UPSC-CMS 2023 Practice Questions

Q: The inferior rectal artery is a branch of :

Internal pudendal artery. ***Internal pudendal artery*** - The **inferior rectal artery** is a key branch of the **internal pudendal artery**, supplying blood to the anal canal below the pectinate line. - This artery typically arises in the **ischioanal fossa** (also known as the ischiorectal fossa), providing vascularization to the external anal sphincter and perineal skin. *Inferior mesenteric artery* - The **inferior mesenteric artery** is responsible for supplying large intestine structures from the distal transverse colon to the superior part of the rectum [1]. - Its main branches are the **left colic artery**, **sigmoid arteries**, and **superior rectal artery**, none of which directly give rise to the inferior rectal artery [1]. *Internal iliac artery* - The **internal iliac artery** is a large artery that supplies many pelvic organs and the perineum; it gives off the **internal pudendal artery** as one of its terminal branches. - While it is the source of the internal pudendal artery, it does not directly branch into the inferior rectal artery. *Median sacral artery* - The **median sacral artery** is a small, unpaired artery that arises from the posterior aspect of the abdominal aorta just above its bifurcation. - It supplies structures in the posterior pelvic wall, such as the sacrum, coccyx, and adjacent posterior muscles but has no direct connection to the inferior rectal artery.

Q: Which of the following statements with regard to Meckel's Diverticulum are correct? 1. It represents a persistent remnant of the vitellointestinal duct. 2. It is a true diverticulum of gastrointestinal tract. 3. It is most commonly found on anti-mesenteric border of ileum. 4. Heterotopic mucosa is present in 50-60% of patients. Select the correct answer using the code given below:

1, 2 and 3. ***Option: 1, 2 and 3 (Correct Answer)*** - **Statement 1 is correct:** Meckel's diverticulum is a **congenital anomaly** resulting from incomplete obliteration of the **vitellointestinal (vitelline) duct**, which connects the midgut to the yolk sac during embryonic development [1]. - **Statement 2 is correct:** It is a **true diverticulum** because it contains all three layers of the intestinal wall: mucosa, submucosa, and muscularis propria (unlike false diverticula which only contain mucosa and submucosa). - **Statement 3 is correct:** It arises from the **anti-mesenteric border of the ileum**, typically within 60-100 cm proximal to the ileocecal valve [1]. - **Statement 4 is incorrect:** Heterotopic mucosa (most commonly gastric mucosa, followed by pancreatic tissue) is present in approximately **20-30% of all Meckel's diverticula**. The 50-60% figure applies specifically to **symptomatic cases**, not all patients with the condition [1]. *Option: 1, 3 and 4* - While statements 1 and 3 are correct, statement 4 overstates the prevalence of heterotopic mucosa in the general population with Meckel's diverticulum [1]. - Additionally, this option excludes statement 2, which is definitively correct and represents an essential characteristic of Meckel's as a true diverticulum. *Option: 1, 2 and 4* - Statements 1 and 2 are correct, but statement 4's percentage for heterotopic mucosa (50-60%) is too high for the overall population [1]. - The actual prevalence of heterotopic mucosa is **20-30% in all cases**, though it is found in the majority of symptomatic presentations. *Option: 1 and 3* - While statements 1 and 3 are correct, this option incorrectly excludes statement 2. - Statement 2 is unequivocally correct: Meckel's is a **true diverticulum** with all intestinal wall layers, which distinguishes it from false diverticula.

Q: Which of the following are correct regarding Trichobezoar ? 1. It is a hair ball in the stomach. 2. It is common in psychiatric patients. 3. Common complications are bleeding, perforation or obstruction. 4. Treated with long course of proton pump inhibitors. Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - A **trichobezoar** is indeed a mass of undigested hair found in the gastrointestinal tract, most commonly in the **stomach**. [1] - It is frequently associated with **psychiatric conditions** such as trichotillomania (compulsive hair pulling) and trichophagia (compulsive hair eating), leading to its occurrence predominantly in psychiatric patients. Common complications include **gastrointestinal bleeding**, **perforation**, and **obstruction** due to the size and abrasive nature of the hairball. [1] *2, 3 and 4* - While trichobezoars are common in psychiatric patients and can lead to bleeding, perforation, or obstruction, the treatment is typically **surgical removal** or **endoscopic fragmentation**, not long-term proton pump inhibitors (PPIs). - PPIs are used to reduce gastric acid, which is not the primary treatment for a physical obstruction like a trichobezoar. *1, 3 and 4* - Although a trichobezoar is a hairball in the stomach and can cause bleeding, perforation, or obstruction, the statement about treatment with a long course of **proton pump inhibitors (PPIs)** is incorrect. - PPIs would not resolve a physical mass like a trichobezoar, which usually requires removal. *1, 2 and 4* - While trichobezoars are stomach hairballs and are more prevalent in psychiatric patients, and long-term **proton pump inhibitors (PPIs)** are not a primary treatment for trichobezoars. - The correct management involves physical removal rather than acid suppression.

Q: Zollinger Ellison syndrome is characterized by which of the following ?

Non-beta islet cell tumour of pancreas. ***Non-beta islet cell tumour of pancreas*** - **Zollinger-Ellison syndrome (ZES)** is caused by a **gastrin-secreting tumor** (gastrinoma), which is a type of **non-beta islet cell tumor** of the pancreas or duodenum. - This gastrinoma leads to excessive gastric acid secretion [1]. *Recurrent ulceration despite treatment* - While **recurrent ulceration** is a prominent symptom of ZES due to hypersecretion of gastric acid, it is a *consequence* of the underlying disease rather than its defining characteristic or cause. - The persistence of ulcers despite standard anti-secretory therapy is a strong clinical indicator that points towards ZES [1]. *Recurrent episodes of dysentery* - **Dysentery** is characterized by bloody diarrhea, often caused by bacterial infections, and is not a typical or primary feature of Zollinger-Ellison syndrome. - While severe diarrhea can occur in ZES due to inactivation of pancreatic enzymes and damage to intestinal mucosa from excessive acid, it is not described as dysentery. *Fulminating gastric ulcers* - Gastric ulcers in ZES can be severe and numerous, but the term "fulminating" typically implies a rapid onset, severe, and aggressive course, often seen in conditions like *H. pylori*-associated ulcers with complications. - While ulcers in ZES are often refractory and severe, the defining characteristic of the syndrome is the gastrinoma itself, not merely the severity of ulcers.

Q: Which one of the following statements regarding Inflammatory Bowel Disease is correct ?

Perianal disease is common in Crohn's disease.. ***Perianal disease is common in Crohn's disease.*** [1] - **Crohn's disease** is characterized by **transmural inflammation** that involves all layers of the bowel wall, leading to complications like **fistulas, strictures, and perianal disease** [2]. - **Perianal disease** manifestations include **fissures, fistulas, abscesses**, and skin tags, and it is a defining characteristic of Crohn's [2]. *Stricture formation is common in Ulcerative Colitis.* - **Stricture formation** is generally **uncommon in uncomplicated ulcerative colitis** but can occur in severe, long-standing disease. - **Strictures** are more characteristic of **Crohn's disease** due to its transmural inflammation and fibrotic changes [3]. *Fistula formation is common in Ulcerative Colitis.* - **Fistula formation** is a hallmark of **Crohn's disease**, resulting from the deep, transmural inflammation that penetrates the bowel wall [2]. - **Ulcerative colitis** inflammation is typically **mucosal and superficial**, making fistula formation rare in this condition [1]. *Rectum is always involved in Crohn's disease.* - While **Crohn's disease** can affect any part of the gastrointestinal tract from mouth to anus, skip lesions are common, and the **rectum is often spared** [1]. - In contrast, **ulcerative colitis always involves the rectum**, extending proximally in a continuous fashion [1].

Q: Which of the following statements are correct with regard to Familial Adenomatous Polyposis ? 1. It is associated with mutation of APC gene located on the long arm of chromosome 5. 2. It is inherited as an autosomal recessive condition. 3. It is associated with 100% lifetime risk for development of Colorectal carcinoma. 4. Congenital hypertrophy of retinal pigment epithelium is present in half of the cases of familial adenomatous polyposis. Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - Familial Adenomatous Polyposis is indeed associated with a mutation in the **APC gene** located on the **short arm of chromosome 5 (5q21-q22)** and carries a **nearly 100% lifetime risk** of developing colorectal carcinoma if left untreated [1]. - **Congenital hypertrophy of the retinal pigment epithelium (CHRPE)**, also known as bear claw lesions, is a characteristic extracolonic manifestation observed in approximately half of FAP patients, though it does not usually affect vision. *1, 2 and 3* - This option is incorrect because FAP is inherited as an **autosomal dominant** condition, not autosomal recessive. - Statement 2, claiming autosomal recessive inheritance, is false, rendering this combination incorrect. *2, 3 and 4* - This option incorrectly states that FAP is inherited as an **autosomal recessive** condition. It is an autosomal dominant disorder. - While statements 3 and 4 are correct, the inclusion of statement 2 makes this option invalid. *1, 2 and 4* - This option is incorrect due to the assertion that FAP is an **autosomal recessive** condition (statement 2). - FAP is correctly linked to the APC gene mutation (statement 1) and CHRPE (statement 4), but the inheritance pattern given here is wrong. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822.

Q: "Collar-stud" abscess is seen in :

Tuberculosis. ***Tuberculosis*** - A "**collar-stud**" abscess is a classic presentation of **tuberculous lymphadenitis**, particularly in the neck. - This type of abscess forms when pus from an infected deep lymph node erodes through the deep fascia but is contained by the superficial fascia, creating a dumbbell or "collar-stud" shape. *Lymphomatous degeneration* - **Lymphomatous degeneration** refers to the transformation of a benign lymphoid process into lymphoma. - While lymph nodes are involved, it typically presents as **lymphadenopathy** (enlargement of lymph nodes) and does not characteristically form an abscess with this specific morphology. *Pseudomonas infection* - **Pseudomonas infections** can cause abscesses, especially in immunocompromised individuals or associated with contaminated wounds or medical devices. - However, they do not specifically form a "**collar-stud**" abscess, which is a hallmark of tuberculous infection of lymph nodes. *Streptococcal infection* - **Streptococcal infections** frequently cause cellulitis, erysipelas, and various forms of abscesses, such as peritonsillar or skin abscesses. - While streptococci can cause **suppurative lymphadenitis**, they do not typically produce the distinctive "**collar-stud**" morphology seen in tuberculosis.

Q: The best cosmetic result following breast reconstruction is achieved with :

Transverse rectus abdominis myocutaneous flap. ***Transverse rectus abdominis myocutaneous flap*** - The **TRAM flap** offers excellent aesthetic outcomes by utilizing the patient's own **abdominal tissue**, providing a natural look and feel that mimics breast tissue. - This method results in a soft, pliable breast mound with good long-term stability and can provide a **simultaneous abdominoplasty** effect. *Latissimus dorsi flap* - While a viable option, the **latissimus dorsi flap** is typically smaller and may require an **implant** to achieve adequate breast volume, potentially leading to a less natural result than a TRAM flap. - It uses tissue from the back, which can leave a noticeable scar and may cause **weakness in the shoulder** or back. *Silicone gel implant with reconstruction* - Implants can provide good cosmetic results but carry risks such as **capsular contracture**, rupture, and the need for future revisions, which can affect long-term satisfaction. - They do not offer the same **natural feel or warmth** as autologous tissue reconstruction, as the reconstructed breast is not made of living tissue. *Acellular dermal matrix flap* - **Acellular dermal matrix (ADM)** is often used as an adjunct in implant-based reconstruction to support and reinforce the breast tissue, rather than as a primary reconstructive flap for optimal cosmetic results. - While it aids in tissue expansion and support, it does not provide the **volume or natural contour** that an autologous flap like the TRAM can achieve on its own.

Q: Which of the following statements with regard to Colorectal Carcinoma are correct ? 1. Left-sided Colorectal Carcinoma presents with bleeding per rectum. 2. Right-sided Colorectal Carcinoma presents with iron deficiency anaemia. 3. Right-sided Colorectal Carcinoma is more common as compared to the left-sided Colorectal Carcinoma. 4. Colonoscopy is the investigation of choice for suspected Colorectal Carcinoma. Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 4*** - **Left-sided colorectal carcinoma** often presents with **bleeding per rectum** due to its proximity to the anus [1]. - **Right-sided colorectal carcinoma** is more likely to cause insidious blood loss, leading to **iron deficiency anemia** [1]. - **Colonoscopy** is considered the **gold standard** for diagnosing colorectal carcinoma due to its ability to visualize the entire colon and allow for biopsy [1]. *2, 3 and 4* - While statements 2 and 4 are correct, statement 3 is incorrect. **Left-sided colorectal carcinoma is more common** than right-sided colorectal carcinoma [1]. - Right-sided lesions more generally cause anemia, and colonoscopy is the appropriate investigation of choice [1]. *1, 2 and 3* - Statements 1 and 2 are correct. However, statement 3 is incorrect; **left-sided colorectal carcinoma has a higher incidence** compared to right-sided colorectal carcinoma [1]. - Bleeding per rectum is characteristic of left-sided lesions while iron deficiency anemia for right-sided lesions [1]. *1, 3 and 4* - While statements 1 and 4 are correct, statement 3 is incorrect. **Left-sided colorectal carcinoma is more prevalent** than right-sided colorectal carcinoma [1]. - Clinical presentation with bleeding per rectum is typical for left-sided cancers, and colonoscopy is the definitive diagnostic tool [1].

Q: While managing oesophageal perforations, which of the following factors favour non-operative management? 1. Perforation by a flexible endoscope 2. Contained perforation without free communication 3. Perforation with a small septic load 4. Perforation of the abdominal oesophagus Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - **Perforation by a flexible endoscope** often results in smaller, less destructive perforations due to the instrument's flexibility, making non-operative management feasible if other favorable conditions are met. - **Contained perforation without free communication** implies that the leak is localized and not actively spreading into surrounding tissues, reducing the risk of widespread mediastinitis or peritonitis. - **Perforation with a small septic load** indicates minimal contamination, which simplifies management and improves the chances of successful non-operative treatment through antibiotics and supportive care. *1, 3 and 4* - This option correctly identifies factors 1 and 3, but **perforation of the abdominal esophagus** is generally treated surgically due to the high risk of widespread peritonitis and severe sepsis. - While smaller perforations are more manageable, the anatomical location in the abdominal cavity predisposes to rapid and severe contamination. *2, 3 and 4* - This option correctly includes factors 2 and 3 that favor non-operative management but incorrectly suggests that **perforation of the abdominal esophagus** is managed non-operatively. - The high risk of peritonitis from an abdominal oesophageal perforation often necessitates surgical intervention to prevent severe complications. *1, 2 and 4* - This option correctly identifies factors 1 and 2 but mistakenly includes **perforation of the abdominal esophagus** as a factor favoring non-operative management. - Abdominal oesophageal perforations are high-risk situations generally requiring early surgical repair to prevent life-threatening complications.

Question 1

The inferior rectal artery is a branch of :

Accepted Answer

Internal pudendal artery

Answer

Inferior mesenteric artery

Answer

Internal iliac artery

Answer

Median sacral artery

Question 2

Which of the following statements with regard to Meckel's Diverticulum are correct?

1. It represents a persistent remnant of the vitellointestinal duct.
2. It is a true diverticulum of gastrointestinal tract.
3. It is most commonly found on anti-mesenteric border of ileum.
4. Heterotopic mucosa is present in 50-60% of patients.

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1 and 3

Question 3

Which of the following are correct regarding Trichobezoar ?

1. It is a hair ball in the stomach.

2. It is common in psychiatric patients.

3. Common complications are bleeding, perforation or obstruction.

4. Treated with long course of proton pump inhibitors.

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Question 4

Zollinger Ellison syndrome is characterized by which of the following ?

Accepted Answer

Non-beta islet cell tumour of pancreas

Answer

Recurrent ulceration despite treatment

Answer

Recurrent episodes of dysentery

Answer

Fulminating gastric ulcers

Question 5

Which one of the following statements regarding Inflammatory Bowel Disease is correct ?

Accepted Answer

Perianal disease is common in Crohn's disease.

Answer

Stricture formation is common in Ulcerative Colitis.

Answer

Fistula formation is common in Ulcerative Colitis.

Answer

Rectum is always involved in Crohn's disease.

Question 6

Which of the following statements are correct with regard to Familial Adenomatous Polyposis ?

1. It is associated with mutation of APC gene located on the long arm of chromosome 5.
2. It is inherited as an autosomal recessive condition.
3. It is associated with 100% lifetime risk for development of Colorectal carcinoma.
4. Congenital hypertrophy of retinal pigment epithelium is present in half of the cases of familial adenomatous polyposis.

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 7

"Collar-stud" abscess is seen in :

Accepted Answer

Tuberculosis

Answer

Lymphomatous degeneration

Answer

Pseudomonas infection

Answer

Streptococcal infection

Question 8

The best cosmetic result following breast reconstruction is achieved with :

Accepted Answer

Transverse rectus abdominis myocutaneous flap

Answer

Latissimus dorsi flap

Answer

Silicone gel implant with reconstruction

Answer

Acellular dermal matrix flap

Question 9

Which of the following statements with regard to Colorectal Carcinoma are correct ?

1. Left-sided Colorectal Carcinoma presents with bleeding per rectum.
2. Right-sided Colorectal Carcinoma presents with iron deficiency anaemia.
3. Right-sided Colorectal Carcinoma is more common as compared to the left-sided Colorectal Carcinoma.
4. Colonoscopy is the investigation of choice for suspected Colorectal Carcinoma.

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 10

While managing oesophageal perforations, which of the following factors favour non-operative management?

1. Perforation by a flexible endoscope

2. Contained perforation without free communication

3. Perforation with a small septic load

4. Perforation of the abdominal oesophagus

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 4

UPSC-CMS 2023

Anatomy

Internal Medicine

Pathology

Surgery