Anesthesiology
2 questionsThe commonly used muscle relaxant with quickest onset of action and spontaneous recovery is :
Mallampati test is used for the assessment of :
UPSC-CMS 2025 - Anesthesiology UPSC-CMS Practice Questions and MCQs
Question 121: The commonly used muscle relaxant with quickest onset of action and spontaneous recovery is :
- A. Vecuronium
- B. Rocuronium
- C. Suxamethonium (Correct Answer)
- D. Atracurium
Explanation: ***Suxamethonium*** - Suxamethonium (succinylcholine) is a **depolarizing neuromuscular blocker** with the most rapid onset of action (30-60 seconds) due to its unique mechanism. - Its short duration of action and **spontaneous recovery** are due to its rapid hydrolysis by **plasma pseudocholinesterase**, making it ideal for rapid sequence intubation. *Vecuronium* - Vecuronium is an **intermediate-duration non-depolarizing neuromuscular blocker** with an onset of action typically around 3-5 minutes, which is slower than suxamethonium. - It does not undergo spontaneous recovery as rapidly as suxamethonium and often requires administration of a **reversal agent**. *Rocuronium* - Rocuronium is a **non-depolarizing neuromuscular blocker** known for its relatively rapid onset of action (60-90 seconds) among non-depolarizing agents, but it is still slower than suxamethonium. - While it can be reversed quickly with sugammadex, its **spontaneous recovery** is much slower than suxamethonium. *Atracurium* - Atracurium is an **intermediate-duration non-depolarizing neuromuscular blocker** with an onset of action (3-5 minutes) that is slower than suxamethonium. - Its metabolism involves **Hofmann elimination** and ester hydrolysis, providing a degree of organ-independent elimination, but its recovery is not as rapid or spontaneous as suxamethonium.
Question 122: Mallampati test is used for the assessment of :
- A. Tongue size
- B. Airway (Correct Answer)
- C. Ability to protrude jaw
- D. Breath hold time
Explanation: ***Airway*** - The **Mallampati test** is a widely used bedside test to assess the **visibility of the soft palate, uvula, tonsillar pillars, and tongue** within the oral cavity. - This assessment helps in predicting the **ease of intubation** and the potential for a difficult airway during anesthesia. *Tongue size* - While the Mallampati test indirectly considers the relative size of the tongue by visualizing how much of the pharynx it obstructs, its primary purpose is not to quantify **tongue size** independently. - The test assesses the **overall oral cavity geometry** for airway management, not just a single anatomical dimension. *Ability to protrude jaw* - The ability to protrude the jaw, or **mandibular protrusion**, is a different airway assessment parameter used to evaluate potential difficulty with intubation. - It is often assessed with the **upper lip bite test** or other maneuvers, not the Mallampati classification. *Breath hold time* - **Breath-hold time** is a measure related to respiratory function and patient cooperation, and it has no direct relevance to the Mallampati test. - The Mallampati test is a **visual assessment** of oral pharyngeal structures at rest or with phonation, not a dynamic respiratory measurement.
Community Medicine
1 questionsA surgical department of a premier medical college conducted a study on rates of post-operative wound infection. The results of the study were negative for the proposed hypothesis. What should the department do with the results?
UPSC-CMS 2025 - Community Medicine UPSC-CMS Practice Questions and MCQs
Question 121: A surgical department of a premier medical college conducted a study on rates of post-operative wound infection. The results of the study were negative for the proposed hypothesis. What should the department do with the results?
- A. Label them as worthless
- B. Redo the study with a new hypothesis
- C. Report the negative results (Correct Answer)
- D. Redesign the study and increase the sample size
Explanation: **Report the negative results** - All research findings, whether positive or negative, contribute to the body of scientific knowledge and should be **ethically reported** to prevent publication bias. - Reporting negative results helps other researchers avoid duplicating efforts and can inform future study designs, potentially leading to a better understanding of the topic. *Label them as worthless* - Labeling negative results as "worthless" contradicts the principles of **scientific integrity** and promotes publication bias, where only positive findings are disseminated. - Even negative findings can provide crucial insights, indicating that a particular intervention or hypothesis is not supported, thus saving time and resources for future research. *Redo the study with a new hypothesis* - While forming new hypotheses may be necessary in some cases, redoing the study with a completely new hypothesis without reporting the initial negative results would be **unethical** and contribute to the problem of **publication bias**. - **New hypotheses** should ideally be formulated based on a comprehensive understanding of existing research, including negative findings. *Redesign the study and increase the sample size* - While redesigning the study and increasing sample size might be appropriate after the initial results have been reported and analyzed, the **immediate and ethical step** is to report the existing negative findings. - A larger sample size alone does not guarantee positive results; careful reevaluation of the methods and hypothesis is needed if the initial study was well-conducted.
Forensic Medicine
2 questionsIf faced with a surgical emergency in a child of 15 years for whom no consent is available for life-saving surgery and no time for seeking authority from someone, the next step should be :
Which of the following information needs to be disclosed in order to establish valid consent for surgical treatment? I. Condition and reasons why it warrants surgery II. Type of surgery proposed III. Unexpected hazards of proposed surgery IV. The surgical experience and expertise of the operating surgeon Select the correct answer using the code given below :
UPSC-CMS 2025 - Forensic Medicine UPSC-CMS Practice Questions and MCQs
Question 121: If faced with a surgical emergency in a child of 15 years for whom no consent is available for life-saving surgery and no time for seeking authority from someone, the next step should be :
- A. Conservative management till lawyer is available
- B. Consent arrangement through Hospital Social Worker
- C. Go ahead with surgery without consent (Correct Answer)
- D. Search for relatives or neighbours
Explanation: ***Go ahead with surgery without consent*** - In a **life-threatening emergency**, when a child's life is at stake and there is no time to obtain consent from parents or legal guardians, the **principle of implied consent** or necessity overrides the need for explicit consent. - The primary ethical and legal responsibility is to save the patient's life, and delaying surgery for consent could be considered **negligent** and harmful. *Conservative management till lawyer is available* - Delaying life-saving surgery in an emergency for legal consultation would be a breach of the **duty of care** and could result in the child's death. - The immediate priority in a surgical emergency is to provide the necessary medical intervention, not to seek legal advice on consent. *Consent arrangement through Hospital Social Worker* - While a hospital social worker can assist in locating family or arranging consent in non-emergent situations, the question specifies "no time for seeking authority from someone" and a "surgical emergency." - This option would still involve a delay that could be fatal in a life-saving scenario. *Search for relatives or neighbours* - This option directly contradicts the premise that there is "no time for seeking authority from someone" for life-saving surgery. - While efforts should be made to contact guardians, in a dire emergency, the **immediate medical intervention** takes precedence over searching for individuals who can provide consent.
Question 122: Which of the following information needs to be disclosed in order to establish valid consent for surgical treatment? I. Condition and reasons why it warrants surgery II. Type of surgery proposed III. Unexpected hazards of proposed surgery IV. The surgical experience and expertise of the operating surgeon Select the correct answer using the code given below :
- A. II, III and IV
- B. I, II and IV
- C. I, II and III (Correct Answer)
- D. I, III and IV
Explanation: ***I, II and III*** - **Valid consent** requires the full disclosure of the **patient's condition and indication for surgery**, the **proposed surgical treatment**, and its **material risks and potential complications** (including unexpected hazards). - This ensures the patient has sufficient information to make an **informed decision** about their care. - These three elements form the **core requirements** for informed consent under traditional medical-legal principles. *II, III and IV* - While the type of surgery, risks, and surgeon's experience are relevant, omitting information about the **patient's underlying condition** and the reasons for surgery renders the consent incomplete. - A patient cannot make an informed choice without understanding **why the surgery is being performed** in relation to their health. *I, II and IV* - This option omits **"unexpected hazards/material risks of proposed surgery,"** which are crucial for true informed consent. - Patients must be aware of potential complications to weigh the **benefits and risks** adequately. - Disclosure of risks is a **fundamental requirement** for valid consent. *I, III and IV* - This option fails to include information about the **"type of surgery proposed,"** which is fundamental to understanding the planned procedure. - Without knowing the specific surgical intervention, the patient cannot provide **meaningful consent**. - Note: While disclosure of surgeon's experience is increasingly recognized in modern practice, it is **not traditionally considered a mandatory element** for valid consent in most jurisdictions.
Internal Medicine
2 questionsWhich of the following are correct regarding late dumping? I. It usually occurs during the second hour after meal. II. It lasts for 30-40 minutes. III. Major symptoms are tremor, faintness, prostration IV. It is relieved by lying down. Select the answer using the code given below :
Which one of the following statements is not correct regarding Gastric outlet obstruction associated with long standing peptic ulcer disease?
UPSC-CMS 2025 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 121: Which of the following are correct regarding late dumping? I. It usually occurs during the second hour after meal. II. It lasts for 30-40 minutes. III. Major symptoms are tremor, faintness, prostration IV. It is relieved by lying down. Select the answer using the code given below :
- A. I, III and IV
- B. II, III and IV
- C. I, II and III (Correct Answer)
- D. I, II and IV
Explanation: ***I, II and III*** - Late dumping syndrome typically manifests **1 to 3 hours after a meal** (usually around the second hour), triggered by rapid carbohydrate absorption leading to hyperinsulinemia and subsequent hypoglycemia. - The symptoms, which include **tremor, faintness, prostration, sweating, and confusion**, are due to hypoglycemia and usually last for **30-60 minutes**. *I, III and IV* - This option is incorrect because lying down generally **does not relieve symptoms** of late dumping syndrome; instead, consuming a small amount of sugar or glucose is recommended to raise blood glucose levels. - While I and III are correct, the inclusion of IV makes this option incorrect. *II, III and IV* - This option is incorrect because statement IV, suggesting relief by lying down, is **false** for late dumping syndrome. - Additionally, statement I "It usually occurs during the second hour after meal" is an accurate description of late dumping, which this option omits. *I, II and IV* - This option is incorrect because statement IV, which claims symptoms are relieved by lying down, is **inaccurate** for late dumping syndrome. - While I and II are correct, the inclusion of IV makes this option incorrect regarding the characteristic management or relief of late dumping.
Question 122: Which one of the following statements is not correct regarding Gastric outlet obstruction associated with long standing peptic ulcer disease?
- A. Medical therapy has no role in the treatment of this condition. (Correct Answer)
- B. Endoscopic biopsy is essential to exclude malignancy.
- C. Hypochloraemic alkalosis is the usual metabolic abnormality in such cases.
- D. Operation is frequently required along with a drainage procedure.
Explanation: ***Medical therapy has no role in the treatment of this condition.*** - This statement is incorrect because **medical management**, including **proton pump inhibitors (PPIs)**, can be effective in reducing inflammation and ulcer healing, which may alleviate symptoms of **gastric outlet obstruction (GOO)**, especially in cases where the obstruction is due to an active ulcer and associated edema. - While surgery is often required for persistent or severe obstruction, initial medical therapy can be attempted to confirm the reversibility of the obstruction or to optimize the patient's condition before surgical intervention. *Endoscopic biopsy is essential to exclude malignancy.* [1] - **Endoscopic biopsy** is crucial because **malignancy** (e.g., gastric adenocarcinoma) can present with symptoms similar to peptic ulcer disease and lead to **gastric outlet obstruction**. - Distinguishing between benign and malignant causes is critical for appropriate management, as the treatment strategies differ significantly. [1] *Hypochloraemic alkalosis is the usual metabolic abnormality in such cases.* [1] - **Hypochloremic alkalosis** occurs due to the repeated **vomiting of gastric contents**, which are rich in hydrochloric acid. [1] - This loss of acid and chloride, along with fluid depletion, leads to increased bicarbonate retention by the kidneys and can cause a metabolic alkalosis with low chloride levels. *Operation is frequently required along with a drainage procedure.* [1] - When medical therapy fails or the obstruction is severe due to **scarring and fibrosis** from chronic peptic ulcer disease, surgical intervention is often necessary. - A drainage procedure, such as **gastrojejunostomy**, is performed to bypass the obstructed pylorus and restore gastric emptying.
Radiology
1 questionsThe first imaging modality of choice for a 35-year-old lady, presenting to surgical emergency with complaints of colicky pain in right lower quadrant of abdomen and vomiting since last 2 days is:
UPSC-CMS 2025 - Radiology UPSC-CMS Practice Questions and MCQs
Question 121: The first imaging modality of choice for a 35-year-old lady, presenting to surgical emergency with complaints of colicky pain in right lower quadrant of abdomen and vomiting since last 2 days is:
- A. Plain X-ray abdomen erect view
- B. Ultrasound abdomen (Correct Answer)
- C. Contrast CT abdomen
- D. Non-contrast CT abdomen
Explanation: ***Ultrasound abdomen*** - Ultrasound is the **first-line imaging modality** for evaluating acute right lower quadrant pain in women of reproductive age due to its **safety (no ionizing radiation)**, availability, and cost-effectiveness. - It effectively visualizes the **appendix**, ovaries, uterus, and can detect **appendicitis**, ovarian pathology (e.g., cysts, torsion, ectopic pregnancy), and other causes of acute abdominal pain. - Follows the **ALARA principle** (As Low As Reasonably Achievable) for radiation exposure in young women. *Plain X-ray abdomen erect view* - Plain X-ray has **limited utility** for acute right lower quadrant pain as it cannot visualize soft tissue structures like the appendix or ovaries. - Primarily useful for detecting **bowel obstruction** (air-fluid levels) or **pneumoperitoneum** (free air under diaphragm), which are not suggested by this clinical presentation. *Contrast CT abdomen* - While highly sensitive for appendicitis and intra-abdominal pathologies, contrast CT involves **ionizing radiation** and **IV contrast administration**. - Should be **minimized in women of reproductive age** due to radiation risks (including potential pregnancy). - Reserved for cases where ultrasound is **inconclusive** or when detailed anatomical assessment is required. *Non-contrast CT abdomen* - Non-contrast CT exposes the patient to **ionizing radiation** without the diagnostic advantage of contrast enhancement. - **Less effective** than contrast-enhanced CT for detecting inflammatory processes and appendiceal pathology. - Not preferred as first-line imaging when ultrasound is available and appropriate.
Surgery
2 questionsConsider the following : I. Diabetes II. Hypertension III. Renal failure IV. Jaundice Which of the above are the risk factors for post-operative wound dehiscence?
Which of the following statements are correct regarding sutures in surgery? I. Barbed sutures have the advantage of eliminating the need for knots. II. Vertical mattress sutures help in eversion of wound edges. III. Aberdeen knot is used for continuous suturing. IV. Silk is preferred for subcuticular suturing. Select the answer using the code given below :
UPSC-CMS 2025 - Surgery UPSC-CMS Practice Questions and MCQs
Question 121: Consider the following : I. Diabetes II. Hypertension III. Renal failure IV. Jaundice Which of the above are the risk factors for post-operative wound dehiscence?
- A. II, III and IV
- B. I, II and III
- C. I, III and IV (Correct Answer)
- D. I, II and IV
Explanation: ***I, III and IV*** - **Diabetes** impairs wound healing through microvascular complications, neuropathy, and increased infection risk. - **Renal failure** (III) leads to uremia, malnutrition, and impaired collagen synthesis, all of which compromise wound integrity. - **Jaundice** (IV) is associated with impaired collagen synthesis, reduced fibroblast activity, and increased risk of infection, contributing to poor wound healing. *II, III and IV* - **Hypertension** (II) alone is not a direct risk factor for post-operative wound dehiscence; its complications (e.g., end-organ damage) might indirectly affect healing. - **Renal failure** (III) and **jaundice** (IV) are indeed significant risk factors, but the exclusion of diabetes makes this option incomplete. *I, II and III* - While **diabetes** (I) and **renal failure** (III) are major risk factors, **hypertension** (II) in isolation does not directly cause wound dehiscance. - This option incorrectly omits **jaundice** (IV), which is a known independent risk factor for impaired wound healing. *I, II and IV* - **Diabetes** (I) and **jaundice** (IV) are strong risk factors, but **hypertension** (II) does not directly contribute. - This option incorrectly excludes **renal failure** (III), which is a significant predisposing factor for wound dehiscence.
Question 122: Which of the following statements are correct regarding sutures in surgery? I. Barbed sutures have the advantage of eliminating the need for knots. II. Vertical mattress sutures help in eversion of wound edges. III. Aberdeen knot is used for continuous suturing. IV. Silk is preferred for subcuticular suturing. Select the answer using the code given below :
- A. I, II and IV
- B. II, III and IV
- C. I, II and III (Correct Answer)
- D. I, III and IV
Explanation: ***I, II and III*** - **I. Barbed sutures** have unidirectional or bidirectional barbs that grip tissue, negating the need for traditional knots to secure the suture line. This property can significantly **reduce operating time** and the volume of foreign material left in the wound. - **II. Vertical mattress sutures** are designed to achieve precise wound edge approximation and eversion, which are crucial for optimal healing and cosmesis, particularly in areas under tension or for thick skin. - **III. The Aberdeen knot** is a slip knot technique specifically designed to secure the end of a **continuous suture line** efficiently and reliably. It provides a flat, secure knot that minimizes bulk and is less prone to loosening. *I, II and IV* - While statements I and II are correct, statement IV is incorrect. **Silk is a braided, non-absorbable multifilament suture** that can cause significant tissue reaction. - It is generally not preferred for subcuticular suturing due to its increased risk of infection, visibility, and foreign body reaction compared to monofilament, absorbable sutures. *II, III and IV* - Statements II and III are correct, but statement IV is incorrect. **Silk is avoided for subcuticular closure** due to its inflammatory properties and potential for suture extrusion or sinus formation. - Subcuticular sutures typically use **absorbable monofilament sutures** (e.g., poliglecaprone 25 or polydioxanone) to minimize tissue reaction and achieve good cosmetic results. *I, III and IV* - Statements I and III are correct regarding barbed sutures and the Aberdeen knot, respectively. However, statement IV is incorrect because **silk suture is a non-absorbable, braided material that is highly reactive and not suitable for subcuticular placement**, where monofilament absorbable sutures are preferred for minimal tissue reaction and good cosmesis.