embolism is :

Accepted Answer

Immediate embolectomy

Answer

Warfarin

Answer

Embolectomy after rest for few days

Answer

Heparin

UPSC-CMS 2013

Anatomy

Community Medicine

Forensic Medicine

Internal Medicine

Orthopaedics

Physiology

Surgery