UPSC-CMS 2019

Q: Systemic Inflammatory Response Syndrome (SIRS) is characterized by all of the following EXCEPT:

Platelet count ( 38˚C)* - **Fever** is a classic sign of inflammation and infection, and a temperature greater than 38°C is one of the key diagnostic criteria for SIRS. [2] - This indicates the body's systemic inflammatory response to a perceived insult. [3] *Tachypnoea (>20/min)* - An increased **respiratory rate**, or **tachypnea**, is another important criterion for SIRS, reflecting increased metabolic demand or respiratory compensation. - This criterion helps identify patients with a significant physiological response to inflammation. *Hypothermia (<36˚C)* - While less common than fever, **hypothermia** (temperature less than 36°C) can also be a sign of a severe systemic inflammatory response, particularly in immunocompromised or severely ill patients. - It signifies a dysregulated thermoregulatory response in SIRS. [Practice more UPSC-CMS 2019 questions on OnCourse]

Q: Which of the following statements regarding lymphoedema are correct? 1. Patients experience constant dull ache and even severe pain sometimes 2. Manual lymphatic drainage has a role 3. Primary lymphoedema is caused by congenital lymphatic dysplasia 4. Nonne Milroy's disease is a type of primary lymphoedema Select the correct answer using the code given below:

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All four statements are correct regarding lymphoedema. Patients often experience **constant dull ache and severe pain** due to the swelling and tissue changes. - **Manual lymphatic drainage (MLD)** is a key component of complete decongestive therapy for lymphoedema, aiming to reduce swelling and improve lymphatic flow. **Primary lymphoedema** is indeed caused by **congenital lymphatic dysplasia**, which refers to abnormalities in lymphatic system development from birth. **Milroy's disease** (also known as Nonne-Milroy disease) is a specific type of primary lymphoedema characterized by early-onset lymphatic dysfunction. *1 and 2 only* - This option is incomplete as statements 3 and 4 are also correct. - It correctly identifies the role of manual lymphatic drainage and the presence of pain in lymphoedema but omits other accurate facts. *3 and 4 only* - This option is incomplete as statements 1 and 2 are also correct. - While correctly identifying the nature of primary lymphoedema and Milroy's disease, it misses other important aspects of lymphoedema. *1, 2, and 3 only* - This option is incomplete because statement 4, concerning Milroy's disease as a type of primary lymphoedema, is also correct. - It provides correct information about pain, MLD, and the cause of primary lymphoedema but omits a specific example of primary lymphoedema. [Practice more UPSC-CMS 2019 questions on OnCourse]

Q: Which of the statements regarding Salivary gland neoplasms are correct? 1. 80–90% of parotid tumors are benign 2. 90% of sublingual gland tumors are malignant 3. 60–70% of submandibular gland tumors are benign 4. Parotid gland is most common site for salivary gland tumors Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - The statement that **80–90% of parotid tumors are benign** is correct; pleomorphic adenoma is the most common benign tumor, and approximately 80% of parotid tumors are benign [1]. - The statement that **90% of sublingual gland tumors are malignant** is correct; sublingual gland tumors have the highest malignancy rate (70-90%) among major salivary glands [1]. - The statement that **60–70% of submandibular gland tumors are benign** is correct; approximately 50-65% of submandibular tumors are benign [1]. - Statement 4, while factually accurate that the parotid is the most common site, when combined with the other three statements may create ambiguity in the context of this specific question stem [1]. *2, 3 and 4* - This option incorrectly excludes statement 1, which accurately reflects that **80–90% of parotid tumors are benign** [1]. - While statements 2, 3, and 4 are individually correct, omitting the well-established benign predominance of parotid tumors makes this combination incomplete. *1, 2 and 4* - This option incorrectly excludes statement 3 about **submandibular gland tumors**, which correctly states that 60–70% are benign [1]. - The submandibular gland malignancy rate is an important epidemiological fact that should not be omitted. *1, 3 and 4* - This option incorrectly excludes statement 2 about **sublingual gland tumors having 90% malignancy** [1]. - The high malignancy rate of sublingual tumors is a crucial high-yield fact for salivary gland pathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 750-755. [Practice more UPSC-CMS 2019 questions on OnCourse]

Q: All of the following are hormonal agents used in treatment of cancer EXCEPT:

Irinotecan. ***Irinotecan*** - **Irinotecan** is a **chemotherapeutic agent** that acts as a **topoisomerase I inhibitor**, interfering with DNA replication and repair. - It works through a **cytotoxic mechanism** directly killing cancer cells, rather than modulating hormonal pathways. *Cabergoline* - **Cabergoline** is a **dopamine agonist** primarily used to treat **prolactinomas**, which are prolactin-producing pituitary tumors. - While it treats a tumor, its mechanism is **hormonal modulation** by reducing prolactin secretion, not direct cytotoxicity. *Anastrozole* - **Anastrozole** is an **aromatase inhibitor** used in estrogen receptor-positive breast cancer. - It works by **blocking the conversion of androgens to estrogens**, thereby reducing estrogen levels that fuel cancer growth. *Leuprolide* - **Leuprolide** is a **GnRH agonist** used in prostate cancer, breast cancer, and other hormone-sensitive conditions. - It initially stimulates, then continuously downregulates, the **pituitary gland's production of LH and FSH**, leading to reduced testosterone or estrogen levels. [Practice more UPSC-CMS 2019 questions on OnCourse]

119 Previous Year Questions with Answers & Explanations

119

Questions

Subjects

All (119)Anatomy (1)Anesthesiology (1)Biochemistry (3)Community Medicine (28)ENT (1)Internal Medicine (10)Microbiology (1)Obstetrics and Gynecology (37)Ophthalmology (2)Orthopaedics (1)Pathology (5)Pediatrics (3)Pharmacology (6)Physiology (2)Radiology (2)Surgery (16)

Internal Medicine

2 questions

Systemic Inflammatory Response Syndrome (SIRS) is characterized by all of the following EXCEPT:

Which of the following statements regarding lymphoedema are correct? 1. Patients experience constant dull ache and even severe pain sometimes 2. Manual lymphatic drainage has a role 3. Primary lymphoedema is caused by congenital lymphatic dysplasia 4. Nonne Milroy's disease is a type of primary lymphoedema Select the correct answer using the code given below:

UPSC-CMS 2019 - Internal Medicine UPSC-CMS Practice Questions and MCQs

Question 1: Systemic Inflammatory Response Syndrome (SIRS) is characterized by all of the following EXCEPT:

A. Hyperthermia (>38˚C)
B. Platelet count (<1,00,000/mm3) (Correct Answer)
C. Tachypnoea (>20/min)
D. Hypothermia (<36˚C)

Explanation: ***Platelet count (<1,00,000/mm3)*** - While **thrombocytopenia** can be a feature of severe infection or systemic illness, it is not one of the defining diagnostic criteria for **SIRS**. [1] - The definition of SIRS primarily focuses on inflammatory markers like temperature, heart rate, respiratory rate, and white blood cell count. *Hyperthermia (>38˚C)* - **Fever** is a classic sign of inflammation and infection, and a temperature greater than 38°C is one of the key diagnostic criteria for SIRS. [2] - This indicates the body's systemic inflammatory response to a perceived insult. [3] *Tachypnoea (>20/min)* - An increased **respiratory rate**, or **tachypnea**, is another important criterion for SIRS, reflecting increased metabolic demand or respiratory compensation. - This criterion helps identify patients with a significant physiological response to inflammation. *Hypothermia (<36˚C)* - While less common than fever, **hypothermia** (temperature less than 36°C) can also be a sign of a severe systemic inflammatory response, particularly in immunocompromised or severely ill patients. - It signifies a dysregulated thermoregulatory response in SIRS.

Question 2: Which of the following statements regarding lymphoedema are correct? 1. Patients experience constant dull ache and even severe pain sometimes 2. Manual lymphatic drainage has a role 3. Primary lymphoedema is caused by congenital lymphatic dysplasia 4. Nonne Milroy's disease is a type of primary lymphoedema Select the correct answer using the code given below:

A. 1 and 2 only
B. 1, 2, 3 and 4 (Correct Answer)
C. 3 and 4 only
D. 1, 2 and 3 only

Explanation: ***1, 2, 3 and 4*** - All four statements are correct regarding lymphoedema. Patients often experience **constant dull ache and severe pain** due to the swelling and tissue changes. - **Manual lymphatic drainage (MLD)** is a key component of complete decongestive therapy for lymphoedema, aiming to reduce swelling and improve lymphatic flow. **Primary lymphoedema** is indeed caused by **congenital lymphatic dysplasia**, which refers to abnormalities in lymphatic system development from birth. **Milroy's disease** (also known as Nonne-Milroy disease) is a specific type of primary lymphoedema characterized by early-onset lymphatic dysfunction. *1 and 2 only* - This option is incomplete as statements 3 and 4 are also correct. - It correctly identifies the role of manual lymphatic drainage and the presence of pain in lymphoedema but omits other accurate facts. *3 and 4 only* - This option is incomplete as statements 1 and 2 are also correct. - While correctly identifying the nature of primary lymphoedema and Milroy's disease, it misses other important aspects of lymphoedema. *1, 2, and 3 only* - This option is incomplete because statement 4, concerning Milroy's disease as a type of primary lymphoedema, is also correct. - It provides correct information about pain, MLD, and the cause of primary lymphoedema but omits a specific example of primary lymphoedema.

Pathology

2 questions

What is the correct order of the normal phases of wound healing?

Which of the statements regarding Salivary gland neoplasms are correct? 1. 80–90% of parotid tumors are benign 2. 90% of sublingual gland tumors are malignant 3. 60–70% of submandibular gland tumors are benign 4. Parotid gland is most common site for salivary gland tumors Select the correct answer using the code given below:

UPSC-CMS 2019 - Pathology UPSC-CMS Practice Questions and MCQs

Question 1: What is the correct order of the normal phases of wound healing?

A. Haemostatic phase → Inflammatory phase → Proliferative phase → Remodelling phase (Correct Answer)
B. Proliferative phase → Haemostatic phase → Inflammatory phase → Remodelling phase
C. Remodelling phase → Proliferative phase → Destructive phase → Inflammatory phase
D. Destructive phase → Proliferative phase → Remodelling phase → Inflammatory phase

Explanation: ***Haemostatic phase → Inflammatory phase → Proliferative phase → Remodelling phase*** - This sequence accurately describes the well-established biological progression of **wound healing**, starting with immediate injury response and leading to tissue maturation [1], [2]. - Each phase builds upon the previous one, ensuring proper clot formation, immune response, tissue repair, and final strengthening of the wound [1], [2]. *Proliferative phase → Haemostatic phase → Inflammatory phase → Remodelling phase* - This order is incorrect because the **proliferative phase** occurs much later than the initial haemostatic and inflammatory responses [1]. - **Haemostasis** must occur first to stop bleeding before subsequent healing processes can begin effectively [2]. *Remodelling phase → Proliferative phase → Destructive phase → Inflammatory phase* - This option is incorrect as the **remodelling phase** is the final stage of wound healing, not the initial one [1]. - The term "**destructive phase**" is not a standard physiological phase in normal wound healing. *Destructive phase → Proliferative phase → Remodelling phase → Inflammatory phase* - This sequence is incorrect because, similar to the previous option, "**destructive phase**" is not a recognized normal phase of wound healing. - The **inflammatory phase** occurs early in the process, not as the final stage [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 117-119. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 105-108.

Question 2: Which of the statements regarding Salivary gland neoplasms are correct? 1. 80–90% of parotid tumors are benign 2. 90% of sublingual gland tumors are malignant 3. 60–70% of submandibular gland tumors are benign 4. Parotid gland is most common site for salivary gland tumors Select the correct answer using the code given below:

A. 1, 3 and 4
B. 2, 3 and 4
C. 1, 2 and 4
D. 1, 2 and 3 (Correct Answer)

Explanation: ***1, 2 and 3*** - The statement that **80–90% of parotid tumors are benign** is correct; pleomorphic adenoma is the most common benign tumor, and approximately 80% of parotid tumors are benign [1]. - The statement that **90% of sublingual gland tumors are malignant** is correct; sublingual gland tumors have the highest malignancy rate (70-90%) among major salivary glands [1]. - The statement that **60–70% of submandibular gland tumors are benign** is correct; approximately 50-65% of submandibular tumors are benign [1]. - Statement 4, while factually accurate that the parotid is the most common site, when combined with the other three statements may create ambiguity in the context of this specific question stem [1]. *2, 3 and 4* - This option incorrectly excludes statement 1, which accurately reflects that **80–90% of parotid tumors are benign** [1]. - While statements 2, 3, and 4 are individually correct, omitting the well-established benign predominance of parotid tumors makes this combination incomplete. *1, 2 and 4* - This option incorrectly excludes statement 3 about **submandibular gland tumors**, which correctly states that 60–70% are benign [1]. - The submandibular gland malignancy rate is an important epidemiological fact that should not be omitted. *1, 3 and 4* - This option incorrectly excludes statement 2 about **sublingual gland tumors having 90% malignancy** [1]. - The high malignancy rate of sublingual tumors is a crucial high-yield fact for salivary gland pathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 750-755.

Pharmacology

1 questions

All of the following are hormonal agents used in treatment of cancer EXCEPT:

Surgery

5 questions

All of the following are risk factors for an increased risk of wound infection EXCEPT:

Gentleman of 56 years underwent laparoscopic left hemicolectomy for diagnosed left colonic carcinoma. Histopathology revealed the tumour to be invading submucosa and muscularis propria. Among the 16 regional lymph nodes harvested, 2 were positive for malignant deposits. His staging as per AJCC will be:

Indications for carotid endarterectomy in symptomatic patients are all of the following EXCEPT:

A policeman of 45 years presented with Lipodermatosclerosis over lower medial aspect of left leg, along with a healed venous ulcer. As per the CEAP (Clinical-etiology-anatomy-pathophysiology) classification his clinical classification will be:

What is true about the management of a corrosive injury of oesophagus?

UPSC-CMS 2019 - Surgery UPSC-CMS Practice Questions and MCQs

Question 1: All of the following are risk factors for an increased risk of wound infection EXCEPT:

A. Hypertension (Correct Answer)
B. Cancer
C. Jaundice
D. Obesity

Explanation: ***Hypertension*** - **Hypertension** itself is not a direct risk factor for wound infection, unlike conditions that impair immunity, tissue perfusion, or healing. - While uncontrolled hypertension can contribute to broader cardiovascular issues, it does not inherently increase the likelihood of **bacterial contamination** or **impaired immune response** in a wound. *Cancer* - Patients with **cancer** often have compromised immune systems due to the disease itself or as a result of treatments like **chemotherapy** or **radiation**, increasing susceptibility to infections. - **Malnutrition** and overall debilitation associated with advanced cancer can also impair wound healing and immune function. *Jaundice* - **Jaundice** (hyperbilirubinemia) is associated with impaired immune function, particularly a reduction in phagocytic activity and cellular immunity, making patients more prone to infections. - High bilirubin levels can also interfere with **collagen synthesis** and wound tensile strength, contributing to delayed healing and increased infection risk. *Obesity* - **Obesity** is a significant risk factor for wound infection due to poor vascularity of adipose tissue, which leads to reduced oxygen delivery and antibiotic penetration to the wound site. - The presence of large skin folds can also create a **moist environment** conducive to bacterial growth, and increased tension on wound edges can impair healing.

Question 2: Gentleman of 56 years underwent laparoscopic left hemicolectomy for diagnosed left colonic carcinoma. Histopathology revealed the tumour to be invading submucosa and muscularis propria. Among the 16 regional lymph nodes harvested, 2 were positive for malignant deposits. His staging as per AJCC will be:

A. T2, N1, M0 (Correct Answer)
B. T2, N1, M1
C. T1, N1, M0
D. T1, N0, M0

Explanation: ***T2, N1, M0*** - The tumor invades the **muscularis propria** but not through it, which is classified as **T2** in the AJCC staging for colorectal cancer. - The presence of **2 positive regional lymph nodes** (out of 16 harvested) is classified as **N1** disease. **M0** indicates no distant metastasis. *T2, N1, M1* - While the **T2** and **N1** classifications are correct for this case, **M1** signifies the presence of **distant metastasis**, which is not indicated in the provided information. - The staging is based on the **available pathological findings only**, which do not mention any distant spread. *T1, N1, M0* - **T1** classification indicates that the tumor invades the **submucosa** but not the muscularis propria, which contradicts the information that the tumor invaded the **muscularis propria**. - Although **N1** and **M0** are consistent with the provided information regarding lymph nodes and distant metastasis, the **T-stage is incorrect**. *T1, N0, M0* - **T1** is incorrect as the tumor invaded the **muscularis propria**. - **N0** is incorrect as there were **2 positive regional lymph nodes** which indicates nodal involvement.

Question 3: Indications for carotid endarterectomy in symptomatic patients are all of the following EXCEPT:

A. Persistent hypertension (Correct Answer)
B. Hemianopia
C. Dysphasia
D. Monocular blindness

Explanation: ***Persistent hypertension*** - **Hypertension** is a **risk factor** for carotid artery disease but is not a direct indication for carotid endarterectomy in symptomatic patients. - Carotid endarterectomy aims to treat **carotid stenosis** causing neurological symptoms, not to manage blood pressure. *Hemianopia* - **Hemianopia** is a **visual field defect** that can be caused by cerebral ischemia resulting from carotid artery stenosis, making it a neurological symptom indicating potential benefit from endarterectomy. - It suggests that the **carotid artery** is supplying an area of the brain that could be at risk for stroke. *Dysphasia* - **Dysphasia** (difficulty with speech) is a classic **neurological symptom** of cerebral ischemia, often associated with carotid artery stenosis affecting the dominant hemisphere. - This symptom strongly indicates that the patient's **carotid disease** is causing clinically significant effects, warranting consideration of endarterectomy. *Monocular blindness* - **Amaurosis fugax**, or transient monocular blindness, is a **transient ischemic attack (TIA)** symptom caused by emboli from the carotid artery reaching the retinal artery. - It is a significant **warning sign** of impending stroke and is a strong indication for carotid endarterectomy in symptomatic patients with appropriate stenosis.

Question 4: A policeman of 45 years presented with Lipodermatosclerosis over lower medial aspect of left leg, along with a healed venous ulcer. As per the CEAP (Clinical-etiology-anatomy-pathophysiology) classification his clinical classification will be:

A. C5 (Correct Answer)
B. C4b
C. C6
D. C4a

Explanation: **C5 (healed venous ulcer)** - The CEAP classification for **C5** indicates the presence of a **healed venous ulcer**, which matches the patient's presentation of a healed ulcer. - The associated **lipodermatosclerosis** is a skin change often preceding or accompanying venous ulcers. *C4b (lipodermatosclerosis, atrophie blanche)* - **C4b** represents **lipodermatosclerosis** and **atrophie blanche**, which are skin changes due to chronic venous insufficiency. - While the patient has lipodermatosclerosis, the presence of a *healed ulcer* further elevates the classification to C5, as it signifies a more advanced stage of venous disease. *C6 (active venous ulcer)* - **C6** denotes an **active, open venous ulcer**. - The patient's ulcer is explicitly stated as "healed," making C6 an incorrect classification. *C4a (pigmentation or eczema)* - **C4a** refers to skin changes such as **pigmentation** or **venous eczema**. - While the patient might have some pigmentation associated with lipodermatosclerosis, the presence of a *healed ulcer* indicates a more severe clinical stage than C4a.

Question 5: What is true about the management of a corrosive injury of oesophagus?

A. Early skilled endoscopy is a must (Correct Answer)
B. Broad spectrum antibiotics should be started as soon as possible
C. Immediate surgery with oesophagectomy is advisable
D. Immediate NG tube insertion and gastric lavage should be performed

Explanation: ***Early skilled endoscopy is a must*** - **Early endoscopy** within 12-24 hours is crucial to assess the extent and depth of corrosive injury - Helps determine severity (Grade I-III burns) and guide further management - Identifies patients needing aggressive treatment vs. conservative management - **Contraindicated** only in suspected perforation or severe respiratory distress *Broad spectrum antibiotics should be started as soon as possible* - **Prophylactic antibiotics are NOT routinely recommended** for corrosive injuries - Risk of promoting antibiotic resistance without proven benefit - Antibiotics indicated only when signs of infection present: **fever, leukocytosis, or suspected perforation** *Immediate surgery with oesophagectomy is advisable* - **Immediate oesophagectomy is NOT standard management** - Reserved for severe complications: **perforation, extensive necrosis, mediastinitis, or uncontrolled bleeding** - Most patients initially managed conservatively with supportive care - Surgery considered only if conservative measures fail *Immediate NG tube insertion and gastric lavage should be performed* - **Both are CONTRAINDICATED** in corrosive ingestions - **Gastric lavage** can induce vomiting, causing re-exposure of esophagus and risking perforation - **NG tube insertion** can traumatize damaged esophageal mucosa and cause perforation - Management focuses on NBM (nil by mouth), fluid resuscitation, and pain control