UPSC-CMS 2010 Practice Questions

Q: Consider the following statements with reference to scalp : 1. The blood vessels lie within dense connective tissue. 2. The anterior scalp is supplied by supraorbital and supratrochlear vessels. 3. The lateral and posterior scalp is supplied by superficial temporal, posterior auricular and occipital arteries. Which of the statements given above are correct?

1, 2 and 3. ***1, 2 and 3*** - All three statements provide accurate anatomical details regarding the scalp's structure and blood supply. The specific arrangement of vessels within the **dense connective tissue** and the listed arterial branches are correct. - The scalp is known for its rich vascularity and its five distinct layers, with the **dense connective tissue** layer anchoring the vessels, and a broad arterial supply covering all regions. *2 and 3 only* - This option is incorrect because statement 1, regarding the blood vessels lying within **dense connective tissue**, is also a correct anatomical fact. - Omitting statement 1 overlooks a crucial structural characteristic of the scalp layers, specifically the second layer (C for connective tissue). *1 and 3 only* - This option is incorrect because statement 2, detailing the supply of the anterior scalp by **supraorbital** and **supratrochlear vessels**, is also accurate. - Excluding statement 2 means ignoring a key component of the arterial supply to the anterior region of the scalp. *1 and 2 only* - This option is incorrect because statement 3, which describes the blood supply to the lateral and posterior scalp by the **superficial temporal**, **posterior auricular**, and **occipital arteries**, is also correct. - Failing to include statement 3 results in an incomplete description of the scalp's extensive and varied arterial network.

Q: The transition between the stomach and duodenum is marked by

vein of Mayo. The transition between the stomach and duodenum is marked by ***vein of Mayo*** - The **vein of Mayo** (also known as the **prepyloric vein**) is a consistent landmark located on the anterior surface of the **pylorus**, making it a reliable surgical indicator for the gastroduodenal junction. - Its presence signifies the anatomical boundary between the **stomach** and the **duodenum** (specifically, the pylorus and duodenal bulb). *incisura* - The **incisura angularis** is a prominent anatomical landmark on the lesser curvature of the stomach, representing the junction between the body and the pyloric antrum of the stomach. It is shown as a major division in the anatomy of the stomach [1]. - It is located within the stomach itself and does not mark the transition to the duodenum. *hepatoduodenal ligament* - The **hepatoduodenal ligament** is part of the lesser omentum that connects the liver to the duodenum. - While it is anatomically close, it is a peritoneal fold containing structures like the portal triad, not a direct landmark for the gastroduodenal junction. *gastroduodenal artery* - The **gastroduodenal artery** is a major artery that branches from the common hepatic artery and supplies portions of the stomach and duodenum. - It is an important blood vessel in the region but does not serve as an anatomical surface landmark for the transition between the stomach and duodenum.

Q: What is the most common indication of tracheostomy in a child?

Vocal cord paralysis. ***Vocal cord paralysis*** - Among the options listed, **vocal cord paralysis** is the most appropriate answer as it remains a relevant pediatric indication for tracheostomy in current practice. - **Bilateral vocal cord paralysis** can cause significant airway obstruction requiring tracheostomy, especially in congenital cases or after cardiac surgery. - Note: In modern pediatric practice, the overall most common indications are **prolonged mechanical ventilation** and **congenital airway anomalies**, but among the specific causes listed here, vocal cord paralysis is the best answer. *Laryngeal diphtheria* - While **laryngeal diphtheria** historically was a common cause of pediatric tracheostomy due to pseudomembrane formation causing severe airway obstruction, its incidence has drastically decreased with **widespread immunization programs**. - In the pre-vaccination era, this was indeed a leading indication, but it is now rare in countries with effective vaccination coverage. *Poliomyelitis* - **Poliomyelitis** can affect respiratory muscles leading to ventilatory failure requiring tracheostomy, but with **global eradication efforts and vaccination**, it is now extremely rare. - This was a significant historical indication but is no longer relevant in most parts of the world. *Carcinoma of larynx* - **Laryngeal carcinoma** is predominantly an adult malignancy with peak incidence in the 6th-7th decades, associated with smoking and alcohol use. - It is **extremely rare in the pediatric population**, making it the least likely indication for tracheostomy in children among all the options listed.

Q: Priapism in a young male could occur because of

leukaemia. ***Leukaemia*** - In leukaemia, especially **myeloid leukaemia**, immature white blood cells can accumulate in the **corpus cavernosa**, leading to stasis and **venous occlusion**. [1] - This cellular congestion prevents venous outflow from the penis, causing a prolonged and **painful erection (priapism)**. *Carcinoid tumour of appendix* - A carcinoid tumour of the appendix is typically associated with **carcinoid syndrome**, which involves symptoms like flushing and diarrhoea. - It does **not directly cause priapism**, as its mediators (e.g., serotonin) do not typically induce this specific local vascular event. *Testicular cancer* - Testicular cancer primarily manifests as a **painless lump in the testis** and can cause symptoms related to metastasis, but **priapism is not a typical direct presenting symptom**. - While some cancers can cause paraneoplastic syndromes, testicular cancer is not associated with priapism. *Penile cancer* - Penile cancer typically presents as a **lesion, ulcer, or mass on the penis**, often associated with pain, bleeding, or discharge. - While it affects the penis, it does **not typically cause prolonged erections (priapism)**, but rather local tissue destruction or obstruction.

Q: In pregnancy, there is a physiological increase of the

cardiac output. ***cardiac output*** - **Cardiac output** increases significantly in pregnancy, by approximately 30-50%, to meet the increased metabolic demands of the growing fetus and maternal tissues. - This increase is primarily due to increases in both **heart rate** and **stroke volume**. *blood viscosity* - **Blood viscosity** actually decreases in pregnancy due to a greater increase in **plasma volume** compared to the increase in red blood cell mass, leading to hemodilution. - This reduction in viscosity can contribute to a lower peripheral vascular resistance. *peripheral resistance of the blood vessels* - **Peripheral resistance** typically decreases in pregnancy due to the vasodilatory effects of hormones like **progesterone** and the establishment of the low-resistance uteroplacental circulation. - This vasodilation helps accommodate the increased blood volume and cardiac output without a significant rise in blood pressure. *blood pressure in the third trimester* - **Blood pressure** usually decreases or remains stable in the first and second trimesters, with a slight rise towards pre-pregnancy levels in the third trimester. - A significant increase in blood pressure, especially in the third trimester, is *not* physiological and can indicate complications like **gestational hypertension** or **preeclampsia**.

Q: A middle-aged man presents with a lower jaw swelling. Clinically, there is expansion of the left ramus and the X-ray mandible shows soap bubble appearance. What is the clinical diagnosis?

Ameloblastoma. ***Ameloblastoma*** - Ameloblastoma is the most common odontogenic tumor, often presenting as a **slow-growing, expansile swelling** in the posterior mandible, as seen in this patient. - The classic **"soap bubble" or "honeycomb" radiographic appearance** is highly characteristic of ameloblastoma, reflecting its multilocular nature. *Aneurysmal bone cyst* - While an aneurysmal bone cyst can cause bony expansion, it typically presents with a **blood-filled lesion** and may not consistently show a "soap bubble" appearance unless it's very large and destructive. - Radiographically, it often appears as a **lytic lesion** rather than strictly multilocular. *Odontogenic myxoma* - Odontogenic myxoma can also cause jaw swelling and has a multilocular appearance, but it's often described as having a **"tennis racket" or "stepped ladder" trabeculation** pattern rather than clear "soap bubbles." - Its incidence is lower than ameloblastoma, making it less likely given the classic presentation. *Keratocyst* - An odontogenic keratocyst (OKC), now often referred to as a **keratocystic odontogenic tumor (KCOT)**, is primarily a cyst that can grow extensively and cause expansion. - Radiographically, it typically appears as a **well-defined, unilocular or multilocular radiolucency** but rarely has the classic "soap bubble" appearance as consistently as ameloblastoma.

Q: A man falls astride a penetrating object. He develops retention of urine, perineal hematoma and bleeding from urinary meatus. The nature of injury would be

rupture of bulbar urethra. ***Rupture of bulbar urethra*** - An injury from falling astride a penetrating object, causing symptoms like **retention of urine**, **perineal hematoma**, and **bleeding from the urinary meatus**, is highly indicative of a **bulbar urethral rupture**. - The **bulbar urethra** is particularly vulnerable to crush injuries against the **pubic symphysis** in astride falls, leading to extravasation of urine and blood into the perineum. *Intraperitoneal rupture of bladder* - This typically occurs from a **direct blow to the lower abdomen** when the bladder is full, resulting in release of urine into the **peritoneal cavity**. - Symptoms would include generalized **abdominal pain**, **rebound tenderness**, and **peritonitis-like signs**, rather than localized perineal hematoma. *Rupture of membranous urethra* - A rupture of the **membranous urethra** is typically associated with **pelvic fractures** and is usually **above the urogenital diaphragm**. - While it can cause hematoma, the extravasation of urine and blood would more commonly track into the **retropubic space** and potentially the anterior abdominal wall, not primarily the perineum. *Extraperitoneal rupture of bladder* - This often results from **pelvic fractures** and is characterized by urine leaking into the **prevesical space**. - Symptoms include **suprapubic pain** and tenderness, but a perineal hematoma and meatal bleeding are less typical in isolation for this type of injury.

Q: Renal carcinoma with solitary lung secondary is best treated by

surgery. ***Surgery*** - For **renal cell carcinoma** with a **solitary lung metastasis**, surgical resection of both the primary tumor (nephrectomy) and the lung metastasis is often the preferred treatment and offers the best chance for long-term survival. - This approach is particularly effective when the patient has a good performance status, the primary tumor is controlled, and the metastasis is truly solitary and resectable. *Chemotherapy* - **Renal cell carcinoma** is classically considered **chemotherapy-resistant**, meaning traditional chemotherapy agents generally have limited efficacy. - While some newer targeted therapies and immunotherapies are used, conventional chemotherapy is not the first-line treatment for metastatic RCC, especially when surgical options are available. *Immunotherapy* - **Immunotherapy** (e.g., nivolumab, pembrolizumab) is a common treatment for advanced or metastatic renal cell carcinoma, particularly when surgery is not feasible or after recurrence. - However, for a **solitary resectable metastasis**, it is typically considered after surgery, or in cases where surgery is contraindicated, rather than as a primary curative approach. *Radiotherapy* - **Radiotherapy** has a limited role in the primary treatment of renal cell carcinoma due to its relative radioresistance, though it can be used for palliative purposes (e.g., pain control, brain metastases). - For a solitary lung metastasis, while **stereotactic body radiation therapy (SBRT)** might be considered in select cases where surgery is not possible, surgical resection remains the gold standard for resectable lesions.

Q: What is the most common cause of gastric outlet obstruction in a 4-week-old baby?

Congenital hypertrophic pyloric stenosis. ***Congenital hypertrophic pyloric stenosis*** - This condition involves thickening of the **pyloric muscle**, leading to a narrowed outflow tract from the stomach. - It classically presents in infants around **2-6 weeks of age** with **projectile, non-bilious vomiting** and a palpable **olive-shaped mass** in the epigastrium. *Foreign body* - While possible, foreign body ingestion is an **uncommon cause** of gastric outlet obstruction in a 4-week-old infant. - Infants within this age range are typically **not mobile** or exploring their environment in a way that would lead to frequent foreign body ingestion. *Annular pancreas* - This is a rare congenital anomaly where pancreatic tissue completely encircles the **duodenum**, causing obstruction. - Although it can cause gastric outlet obstruction, it is **less common** than pyloric stenosis as the cause in this age group. *Duodenal atresia* - This condition is a complete blockage of the duodenum and typically presents with **bilious vomiting** within the **first 24-48 hours of life**. - The onset of symptoms in a 4-week-old, especially with non-bilious vomiting, makes duodenal atresia a less likely diagnosis.

Question 1

Consider the following statements with reference to scalp :

1. The blood vessels lie within dense connective tissue.

2. The anterior scalp is supplied by supraorbital and supratrochlear vessels.

3. The lateral and posterior scalp is supplied by superficial temporal, posterior auricular and occipital arteries.
Which of the statements given above are correct?

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 3 only

Answer

1 and 2 only

Question 2

The transition between the stomach and duodenum is marked by

Accepted Answer

vein of Mayo

Answer

incisura

Answer

hepatoduodenal ligament

Answer

gastroduodenal artery

Question 3

What is the most common indication of tracheostomy in a child?

Accepted Answer

Vocal cord paralysis

Answer

Laryngeal diphtheria

Answer

Poliomyelitis

Answer

Carcinoma of larynx

Question 4

Priapism in a young male could occur because of

Accepted Answer

leukaemia

Answer

carcinoid tumour of appendix

Answer

testicular cancer

Answer

penile cancer

Question 5

In pregnancy, there is a physiological increase of the

Accepted Answer

cardiac output

Answer

blood viscosity

Answer

peripheral resistance of the blood vessels

Answer

blood pressure in the third trimester

Question 6

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→4  B→3  C→2  D→1

Answer

A→3  B→4  C→1  D→2

Answer

A→3  B→1  C→4  D→2

Answer

A→2  B→4  C→1  D→3

Question 7

A middle-aged man presents with a lower jaw swelling. Clinically, there is expansion of the left ramus and the X-ray mandible shows soap bubble appearance. What is the clinical diagnosis?

Accepted Answer

Ameloblastoma

Answer

Aneurysmal bone cyst

Answer

Odontogenic myxoma

Answer

Keratocyst

Question 8

A man falls astride a penetrating object. He develops retention of urine, perineal hematoma and bleeding from urinary meatus. The nature of injury would be

Accepted Answer

rupture of bulbar urethra

Answer

intraperitoneal rupture of bladder

Answer

rupture of membranous urethra

Answer

extraperitoneal rupture of bladder

Question 9

Renal carcinoma with solitary lung secondary is best treated by

Accepted Answer

surgery

Answer

chemotherapy

Answer

immunotherapy

Answer

radiotherapy

Question 10

What is the most common cause of gastric outlet obstruction in a 4-week-old baby?

Accepted Answer

Congenital hypertrophic pyloric stenosis

Answer

Foreign body

Answer

Annular pancreas

Answer

Duodenal atresia

UPSC-CMS 2010

Anatomy

ENT

Internal Medicine

Obstetrics and Gynecology

Pathology

Radiology

Surgery