UPSC-CMS 2021 Practice Questions

Q: A comatose patient after sustaining severe head injury has been admitted to the neurosurgical ICU. Which of the following parameters should ideally be maintained in this patient? 1. pCO2 = 4.5 - 5.0 kPa (33-38 mm Hg) 2. MAP = 80 - 90 mm of Hg 3. pO2 > 11 kPa (> 80 mm Hg) 4. Na+ < 130 meq/L

1, 2 and 3. ***1, 2 and 3*** - Maintaining **pCO2 between 4.5-5.0 kPa (33-38 mmHg)** helps optimize cerebral blood flow; values outside this range can cause vasoconstriction or vasodilation, affecting intracranial pressure (ICP). - A **mean arterial pressure (MAP) of 80-90 mmHg** ensures adequate cerebral perfusion pressure (CPP) and minimizes the risk of secondary brain injury from ischemia. - An **arterial partial pressure of oxygen (pO2) above 11 kPa (>80 mmHg)** is crucial to prevent cerebral hypoxia, which can exacerbate brain damage in severely injured patients. *2, 3 and 4* - This option correctly identifies the importance of maintaining adequate MAP and pO2 but incorrectly suggests a low sodium level. - A low **serum sodium (Na+) below 130 mEq/L (hyponatremia)** should be avoided in severe head injury as it can worsen cerebral edema and increase ICP. *1, 2 and 4* - While maintaining pCO2 and MAP within target ranges is essential, a **sodium level below 130 mEq/L (hyponatremia)** is detrimental and not an ideal parameter to maintain. - Hyponatremia can lead to further **brain swelling** and increased intracranial pressure. *1, 3 and 4* - This combination correctly identifies ideal pCO2 and pO2 targets but incorrectly includes **hyponatremia (Na+ < 130 mEq/L)** as a desirable parameter. - Severe hyponatremia can cause significant neurological complications including **seizures** and worsening cerebral edema.

Q: Perioperative benefit from transfusion is with a haemoglobin level of

6 - 8 gm/dl. **6 - 8 gm/dl** - Transfusions are generally recommended for **symptomatic anemia** or when the hemoglobin level falls below **7 g/dL** in most patients. - For patients undergoing surgery, a hemoglobin range of **6-8 gm/dl** often indicates a need for transfusion to optimize oxygen delivery and prevent complications. *8 - 10 gm/dl* - Hemoglobin levels in this range are often considered stable enough for many patients, and transfusion may not be necessary unless there are specific **cardiovascular risks** or **acute bleeding**. - Routine transfusion for non-symptomatic patients with hemoglobin in this range has not shown significant perioperative benefit and can expose patients to transfusion risks. *< 6 gm/dl* - A hemoglobin level below **6 gm/dl** typically indicates **severe anemia** and almost always warrants transfusion regardless of surgical context due to the high risk of **tissue hypoxia** and organ dysfunction. - While transfusion is definitely beneficial in this range, the question asks about the range where benefit *commences* for perioperative settings, which typically falls slightly higher to prevent severe drops. *> 10 gm/dl* - A hemoglobin level **above 10 gm/dl** is generally considered good and does not usually require transfusion, even in the perioperative setting. - Transfusing patients with hemoglobin levels above this threshold is associated with **no significant clinical benefit** and increases the risk of transfusion-related adverse events.

Q: Ideal weight gain during pregnancy for a woman with normal BMI should be

11-16 kg. ***11-16 kg*** - For a woman with a **normal Body Mass Index (BMI)** (18.5-24.9), the recommended total weight gain during pregnancy is **11.5 to 16 kg (25 to 35 lbs)**. - This range supports optimal fetal growth and maternal health, reducing risks associated with both inadequate and excessive weight gain. *More than 18 kg* - Gaining more than **18 kg (40 lbs)** during pregnancy, especially for women with a normal BMI, is generally considered **excessive**. - This can increase the risk of complications such as **gestational diabetes**, **hypertension**, **macrosomia**, and **cesarean delivery**. *7 kg* - A total weight gain of only **7 kg (15 lbs)** for a woman with a normal BMI during pregnancy is typically considered **insufficient**. - Inadequate weight gain can lead to a higher risk of delivering a **low birth weight infant** or one who is **small for gestational age**. *18 kg* - A weight gain of **18 kg (approximately 40 lbs)** **exceeds the recommended range** for women with a normal BMI (11.5-16 kg). - This represents the **upper limit** of recommended weight gain for **underweight women** (BMI <18.5), whose target range is 12.5-18 kg (28-40 lbs). - For normal BMI women, 18 kg is considered **excessive** and may increase risks of maternal and fetal complications.

Q: Blood volume increases during pregnancy above nonpregnant level at 30-34 weeks by:

by 40-50 per cent. ***by 40-50 per cent*** - During pregnancy, **blood volume significantly increases**, primarily due to hormonal changes, to support the growing fetus and uteroplacental unit, with the peak increase typically occurring around the third trimester. - This expansion involves both **plasma volume (greater increase)** and **red blood cell mass**, leading to a state of physiologic hemodilution. *Blood volume does not increase at all* - This statement is incorrect as a substantial **increase in blood volume is a hallmark of normal pregnancy physiology** to meet increased metabolic demands. - Failure of blood volume to increase would imply a pathologic state, potentially compromising both maternal and fetal well-being. *by 25-30 per cent* - While a significant increase, **25-30% is generally an underestimation** of the full extent of blood volume expansion that occurs in a healthy pregnancy. - The total increase often reaches higher values, particularly when considering the combined rise in plasma and red blood cells. *by 10-20 per cent* - An increase of **10-20% is considerably less** than what is typically observed during a normal pregnancy. - This level of increase would likely be insufficient to adequately support the physiological demands of the mother and fetus.

Q: Which of the following are contra-indications to external cephalic version in antenatal management of breech presentation? 1. Antepartum haemorrhage 2. Multiple pregnancy 3. Reactive Non Stress Test 4. Severe oligohydramnios

1, 2 and 4. ***1, 2 and 4*** * **Antepartum haemorrhage**, **multiple pregnancy**, and **severe oligohydramnios** are all contraindications to external cephalic version (ECV) due to increased risks of fetal distress, placental abruption, and uterine rupture. * These conditions either compromise fetal well-being directly or make the procedure significantly more dangerous for both mother and fetus. *2, 3 and 4* * This option incorrectly includes a **reactive non-stress test** as a contraindication, which actually indicates fetal well-being and is a prerequisite for ECV. * Excluding **antepartum haemorrhage** as a contraindication is also incorrect, as it poses a significant risk. *1, 2, 3 and 4* * This option is incorrect because a **reactive non-stress test** is a sign of fetal health and is a requirement *before* performing an ECV, not a contraindication. * Including it diminishes the specificity of contraindications for this procedure. *1, 2 and 3* * This option erroneously lists a **reactive non-stress test** as a contraindication, when in reality, it's a reassuring finding critical for proceeding with ECV. * It also omits **severe oligohydramnios** which is a significant contraindication due to the inability to safely manipulate the fetus.

Q: Antepartum haemorrhage is defined as bleeding from genital tract occurring:

After 28 weeks of pregnancy. ***After 28 weeks of pregnancy*** - **Antepartum hemorrhage (APH)** is defined as any bleeding from the genital tract occurring from **28 weeks of gestation** until the onset of labour. - This definition helps differentiate it from bleeding in earlier pregnancy, which is typically classified as **threatened abortion**, **miscarriage**, or other early pregnancy complications. *Before 20 weeks of pregnancy* - Bleeding occurring before 20 weeks of pregnancy is generally referred to as **threatened abortion**, **inevitable abortion**, **incomplete abortion**, or **complete abortion**. - These conditions are distinct from antepartum hemorrhage, which pertains to later stages of pregnancy. *Before 24 weeks of pregnancy* - Similar to before 20 weeks, bleeding before 24 weeks would fall under categories related to **early pregnancy loss or complications**, not antepartum hemorrhage. - The viability of the fetus is often still a critical factor in this gestational range, and management differs. *After 34 weeks of pregnancy* - While bleeding after 34 weeks is a form of antepartum hemorrhage, the definition of APH encompasses any bleeding **from 28 weeks onwards**, making "After 28 weeks of pregnancy" the most accurate and comprehensive definition. - Specifying "after 34 weeks" is too narrow and excludes bleeding events that occur between 28 and 34 weeks which are still considered APH.

Q: Which one of the following is NOT a risk factor for pre-eclampsia ?

Placenta previa. ***Placenta previa*** - **Placenta previa** is a condition where the placenta partially or totally covers the mother's cervix, causing **vaginal bleeding** during pregnancy, but it is **not linked to the development of pre-eclampsia**. - It is a placental implantation abnormality characterized by abnormal location, not a risk factor for the systemic vascular and endothelial dysfunction characteristic of pre-eclampsia. - The pathophysiology involves placental position, not the defective placentation or spiral artery remodeling seen in pre-eclampsia. *Pre-existing vascular disease* - Conditions like **chronic hypertension**, **diabetes mellitus**, and **chronic kidney disease** are well-established risk factors for pre-eclampsia. - These diseases impair endothelial function and increase the likelihood of the systemic inflammatory response and vasospasm seen in pre-eclampsia. - Pre-existing vascular dysfunction predisposes to inadequate placental perfusion and abnormal trophoblast invasion. *Obesity* - **Obesity** (BMI ≥30 kg/m²) is a significant risk factor for pre-eclampsia due to its association with **insulin resistance**, chronic inflammation, and endothelial dysfunction. - Maternal obesity leads to heightened oxidative stress, increased inflammatory cytokines, and impaired angiogenesis, contributing to defective placentation. - The risk increases proportionally with increasing BMI. *Primigravida* - Being a **primigravida** (first pregnancy) is an established risk factor for pre-eclampsia, with primiparous women having 2-3 times higher incidence compared to multiparous women. - This is thought to be due to initial exposure to paternal antigens and less robust maternal immune tolerance to placental antigens. - The risk decreases significantly in subsequent pregnancies with the same partner.

Q: Which of the following are correct about ectopic ureters? 1. They are more common in males 2. They drain the upper pole of kidney 3. They are associated with duplex ureter 4. They may cause incontinence

2, 3 and 4. ***2, 3 and 4*** - **Statement 2 is correct:** Ectopic ureters in duplex systems typically drain the **upper pole moiety** of the kidney (Weigert-Meyer rule) - **Statement 3 is correct:** Ectopic ureters are most commonly associated with **complete ureteral duplication** (duplex collecting system) - **Statement 4 is correct:** Ectopic ureters can cause **continuous urinary incontinence**, especially in females when insertion is below the sphincter mechanism (vagina, urethra, vestibule) - **Statement 1 is incorrect:** Ectopic ureters are **more common in females** (approximately 80% of cases), not males *1, 2 and 4* - Incorrectly includes statement 1 - ectopic ureters are **more common in females**, not males *1, 2 and 3* - Incorrectly includes statement 1 - ectopic ureters are **more common in females**, not males - Missing statement 4, which is correct - ectopic ureters **do cause incontinence** *1, 2, 3 and 4* - Incorrectly includes statement 1 - ectopic ureters are **more common in females**, not males

Q: Untidy wounds are characterised by which of the following? 1. Crushed or avulsed tissues 2. Contaminated wound 3. Devitalised tissue 4. No loss of tissue

1, 2 and 3. ***1, 2 and 3*** - **Untidy wounds**, often resulting from high-energy trauma, are defined by the presence of **crushed or avulsed tissues**, **contamination**, and **devitalized tissue**. - These characteristics make the wound more complex to manage and prone to complications like infection. *1, 2, 3 and 4* - This option incorrectly includes "no loss of tissue" (option 4) as a characteristic of untidy wounds. **Untidy wounds** frequently involve **tissue loss**, making this statement contradictory to their definition. - The presence of **crushed or avulsed tissues** inherently suggests some degree of tissue damage or loss. *1, 2 and 4* - This option incorrectly states that "no loss of tissue" is a characteristic of untidy wounds. In reality, **untidy wounds** are often associated with significant **tissue destruction and loss**. - **Crushed and avulsed tissues** are direct indicators of tissue damage and potential loss. *2, 3 and 4* - This option incorrectly omits "crushed or avulsed tissues" (option 1), which is a cardinal feature of untidy wounds. It also incorrectly includes "no loss of tissue" (option 4). - While **contamination** and **devitalized tissue** are hallmarks of untidy wounds, the absence of crushed/avulsed tissue and the idea of no tissue loss are inaccurate.

Q: Which one of the following statements regarding the composition of common crystalloid solutions is correct ?

Hartmann’s solution contains 111 meq/L of Cl. ***Hartmann’s solution contains 111 meq/L of Cl*** - **Hartmann's solution** (Lactated Ringer's) typically contains **111 mmol/L** (or meq/L) of chloride. - Its electrolyte composition aims to mimic plasma more closely than normal saline, with **lower chloride content** to reduce the risk of hyperchloremic acidosis. *Hartmann’s solution contains 111 meq/L of Na* - Hartmann's solution contains approximately **130 meq/L of Na**, not 111 meq/L. - The sodium concentration is higher than 111 meq/L to maintain **isotonicity** and match plasma osmolality. *Normal saline contains 130 meq/L of Cl* - **Normal saline (0.9% NaCl)** contains **154 meq/L of Cl**, which is significantly higher than 130 meq/L. - Its high chloride content can lead to **hyperchloremic metabolic acidosis** if administered in large volumes. *Normal saline contains 100 meq/L of Na* - **Normal saline (0.9% NaCl)** contains **154 meq/L of Na**, not 100 meq/L [1]. - This higher sodium concentration contributes to its **isotonicity** with plasma [1].

Question 1

A comatose patient after sustaining severe head injury has been admitted to the neurosurgical ICU. Which of the following parameters should ideally be maintained in this patient?

1. pCO2 = 4.5 - 5.0 kPa (33-38 mm Hg)

2. MAP = 80 - 90 mm of Hg

3. pO2 > 11 kPa (> 80 mm Hg)

4. Na+ < 130 meq/L

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 2

Perioperative benefit from transfusion is with a haemoglobin level of

Accepted Answer

6 - 8 gm/dl

Answer

8 - 10 gm/dl

Answer

< 6 gm/dl

Answer

> 10 gm/dl

Question 3

Ideal weight gain during pregnancy for a woman with normal BMI should be

Accepted Answer

11-16 kg

Answer

More than 18 kg

Answer

7 kg

Answer

18 kg

Question 4

Blood volume increases during pregnancy above nonpregnant level at 30-34 weeks by:

Accepted Answer

by 40-50 per cent

Answer

Blood volume does not increase at all

Answer

by 25-30 per cent

Answer

by 10-20 per cent

Question 5

Which of the following are contra-indications to external cephalic version in antenatal management of breech presentation?

1. Antepartum haemorrhage
2. Multiple pregnancy
3. Reactive Non Stress Test
4. Severe oligohydramnios

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2, 3 and 4

Answer

1, 2 and 3

Question 6

Antepartum haemorrhage is defined as bleeding from genital tract occurring:

Accepted Answer

After 28 weeks of pregnancy

Answer

Before 20 weeks of pregnancy

Answer

Before 24 weeks of pregnancy

Answer

After 34 weeks of pregnancy

Question 7

Which one of the following is NOT a risk factor for pre-eclampsia ?

Accepted Answer

Placenta previa

Answer

Pre-existing vascular disease

Answer

Obesity

Answer

Primigravida

Question 8

Which of the following are correct about ectopic ureters?

1. They are more common in males
2. They drain the upper pole of kidney
3. They are associated with duplex ureter
4. They may cause incontinence

Accepted Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

1, 2, 3 and 4

Question 9

Untidy wounds are characterised by which of the following?

1. Crushed or avulsed tissues
2. Contaminated wound
3. Devitalised tissue
4. No loss of tissue

Accepted Answer

1, 2 and 3

Answer

1, 2, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 10

Which one of the following statements regarding the composition of common crystalloid solutions is correct ?

Accepted Answer

Hartmann’s solution contains 111 meq/L of Cl

Answer

Hartmann’s solution contains 111 meq/L of Na

Answer

Normal saline contains 130 meq/L of Cl

Answer

Normal saline contains 100 meq/L of Na

UPSC-CMS 2021

Anesthesiology

Obstetrics and Gynecology

Surgery