UPSC-CMS 2016 Practice Questions

Q: At present, treatment is recommended for H. pylori in association with the following except:

Functional dyspepsia without alarm features. ***Functional dyspepsia without alarm features*** - While *H. pylori* eradication can be considered for some patients with **functional dyspepsia**, it is not universally recommended as a primary treatment given the **variable and often limited symptomatic improvement**. - The decision to treat in this specific scenario often depends on individual patient factors and local epidemiology, and it's not a standard indication compared to other *H. pylori*-associated conditions. *MALT lymphoma* - **Eradication of *H. pylori*** is a cornerstone of treatment for **gastric MALT lymphoma**, often leading to remission [1]. - This is a well-established indication for *H. pylori* therapy due to the direct pathogenic link [1]. *Duodenal ulcer* - All patients with **duodenal ulcers** who test positive for *H. pylori* should receive eradication therapy [2]. - *H. pylori* infection is a major cause of **duodenal ulcers**, and eradication significantly reduces recurrence [2]. *Peptic ulcer disease* - **Eradication of *H. pylori*** is strongly recommended for all patients with **peptic ulcer disease** (gastric or duodenal) found to be *H. pylori* positive [2]. - This intervention is crucial for **healing ulcers** and preventing future recurrences and complications [2].

Q: Which of the following is not a clinical feature of tetanus?

Loss of consciousness. ***Loss of consciousness*** - Tetanus is characterized by **spasms** and increased muscle tone, but patients typically remain **fully conscious** throughout the disease course. - The disease primarily affects the **motor neurons**, not the brain structures responsible for consciousness. *Risus sardonicus* - This is a characteristic feature of tetanus, referring to a **sustained, grotesque grin** caused by spasms of the facial muscles. - It is a classic clinical sign resulting from the **excitatory effects** of tetanospasmin on motor neurons [1]. *Respiratory failure* - This is a common and serious complication of tetanus, often leading to death, caused by **spasms of the respiratory muscles** [1]. - **Laryngeal spasms** and rigidity of the chest wall muscles impair breathing, necessitating mechanical ventilation. *Opisthotonus* - This refers to a severe, sustained **arching of the back** due to muscle spasms, causing the head and heels to bend backward. - It is a hallmark sign of generalized tetanus, reflecting profound **muscle rigidity** and uncontrolled muscle contractions [1].

Q: With reference to frozen shoulder, consider the following statements: 1. It is associated with diabetes and heart disease. 2. It may follow minor trauma. 3. Its differential diagnosis are infection and fractures. 4. Treatment of choice is surgery. Which of the statements given above are correct?

1, 2 and 3. ***1, 2 and 3*** - **Frozen shoulder** (adhesive capsulitis) has a higher incidence in individuals with **diabetes mellitus** and **cardiovascular diseases**, indicating systemic associations. - It can be triggered by minor trauma or surgery, but often it has **no identifiable cause** (idiopathic). - The differential diagnoses for shoulder pain and restricted motion include serious conditions like **infection (septic arthritis)** and **fractures**, which must be ruled out. *1 and 2 only* - This option correctly identifies the association with diabetes and heart disease, and the possibility of minor trauma. - However, it incorrectly excludes the importance of considering infection and fractures in the differential diagnosis. *3 and 4 only* - This option correctly identifies the importance of differential diagnosis (infection and fractures). - However, **surgery is generally not the first-line treatment for frozen shoulder**; it is reserved for severe cases unresponsive to conservative measures. - It also fails to acknowledge the associations with diabetes and heart disease, or the role of minor trauma. *2, 3 and 4* - This option correctly notes that frozen shoulder can follow minor trauma and that infection and fractures are important differential diagnoses. - However, it incorrectly states that **surgery is the treatment of choice**, when **conservative management is usually first-line**. - It also misses the crucial association with **diabetes and heart disease**.

Q: The prognosis in reduced or unreduced fractures involving epiphyseal plate is very poor if the fracture line:

Crushes the epiphyseal plate. ***Crushes the epiphyseal plate*** - A crushed epiphyseal plate (Salter-Harris Type V) leads to **irreversible damage to the growth plate**, resulting in almost certain growth arrest and significant limb length discrepancy. - This type of injury directly destroys the proliferative and hypertrophic zones responsible for longitudinal bone growth, making its prognosis exceptionally poor. *Runs along the epiphyseal plate* - This typically describes a Salter-Harris Type I or II fracture, where the fracture line separates the epiphysis from the metaphysis **without damaging the growth plate itself**. - While requiring careful reduction, the prognosis is generally good as long as there is no significant displacement or vascular compromise, and the **growth plate remains viable**. *Crosses the epiphyseal plate* - This description is vague but could refer to a Salter-Harris Type III or IV fracture, which involves **articular surface involvement** and crossing the physis. - While these types have a poorer prognosis than Type I and II due to potential for incongruity and **growth arrest**, they are not as universally dire as a crush injury, provided proper anatomical reduction is achieved. *Extends into epiphysis* - This describes a Salter-Harris Type III fracture, where the fracture line extends from the growth plate into the epiphysis and often involves the **articular cartilage**. - The prognosis is generally good if **anatomical reduction** and fixation are achieved, but there is a risk of growth disturbance and **arthrosis** if displacement is not corrected.

Q: Endoluminal probe for transrectal ultrasonography operates at the frequency of:

7.5 MHz. ***7.5 MHz*** * **Transrectal ultrasonography (TRUS)** typically utilizes frequencies between **7 and 10 MHz** to achieve a good balance of penetration depth and resolution in the prostate and surrounding tissues. * A frequency of **7.5 MHz** is commonly employed for detailed imaging of the prostate, allowing for clear visualization of anatomical structures and detection of abnormalities like tumors or inflammation. *5.0 MHz* * A frequency of **5.0 MHz** provides greater penetration depth but offers lower resolution, which is generally not optimal for the detailed imaging required in TRUS of the prostate. * Lower frequencies are more often used for imaging deeper structures or in situations where tissue attenuation is high, which is less of a concern for the relatively superficial prostate. *2.5 MHz* * A frequency of **2.5 MHz** offers significantly higher penetration but at the cost of very low resolution, making it unsuitable for the precise diagnostic imaging of the prostate gland. * This lower frequency range is typically used for general abdominal imaging or structures requiring deep penetration, where fine detail is not the primary concern. *15.0 MHz* * A frequency of **15.0 MHz** provides excellent resolution but has very limited penetration depth, making it less practical for comprehensive transrectal imaging of the entire prostate gland. * While high frequencies can be used for very superficial structures or specific applications requiring extremely fine detail, they often cannot visualize the entire organ effectively due to rapid attenuation.

Q: A Seldinger needle is used for:

Arteriography. ***Arteriography*** - The **Seldinger technique** involves using a needle to puncture a blood vessel, typically an artery, after which a guidewire is threaded through the needle. - This method is fundamental for inserting catheters for procedures like **arteriography**, which visualizes arteries using contrast. *Breast biopsy* - Breast biopsies typically use specialized biopsy needles (e.g., **core needle biopsy** or vacuum-assisted biopsy needles) designed to extract tissue samples. - These are distinct from the Seldinger needle, which is primarily for accessing blood vessels. *Lymphangiography* - Lymphangiography involves injecting contrast into **lymphatic vessels**, which are typically very fine and superficial. - This procedure usually employs fine-gauge needles or direct cannulation of lymphatic vessels, not the Seldinger needle which is designed for larger vessels. *Liver biopsy* - Liver biopsies are usually performed with a **Menghini needle** or other types of cutting needles that can obtain a core sample from the liver parenchyma. - The Seldinger needle is not designed for obtaining solid tissue biopsies from organs like the liver.

Q: The commonest major surgical complication following Whipple procedure is:

Disruption of pancreatic anastomosis. ***Disruption of pancreatic anastomosis*** - **Pancreatic fistula** resulting from the disruption of the pancreatic anastomosis is the most frequent and most serious complication, occurring in 5-20% of cases. - Leakage of pancreatic fluids can lead to severe **intra-abdominal infection**, hemorrhage, and multi-organ failure. *Disruption of gastric anastomosis* - While possible, leak from the **gastric or duodenal anastomosis** is less common than pancreatic fistula. - This complication typically leads to peritonitis or abscess formation but generally has a lower morbidity compared to pancreatic leaks. *Biliary peritonitis* - **Bile leaks** from the hepaticojejunostomy are less common than pancreatic leaks and generally have a lower risk of severe systemic complications. - They primarily cause **peritonitis** and sometimes require percutaneous drainage or re-operation. *GI bleeding* - Gastrointestinal bleeding can occur post-Whipple, either from the **anastomotic sites**, stress ulcers, or coagulation issues. - While serious, it is typically less common and often more manageable than the sequelae of a pancreatic fistula.

Q: A 60 year old male presents with bleeding per rectum. Proctoscopy reveals 2nd degree hemorrhoids. The treatment of choice is:

Banding. ***Banding*** - **Rubber band ligation** is the preferred treatment for **second-degree hemorrhoids** because it is effective, minimally invasive, and can be done in an outpatient setting. - The bands cause the hemorrhoid tissue to necrose and fall off within a few days, alleviating symptoms. *Cryotherapy* - **Cryotherapy** involves freezing the hemorrhoid tissue, but it is rarely used due to a **higher risk of complications** such as pain, prolonged discharge, and incomplete tissue destruction. - It is generally considered less effective and associated with more discomfort and potential for recurrence compared to other treatments. *Sclerotherapy* - **Sclerotherapy** involves injecting a chemical solution into the hemorrhoid to cause fibrosis and shrinkage, primarily used for **first-degree hemorrhoids**. - While it can be effective for smaller hemorrhoids, it is less effective than banding for **second-degree hemorrhoids** and has a higher recurrence rate for this grade. *Surgery* - **Surgical hemorrhoidectomy** is typically reserved for **third- and fourth-degree hemorrhoids** or those that have failed other less invasive treatments. - While highly effective, surgery is more invasive, carries **higher risks of complications**, and requires a longer recovery period, making it overtreatment for second-degree hemorrhoids.

Q: Hyperchloremic acidosis is a common complication of:

Ureterosigmoidostomy. ***Ureterosigmoidostomy*** - This procedure directly connects the ureters to the sigmoid colon, allowing for the **reabsorption of urinary chloride and ammonium** by the colonic mucosa in exchange for bicarbonate secretion. - The mechanism involves **active reabsorption of chloride** from urine coupled with bicarbonate loss into the bowel lumen, leading to **hyperchloremic metabolic acidosis**. - This is the **classic urological cause** of hyperchloremic acidosis and the most specific answer in a surgical context. *Ileostomy* - **Ileostomy** typically leads to significant loss of fluids and electrolytes, including sodium and potassium, through the stoma. - While it can cause dehydration and electrolyte imbalances, it is more commonly associated with **hypokalemia, hyponatremia, and dehydration** rather than hyperchloremic acidosis. *Vomiting* - **Protracted vomiting** primarily results in the loss of gastric acid (HCl), leading to **hypochloremia** and **metabolic alkalosis** (not acidosis). - The loss of hydrogen ions from the stomach causes the kidneys to retain bicarbonate to maintain pH balance, resulting in elevated serum HCO3-. *Diarrhoea* - Severe **diarrhea** causes the loss of **bicarbonate-rich fluids** from the gastrointestinal tract, which can indeed lead to **normal anion gap metabolic acidosis** (hyperchloremic acidosis). - However, in the context of **surgical/urological complications**, **ureterosigmoidostomy** is the more specific and classic answer, as it involves a unique mechanism of **direct chloride reabsorption from urine** rather than simple bicarbonate loss. - Diarrhea-induced acidosis is also typically an acute medical condition rather than a surgical complication.

Question 1

At present, treatment is recommended for H. pylori in association with the following except:

Accepted Answer

Functional dyspepsia without alarm features

Answer

MALT lymphoma

Answer

Duodenal ulcer

Answer

Peptic ulcer disease

Question 2

Which of the following is not a clinical feature of tetanus?

Accepted Answer

Loss of consciousness

Answer

Risus sardonicus

Answer

Respiratory failure

Answer

Opisthotonus

Question 3

With reference to frozen shoulder, consider the following statements:

1. It is associated with diabetes and heart disease.

2. It may follow minor trauma.

3. Its differential diagnosis are infection and fractures.

4. Treatment of choice is surgery.
Which of the statements given above are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

3 and 4 only

Answer

2, 3 and 4

Question 4

The prognosis in reduced or unreduced fractures involving epiphyseal plate is very poor if the fracture line:

Accepted Answer

Crushes the epiphyseal plate

Answer

Runs along the epiphyseal plate

Answer

Crosses the epiphyseal plate

Answer

Extends into epiphysis

Question 5

Endoluminal probe for transrectal ultrasonography operates at the frequency of:

Accepted Answer

7.5 MHz

Answer

5.0 MHz

Answer

2.5 MHz

Answer

15.0 MHz

Question 6

A Seldinger needle is used for:

Accepted Answer

Arteriography

Answer

Breast biopsy

Answer

Lymphangiography

Answer

Liver biopsy

Question 7

The commonest major surgical complication following Whipple procedure is:

Accepted Answer

Disruption of pancreatic anastomosis

Answer

Disruption of gastric anastomosis

Answer

Biliary peritonitis

Answer

GI bleeding

Question 8

A 60 year old male presents with bleeding per rectum. Proctoscopy reveals 2nd degree hemorrhoids. The treatment of choice is:

Accepted Answer

Banding

Answer

Cryotherapy

Answer

Sclerotherapy

Answer

Surgery

Question 9

Pott's puffy tumour is a:

Accepted Answer

Subperiosteal abscess associated with osteomyelitis of frontal bone

Answer

Tuberculosis of the skull bone

Answer

Fungating scrotal malignancy

Answer

Squamous cell cancer of scalp

Question 10

Hyperchloremic acidosis is a common complication of:

Accepted Answer

Ureterosigmoidostomy

Answer

Ileostomy

Answer

Vomiting

Answer

Diarrhoea

UPSC-CMS 2016

Internal Medicine

Orthopaedics

Radiology

Surgery