UPSC-CMS 2013 Practice Questions

Q: All of the following cranial nerves pass through the jugular foramen except :

Hypoglossal. ***Hypoglossal*** - The **hypoglossal nerve (CN XII)** exits the skull through the **hypoglossal canal**, not the jugular foramen. - Its primary function is to innervate the intrinsic and extrinsic muscles of the **tongue**. *Vagus* - The **vagus nerve (CN X)** is one of the three cranial nerves that traverse the **jugular foramen**. - It has extensive innervation, including parasympathetic supply to the **heart, lungs, and most of the gastrointestinal tract**. *Glossopharyngeal* - The **glossopharyngeal nerve (CN IX)** exits the skull via the **jugular foramen**. - It is responsible for **taste sensation** from the posterior one-third of the tongue and motor innervation to the **stylopharyngeus muscle**. *Spinal accessory* - The **spinal accessory nerve (CN XI)** passes through the **jugular foramen** after entering the cranial cavity through the foramen magnum. - It innervate the **sternocleidomastoid** and **trapezius muscles**, responsible for head and shoulder movements.

Q: Which of the following ligaments contains splenic artery?

Spleno-renal ligament. ***Spleno-renal ligament*** - The **splenic artery**, a branch of the **celiac trunk**, runs along the **superior border of the pancreas** and then travels within the **spleno-renal (lienorenal) ligament** to reach the hilum of the spleen. - This ligament connects the **spleen to the left kidney** and also contains the **splenic vein** and the **tail of the pancreas** [1], . - The splenic artery is the primary vessel within this ligament. *Spleno-colic ligament* - This ligament connects the **spleen to the transverse colon** and does not contain the splenic artery [1], . - It primarily functions to stabilize the spleen's position relative to the colon. *Spleno-phrenic ligament* - This ligament connects the **spleen to the diaphragm** and is part of the suspensory ligaments of the spleen. - It does not contain major vessels like the splenic artery but may contain small accessory splenic vessels. *Gastro-splenic ligament* - This ligament connects the **spleen to the greater curvature of the stomach**. - It contains the **short gastric arteries** and the **left gastroepiploic vessels**, which are **branches of the splenic artery**, but not the main splenic artery itself [1], .

Q: Deep vein thrombosis of calf is best managed by :

anticoagulants. ***Anticoagulants*** - **Anticoagulation** therapy is the cornerstone of DVT management, preventing clot extension and reducing the risk of **pulmonary embolism** [1]. - Medications like **heparin**, **low molecular weight heparin**, or **direct oral anticoagulants (DOACs)** are commonly used [1]. *active physiotherapy* - While physical activity can prevent DVT, it is generally **contraindicated in acute DVT** due to the risk of dislodging the clot. - Mobilization is introduced gradually once anticoagulation is therapeutic and the risk of **embolization** is reduced. *thrombolysis* - **Thrombolysis** (clot dissolution) is usually reserved for **proximal, extensive DVT** [1] or DVT with **limb-threatening ischemia** [2]. - It carries a **higher risk of bleeding** compared to anticoagulation and is not typically necessary for isolated calf DVT [2]. *surgical venous thrombectomy* - **Surgical thrombectomy** is rarely performed for DVT and is generally reserved for **massive iliocaval thrombosis** with severe limb threat. - It is an **invasive procedure** with significant risks and is not indicated for typical calf DVT.

Q: To differentiate pancreatic ascites from ascites secondary to cirrhosis of the liver, the most important test is :

Abdominal paracentesis. ***Abdominal paracentesis*** - This procedure involves analyzing the **ascitic fluid**, which is crucial for distinguishing between pancreatic ascites and cirrhosis-related ascites [1]. - In **pancreatic ascites**, the fluid will have a very high **amylase** content and often a high protein level (>2.5 g/dL), whereas in **cirrhosis**, the amylase is typically normal and the protein is usually low (<2.5 g/dL) [1]. *Abdominal ultrasound* - While useful for detecting ascites and underlying liver disease (cirrhosis), it cannot definitively determine the **cause of ascites** or the specific content of the ascitic fluid [2]. - Ultrasound can visualize the pancreas but cannot reliably differentiate pancreatic ascites from other causes without **fluid analysis**. *Endoscopic retrograde cholangiopancreatography (ERCP)* - This is an **invasive procedure** primarily used for diagnosing and treating disorders of the bile ducts and pancreatic duct, such as strictures or stones. - It is not the most important or initial test for differentiating the cause of ascites, as its main role is in identifying **ductal leaks** that might lead to pancreatic ascites, rather than direct fluid analysis. *Computed tomogram (CT) scan* - CT can confirm the presence of ascites, evaluate the **pancreas** for inflammation or pseudocysts, and assess the **liver** for signs of cirrhosis [2]. - However, like ultrasound, a CT scan cannot provide the definitive **biochemical analysis** of the ascitic fluid that is necessary to distinguish pancreatic ascites from other causes.

Q: Most common cause of intestinal obstruction in childhood is:

Intussusception. ***Intussusception*** - **Intussusception** is the most common cause of intestinal obstruction in children between **3 months and 6 years** of age, particularly in infants. - It involves the telescoping of one segment of the intestine into an adjacent segment, leading to obstruction and potentially **ischemia**. *Mucoviscidosis* - **Mucoviscidosis**, or **cystic fibrosis**, can cause intestinal obstruction in newborns due to **meconium ileus**, but it is less common across the entire childhood period than intussusception. - While it is a significant cause of intestinal issues, its prevalence as the *most common overall cause* of obstruction in childhood is lower. *Hirschsprung's disease* - **Hirschsprung's disease** is a congenital absence of **ganglion cells** in the distal bowel, leading to functional obstruction, primarily in **neonates** and infants. - While an important cause of obstruction in early life, its overall incidence is less than intussusception, especially when considering the broader childhood age range. *Volvulus* - **Volvulus** is the twisting of a section of the intestine around its mesentery, which can occur at any age but is less frequent than intussusception in childhood. - It often presents as an acute surgical emergency with severe symptoms, but it is not the *most common* cause of obstruction across childhood.

Q: The most common early sign of increasing intracranial pressure in the victim of head injury is :

Change of level of consciousness. ***Change of level of consciousness*** - A **deterioration in the level of consciousness** is often the earliest and most sensitive indicator of increasing intracranial pressure (ICP) following a head injury. - This change can manifest as **confusion, lethargy, drowsiness, or difficulty arousing** the patient. *Contralateral pupillary dilation* - **Contralateral pupillary dilation** typically occurs later in the progression of increased ICP, often indicating brainstem compression. - This sign suggests a more advanced and severe stage of brain herniation. *Ipsilateral pupillary dilatation* - **Ipsilateral pupillary dilation** is a classic sign of **uncal herniation**, which occurs as increased ICP pushes the temporal lobe. - While a critical sign, it is generally not the earliest indicator and suggests significant mass effect on the oculomotor nerve. *Hemiparesis* - **Hemiparesis**, or weakness on one side of the body, is a **focal neurological deficit** that can result from direct brain injury or compression. - It usually appears later than changes in the level of consciousness and may not be the initial symptom of rising ICP, especially if the pressure increase is diffuse.

Q: Surgical treatment for a 40-years old lady with 3 x 3 cm. papillary carcinoma thyroid with level III enlarged lymph nodes is :

Total thyroidectomy with functional neck dissection. ***Total thyroidectomy with functional neck dissection*** - For **papillary thyroid carcinoma** with **level III lymph node involvement**, the standard approach is **total thyroidectomy** with **therapeutic lateral neck dissection** (functional/modified radical neck dissection). - **Level III nodes** are part of the **lateral compartment** (levels II-IV), requiring formal **compartment-oriented dissection** rather than selective node excision for adequate oncological clearance. *Total thyroidectomy with excision of involved nodes* - **"Excision of involved nodes"** is not standard terminology in thyroid surgery and **"berry-picking"** individual nodes is generally not recommended for therapeutic purposes. - **Compartment-oriented dissection** is preferred over selective node removal as it provides better oncological outcomes and staging accuracy. *Total thyroidectomy with radical neck dissection* - **Radical neck dissection** involves removal of cervical lymph node levels I-V along with the **sternocleidomastoid muscle**, **internal jugular vein**, and **spinal accessory nerve**. - This extensive procedure is reserved for cases with **extensive extranodal extension** or when these structures are directly involved, causing significant morbidity. *Total thyroidectomy with post-operative radio-iodine ablation* - **Radioiodine ablation** is an **adjuvant therapy** used after thyroidectomy to destroy remaining thyroid tissue and microscopic disease. - This option doesn't address the **surgical management** of enlarged lymph nodes, which is specifically what the question asks about.

Q: Splenectomy is best indicated for :

Hereditary spherocytosis. ***Hereditary spherocytosis*** - Splenectomy is a curative treatment for **hereditary spherocytosis** as it removes the primary site of red blood cell destruction. - It alleviates **anemia** and prevents complications such as **gallstones** by reducing hemolysis. *Cirrhosis liver with portal hypertension* - In cirrhosis with **portal hypertension**, splenectomy is generally not the primary treatment and may even worsen portal hypertension in some cases. - Management focuses on treating the underlying **liver disease** and its complications, such as **variceal bleeding**. *Sickle cell disease* - Splenectomy is generally avoided in **sickle cell disease** due to the increased risk of **overwhelming post-splenectomy sepsis** and other complications. - The primary approach is supportive care to manage crises, pain, and prevent infections. *Gaucher's disease* - **Gaucher's disease** involves the accumulation of glucocerebroside in various organs, including the spleen, often leading to **splenomegaly**. - Treatment primarily involves **enzyme replacement therapy (ERT)** and substrate reduction therapy, with splenectomy reserved for rare cases of severe symptoms unresponsive to medical therapy.

Q: A retained stone in CBD (common bile duct) diagnosed by T-tube cholangiogram is best treated by :

Endoscopic papillotomy. ***Endoscopic papillotomy*** - This procedure, typically performed via an **ERCP**, allows for the removal of **retained common bile duct stones** in a less invasive manner than re-exploration. - It involves incising the **sphincter of Oddi** to facilitate stone extraction or spontaneous passage, especially when a **T-tube** is already in place, making access easier. *Re-exploration of common bile duct* - This is a more invasive surgical procedure with higher risks compared to endoscopic approaches. - Re-exploration is generally reserved for cases where **endoscopic techniques fail** or where there are specific contraindications to endoscopy. *Extra corporeal shock wave lithotripsy* - **ESWL** is primarily used for **kidney stones** and sometimes for large pancreatic or gallbladder stones that are difficult to access endoscopically. - Its effectiveness in fragmenting **CBD stones**, especially when a T-tube is present, is limited, and fragments may still obstruct the duct. *Dissolution therapy* - This therapy involves administering **ursodeoxycholic acid** to dissolve cholesterol stones. - It is a **slow process** and is generally ineffective for pigmented stones or for promptly resolving symptomatic or **obstructive retained CBD stones**.

Q: All of the following statements regarding gallstones are true except :

They are mostly radio opaque. ***They are mostly radio opaque*** - Only about **10-20% of gallstones** are sufficiently calcified to be visible on a plain abdominal radiograph. - The majority of gallstones, especially **cholesterol stones**, are radiolucent and are best visualized by ultrasound. *They can cause intestinal obstruction* - This statement is true. A large gallstone can erode through the gallbladder wall into the small intestine, typically the duodenum, leading to a gallstone ileus. - **Gallstone ileus** is a rare form of mechanical bowel obstruction caused by a gallstone impaction, usually in the terminal ileum. *They can lead to acute cholangitis by slipping into the common bile duct* - This statement is true. Gallstones can migrate from the gallbladder into the **common bile duct (CBD)**, obstructing bile flow and leading to **choledocholithiasis**. - Obstruction of the CBD by gallstones, especially with superimposed bacterial infection, can cause **acute cholangitis**. *Mixed stones are the commonest type* - This statement is true. **Mixed gallstones**, which contain a combination of cholesterol, calcium salts, and bilirubin, are the most prevalent type of gallstones. - Pure cholesterol stones and pure pigment stones (black or brown) are less common than mixed stones.

Question 1

All of the following cranial nerves pass through the jugular foramen except :

Accepted Answer

Hypoglossal

Answer

Vagus

Answer

Glossopharyngeal

Answer

Spinal accessory

Question 2

Which of the following ligaments contains splenic artery?

Accepted Answer

Spleno-renal ligament

Answer

Spleno-colic ligament

Answer

Spleno-phrenic ligament

Answer

Gastro-splenic ligament

Question 3

Deep vein thrombosis of calf is best managed by :

Accepted Answer

anticoagulants

Answer

active physiotherapy

Answer

thrombolysis

Answer

surgical venous thrombectomy

Question 4

To differentiate pancreatic ascites from ascites secondary to cirrhosis of the liver, the most important test is :

Accepted Answer

Abdominal paracentesis

Answer

Abdominal ultrasound

Answer

Endoscopic retrograde cholangio pancreatography (ERCP)

Answer

Computed tomogram (CT) scan

Question 5

Most common cause of intestinal obstruction in childhood is:

Accepted Answer

Intussusception

Answer

Mucoviscidosis

Answer

Hirschsprung's disease

Answer

Volvulus

Question 6

The most common early sign of increasing intracranial pressure in the victim of head injury is :

Accepted Answer

Change of level of consciousness

Answer

Contralateral pupillary dilation

Answer

Ipsilateral pupillary dilatation

Answer

Hemiparesis

Question 7

Surgical treatment for a 40-years old lady with 3 x 3 cm. papillary carcinoma thyroid with level III enlarged lymph nodes is :

Accepted Answer

Total thyroidectomy with functional neck dissection

Answer

Total thyroidectomy with radical neck dissection

Answer

Total thyroidectomy with post-operative radio-iodine ablation

Answer

Total thyroidectomy with excision of involved nodes

Question 8

Splenectomy is best indicated for :

Accepted Answer

Hereditary spherocytosis

Answer

Cirrhosis liver with portal hypertension

Answer

Sickle cell disease

Answer

Gaucher's disease

Question 9

A retained stone in CBD (common bile duct) diagnosed by T-tube cholangiogram is best treated by :

Accepted Answer

Endoscopic papillotomy

Answer

Re-exploration of common bile duct

Answer

Extra corporeal shock wave lithotripsy

Answer

Dissolution therapy

Question 10

All of the following statements regarding gallstones are true except :

Accepted Answer

They are mostly radio opaque

Answer

They can cause intestinal obstruction

Answer

They can lead to acute cholangitis by slipping into the common bile duct

Answer

Mixed stones are the commonest type

UPSC-CMS 2013

Anatomy

Internal Medicine

Pediatrics

Surgery