UPSC-CMS 2023 Practice Questions

Q: Inhaled foreign bodies are more likely to get lodged in the right main bronchus because

Right main bronchus is shorter, wider and nearly vertical. ***Right main bronchus is shorter, wider and nearly vertical*** - The **anatomical configuration** of the right main bronchus makes it a more direct continuation of the trachea. - Its **wider diameter** and **more vertical angle** allow foreign bodies to fall into it more easily due to gravity and airflow. *Left main bronchus is wider and shorter* - This statement is incorrect; the **left main bronchus** is actually **narrower and longer** than the right. - Its **more acute angle** stemming from the trachea also makes it less likely for foreign objects to lodge there directly. *Right main bronchus is shorter, narrower and lies horizontally in relation to trachea* - This statement is incorrect as the **right main bronchus** is indeed **shorter** but is **wider** and takes a **more vertical** course, not horizontal. - The description of being "narrower" and "horizontally" contradicts the anatomical characteristics that facilitate foreign body impaction. *Left main bronchus is narrow and longer* - This statement is anatomically correct for the left main bronchus; however, these characteristics make it **less likely** for foreign bodies to get lodged here. - The **narrower lumen** and **longer path**, combined with a more acute angle, make it a less direct route for inhaled objects.

Q: A localized nodule of squamous cell carcinoma in the vocal cord is best treated by

Laser therapy. ***Laser therapy (Transoral Laser Microsurgery)*** - **CO2 laser excision** is an excellent first-line treatment for localized T1a squamous cell carcinoma of the vocal cord, offering **>90% cure rates**. - Advantages include: **precise tumor removal**, immediate pathological assessment with margin evaluation, **excellent voice preservation**, and shorter treatment duration compared to radiotherapy. - **Transoral laser microsurgery (TLM)** allows for cord-sparing procedures that maintain vocal function while achieving complete oncological resection. *Radiotherapy* - **Important Note:** **Radiotherapy is EQUALLY effective** as laser therapy for early T1 glottic cancer, with comparable **5-year local control rates (>90%)** and voice quality outcomes. - Both laser surgery and radiotherapy are **guideline-recommended first-line treatments** (NCCN, ESMO guidelines). - Choice between the two depends on tumor characteristics (anterior commissure involvement), patient preference, institutional expertise, and functional outcomes. - In examination contexts, laser therapy may be preferred as it provides histopathological confirmation and is often considered more definitive for "localized nodules." *Cryosurgery* - **Cryosurgery** is rarely used for vocal cord lesions due to **unpredictable tissue destruction**, potential for severe **vocal cord scarring**, and inability to obtain tissue for pathological margin assessment. - Not a standard treatment option for laryngeal cancer. *Surgical excision* - This term is ambiguous as **laser excision IS a form of surgical excision**. - If referring to **open surgical approaches** (laryngofissure, cordectomy via external approach), these are more invasive than transoral laser surgery and are reserved for larger tumors or salvage situations. - Traditional "cold steel" endoscopic excision is less precise than laser and can cause more trauma and scarring.

Q: In patients with systemic hypertension, the characteristic haemorrhage seen on ophthalmoscopy is

Flame-shaped haemorrhage. ***Flame-shaped haemorrhage*** - **Flame-shaped hemorrhages** are superficial, linear hemorrhages occurring in the **nerve fiber layer** of the retina, characteristic of **hypertensive retinopathy**. - They result from the rupture of superficial capillaries due to **elevated intravascular pressure** in systemic hypertension. *Wet sponge haemorrhage* - This term is not a standard description for retinal hemorrhage types. - Retinal hemorrhages are typically categorized by their shape and depth, such as dot-and-blot, flame-shaped, or subretinal. *Suprachoroidal haemorrhage* - **Suprachoroidal hemorrhages** occur between the choroid and the sclera, often due to trauma or surgical complications. - They are much deeper than retinal hemorrhages and are typically not a direct, primary manifestation of chronic systemic hypertension on routine ophthalmoscopy. *Dot haemorrhage* - **Dot haemorrhages** are deep, punctate hemorrhages occurring in the **inner nuclear** or **outer plexiform layers** of the retina. - While they can be seen in various conditions including diabetic retinopathy, they are not the most characteristic type of hemorrhage seen specifically in systemic hypertension.

Q: Spring catarrh is a type of conjunctivitis caused by

Exogenous allergen. ***Exogenous allergen*** - **Spring catarrh**, also known as **vernal keratoconjunctivitis (VKC)**, is exclusively a type of allergic conjunctivitis. - It is triggered by exposure to **environmental allergens**, commonly identified as dust, pollen, or other airborne irritants, especially during warmer seasons. *Virus infection* - Viral conjunctivitis, such as that caused by **adenovirus**, often presents with watery discharge, redness, and may be associated with an upper respiratory tract infection. - Unlike spring catarrh, it is highly **contagious** and does not typically recur seasonally due to allergen exposure. *Endogenous toxins* - Ocular conditions caused by endogenous toxins are rare and usually associated with systemic diseases or metabolic disorders affecting body system, not typically a primary cause of conjunctivitis. - This category does not align with the clear allergic and seasonal presentation characteristic of spring catarrh. *Bacterial infection* - Bacterial conjunctivitis is characterized by purulent (pus-like) discharge, severe redness, and often involves one eye initially (though can spread to both). - It is treated with antibiotics and does not typically exhibit the seasonal recurrence or papillary hypertrophy on the tarsal conjunctiva seen in spring catarrh.

Q: The following hallmarks characterise Diaphyseal aclasis except

Chondrosarcoma may occur in less than 1% cases. ***Chondrosarcoma may occur in less than 1% cases*** - This statement is incorrect as the risk of malignant transformation to **chondrosarcoma** in Diaphyseal aclasis (hereditary multiple exostoses) is commonly reported to be significantly higher, ranging from **5-25%**. - Therefore, stating it occurs in "less than 1% cases" is factually inaccurate, making this the correct answer as to what does *not* characterize the condition. *Pseudoarthrosis is common* - **Pseudoarthrosis** (false joint formation) can occur as a complication of **bony deformities** and the presence of osteochondromas, particularly in regions where they interfere with bone growth or cause fractures. - The abnormal growth of osteochondromas can predispose to fractures, which may heal poorly and result in pseudoarthrosis. *It is inherited as an autosomal dominant dysplasia* - Diaphyseal aclasis, also known as **hereditary multiple exostoses (HME)**, is indeed an **autosomal dominant** skeletal dysplasia. - It is caused by mutations in the **EXT1 or EXT2 genes**, which are involved in heparan sulfate proteoglycan synthesis, leading to abnormal bone growth. *Genu valgum can be found* - **Genu valgum** (knock-knees) is a common **skeletal deformity** observed in individuals with Diaphyseal aclasis. - The multiple osteochondromas can disturb the normal growth and alignment of long bones, frequently affecting the distal femur and proximal tibia leading to this angular deformity.

Q: Match List-I with List-II and select the correct answer using the code given below the Lists: **List-I** A. Pineal gland B. Testis C. Adrenal gland D. Ovary **List-II** 1. Testosterone 2. Estrogen 3. Cortisol 4. Melatonin

A→4 B→1 C→3 D→2. **A→4 B→1 C→3 D→2** - This option correctly matches each endocrine gland with its primary hormone: the **pineal gland** produces **melatonin**, the **testis** produces **testosterone**, the **adrenal gland** produces **cortisol**, and the **ovary** produces **estrogen**. - These pairings are fundamental to understanding the basic functions of the endocrine system. *A→4 B→3 C→1 D→2* - This option incorrectly matches the **testis** with **cortisol** (should be testosterone) and the **adrenal gland** with **melatonin** (should be cortisol). - Cortisol is a steroid hormone produced by the adrenal cortex, while melatonin from the pineal gland regulates sleep-wake cycles. *A→4 B→2 C→3 D→1* - This option incorrectly matches the **testis** with **estrogen** (should be testosterone) and the **ovary** with **melatonin** (should be estrogen). - Estrogen is the primary female sex hormone, while testosterone is the primary male sex hormone. *A→3 B→4 C→1 D→2* - This option incorrectly matches the **pineal gland** with **cortisol** (should be melatonin) and the **testis** with **estrogen** (should be testosterone). - The pineal gland is known for its role in circadian rhythms through melatonin production, not stress response hormones like cortisol.

Q: Following radical surgery for the carcinoma of breast, reconstruction of the breast can be performed by using the following procedures except

Deltopectoral flap. ***Deltopectoral flap*** - The **deltopectoral flap**, also known as the Bakamjian flap, is primarily used for **head and neck reconstruction**, particularly for defects in the pharynx, esophagus, or oral cavity. - It involves tissue from the shoulder and chest wall, but its design and vascular supply make it unsuitable for **breast reconstruction** after radical mastectomy, which requires significantly more volume and different tissue characteristics. *Silicone implants* - **Silicone implants** are a common method for breast reconstruction, offering a less invasive option than flap procedures. - They are placed either beneath the pectoral muscle or subcutaneously to restore breast volume and shape. *Transversus abdominis muscle flap (TRAM flap)* - The **TRAM flap** is a widely used and versatile autologous tissue reconstruction method, utilizing tissue from the lower abdomen to create a new breast mound. - It can be either pedicled (retaining its original blood supply) or free (requiring microvascular anastomosis), providing a natural-feeling and long-lasting reconstruction. *Latissimus dorsi flap (LD flap)* - The **latissimus dorsi (LD) flap** involves transferring muscle, fat, and skin from the back to the chest to reconstruct the breast. - It is particularly useful for smaller breasts or when combined with an implant, and it can provide good aesthetic results with reliable blood supply.

Q: A Wolfe graft is a

Large full thickness skin graft. ***Large full thickness skin graft*** - A **Wolfe graft** is a type of **large full-thickness skin graft** that includes the epidermis and entire dermis. - Due to its full thickness, it provides better cosmetic results and less contracture compared to split-thickness grafts, but requires optimal **vascularization** at the recipient site. - The term "Wolfe graft" specifically refers to the **large size** of the full-thickness graft, distinguishing it from smaller grafts. *Partial thickness skin graft* - A **partial-thickness skin graft** (also known as a split-thickness skin graft) includes the epidermis and only a portion of the dermis. - While easier to harvest and more likely to **take** in less ideal recipient beds, they are known for more contraction and a less cosmetic appearance. *Pinch skin graft* - A **pinch graft** is a small, conical piece of skin, including the epidermis and dermis, taken by pinching the skin. - These grafts are generally less aesthetically pleasing, have limited applications, and are often used for small, non-cosmetic defects. *Pedicle graft* - A **pedicle graft** (or flap) is a section of tissue that remains attached to its original site at one or more points, maintaining its own **blood supply**. - Unlike a free graft, it is not completely detached from the donor site, allowing for transfer of more complex tissues like muscle or bone.

Q: The indications for surgery in patients with pulmonary tuberculosis include all of the following except

AFB positive sputum with normal chest CT scan. ***AFB positive sputum with normal chest CT scan*** - This scenario typically indicates **early or uncomplicated pulmonary tuberculosis** that is responsive to standard antitubercular drug therapy. - A normal chest CT scan suggests the absence of significant cavitations, extensive lung damage, or other structural abnormalities that would necessitate surgical intervention. *Drug-resistant chronic tuberculous abscess* - **Drug resistance** and the presence of a **chronic tuberculous abscess** make medical management difficult and often ineffective. - Surgical resection can remove the source of infection, facilitate cure, and prevent further dissemination of drug-resistant organisms. *Severe life-threatening haemoptysis* - **Severe or life-threatening haemoptysis** in TB patients often arises from eroded pulmonary vessels within cavitary lesions. - Surgical intervention (e.g., lobectomy, pneumonectomy) is critical to control bleeding and prevent fatal outcomes when conservative measures fail. *Aspergilloma within a tuberculous cavity with recurrent haemoptysis* - An **aspergilloma (fungal ball)** developing in a pre-existing tuberculous cavity can cause **recurrent haemoptysis** due to erosion of blood vessels by the fungus. - Surgical resection is often the definitive treatment to remove the aspergilloma and prevent further bleeding.

Q: In a patient with stage T1 (tumor invading lamina propria) transitional cell carcinoma of the urinary bladder, the recommended treatment is

Trans urethral resection of bladder tumour (TURBT). ***Trans urethral resection of bladder tumour (TURBT)*** - For **stage 1 (confined to mucosa and submucosa) transitional cell carcinoma** of the urinary bladder, TURBT is the primary and often curative treatment. - This procedure allows for both diagnostic staging and complete resection of visible tumors. *Radiation therapy* - **Radiation therapy** is generally reserved for more advanced stages or for patients who are not surgical candidates. - It is often used in combination with chemotherapy or as a palliative measure, not typically as monotherapy for early-stage disease. *Systemic chemotherapy* - **Systemic chemotherapy** is typically indicated for advanced, metastatic bladder cancer or as neoadjuvant/adjuvant therapy in muscle-invasive disease. - It is not the primary treatment for early-stage, non-muscle invasive bladder cancer. *Radical cystectomy* - **Radical cystectomy** is a major surgical procedure involving removal of the entire bladder and surrounding structures. - It is reserved for **muscle-invasive bladder cancer** or recurrent high-grade non-muscle invasive bladder cancer that has failed conservative treatments.

Question 1

Inhaled foreign bodies are more likely to get lodged in the right main bronchus because

Accepted Answer

Right main bronchus is shorter, wider and nearly vertical

Answer

Left main bronchus is wider and shorter

Answer

Right main bronchus is shorter, narrower and lies horizontally in relation to trachea

Answer

Left main bronchus is narrow and longer

Question 2

A localized nodule of squamous cell carcinoma in the vocal cord is best treated by

Accepted Answer

Laser therapy

Answer

Cryosurgery

Answer

Radiotherapy

Answer

Surgical excision

Question 3

In patients with systemic hypertension, the characteristic haemorrhage seen on ophthalmoscopy is

Accepted Answer

Flame-shaped haemorrhage

Answer

Wet sponge haemorrhage

Answer

Suprachoroidal haemorrhage

Answer

Dot haemorrhage

Question 4

Spring catarrh is a type of conjunctivitis caused by

Accepted Answer

Exogenous allergen

Answer

Virus infection

Answer

Endogenous toxins

Answer

Bacterial infection

Question 5

The following hallmarks characterise Diaphyseal aclasis except

Accepted Answer

Chondrosarcoma may occur in less than 1% cases

Answer

Pseudoarthrosis is common

Answer

It is inherited as an autosomal dominant dysplasia

Answer

Genu valgum can be found

Question 6

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

**List-I**
A. Pineal gland
B. Testis
C. Adrenal gland
D. Ovary

**List-II**
1. Testosterone
2. Estrogen
3. Cortisol
4. Melatonin

Accepted Answer

A→4  B→1  C→3  D→2

Answer

A→4  B→3  C→1  D→2

Answer

A→4  B→2  C→3  D→1

Answer

A→3  B→4  C→1  D→2

Question 7

Following radical surgery for the carcinoma of breast, reconstruction of the breast can be performed by using the following procedures except

Accepted Answer

Deltopectoral flap

Answer

Silicone implants

Answer

Transversus abdominis muscle flap (TRAM flap)

Answer

Latissimus dorsi flap (LD flap)

Question 8

A Wolfe graft is a

Accepted Answer

Large full thickness skin graft

Answer

Partial thickness skin graft

Answer

Pinch skin graft

Answer

Pedicle graft

Question 9

The indications for surgery in patients with pulmonary tuberculosis include all of the following except

Accepted Answer

AFB positive sputum with normal chest CT scan

Answer

Drug-resistant chronic tuberculous abscess

Answer

Severe life-threatening haemoptysis

Answer

Aspergilloma within a tuberculous cavity with recurrent haemoptysis

Question 10

In a patient with stage T1 (tumor invading lamina propria) transitional cell carcinoma of the urinary bladder, the recommended treatment is

Accepted Answer

Trans urethral resection of bladder tumour (TURBT)

Answer

Radiation therapy

Answer

Systemic chemotherapy

Answer

Radical cystectomy

UPSC-CMS 2023

Anatomy

ENT

Ophthalmology

Orthopaedics

Physiology

Surgery