UPSC-CMS 2019 Practice Questions

Q: Preoperative Samsoon and Young modified, Mallampati test is used for assessing:

Difficulty in intubation. ***Difficulty in intubation*** - The **Mallampati test** classifies the visibility of pharyngeal structures, which directly correlates with the **likelihood of difficult intubation**. - A higher Mallampati score (e.g., Class III or IV) indicates **less visibility of the soft palate, uvula, and fauces**, suggesting potential challenges during airway management. *Preoperative nutrition status of patient* - Preoperative nutritional status is assessed using methods like **albumin levels, BMI, and nutritional risk screening tools**, not the Mallampati score. - While patient health influences surgery, the Mallampati test is specifically for **airway anatomy**. *Patient's overall fitness for surgery* - Overall fitness for surgery involves a comprehensive assessment of **cardiac, pulmonary, renal, and metabolic health**, often using tools like the ASA physical status classification. - The Mallampati test focuses solely on **airway assessment** and does not provide a global measure of surgical fitness. *Blood requirement during surgery* - Blood requirements during surgery are estimated based on the **type of surgery, anticipated blood loss, patient's hemoglobin levels, and coagulation status**, not the Mallampati test. - The Mallampati test is entirely unrelated to **hemostasis or transfusion needs**.

Q: Refeeding syndrome seen after enteral or parenteral nutrition is characterized by all EXCEPT:

Hyponatremia. ***Hyponatremia*** - **Hyponatremia** is not a characteristic feature of refeeding syndrome; rather, fluid retention can sometimes lead to dilutional hyponatremia, but it's not a direct electrolyte shift caused by refeeding. - The core biochemical derangements in refeeding syndrome involve shifts of potassium, magnesium, and phosphate intracellularly [1]. *Hypomagnesemia* - **Hypomagnesemia** is a common and characteristic feature of refeeding syndrome as magnesium is required for ATP generation and cell growth, leading to intracellular shift [1]. - This can contribute to various symptoms such as arrhythmias, weakness, and altered mental status. *Hypocalcemia* - While less direct than other electrolyte disturbances, **hypocalcemia** can occur in refeeding syndrome, partly due to the association with hypophosphatemia and hypomagnesemia. - It may also be exacerbated by vitamin D deficiency or increased parathyroid hormone resistance in malnourished states. *Hypophosphatemia* - **Hypophosphatemia** is the biochemical hallmark of refeeding syndrome, as phosphate is rapidly taken up by cells for ATP synthesis and other metabolic processes during refeeding [1]. - Severe hypophosphatemia can lead to **respiratory failure**, cardiac dysfunction, and rhabdomyolysis.

Q: The capillary refill time is prolonged in all types of shock EXCEPT:

Septic shock. ***Septic shock*** - In **warmed septic shock**, capillary refill time may be **normal or even brisk** due to peripheral vasodilation caused by inflammatory mediators. - While other forms of shock present with decreased peripheral perfusion and prolonged capillary refill, early septic shock can manifest with a **hyperdynamic circulation**. *Obstructive shock* - This type of shock, often due to conditions like **tension pneumothorax** or **cardiac tamponade**, leads to reduced cardiac output and poor peripheral perfusion. - Reduced peripheral blood flow results in a **prolonged capillary refill time**. *Hypovolemic shock* - Characterized by a significant **loss of circulating blood volume**, leading to reduced cardiac output and vasoconstriction. - This peripheral vasoconstriction directly causes a **prolonged capillary refill time** as blood flow to the capillaries is diminished. *Cardiogenic shock* - Results from **primary heart failure**, leading to decreased cardiac output and systemic hypoperfusion. - The reduced effective circulating volume and compensatory vasoconstriction cause impaired peripheral perfusion, manifesting as a **prolonged capillary refill time**.

Q: All of the following are causes of acute red eye EXCEPT:

Acute macular oedema. ***Acute macular oedema*** - **Macular edema** primarily affects **central vision** and does not typically cause the visible **redness** associated with acute inflammation of the ocular surface or anterior segment. - It involves **fluid accumulation** in the **macula** (the central part of the retina), which is a posterior segment issue and does not present as a red eye. *Conjunctivitis* - **Inflammation** of the **conjunctiva** (the membrane lining the eyelid and sclera) commonly leads to **vasodilatation** and **redness** of the eye. - Often accompanied by **discharge**, **itching**, or a **gritty sensation**. *Acute glaucoma* - An acute rise in **intraocular pressure** (IOP) can cause significant eye **redness** due to **conjunctival injection** and **ciliary flush**. - Other symptoms include **severe eye pain**, **blurred vision**, and **halos around lights**. *Keratitis* - **Inflammation** of the **cornea** typically results in marked **redness**, often with a **ciliary flush** (perilimbal injection) due to perilimbal vascular engorgement. - Associated with **eye pain**, **photophobia**, and potential **vision loss**.

Q: All are true about Vernal conjunctivitis EXCEPT:

Most signs are in lower lid. ***Most signs are in lower lid*** ✗ - This is **INCORRECT** and is the answer to this EXCEPT question. - **Vernal conjunctivitis (VKC)** primarily affects the **upper tarsal conjunctiva**, not the lower lid. - The characteristic **cobblestone papillae** develop on the **upper eyelid** due to friction from blinking, causing **papillary hypertrophy**. - While bulbar conjunctiva and limbus can be affected, the most severe signs are in the **upper lid**. *Type of allergic conjunctivitis* ✓ - **VKC** is correctly classified as a chronic, bilateral, severe form of **allergic conjunctivitis**. - It is typically a **Type I hypersensitivity reaction**, often associated with atopy. *Cobblestone appearance* ✓ - This refers to the characteristic **large, flattened giant papillae** that develop on the **upper tarsal conjunctiva** in VKC. - The appearance results from marked hypertrophy of these papillae, resembling cobblestones. *Itchy eyes with other allergic problems* ✓ - **Intense itching** is the cardinal symptom of VKC, often accompanied by **photophobia**, **tearing**, and stringy mucous discharge. - Patients frequently have a personal or family history of other **atopic conditions** like asthma, eczema, or allergic rhinitis.

Q: Which of the following statements regarding flat feet are true? 1. Nearly all children below 3 years have flat feet 2. 15% of adults have flat feet 3. Painless flexible flat feet need no treatment 4. Rigid flat feet result from tarsal coalition Select the correct answer using the code given below:

3 and 4 only. ***3 and 4 only*** - **Painless flexible flat feet** in both children and adults generally require **no treatment**, as they are often a physiological variant and do not cause functional limitations. - **Rigid flat feet** are almost always pathological and are commonly caused by a **tarsal coalition**, an abnormal connection between two or more bones in the foot. *1 and 2 only* - While nearly all children below 3 years have **physiological flat feet**, the statement that 15% of adults have flat feet is an underestimation; prevalence varies, but it is often reported to be higher, ranging from 20-30%. - This option incorrectly excludes the importance of not treating painless flexible flat feet and the established link between rigid flat feet and tarsal coalition. *1, 2, 3 and 4* - The statement that 15% of adults have flat feet is likely an **understatement** of the true prevalence, which is often cited as higher. - While statements 1, 3, and 4 are generally correct, the inaccuracy of statement 2 makes this option incorrect. *1, 2 and 3 only* - This option correctly identifies that nearly all children below 3 have flat feet and that painless flexible flat feet do not require treatment. - However, it incorrectly excludes the crucial fact that **rigid flat feet often result from tarsal coalition**, which is a significant pathological cause.

Q: In Split thickness graft, which part of the skin is/are included?

Epidermis and part of dermis. ***Epidermis and part of dermis*** - A **split-thickness skin graft** includes the entire **epidermis** and only a **portion of the dermis**. - This allows for easier engraftment and donor site healing due to less deep tissue removal. *Epidermis and dermis* - This describes a **full-thickness skin graft**, which includes the entire epidermis and the entire dermis. - While it provides better cosmetic results and less contraction, it requires a more complex donor site closure. *Epidermis only* - A graft consisting only of the epidermis would be too thin to be clinically useful and would likely not survive. - The dermis provides structural support and a blood supply critical for graft viability. *Epidermis, dermis and part of subcutaneous tissue* - This typically refers to a **composite graft** or a **flap**, not a split-thickness skin graft. - These grafts include deeper tissues, such as subcutaneous fat, to provide bulk and specialized structures.

Q: A young boy riding a motorcycle met with a road traffic accident. On examination he had maxillofacial trauma with paraesthesia of the lower lip. Most likely underlying fracture he has is:

Fracture of the mandibular body. ***Fracture of the mandibular body*** - **Paraesthesia of the lower lip** is a classic symptom of injury to the **inferior alveolar nerve**, which runs within the mandibular canal through the body of the mandible. - A fracture in the mandibular body can directly damage or compress this nerve, leading to altered sensation. *Fracture involving infraorbital foramen* - A fracture involving the **infraorbital foramen** would affect the **infraorbital nerve**, causing paraesthesia in the midface region, including the cheek, upper lip, and side of the nose, not the lower lip. - This nerve is a branch of the **trigeminal nerve (V2)**, whereas the nerve supplying the lower lip is a branch of **V3**. *Fracture of temporal bone* - A **temporal bone fracture** is more likely to cause symptoms related to the **facial nerve (cranial nerve VII)**, leading to facial paralysis, or hearing/balance issues due to damage to the inner ear structures. - It does not typically cause isolated paraesthesia of the lower lip. *Fracture involving floor of orbit* - A fracture of the floor of the orbit, often a **blowout fracture**, can entrap the **inferior rectus** or **inferior oblique muscles** and cause **diplopia** (double vision). - It may also involve the **infraorbital nerve**, leading to paraesthesia of the cheek, upper lip, and upper teeth, but not specifically the lower lip.

Q: A 20-year-old patient underwent open hernia surgery four days ago. He has had fever for the last day and on local examination the operated site was wet with pus and surrounding redness and edema. The appropriate management would be:

Opening sutures and cleaning of wound. ***Opening sutures and cleaning of wound*** - The presence of **fever**, **pus**, **redness**, and **edema** indicates a **surgical site infection (SSI)** with abscess formation, necessitating immediate **wound exploration** and **drainage**. - **Opening the sutures** allows for complete removal of pus, debridement of necrotic tissue, and proper irrigation, which are critical steps in managing a deep-seated infection. *Sending pus for C/S* - While **culture and sensitivity (C/S)** is important for guiding antibiotic therapy, it does not address the immediate mechanical problem of pus accumulation. - Delaying drainage for C/S results would allow the infection to spread, causing further tissue damage. *Daily dressing* - **Daily dressing** alone is insufficient for a wound with active infection and pus accumulation; it cannot effectively drain the infection. - Though necessary as part of wound care, it needs to be preceded by effective drainage. *Change of antibiotics* - Changing **antibiotics** without addressing the underlying source of infection (the pus collection) will likely be ineffective as antibiotics cannot penetrate well into an abscess. - Antibiotics are a crucial adjunct to surgical drainage, not a replacement.

Q: Good surgical practice and surgical ethics include all EXCEPT:

Experiment without consent. ***Experiment without consent*** - Performing an experiment or research procedure on a patient **without proper informed consent** is a direct violation of medical ethics and good surgical practice. - Even well-designed clinical research requires **explicit patient consent**, **ethics committee approval**, and adherence to principles of *non-maleficence* and *beneficence*. - Conducting any experimental procedure without consent violates patient autonomy and the fundamental ethical principle of **informed consent**. *Confidentiality* - **Confidentiality** is a cornerstone of patient care, ensuring that patient information is protected and disclosed only with proper consent or legal requirement. - Maintaining confidentiality is an essential component of good surgical practice and medical ethics. *Informed consent* - **Informed consent** is a fundamental ethical and legal requirement before any medical procedure, ensuring the patient understands the *risks, benefits, alternatives*, and prognosis. - It upholds the principle of *patient autonomy*, allowing individuals to make decisions about their own healthcare. *Respect autonomy* - **Respect for autonomy** means acknowledging and upholding a patient's right to *make their own decisions* about their medical care, free from coercion. - This principle guides processes like obtaining informed consent and respecting a patient's choices, even if they differ from the medical professional's recommendation, as long as the patient is competent.

Question 1

Preoperative Samsoon and Young modified, Mallampati test is used for assessing:

Accepted Answer

Difficulty in intubation

Answer

Preoperative nutrition status of patient

Answer

Patient's overall fitness for surgery

Answer

Blood requirement during surgery

Question 2

Refeeding syndrome seen after enteral or parenteral nutrition is characterized by all EXCEPT:

Accepted Answer

Hyponatremia

Answer

Hypomagnesemia

Answer

Hypocalcemia

Answer

Hypophosphatemia

Question 3

The capillary refill time is prolonged in all types of shock EXCEPT:

Accepted Answer

Septic shock

Answer

Obstructive shock

Answer

Hypovolaemic shock

Answer

Cardiogenic shock

Question 4

All of the following are causes of acute red eye EXCEPT:

Accepted Answer

Acute macular oedema

Answer

Conjunctivitis

Answer

Acute glaucoma

Answer

Keratitis

Question 5

All are true about Vernal conjunctivitis EXCEPT:

Accepted Answer

Most signs are in lower lid

Answer

Type of allergic conjunctivitis

Answer

Cobblestone appearance

Answer

Itchy eyes with other allergic problems

Question 6

Which of the following statements regarding flat feet are true?

1. Nearly all children below 3 years have flat feet
2. 15% of adults have flat feet
3. Painless flexible flat feet need no treatment
4. Rigid flat feet result from tarsal coalition

Select the correct answer using the code given below:

Accepted Answer

3 and 4 only

Answer

1 and 2 only

Answer

1, 2, 3 and 4

Answer

1, 2 and 3 only

Question 7

In Split thickness graft, which part of the skin is/are included?

Accepted Answer

Epidermis and part of dermis

Answer

Epidermis and dermis

Answer

Epidermis only

Answer

Epidermis, dermis and part of subcutaneous tissue

Question 8

A young boy riding a motorcycle met with a road traffic accident. On examination he had maxillofacial trauma with paraesthesia of the lower lip. Most likely underlying fracture he has is:

Accepted Answer

Fracture of the mandibular body

Answer

Fracture involving infraorbital foramen

Answer

Fracture of temporal bone

Answer

Fracture involving floor of orbit

Question 9

A 20-year-old patient underwent open hernia surgery four days ago. He has had fever for the last day and on local examination the operated site was wet with pus and surrounding redness and edema. The appropriate management would be:

Accepted Answer

Opening sutures and cleaning of wound

Answer

Sending pus for C/S

Answer

Daily dressing

Answer

Change of antibiotics

Question 10

Good surgical practice and surgical ethics include all EXCEPT:

Accepted Answer

Experiment without consent

Answer

Confidentiality

Answer

Informed consent

Answer

Respect autonomy

UPSC-CMS 2019

Anesthesiology

Internal Medicine

Ophthalmology

Orthopaedics

Surgery