UPSC-CMS 2018 Practice Questions

Q: Which one of the following regarding Nasal polyps is NOT true?

Nasal polyps are very painful to touch. ***Nasal polyps are very painful to touch*** * **Nasal polyps** are typically **painless** and soft to the touch, as they are edematous mucosal outgrowths. * Pain associated with **nasal polyps** usually indicates a secondary complication such as **infection** or, rarely, **malignancy**, rather than the polyps themselves. * *Meningocele must be excluded in children with polyps* * **Meningoceles** or **encephalocele** are important considerations in children presenting with **nasal masses**, as they represent a protrusion of brain tissue or meninges and resemble polyps. * Their exclusion is critical due to the risk of **meningitis** during surgical intervention if misdiagnosed as routine polyps. * *Bleeding polyp may indicate malignancy* * While polyps are generally not prone to bleeding, the presence of **unilateral**, **bleeding**, or **friable polyps** raises suspicion for **malignancy**, such as **nasopharyngeal carcinoma** or **sinonasal cancers**. * Any atypical presentation, especially with ulceration or persistent epistaxis, warrants **biopsy** and further investigation. * *Simple polyps are bilateral* * **Simple inflammatory polyps** (e.g., from **chronic rhinosinusitis** with nasal polyps) are most commonly found **bilaterally**. * Unilateral polyps or masses, especially in adults, should prompt suspicion for other causes, including **neoplasms**.

Q: Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

Neurofibromatosis Type II. ***Neurofibrofomatosis Type II*** - This condition is primarily associated with **central nervous system tumors** like **vestibular schwannomas** and **meningiomas**, not Berry aneurysms [2]. - While it affects the nervous system, its vascular manifestations are typically different from those predisposing to aneurysms. *Marfan’s syndrome* - Patients with Marfan's syndrome have **fragile connective tissue** due to a defect in **fibrillin-1**, which can weaken arterial walls. - This weakness increases the risk of **aortic aneurysms** and dissections, and can also predispose to intracranial aneurysms like Berry aneurysms. *Adult polycystic kidney* - This **autosomal dominant** disorder is characterized by the formation of **cysts in the kidneys**, but also has systemic manifestations [1]. - There is a well-established association between **autosomal dominant polycystic kidney disease (ADPKD)** and an increased incidence of **Berry aneurysms**. *Fibromuscular dysplasia* - This condition involves **abnormal cellular development** in the **arterial walls**, leading to areas of narrowing and enlargement. - It commonly affects the **renal arteries** and **carotid arteries**, and is also a known risk factor for the development of **intracranial aneurysms**, including Berry aneurysms.

Q: Radiologic views used for fracture Mandible (body and Ramus) are all EXCEPT:

Submentovertex. ***Submentovertex*** - The **Submentovertex (SMV) view** is primarily used to assess the **zygomatic arches**, base of the skull, and sphenoid sinuses, not typically for mandibular body or ramus fractures. - While it can provide some information about the medial aspects of the mandible, it offers **limited structural detail** crucial for diagnosing fractures in the body and ramus. *Lower occlusal* - **Lower occlusal films** are useful for visualizing the **anterior mandible**, including the symphysis and parasymphysis regions, and the lingual aspect of the body. - They can provide detailed views of these specific areas but are not the primary view for comprehensive assessment of the entire body or ramus. *Lateral obliques* - **Lateral oblique views** are highly effective for visualizing the **body, angle, and ramus** of the mandible, providing a good representation of these regions without superimposition from the contralateral side. - This projection allows for assessment of fracture displacement and angulation in the lateral and postero-lateral aspects of the mandible. *Orthopantomogram* - An **Orthopantomogram (OPG)**, also known as a panoramic radiograph, provides a comprehensive view of the **entire mandible** and maxilla on a single film. - It is an excellent screening tool for identifying fractures in the **condyle, ramus, angle, body, and symphysis** of the mandible due to its broad coverage.

Q: Which one of the following regarding abdominal pediatric surgery is correct?

Incision can be closed with absorbable suture. ***Incision can be closed with absorbable suture*** - **Absorbable sutures** are commonly used in pediatric abdominal surgery for closing deeper layers and sometimes skin, as they degrade over time and do not require removal. - This is particularly beneficial in children to avoid the trauma and discomfort of suture removal and to promote good cosmetic outcomes. *Transverse abdominal incision is always used* - While **transverse incisions** are often preferred in pediatric abdominal surgery for their good cosmetic results and lower incidence of incisional hernias, they are not *always* used. - Other incisions, such as **vertical midline incisions**, may be utilized depending on the surgical exposure required, the specific pathology, or the surgeon's preference. *Bowel must be always anastomosed in double layer* - **Bowel anastomoses** in pediatric surgery can be performed using either a **single-layer** or **double-layer** technique. - The choice depends on surgeon preference, the specific bowel segment involved, and the patient's condition, with both methods demonstrating comparable outcomes in many situations. *Skin over abdomen can never be closed with subcuticular sutures* - **Subcuticular sutures** are frequently used for skin closure in pediatric abdominal surgery, especially for their excellent cosmetic results and to avoid external suture removal. - This technique places the suture material under the skin surface, minimizing scarring and being well-suited for a child's healing skin.

Q: Allen's test is used in cardiac surgery for:

When radial artery harvest is planned. ***When radial artery harvest is planned*** - **Allen's test** is performed to assess the patency of the **ulnar artery** and ensure adequate collateral circulation to the hand before harvesting the radial artery. - A positive test (indicating good collateral flow) is crucial to prevent **hand ischemia** if the radial artery is removed. *To select finger prick for blood glucose estimation* - Finger prick sites for **blood glucose estimation** are chosen based on adequate capillary blood flow and patient comfort, not by Allen's test. - Allen's test is specifically for evaluating **arterial patency** and collateral circulation, which is irrelevant for routine fingersticks. *To check warmth of hands* - Checking the **warmth of hands** is a basic clinical assessment for peripheral perfusion but does not involve Allen's test. - Allen's test is a dynamic test of **vascular competence**, not a static thermal assessment. *For evaluation of AV fistula* - **AV fistula evaluation** involves assessing patency, thrill, and bruit, and is typically done using physical examination and Doppler ultrasound. - Allen's test is not used for this purpose, as it assesses **collateral arterial flow** to a digit, not the patency of an arteriovenous connection.

Q: In a lateral facial wound, if facial nerve injury is suspected, it should be:

Primary repair should be attempted. ***Primary repair should be attempted*** - **Early surgical repair** of facial nerve injuries, ideally within the first 72 hours, offers the best chance for **functional recovery**. - **Primary repair** involves direct reapproximation and meticulous suturing of the severed nerve ends under magnification. *Left alone* - Leaving a suspected facial nerve injury untreated can lead to **permanent facial paralysis** and significant functional and aesthetic deficits. - The facial nerve has a limited capacity for spontaneous regeneration, especially after a **complete transection**. *Secondary repair using microscope gives best result* - While microscopic techniques are crucial for nerve repair, **secondary repair** (performed weeks or months after the injury) generally yields poorer outcomes compared to primary repair. - **Scar tissue formation** and **nerve end retraction** make secondary repair more challenging and less effective. *Skin and subcutaneous flaps to be raised to cover the cut ends* - This approach addresses wound closure but **does not repair the underlying nerve injury**, leading to persistent motor deficits. - Covering the nerve ends without repair would still result in **facial paralysis** as the nerve fibers cannot reconnect across the gap.

Q: Mallory-Weiss tear causing haematemesis is seen over:

Gastroesophageal junction. ***Gastroesophageal junction*** - Mallory-Weiss tears are **linear mucosal lacerations** typically located at the **gastroesophageal junction**, where the esophagus meets the stomach. - These tears are caused by sudden increases in **intra-abdominal pressure**, often due to forceful retching or vomiting, leading to bleeding. *Oesophagus* - While located close, Mallory-Weiss tears are specifically at the **junction**, not generally throughout the esophageal body. - **Esophageal varices** are a more common cause of hematemesis originating from the esophagus itself, distinct from Mallory-Weiss tears. *Anterior wall of stomach* - Tears in the anterior wall of the stomach are less common and typically associated with other conditions like **ulcers** or **trauma**, not the characteristic forceful vomiting seen in Mallory-Weiss syndrome. - The unique anatomical stress at the **gastroesophageal junction** during retching makes it the preferred site for Mallory-Weiss lacerations. *Fundus of stomach* - Tears in the fundus are rare in the context of Mallory-Weiss syndrome; the fundus is usually affected by other conditions such as **gastric ulcers** or **gastric varices**. - The biomechanical forces that cause Mallory-Weiss tears are concentrated where the **esophageal and gastric mucosa meet**, not primarily in the fundus.

Q: Sleeve Gastrectomy done for Morbid obesity is a:

Restrictive procedure. ***Restrictive procedure (Correct Answer)*** - A **sleeve gastrectomy** involves removing a large portion of the stomach (approximately 75-80%), leaving a banana-shaped "sleeve," which significantly **reduces stomach volume**. - This reduction in volume **restricts** the amount of food a patient can consume at one time, leading to early satiety and weight loss. - It is classified as a **purely restrictive** bariatric procedure. *Mildly restrictive and mainly malabsorptive* - While there is some malabsorption due to faster gastric emptying, the primary mechanism of weight loss in sleeve gastrectomy is **restriction**, not malabsorption. - Procedures like **Roux-en-Y gastric bypass** are considered both restrictive and malabsorptive. *Reversible procedure* - Sleeve gastrectomy involves the **irreversible removal** of a significant part of the stomach. - Unlike devices like the **adjustable gastric band**, it cannot be undone or reversed. *Malabsorptive procedure only* - Sleeve gastrectomy does not significantly alter the **intestinal tract** to cause malabsorption. - Procedures that are primarily **malabsorptive**, such as **biliopancreatic diversion with duodenal switch**, involve bypassing large sections of the small intestine.

Q: Pre-operative Nutrition Screening in a patient with morbid obesity planned for Gastric Bypass includes all EXCEPT:

Serum Insulin. ***Serum Insulin*** - While relevant to **diabetes** and metabolic health, routine **pre-operative insulin screening** is not standard for gastric bypass. - Nutritional screening focuses on identifying and correcting deficiencies that could complicate surgery or post-operative recovery. *Serum Vitamin B12* - Patients undergoing **gastric bypass** are at high risk for **Vitamin B12 deficiency** due to altered absorption in the bypassed stomach and small intestine. - Pre-operative screening is essential to identify and replete deficiencies to prevent post-operative neurological complications. *Serum Calcium* - **Malabsorption of calcium** is a known risk after gastric bypass due to changes in the digestive tract. - Pre-operative **calcium levels** are crucial for bone health assessment and to guide supplementation strategies. *Serum Magnesium* - **Magnesium deficiency** can occur post-gastric bypass due to malabsorption. - Pre-operative screening helps to identify existing deficiencies, which can impact cardiac function and neuromuscular health.

Question 1

Which one of the following regarding Nasal polyps is NOT true?

Accepted Answer

Nasal polyps are very painful to touch

Answer

Meningocele must be excluded in children with polyps

Answer

Bleeding polyp may indicate malignancy

Answer

Simple polyps are bilateral

Question 2

Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

Accepted Answer

Neurofibromatosis Type II

Answer

Marfan’s syndrome

Answer

Adult polycystic kidney

Answer

Fibromuscular dysplasia

Question 3

Which one of the following factors is NOT involved in the pathogenesis of Systemic inflammatory response syndrome (SIRS)?

Accepted Answer

Microvascular occlusion

Answer

Free radical production

Answer

Increased cytokine production

Answer

Abnormal nitric oxide synthesis

Question 4

Radiologic views used for fracture Mandible (body and Ramus) are all EXCEPT:

Accepted Answer

Submentovertex

Answer

Lower occlusal

Answer

Lateral obliques

Answer

Orthopantomogram

Question 5

Which one of the following regarding abdominal pediatric surgery is correct?

Accepted Answer

Incision can be closed with absorbable suture

Answer

Transverse abdominal incision is always used

Answer

Bowel must be always anastomosed in double layer

Answer

Skin over abdomen can never be closed with subcuticular sutures

Question 6

Allen's test is used in cardiac surgery for:

Accepted Answer

When radial artery harvest is planned

Answer

To select finger prick for blood glucose estimation

Answer

To check warmth of hands

Answer

For evaluation of AV fistula

Question 7

In a lateral facial wound, if facial nerve injury is suspected, it should be:

Accepted Answer

Primary repair should be attempted

Answer

Left alone

Answer

Secondary repair using microscope gives best result

Answer

Skin and subcutaneous flaps to be raised to cover the cut ends

Question 8

Mallory-Weiss tear causing haematemesis is seen over:

Accepted Answer

Gastroesophageal junction

Answer

Oesophagus

Answer

Anterior wall of stomach

Answer

Fundus of stomach

Question 9

Sleeve Gastrectomy done for Morbid obesity is a:

Accepted Answer

Restrictive procedure

Answer

Mildly restrictive and mainly malabsorptive

Answer

Reversible procedure

Answer

Malabsorptive procedure only

Question 10

Pre-operative Nutrition Screening in a patient with morbid obesity planned for Gastric Bypass includes all EXCEPT:

Accepted Answer

Serum Insulin

Answer

Serum Vitamin B12

Answer

Serum Calcium

Answer

Serum Magnesium

UPSC-CMS 2018

ENT

Internal Medicine

Pathology

Radiology

Surgery