UPSC-CMS 2022 Practice Questions

Q: Which of the following scoring systems are PRIMARILY designed for assessing the severity of acute pancreatitis?

1. Ranson and Glasgow score. ***Ranson and Glasgow score*** - The **Ranson criteria** and the **Glasgow Coma Scale** (also known as the Imrie score) are classical scoring systems specifically developed and widely used to assess the **severity of acute pancreatitis** [1]. - Both scores incorporate multiple clinical and laboratory parameters evaluated at admission and within the first 48 hours to predict the likelihood of complications and mortality in acute pancreatitis. *APACHE score* - The **Acute Physiology, Age, Chronic Health Evaluation (APACHE) score** (e.g., APACHE II, APACHE III) is a general severity-of-illness classification system for critically ill patients and is not specific to acute pancreatitis. - While it can be applied to patients with acute pancreatitis in the ICU, it's designed for a **broader range of critical illnesses** rather than primarily for pancreatitis. *MELD score* - The **Model for End-Stage Liver Disease (MELD) score** is used to assess the severity of **chronic liver disease** and predict prognosis, particularly for patients awaiting liver transplantation. - It is **not designed for acute pancreatitis** and is irrelevant in this context. *Modified Marshall score* - The **Modified Marshall scoring system** is primarily used to assess **organ dysfunction** in acute pancreatitis, especially in clinical trials or for defining severe acute pancreatitis. - While relevant to pancreatitis severity, it is more focused on **specific organ systems' failure** rather than providing a global predictive score for overall severity and mortality in the same way Ranson or Glasgow scores do.

Q: Which of the following are the causes of retroperitoneal fibrosis?

Drugs. ***Drugs*** - Various medications can induce retroperitoneal fibrosis, including **methysergide**, **beta-blockers**, and some **antibiotics**. - Drug-induced retroperitoneal fibrosis often resolves with **discontinuation of the offending agent**. *Lymphoma* - While lymphoma can cause retroperitoneal masses, it typically presents with distinct features such as **lymphadenopathy** and **B symptoms** (fever, night sweats, weight loss) rather than generalized fibrosis [1]. - Lymphoma involves neoplastic proliferation of lymphocytes, leading to **mass effect** and infiltration, which is distinct from the fibrotic process [1]. *Carcinoid tumours* - Carcinoid tumors can cause fibrosis, but typically in the **pericardium** or **pleura** (carcinoid heart disease) or **mesenterium**, not the retroperitoneum directly as a primary cause in this context. - The fibrosis associated with carcinoid syndrome is due to the release of **serotonin** and other vasoactive substances. *Continuous Ambulatory Peritoneal Dialysis (CAPD)* - CAPD can lead to **peritoneal fibrosis** (sclerosing encapsulating peritonitis), which affects the peritoneum lining the abdominal cavity, not the retroperitoneum. - This complication is distinct from retroperitoneal fibrosis and involves changes to the **peritoneal membrane**, often due to bio-incompatible dialysate.

Q: The most common brain tumour in an adult is

cerebral metastasis. ***Cerebral metastasis*** - **Cerebral metastases** are the **most common brain tumours in adults**, originating from primary cancers elsewhere in the body (e.g., lung, breast, melanoma). - They often present as **multiple lesions** and can cause focal neurological deficits, seizures, and increased intracranial pressure. *Glioma* - While **gliomas** (including astrocytomas, glioblastoma multiforme) are the most common primary brain tumours, they are less common than metastatic lesions overall in adults. - They arise from **glial cells** within the brain and can be highly aggressive. *Pituitary tumour* - **Pituitary tumours** are benign adenomas originating from the pituitary gland. - They are common but constitute a smaller proportion of all adult brain tumours compared to metastases or gliomas, and often present with **endocrine disturbances** or **visual field defects**. *Vestibular schwannoma* - **Vestibular schwannomas** (acoustic neuromas) are benign tumours arising from the **vestibulocochlear nerve (cranial nerve VIII)**. - They are relatively rare and typically present with **hearing loss**, **tinnitus**, and **balance issues**.

Q: Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation? 1. Raised ICP 2. Seizures 3. Hemianopia 4. Focal deficit

1. Raised ICP. ***Raised ICP*** - **Increased Intracranial Pressure (ICP)** is the fundamental underlying cause of the classic triad of brain tumor symptoms [1]. - As a tumor grows, it occupies space within the rigid skull, leading to an increase in pressure that manifests as headache, nausea/vomiting, and papilledema [1]. *Anopia* - **Anopia** (complete blindness in one eye) is a specific visual field defect, not a general underlying pathophysiological mechanism for the classic triad. - While brain tumors can cause visual field defects, these are typically considered focal neurological deficits rather than the primary cause of the general triad [1]. *Focal deficit* - **Focal neurological deficits** (like hemianopia, weakness, or sensory loss) are *symptoms* caused by brain tumors, but they represent localized damage, not the overarching pathophysiology of the classic triad [1]. - The classic triad (headache, nausea/vomiting, papilledema) is a manifestation of diffuse increased pressure, not specific focal damage [1]. *Seizures* - **Seizures** are a common symptom of brain tumors, often due to irritation of cortical tissue [1]. - However, seizures are a *symptom* that can occur due to focal irritation or diffuse pressure and do not represent the primary underlying pathophysiology (raised ICP) that causes the classic triad itself [1].

Q: The least marked function of a human spleen is

reservoir function. ***Reservoir Function*** - In **humans**, the spleen stores only a **minimal amount of blood** (~30-40 ml of RBCs), unlike in animals like dogs and horses where it serves as a major blood reservoir - While it does store some **platelets and monocytes**, the reservoir function is the **least marked** among the spleen's primary functions in humans - This function is relatively insignificant compared to the spleen's other critical roles *Filter Function* - The spleen is a **major blood filter**, removing **old and damaged red blood cells**, bacteria, and cellular debris - Removes approximately **20-30 ml of aged RBCs daily** through selective filtration in the red pulp - This is one of the **most important** and highly marked functions of the spleen *Immune Function* - The spleen is a **major secondary lymphoid organ** containing **25% of the body's lymphocytes** - Produces **antibodies** (IgM and IgG) and responds to blood-borne antigens - Critical for fighting **encapsulated organisms** (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis) - Post-splenectomy patients face risk of **OPSI** (overwhelming post-splenectomy infection), highlighting its crucial immune role *Pitting Function* - The spleen performs the unique **pitting function** by selectively removing intracellular inclusions (**Howell-Jolly bodies, Pappenheimer bodies, Heinz bodies**) from RBCs without destroying the entire cell - This specialized function helps maintain RBC quality and is particularly evident in splenectomized patients who show these inclusions in peripheral blood

Q: Triaging is done to prioritize the treatment in case of trauma and the patients are colour coded. The yellow colour code signifies

urgent. ***urgent*** - The **yellow (urgent)** code indicates that the patient requires medical attention within a few hours, but their condition is not immediately life-threatening. - These patients are stable enough to wait for treatment after more critical patients have been addressed but still need significant care soon. *non-urgent* - **Green (non-urgent)** code is for patients with minor injuries or conditions that can wait for extended periods for treatment. - They typically have stable vital signs and minimal risk of deterioration. *immediate* - **Red (immediate)** code signifies patients with life-threatening injuries or conditions requiring immediate intervention to save life or limb. - These are the highest priority patients who need attention within minutes. *unsalvageable* - **Black (unsalvageable/deceased)** code is for patients who are either deceased or have injuries so severe that survival is unlikely even with immediate medical intervention. - These patients are given palliative care if alive, or their bodies are managed if deceased.

Q: Hypotension in an unconscious head injury patient is most commonly due to

associated injuries of abdomen or chest. ***associated injuries of abdomen or chest*** - **Hypotension** in an unconscious head injury patient is rarely caused by the head injury itself, as the brain cannot lose enough blood to cause systemic hypotension. - Therefore, other concurrent injuries, such as **intra-abdominal or intrathoracic hemorrhage**, are the most common cause of hypotension in this setting, requiring a thorough secondary survey. *intracerebral haemorrhage* - While intracerebral hemorrhage can lead to increased intracranial pressure and neurological deterioration, it generally does not cause **systemic hypotension** on its own. - The volume of bleeding within the brain is typically insufficient to result in clinically significant **blood loss** leading to shock. *extradural haemorrhage* - An extradural hematoma involves bleeding between the **dura mater** and the skull, often from a ruptured middle meningeal artery. - It primarily causes increased intracranial pressure and **neurological symptoms**, but like other cranial hemorrhages, it's not a common cause of **systemic hypotension**. *pontine haemorrhage* - A pontine hemorrhage is a severe form of stroke affecting the **brainstem**, leading to rapid neurological decline and often coma. - While devastating, its effect on blood pressure is typically through **autonomic dysfunction**, which can cause hypertension or profound bradycardia, but not usually **hypotension** due to blood loss.

Q: Preoperative investigations done prior to surgery depend upon which of the following? 1. Type of surgery 2. Patient origin 3. Patient comorbidities 4. Experience of surgeon

1. Type of surgery. ***1. Type of surgery*** - The **type of surgery** is a primary determinant of preoperative investigations, as it defines the baseline assessment needed based on the procedure's complexity, invasiveness, and physiological stress. - Minor surgeries (e.g., superficial excisions) typically require minimal investigations, while major surgeries (e.g., cardiac, neurosurgery) mandate comprehensive cardiovascular, pulmonary, and hematological workups. - **Clinical Note:** In practice, preoperative investigations depend on BOTH the surgery type AND patient comorbidities working together, but this question likely seeks the most fundamental starting point. *3. Patient comorbidities* - **Patient comorbidities** are undeniably crucial in determining the extent and nature of preoperative investigations. - A patient with diabetes, hypertension, or cardiac disease requires additional specific investigations regardless of the surgery type. - However, the surgery type establishes the baseline framework, which is then modified based on comorbidities. *2. Patient origin* - **Patient origin** (geographical location, ethnicity) is generally not a direct determinant of preoperative investigation protocols. - While certain populations may have higher prevalence of specific conditions, investigations are based on individual patient assessment, not origin. *4. Experience of surgeon* - The **experience of the surgeon** does not alter the medical necessity or standard protocols for preoperative investigations. - Patient safety standards and investigation requirements remain consistent regardless of surgical expertise level.

Question 1

A 6-year-old boy has recurrent history of pain and swelling below his left ear, which generally lasts for 3–7 days and improves mildly after a course of antibiotics. Sialography shows punctate sialectasis. He should be treated by

Accepted Answer

endoscopic washouts and antibiotics

Answer

radiotherapy

Answer

prolonged low-dose antibiotics

Answer

total conservative parotidectomy

Question 2

Which of the following scoring systems are PRIMARILY designed for assessing the severity of acute pancreatitis?

Accepted Answer

1. Ranson and Glasgow score

Answer

2. APACHE score

Answer

3. MELD score

Answer

4. Modified Marshall score

Question 3

Which of the following are the causes of retroperitoneal fibrosis?

Accepted Answer

Drugs

Answer

Lymphoma

Answer

Carcinoid tumours

Answer

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Question 4

The most common brain tumour in an adult is

Accepted Answer

cerebral metastasis

Answer

glioma

Answer

pituitary tumour

Answer

vestibular schwannoma

Question 5

Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation?

1. Raised ICP
2. Seizures
3. Hemianopia
4. Focal deficit

Accepted Answer

1. Raised ICP

Answer

3. Anopia

Answer

4. Focal deficit

Answer

2. Seizures

Question 6

The least marked function of a human spleen is

Accepted Answer

reservoir function

Answer

filter function

Answer

immune function

Answer

pitting function

Question 7

Which of the following statements regarding a patient of liver trauma are correct?

1. Liver is the most common organ injured following abdominal trauma.
2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST.
3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients.
4. Blunt injuries have a higher mortality as compared to penetrating injuries.

Accepted Answer

3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients.

Answer

1. Liver is the most common organ injured following abdominal trauma.

Answer

2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST.

Answer

4. Blunt injuries have a higher mortality as compared to penetrating injuries.

Question 8

Triaging is done to prioritize the treatment in case of trauma and the patients are colour coded. The yellow colour code signifies

Accepted Answer

urgent

Answer

non-urgent

Answer

immediate

Answer

unsalvageable

Question 9

Hypotension in an unconscious head injury patient is most commonly due to

Accepted Answer

associated injuries of abdomen or chest

Answer

intracerebral haemorrhage

Answer

extradural haemorrhage

Answer

pontine haemorrhage

Question 10

Preoperative investigations done prior to surgery depend upon which of the following?

1. Type of surgery
2. Patient origin
3. Patient comorbidities
4. Experience of surgeon

Accepted Answer

1. Type of surgery

Answer

4. Experience of surgeon

Answer

2. Patient origin

Answer

3. Patient comorbidities

UPSC-CMS 2022

ENT

Internal Medicine

Physiology

Surgery