UPSC-CMS 2023 - General Medicine PYQs Practice Questions

Q: The complications of prolonged parenteral hyperalimentation may include the following except

Hyperphosphataemia. ***Hyperphosphataemia*** - **Hypophosphatemia** is a common complication of prolonged parenteral hyperalimentation (TPN), particularly during refeeding syndrome, due to increased cellular uptake of phosphate for ATP synthesis [1]. - **Hyperphosphatemia** is rare in TPN unless there is significant renal impairment or excessive phosphate administration, which is usually avoided. *Hyperosmolar acidosis* - This can occur with total parenteral nutrition (TPN) if the **glucose load is too high** or if the patient has underlying impaired glucose tolerance [1]. - The high glucose acts as an **osmotic diuretic**, leading to dehydration and metabolic acidosis [1]. *Hyperammonaemia* - This is a potential complication, especially with **excessive amino acid administration** in patients with liver dysfunction or immature liver enzymes (e.g., neonates). - The inability to adequately metabolize ammonia can lead to **encephalopathy**. *Cholestatic jaundice* - Prolonged TPN is a recognized cause of **TPN-associated liver disease**, which can manifest as cholestatic jaundice. - The etiology is multifactorial, involving factors such as **lack of enteral stimulation**, hepatotoxic components in TPN solutions, and altered bile flow. [Practice more General Medicine PYQs on OnCourse]

Q: The best position to palpate the minimal enlargement of spleen is :

Supine with lower limbs extended. ***Supine with lower limbs extended*** - This position allows for optimal relaxation of the abdominal muscles, making it easier to **palpate the spleen** as it descends during inspiration. - In a supine position, the examiner can effectively use techniques like the **hooking method** or palpation from the right side of the patient to detect minimal splenic enlargement. *Bimanual palpation in supine position* - While bimanual palpation is useful for organs like the kidneys, it is generally less effective for detecting minimal splenic enlargement compared to other specialized techniques. - The goal is to feel the spleen as it descends, which is better achieved with precise contact during inspiration rather than a bimanual 'capture'. *Palpation of left subcostal area in right lateral decubitus position* - The **right lateral decubitus position** (Lieper's or Opeczky's position) is indeed used to make a slightly enlarged spleen more prominent by shifting it anteriorly and inferiorly. - However, while helpful for a potentially palpable spleen, the combined supine position with relaxed abdominal muscles can be overall more sensitive for **minimal enlargement** when initially assessing. *Palpation of left subcostal area in knee-elbow position* - The knee-elbow position is primarily used for rectal or vaginal examinations and is not suitable for abdominal palpation, especially for organs like the spleen. - It would make abdominal muscle contraction more likely, hindering effective palpation of the left subcostal area. [Practice more General Medicine PYQs on OnCourse]

Question 1

The complications of prolonged parenteral hyperalimentation may include the following except

Accepted Answer

Hyperphosphataemia

Answer

Hyperosmolar acidosis

Answer

Hyperammonaemia

Answer

Cholestatic jaundice

Question 2

The best position to palpate the minimal enlargement of spleen is :

Accepted Answer

Supine with lower limbs extended

Answer

Bimanual palpation in supine position

Answer

Palpation of left subcostal area in right lateral decubitus position

Answer

Palpation of left subcostal area in knee-elbow position

UPSC-CMS 2023 — General Medicine