Dermatology
1 questionsConsider the following in respect of Salmon patch : 1. It is a hemangioma. 2. Its usual site is nape of neck. 3. It is common in children. 4. It needs surgical excision. Which of the statements given above are correct ?
UPSC-CMS 2023 - Dermatology UPSC-CMS Practice Questions and MCQs
Question 111: Consider the following in respect of Salmon patch : 1. It is a hemangioma. 2. Its usual site is nape of neck. 3. It is common in children. 4. It needs surgical excision. Which of the statements given above are correct ?
- A. 1, 3 and 4
- B. 1, 2 and 4
- C. 2 and 3 (Correct Answer)
- D. 1, 2 and 3
Explanation: ***2 and 3*** - **Salmon patches**, also known as nevus simplex or stork bites, are common capillary malformations occurring in up to 70% of newborns, making them common in children. - They frequently appear on the **nape of the neck**, eyelids, glabella, and forehead. *1, 3 and 4* - Salmon patches are **capillary malformations**, not true hemangiomas, which are benign vascular tumors. - They are typically benign and resolve spontaneously, and therefore **do not require surgical excision**. *1, 2 and 4* - Salmon patches are **capillary malformations**, not hemangiomas, and are common in children and usually found on the nape of the neck. - They are benign and **do not require surgical excision**, as most fade spontaneously. *1, 2 and 3* - Salmon patches are a type of **capillary malformation**, distinct from hemangiomas. - While they are common in children and often found on the nape of the neck, they are not hemangiomas.
Internal Medicine
2 questionsWhich of the following are components of "Klippel-Trenaunay syndrome" ? 1. Cutaneous Naevus 2. Subcutaneous Lipomas 3. Varicose veins 4. Soft tissue hypertrophy Select the correct answer using the code given below :
A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is :
UPSC-CMS 2023 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 111: Which of the following are components of "Klippel-Trenaunay syndrome" ? 1. Cutaneous Naevus 2. Subcutaneous Lipomas 3. Varicose veins 4. Soft tissue hypertrophy Select the correct answer using the code given below :
- A. 1, 2 and 3
- B. 1, 3 and 4 (Correct Answer)
- C. 2, 3 and 4
- D. 1, 2 and 4
Explanation: ***1, 3 and 4*** - Klippel-Trenaunay syndrome is characterized by a triad of **capillary malformations (cutaneous naevus)**, **venous malformations (varicose veins)**, and **limb overgrowth (soft tissue hypertrophy)**. - These features are typically present at birth and often affect a single limb or a region of the body. *1, 2 and 3* - This option incorrectly includes **subcutaneous lipomas** as a core component of Klippel-Trenaunay syndrome, which are not typically associated with the condition. - While capillary malformations and varicose veins are characteristic, the inclusion of lipomas makes this option incorrect. *2, 3 and 4* - This option incorrectly includes **subcutaneous lipomas** and omits the essential feature of **cutaneous naevus (capillary malformation)**. - The absence of cutaneous naevus, a hallmark of the syndrome, makes this selection inaccurate. *1, 2 and 4* - This option incorrectly includes **subcutaneous lipomas** and omits **varicose veins**, a key component of the syndrome. - The presence of capillary malformations and soft tissue hypertrophy are correct, but the missing varicose veins and incorrect inclusion of lipomas render this option incorrect.
Question 112: A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is :
- A. Erythroplakia
- B. Oral candidiasis
- C. Leukoplakia
- D. Speckled leucoplakia (Correct Answer)
Explanation: ***Speckled leucoplakia*** - This patient, a **tobacco chewer** and **bidi smoker**, has risk factors and presents with a "white buccal mucosa with a bright red velvety plaque" (known as **speckled leukoplakia**), which is a highly suspicious lesion for **oral squamous cell carcinoma (OSCC)**, especially with symptoms like diminished mouth opening and occasional spitting of blood. - **Speckled leukoplakia** combines features of both leukoplakia (white areas) and erythroplakia (red velvety areas), and is considered the **highest risk precancerous lesion** for malignant transformation. *Erythroplakia* - Characterized by a **bright red velvety patch** that is flat or slightly depressed. - While highly suspicious for malignancy (with a 90% chance of being dysplastic or malignant), the description also includes a "white buccal mucosa," indicating a mixed white and red lesion. *Oral candidiasis* - Presents as **white, curdy patches** that can be scraped off, often revealing an erythematous base, and is typically associated with immunosuppression or antibiotic use. - It does not usually present with a persistent **red velvety component** or symptoms of diminished mouth opening indicative of malignancy. *Leukoplakia* - Defined as a **white plaque** that cannot be rubbed off and cannot be characterized as any other diagnosable disease. - Only describes the white component, while the patient's lesion also has a significant **red, velvety component**, classifying it more accurately as speckled leukoplakia.
Microbiology
1 questionsWhich one of the following statements regarding Gas Gangrene Infection is correct?
UPSC-CMS 2023 - Microbiology UPSC-CMS Practice Questions and MCQs
Question 111: Which one of the following statements regarding Gas Gangrene Infection is correct?
- A. It is caused by C. perfringens, a gram negative aerobic non-spore-forming bacilli.
- B. It is caused by C. tetani, a gram negative anaerobic non-spore-forming bacilli.
- C. It is caused by C. tetani, a gram positive anaerobic spore-forming bacilli.
- D. It is caused by C. perfringens, a gram positive anaerobic spore-forming bacilli. (Correct Answer)
Explanation: ***It is caused by C. perfringens, a gram positive anaerobic spore-forming bacilli.*** - **Gas gangrene** is primarily caused by **Clostridium perfringens**, which is a **gram-positive**, **anaerobic**, and **spore-forming bacillus**. - These characteristics allow it to thrive in low-oxygen environments characteristic of deep wounds and produce toxins that cause tissue necrosis and gas formation. *It is caused by C. perfringens, a gram negative aerobic non-spore-forming bacilli.* - This statement is incorrect because **C. perfringens** is a **gram-positive** bacterium, not gram-negative. - Furthermore, it is an **anaerobic** organism, meaning it grows in the absence of oxygen, not aerobic. *It is caused by C. tetani, a gram negative anaerobic non-spore-forming bacilli.* - This statement is incorrect because **gas gangrene** is caused by **C. perfringens**, not C. tetani (which causes tetanus). - Also, **C. tetani** is a **gram-positive** bacterium, not gram-negative, and it is **spore-forming**. *It is caused by C. tetani, a gram positive anaerobic spore-forming bacilli.* - This statement is incorrect because, as mentioned, **gas gangrene** is caused by **C. perfringens**, not **C. tetani**. - While **C. tetani** is indeed **gram-positive**, **anaerobic**, and **spore-forming**, it is the causative agent of **tetanus**, not gas gangrene.
Pathology
1 questionsThe term "Gompertzian curve" is related to which one of the following ?
UPSC-CMS 2023 - Pathology UPSC-CMS Practice Questions and MCQs
Question 111: The term "Gompertzian curve" is related to which one of the following ?
- A. Intestinal obstruction
- B. Gallstone
- C. Tumour (Correct Answer)
- D. Hernia
Explanation: ***Correct Option: Tumour*** - The **Gompertzian curve** describes the growth pattern of tumors, characterized by an initial exponential growth phase followed by a deceleration of growth as the tumor size increases - This deceleration occurs due to limiting factors like **nutrient supply, oxygen availability, and accumulation of waste products** - This model is widely used in **oncology** to understand tumor kinetics, predict responses to treatment, and explain why smaller tumors respond better to chemotherapy than larger ones - The concept is fundamental in understanding **tumor doubling time** and **fractional cell kill hypothesis** in cancer therapy *Incorrect Option: Intestinal obstruction* - **Intestinal obstruction** refers to a mechanical or functional blockage in the intestine - Its clinical course is acute and does not follow a growth curve model - The progression is determined by the degree and location of obstruction, not by cellular proliferation kinetics *Incorrect Option: Gallstone* - A **gallstone** is a hardened deposit of digestive fluid that forms in the gallbladder - Gallstone formation involves bile supersaturation and precipitation of cholesterol or bilirubin, not cellular growth - Its development does not follow the Gompertzian pattern of exponential growth followed by plateau *Incorrect Option: Hernia* - A **hernia** occurs when an organ or tissue protrudes through a weakness in the surrounding muscle or connective tissue - Hernia development is a **structural/anatomical defect**, not a process involving cellular proliferation - It does not involve growth kinetics and is unrelated to the Gompertzian curve concept
Pediatrics
1 questionsA 5-year-old male child comes with a left sided scrotal swelling which has no cough impulse and does not reduce on compression or lying down but the parents give a definite history that swelling is absent in the morning and comes by in the evening. The best treatment is :
UPSC-CMS 2023 - Pediatrics UPSC-CMS Practice Questions and MCQs
Question 111: A 5-year-old male child comes with a left sided scrotal swelling which has no cough impulse and does not reduce on compression or lying down but the parents give a definite history that swelling is absent in the morning and comes by in the evening. The best treatment is :
- A. Herniotomy (Correct Answer)
- B. Eversion of sac
- C. To leave it alone (masterly inactivity)
- D. Hernioplasty
Explanation: ***Herniotomy*** - This presentation is classic for a **communicating hydrocele** in a 5-year-old child, where peritoneal fluid accumulates in the scrotum through a **patent processus vaginalis** during the day (when upright) and drains back into the peritoneal cavity overnight (when recumbent), explaining the absence in morning and presence in evening. - The absence of cough impulse and lack of reducibility on compression distinguishes this from a typical inguinal hernia, but the fluctuating size pattern confirms communication with the peritoneal cavity. - **Management:** While communicating hydroceles may resolve spontaneously in infancy (typically by 12-18 months), **persistence beyond 2 years of age is an indication for surgical repair**. At **age 5**, surgical correction is clearly indicated. - **Herniotomy** with **high ligation of the patent processus vaginalis** is the treatment of choice. This procedure closes the communication between the peritoneal cavity and the tunica vaginalis, preventing further fluid accumulation. - The processus vaginalis is ligated at the internal inguinal ring, and the distal sac is left open to allow reabsorption of any residual fluid. *To leave it alone (masterly inactivity)* - **Observation (masterly inactivity)** is appropriate for communicating hydroceles in **infants under 12-18 months** as spontaneous closure of the processus vaginalis commonly occurs. - However, at **age 5 years**, the likelihood of spontaneous resolution is extremely low, and continued observation would be inappropriate. - Persistent patent processus vaginalis carries a risk of developing an indirect inguinal hernia, making surgical intervention the standard of care at this age. *Eversion of sac* - **Eversion of the sac** (Jaboulay's procedure) or plication (Lord's procedure) is used for **non-communicating hydroceles in adults** where the processus vaginalis is obliterated. - These procedures are **not appropriate for communicating hydroceles in children** as they do not address the underlying patent processus vaginalis. - Without ligating the patent communication, fluid will continue to accumulate from the peritoneal cavity. *Hernioplasty* - **Hernioplasty** typically refers to hernia repair with **mesh reinforcement**, which is an adult procedure. - In pediatric inguinal region surgery, mesh is generally **avoided** due to concerns about growth, tissue reaction, and long-term complications. - The pediatric approach focuses on simple high ligation of the sac (herniotomy) rather than mesh repair (hernioplasty).
Radiology
1 questions"Mickey Mouse Sign" during B-mode duplex ultrasound imaging comprises :
UPSC-CMS 2023 - Radiology UPSC-CMS Practice Questions and MCQs
Question 111: "Mickey Mouse Sign" during B-mode duplex ultrasound imaging comprises :
- A. Popliteal artery, Popliteal vein and Tibial nerve (Correct Answer)
- B. Common femoral vein, Common femoral artery and Great Saphenous vein
- C. Anterior tibial artery, Dorsalis pedis artery and Extensor hallucis tendon
- D. Brachial artery, Basilic vein and Biceps tendon
Explanation: ***Popliteal artery, Popliteal vein and Tibial nerve*** - The \"Mickey Mouse Sign\" in the **popliteal fossa** visualizes the **popliteal artery** as the \"head\" and the **popliteal vein** and **tibial nerve** as the \"ears.\" - This specific configuration is seen on **transverse B-mode ultrasound** of the popliteal fossa and is crucial for identifying neurovascular structures for **popliteal nerve blocks** and vascular assessments. - The tibial nerve is the largest branch of the sciatic nerve in the popliteal fossa and runs alongside these vessels. *Common femoral vein, Common femoral artery and Great Saphenous vein* - This is the **most commonly referenced \"Mickey Mouse Sign\"** in ultrasound, visualized in the **groin/femoral region**. - The **common femoral artery** forms the \"head\" and the **common femoral vein** and **great saphenous vein** (at its junction) form the \"ears.\" - This sign is important for **central venous access**, **femoral vessel assessment**, and **avoiding complications** during procedures. *Anterior tibial artery, Dorsalis pedis artery and Extensor hallucis tendon* - These structures are located in the **lower leg and foot**, not in a configuration that forms the Mickey Mouse sign. - They are important for assessing **peripheral vascular status** but do not constitute this specific ultrasound landmark. *Brachial artery, Basilic vein and Biceps tendon* - These are structures found in the **upper arm**. - While important for upper extremity vascular imaging, they do not form the \"Mickey Mouse Sign\" pattern on ultrasound.
Surgery
3 questionsA 25-year-old gentleman complains of dragging pain in the scrotum. The examination reveals the scrotum full of bag of worms which disappear on lying down. The usual first line option for relief is :
A malnourished 60-year-old man underwent emergency surgery for Strangulated Sigmoid Volvulus. After resection of the sigmoid colon, a colostomy was fashioned. The postoperative period was stormy and he developed a painful calf swelling in right lower limb. The most probable diagnosis is :
Which of the following statements regarding Thyroglossal duct are correct ? 1. It is situated in midline of neck. 2. It moves upwards on swallowing but not on tongue protrusion. 3. It is treated with Sistrunk operation. 4. It may be the only functioning thyroid tissue in the body. Select the correct answer using the code given below :
UPSC-CMS 2023 - Surgery UPSC-CMS Practice Questions and MCQs
Question 111: A 25-year-old gentleman complains of dragging pain in the scrotum. The examination reveals the scrotum full of bag of worms which disappear on lying down. The usual first line option for relief is :
- A. Surgical varicocelectomy (ligation of testicular veins) (Correct Answer)
- B. Radio frequency ablation of testicular veins
- C. Percutaneous embolization of gonadal veins
- D. Laparoscopic excision of affected testes
Explanation: ***Surgical varicocelectomy (ligation of testicular veins)*** - The "bag of worms" sensation that disappears on lying down is **pathognomonic for varicocele**, representing dilated pampiniform plexus veins - **Varicocelectomy** (surgical ligation of the internal spermatic/testicular veins) is the **gold standard first-line treatment** for symptomatic varicoceles causing pain or infertility - Common approaches include **open (Palomo or Ivanissevich technique)**, **laparoscopic**, or **microscopic subinguinal** varicocelectomy with success rates of 90-95% - The procedure involves **ligation** (tying off) the dilated veins, not excision of the entire pampiniform plexus *Radio frequency ablation of testicular veins* - **Radiofrequency ablation** is not a standard treatment modality for varicoceles - The testicular veins are not amenable to standard RFA techniques used for other venous insufficiencies - This is **not considered a first-line option** in clinical practice *Percutaneous embolization of gonadal veins* - **Percutaneous embolization** is an alternative **minimally invasive first-line treatment** option for symptomatic varicoceles, particularly in resource-rich settings - Success rates are comparable to surgery (90-95%) with potentially lower complication rates and faster recovery - However, in the context of **traditional Indian surgical practice** and most PG examinations, **surgical varicocelectomy remains the conventional first-line answer** - Embolization involves retrograde catheterization and occlusion of the testicular vein with coils or sclerosants *Laparoscopic excision of affected testes* - **Orchiectomy** (testicular excision) is completely inappropriate for varicocele management - This radical procedure is reserved for **testicular malignancy**, severe trauma with non-viable testis, or torsion with necrosis - **Never a treatment option** for simple symptomatic varicocele
Question 112: A malnourished 60-year-old man underwent emergency surgery for Strangulated Sigmoid Volvulus. After resection of the sigmoid colon, a colostomy was fashioned. The postoperative period was stormy and he developed a painful calf swelling in right lower limb. The most probable diagnosis is :
- A. Myocardial failure due to fluid overload
- B. Deep vein thrombosis (Correct Answer)
- C. Oedema of renal failure
- D. Hypoproteinaemia
Explanation: ***Deep vein thrombosis*** - Postoperative patients, especially those undergoing **abdominal surgery** and those with **malnutrition**, are at high risk for **deep vein thrombosis (DVT)** due to Virchow's triad (venous stasis, endothelial injury, hypercoagulability). - A **painful calf swelling** is a classic symptom of DVT, indicating clot formation within the deep veins of the leg. *Myocardial failure due to fluid overload* - While fluid overload can occur post-surgery, it typically leads to **generalized edema**, shortness of breath, and signs of cardiac dysfunction, not isolated painful calf swelling. - The primary presentation here is a localized, painful swelling, which is less consistent with systemic cardiac issues. *Oedema of renal failure* - **Renal failure** can cause **edema**, but it tends to be **pitting, bilateral, and generalized**, often affecting the ankles and sacral areas. - It would not typically present as a painful, unilateral calf swelling without other signs of kidney dysfunction. *Hypoproteinaemia* - **Hypoproteinaemia**, common in **malnourished** individuals, can cause **generalized non-pitting edema** due to decreased oncotic pressure, not specifically a painful calf swelling. - It would manifest as widespread edema rather than a localized, painful swelling indicative of a thrombotic event.
Question 113: Which of the following statements regarding Thyroglossal duct are correct ? 1. It is situated in midline of neck. 2. It moves upwards on swallowing but not on tongue protrusion. 3. It is treated with Sistrunk operation. 4. It may be the only functioning thyroid tissue in the body. Select the correct answer using the code given below :
- A. 1, 3 and 4 (Correct Answer)
- B. 1, 2 and 3
- C. 2, 3 and 4
- D. 1, 2 and 4
Explanation: ***1, 3 and 4*** - The **thyroglossal duct** is embryological remnant located in the **midline of the neck** and often presents as a cyst. - The **Sistrunk operation** is the definitive surgical treatment for **thyroglossal duct cysts**, involving removal of the cyst, the midline portion of the hyoid bone, and the tract to the foramen cecum. - In some cases, a **thyroglossal duct cyst** may harbor the patient's only functional **thyroid tissue**, making preoperative imaging crucial to avoid inadvertently causing hypothyroidism. *1, 2 and 3* - This option incorrectly states that the thyroglossal duct moves upwards only on swallowing and not on **tongue protrusion**. - In fact, its connection to the foramen cecum at the base of the tongue means it **elevates with tongue protrusion** as well as swallowing. *2, 3 and 4* - This option incorrectly states that the **thyroglossal duct** moves upwards only on swallowing and not on **tongue protrusion**. - The **midline location** (statement 1) is a key characteristic of thyroglossal duct remnants and is correctly included in the comprehensive correct option. *1, 2 and 4* - This option incorrectly claims that the thyroglossal duct moves upwards only on swallowing and not on **tongue protrusion**. - It also omits the **Sistrunk operation** (statement 3), which is the standard surgical treatment for **thyroglossal duct cysts**.