UPSC-CMS 2020 Practice Questions

Q: The Child-Turcotte-Pugh (CTP) score for quantifying the severity of chronic liver disease includes all variables EXCEPT:

Serum creatinine. ***Body Mass Index (BMI)*** - The Child-Turcotte-Pugh (CTP) score is an established clinical tool for assessing prognosis in **chronic liver disease**, and it does not include **Body Mass Index (BMI)** as one of its parameters. - The CTP score focuses on liver function and complications of portal hypertension, which are reflected by specific laboratory values and clinical signs, not nutritional status as measured by BMI [1]. *International Normalized Ratio (INR)* - **INR** is a crucial component of the Child-Turcotte-Pugh (CTP) score, as it reflects the liver's synthetic function, specifically its ability to produce clotting factors [1]. - An elevated INR indicates **impaired liver synthetic function** and contributes to a higher CTP score, signifying more severe liver disease. *Serum bilirubin* - **Serum bilirubin** is a key laboratory parameter included in the Child-Turcotte-Pugh (CTP) score [1]. - Elevated bilirubin levels indicate **impaired liver excretory function** and hepatocellular damage, directly correlating with the severity of liver disease. *Serum albumin* - **Serum albumin** is a vital component of the Child-Turcotte-Pugh (CTP) score, reflecting the liver's synthetic capacity [1]. - Low serum albumin levels indicate **reduced liver synthesis**, often seen in advanced liver disease, and contribute to a higher CTP score [1].

Q: Which one of the following statements is NOT correct regarding Pyogenic Liver Abscess?

Treatment is with oral antibiotics alone. ***Treatment is with oral antibiotics alone*** - This statement is incorrect because pyogenic liver abscesses typically require **drainage** (percutaneous or surgical) in addition to **intravenous antibiotics** initially. Oral antibiotics alone are generally insufficient for definitive treatment. - The goal is to eradicate the infection, which often involves both source control (drainage) and systemic antimicrobial therapy. *It is more common in elderly, diabetics and immunocompromised patients* - This statement is correct. Factors such as **age**, **diabetes mellitus**, and **immunocompromised states** weaken the immune response, making individuals more susceptible to developing pyogenic liver abscesses [1]. - These conditions can impair the body's ability to clear bacteria effectively, increasing the risk of infection and abscess formation. *Streptococcus milleri and escherichia coli are the most common causative organisms* - This statement is correct. **_Streptococcus milleri_ (now _Streptococcus anginosus_)** is frequently implicated due to its ability to form abscesses, while **_Escherichia coli_** is common because many liver abscesses arise from biliary or enteric sources. - Other common pathogens include other **Gram-negative bacilli** and **anaerobes**, reflecting the varied etiologies. *Anorexia, fever, malaise and right upper quadrant abdominal discomfort are the most common presenting features* - This statement is correct. These are classic symptoms of liver abscess, reflecting the inflammatory process and the location of the infection [1]. - **Fever** and **right upper quadrant pain** are particularly prominent and should raise suspicion for a liver abscess [1].

Q: Which of the following are correct regarding splenic artery aneurysm? 1. Main arterial trunk is the common site 2. Palpable thrill can be felt 3. It is symptomless unless it ruptures Select the correct answer using the code given below:

1 and 3 only. ***1 and 3 only*** - The **main arterial trunk** is indeed the most common site for splenic artery aneurysms, accounting for approximately 60% of cases. - Splenic artery aneurysms are typically **asymptomatic** until rupture, which can be a life-threatening event. *1, 2 and 3* - While the main arterial trunk is a common site and these aneurysms are often symptomless until rupture, a **palpable thrill** is generally not a feature of splenic artery aneurysms. - Thrills are usually associated with **arteriovenous fistulas** or very large, superficial aneurysms with turbulent flow, which is less common for the splenic artery. *2 and 3 only* - A **palpable thrill** is not a typical finding for splenic artery aneurysms. - While they are often symptomless until rupture, the statement that the **main arterial trunk is a common site** is also correct and should be included. *1 and 2 only* - Although the main arterial trunk is a common site, a **palpable thrill** is not a characteristic sign of splenic artery aneurysms. - The crucial point that they are **symptomless unless they rupture** is omitted from this option.

Q: Spontaneous bacterial peritonitis occurs due to:

acute bacterial infection of ascites. ***acute bacterial infection of ascites*** - **Spontaneous bacterial peritonitis (SBP)** is a common and serious complication in patients with **cirrhosis and ascites**, characterized by an infection of the **ascitic fluid** without an obvious source within the abdominal cavity. - The infection typically arises from the **translocation of bacteria** from the gut lumen into the mesenteric lymph nodes and then into the ascitic fluid. *duodenal stump blowout* - A **duodenal stump blowout** is a rare but severe complication following gastric surgery (e.g., gastrectomy with Billroth II reconstruction) where the closed end of the duodenum ruptures. - This complication leads to **peritonitis**, but it is a **secondary bacterial peritonitis** due to leakage of GI contents, not spontaneous. *infection via fallopian tubes* - While bacteria can access the peritoneal cavity via the fallopian tubes, leading to **pelvic inflammatory disease (PID)** or **peritonitis**, this mechanism is specific to females and typically involves sexually transmitted infections ascending from the lower genital tract. - This pathway does not describe the typical pathogenesis of SBP, which is primarily associated with **ascites** in cirrhotic patients and gut bacterial translocation. *peptic ulcer perforation* - A **perforated peptic ulcer** involves a breach in the wall of the stomach or duodenum, leading to the leakage of gastric or duodenal contents into the peritoneal cavity. - This causes an acute abdomen and **secondary bacterial peritonitis**, which is distinguishable from SBP as it has an identifiable intrabdominal source of infection.

Q: 'Chain of Lakes' appearance due to sacculation with intervening short strictures of pancreatic duct is seen on:

ERCP. ***ERCP*** - **Endoscopic Retrograde Cholangiopancreatography (ERCP)** is an invasive imaging technique that directly visualizes the bile and pancreatic ducts by injecting contrast, allowing for the classic "chain of lakes" appearance (dilatation and stricturing) seen in chronic pancreatitis. - This characteristic appearance on ERCP is a definitive sign of advanced **chronic pancreatitis**, indicating ductal irregularity, strictures, and dilations. *Ultrasonography* - While ultrasonography can show features of chronic pancreatitis like **pancreatic calcifications** and **ductal dilation**, it typically does not provide the detailed luminal view necessary to appreciate the "chain of lakes" pattern. - Its utility in visualizing the pancreatic duct can be limited by **bowel gas** and patient body habitus, making it less sensitive for intricate ductal changes. *CECT abdomen* - **Contrast-Enhanced Computed Tomography (CECT) of the abdomen** can identify pancreatic calcifications, **atrophy**, and **ductal dilation** in chronic pancreatitis but is generally not as precise as ERCP in delineating the intricate "chain of lakes" pattern within the duct itself. - CECT is more effective for assessing parenchymal changes and complications like **pseudocysts** rather than the fine ductal morphology. *Plain X-ray abdomen* - A plain X-ray of the abdomen primarily visualizes **calcifications** within the pancreas, which are a common feature of chronic pancreatitis. - However, it does not provide any information about the **ductal anatomy** or the "chain of lakes" appearance, as it is a 2D image without contrast in the ducts.

Q: All of the following are sequelae of peptic ulcer surgery EXCEPT:

Increased appetite. ***Increased appetite*** - **Increased appetite** is generally not a sequela of peptic ulcer surgery; patients commonly experience *early satiety* or *anorexia* due to faster gastric emptying and altered nutrient absorption. - Surgical alterations to the GI tract often lead to changes in hunger and satiety signals, typically *reducing desire for large meals* rather than increasing appetite. *Dumping syndrome* - **Dumping syndrome** is a common sequela, particularly after gastrectomy or vagotomy, due to *rapid emptying* of undigested food into the small intestine. - Symptoms include abdominal pain, nausea, diarrhea, and vasomotor symptoms like palpitations and sweating, often occurring post-prandially. *Bilious vomiting* - **Bilious vomiting** can occur, especially after gastrectomy or gastrojejunostomy, when *bile refluxes* into the gastric remnant and is subsequently vomited. - This is often due to an *altered anatomical arrangement* that allows bile to enter the stomach more easily. *Diarrhoea* - **Diarrhea** is a frequently reported complication, often resulting from *accelerated gastric emptying*, *bacterial overgrowth* in the small intestine, or *loss of vagal innervation*. - It can be chronic and significantly impact quality of life due to malabsorption or rapid transit of chyme.

Q: 'Swiss cheese defects' are seen during laparoscopic repair of:

Inguinal hernia. ***Inguinal hernia*** - **Swiss cheese defects** refer to multiple small defects in the **transversalis fascia** seen in some cases of direct inguinal hernias. - These defects require careful identification and repair during **laparoscopic inguinal hernia repair** to prevent recurrence. *Ventral hernia* - Ventral hernias are typically located on the **anterior abdominal wall**, often at previous surgical incision sites. - The term **Swiss cheese defects** is not commonly used to describe the fascial defects associated with ventral hernias. *Obturator hernia* - An **obturator hernia** protrudes through the obturator foramen and is a rare type of pelvic hernia. - The pattern of fascial defects described as **Swiss cheese** is unrelated to this type of hernia. *Femoral hernia* - A **femoral hernia** protrudes through the femoral canal, inferior to the inguinal ligament. - This type of hernia involves a distinct anatomical defect, which does not typically present as multiple small holes referred to as **Swiss cheese defects**.

Q: Valentino's syndrome is:

Pain in right iliac fossa in perforated peptic ulcer. ***Pain in right iliac fossa in perforated peptic ulcer*** - **Valentino's syndrome** (also known as **Valentino's sign**) specifically describes the clinical presentation of **right iliac fossa (RIF) pain** in patients with a **perforated peptic ulcer**. - This occurs when gastric or duodenal contents from the perforation track down along the **right paracolic gutter** due to gravity and peritoneal fluid flow, accumulating in the RIF and causing **localized peritonitis**. - This can **mimic acute appendicitis** clinically, making it an important differential diagnosis. - Named after Rudolph Valentino, the famous actor who died from complications of a perforated gastric ulcer. *Pain over left shoulder in left hypochondriac collection* - This describes **Kehr's sign**, which is referred pain to the left shoulder due to **diaphragmatic irritation** from blood or fluid in the left upper quadrant (e.g., splenic rupture, subphrenic abscess). - Caused by irritation of the phrenic nerve (C3-C5), which also supplies sensation to the shoulder. - This is **not** Valentino's syndrome. *Pain on per-vaginal examination in pelvic abscess* - Cervical excitation pain or adnexal tenderness on vaginal examination suggests **pelvic pathology** such as pelvic inflammatory disease, ectopic pregnancy, or pelvic abscess. - This finding is unrelated to Valentino's syndrome, which involves upper GI perforation with RIF pain. *Pain over left groin in perirenal collection* - Groin pain from perirenal pathology may occur with conditions like renal calculi, pyelonephritis, or perinephric abscess. - This is not associated with Valentino's syndrome, which has a specific anatomical pattern related to peptic ulcer perforation.

Q: Structure not forming boundaries of the "Triangle of doom" seen during laparoscopic inguinal hernia surgery dissection is:

Inferior epigastric artery. ***Inferior epigastric artery*** - The **inferior epigastric artery** does NOT form a boundary of the **"Triangle of Doom"** during laparoscopic inguinal hernia repair. - Instead, it forms the **lateral boundary of Hesselbach's triangle** and the **medial boundary of the "Triangle of Pain"** (another important anatomical landmark containing the lateral femoral cutaneous nerve and genitofemoral nerve). - The Triangle of Doom is bounded by the **vas deferens medially**, the **spermatic vessels (gonadal vessels) laterally**, and the **peritoneal reflection inferiorly**. *Spermatic cord vessels* - The **spermatic vessels (testicular artery and pampiniform plexus)** form the **lateral boundary** of the **"Triangle of Doom."** - This triangle contains the **external iliac artery and vein**, which pose significant risk of major hemorrhage if injured. - Careful identification of these vessels is crucial to avoid devastating vascular complications. *Vas deferens* - The **vas deferens** forms the **medial boundary** of the **"Triangle of Doom."** - This structure runs within the spermatic cord and must be carefully preserved to prevent male infertility. - Injury to the vas deferens during dissection can result in permanent reproductive consequences. *Peritoneum* - The **peritoneum (peritoneal reflection)** forms the **base/inferior boundary** of the **"Triangle of Doom."** - This serous membrane provides the anatomical floor of the triangle during laparoscopic visualization. - Understanding the peritoneal boundaries helps surgeons safely navigate this high-risk anatomical area.

Question 1

The Child-Turcotte-Pugh (CTP) score for quantifying the severity of chronic liver disease includes all variables EXCEPT:

Accepted Answer

Serum creatinine

Answer

INR (International Normalised Ratio)

Answer

Serum bilirubin

Answer

Serum albumin

Question 2

Which one of the following statements is NOT correct regarding Pyogenic Liver Abscess?

Accepted Answer

Treatment is with oral antibiotics alone

Answer

It is more common in elderly, diabetics and immunocompromised patients

Answer

Streptococcus milleri and escherichia coli are the most common causative organisms

Answer

Anorexia, fever, malaise and right upper quadrant abdominal discomfort are the most common presenting features

Question 3

Which of the following are correct regarding splenic artery aneurysm?

1. Main arterial trunk is the common site
2. Palpable thrill can be felt
3. It is symptomless unless it ruptures

Select the correct answer using the code given below:

Accepted Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 2 and 3

Question 4

Spontaneous bacterial peritonitis occurs due to:

Accepted Answer

acute bacterial infection of ascites

Answer

duodenal stump blowout

Answer

infection via fallopian tubes

Answer

peptic ulcer perforation

Question 5

All of the following are major subtypes of breast cancer based on Gene array analysis EXCEPT:

Accepted Answer

Estrogen receptor positive

Answer

Luminal A and Luminal B

Answer

Triple negative

Answer

Her-2 receptor positive

Question 6

'Chain of Lakes' appearance due to sacculation with intervening short strictures of pancreatic duct is seen on:

Accepted Answer

ERCP

Answer

Ultrasonography

Answer

CECT abdomen

Answer

Plain X-ray abdomen

Question 7

All of the following are sequelae of peptic ulcer surgery EXCEPT:

Accepted Answer

Increased appetite

Answer

Dumping syndrome

Answer

Bilious vomiting

Answer

Diarrhoea

Question 8

'Swiss cheese defects' are seen during laparoscopic repair of:

Accepted Answer

Inguinal hernia

Answer

Ventral hernia

Answer

Obturator hernia

Answer

Femoral hernia

Question 9

Valentino's syndrome is:

Accepted Answer

Pain in right iliac fossa in perforated peptic ulcer

Answer

Pain over left shoulder in left hypochondriac collection

Answer

Pain on per-vaginal examination in pelvic abscess

Answer

Pain over left groin in perirenal collection

Question 10

Structure not forming boundaries of the "Triangle of doom" seen during laparoscopic inguinal hernia surgery dissection is:

Accepted Answer

Inferior epigastric artery

Answer

Spermatic cord vessels

Answer

Vas deferens

Answer

Peritoneum

UPSC-CMS 2020

Internal Medicine

Pathology

Radiology

Surgery