UPSC-CMS 2019

119 Questions — Page 2 of 12

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)

Anatomy

1 questions

Q11

Which of the statements regarding Calot's triangle are correct? 1. Common hepatic duct forms the medial boundary of the Calot's triangle 2. Inferior surface of the right lobe of the liver forms the superior boundary of Calot's triangle 3. Right hepatic artery is usually found as a content of the Calot's triangle 4. Cystic duct and medial border of gall bladder forms the lateral border of Calot's triangle Select the correct answer using the code given below:

Internal Medicine

5 questions

Q11

A few days following viral fever, a 50 year old female presented with pain in neck, fever, malaise and firm enlargement of both the lobes of thyroid. On investigation thyroid antibodies were normal & serum T4 was high normal. Probable diagnosis is:

Q12

A gentleman of 36 years presented with a long history of upper abdominal pain which was periodic and often occurred early morning. For last 3 months, he is having projectile vomiting, which is non bilious, unpleasant in nature with undigested food materials. On examination he appears unwell, dehydrated and seemed to have lost weight. Probably he is suffering from:

Q13

A 40 year old female patient presents with colicky abdominal pain associated with episodes of mild diarrhoea for last 6 months accompanied with intermittent fever and weight loss. There are multiple discharging sinuses on perineal examination. The most likely clinical diagnosis in this patient is:

Q14

A gentleman of 48 years was being worked up for hepatocellular function. He had no history or signs of encephalopathy. His serum bilirubin was 5 mg%, serum albumin was 3.9 gm%, International normalized ratio was 1.6. On ultrasound no free fluid was detected inside abdomen. As per Child-Turcotte-Pugh (CTP) classification, he was in:

Q15

Consider the following statements regarding Opportunistic post-splenectomy infections (OPSI): 1. Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae are the most common causative agents 2. Risk is greatest in the patients who have undergone splenectomy for trauma 3. Risk is greatest within the first 2–3 years following splenectomy 4. Prophylactic vaccination should be done 2 weeks prior to elective splenectomy Which of the statements given above are correct?

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

Question 11: A few days following viral fever, a 50 year old female presented with pain in neck, fever, malaise and firm enlargement of both the lobes of thyroid. On investigation thyroid antibodies were normal & serum T4 was high normal. Probable diagnosis is:

A. Lymphoma of thyroid
B. Riedel's thyroiditis
C. Autoimmune thyroiditis
D. Granulomatous thyroiditis (Correct Answer)

Explanation: ***Granulomatous thyroiditis*** - The presentation of **neck pain**, **fever**, **malaise**, and **firm, enlarged thyroid lobes** following a viral fever, along with normal thyroid antibodies and high-normal T4, is highly characteristic of **subacute granulomatous thyroiditis (de Quervain's thyroiditis)** [1]. - This condition is typically **post-viral**, causes inflammation leading to temporary hyperthyroidism due to hormone release, and is often painful [1]. *Lymphoma of thyroid* - Thyroid lymphoma usually presents as a **rapidly growing neck mass** in older individuals and is not typically preceded by a viral illness. - It is less commonly associated with pain and fever in this manner, and thyroid function can be variable. *Riedel's thyroiditis* - **Riedel's thyroiditis** is a rare, invasive fibrosis of the thyroid and surrounding structures, leading to a **rock-hard, painless goiter**. - It does not typically follow a viral infection with acute pain and fever or present with high-normal T4. *Autoimmune thyroiditis* - **Autoimmune thyroiditis (Hashimoto's thyroiditis)** is characterized by elevated thyroid antibodies and typically presents with **hypothyroidism**, often with a **painless goiter**. - It does not usually follow a viral illness with acute pain and fever or cause temporary thyrotoxicosis with normal antibodies [1].

Question 12: A gentleman of 36 years presented with a long history of upper abdominal pain which was periodic and often occurred early morning. For last 3 months, he is having projectile vomiting, which is non bilious, unpleasant in nature with undigested food materials. On examination he appears unwell, dehydrated and seemed to have lost weight. Probably he is suffering from:

A. Gastric outlet obstruction (Correct Answer)
B. Superior mesenteric artery syndrome
C. Carcinoma stomach
D. Gastro-oesophageal reflux with oesophagitis

Explanation: ***Gastric outlet obstruction*** - The combination of a long history of **periodic upper abdominal pain** followed by **projectile, non-bilious vomiting** containing undigested food is highly characteristic of gastric outlet obstruction. [1] - **Weight loss** and **dehydration** are common due to inadequate nutrient absorption and persistent vomiting. [1] *Superior mesenteric artery syndrome* - This syndrome is characterized by compression of the **duodenum** between the superior mesenteric artery and the aorta. - While it can cause vomiting and weight loss, the presenting symptoms are typically more acute or chronic pain related to postural changes, and not usually preceded by a long history of periodic upper abdominal pain suggesting prior peptic ulcer disease. *Carcinoma stomach* - While carcinoma of the stomach can cause weight loss and vomiting due to obstruction, the long history of **relieving periodic pain** prior to the onset of projectile vomiting is less typical. - Vomiting in carcinoma stomach might be bilious if the tumor is distal to the ampulla of Vater. *Gastro-oesophageal reflux with oesophagitis* - This condition primarily causes **heartburn**, regurgitation, and sometimes difficulty swallowing or chest pain. - It does not typically lead to repeated **projectile vomiting** of undigested food or significant weight loss in the absence of severe complications like stricture formation, which would present differently.

Question 13: A 40 year old female patient presents with colicky abdominal pain associated with episodes of mild diarrhoea for last 6 months accompanied with intermittent fever and weight loss. There are multiple discharging sinuses on perineal examination. The most likely clinical diagnosis in this patient is:

A. Ileocaecal Tuberculosis
B. Ulcerative colitis
C. Crohn disease (Correct Answer)
D. Amoebic colitis

Explanation: ### Crohn disease - **Colicky abdominal pain**, **diarrhea**, **fever**, and **weight loss** are classic symptoms of Crohn disease, indicating chronic inflammation of the gastrointestinal tract [1]. - The presence of **discharging perineal sinuses** is highly characteristic of Crohn disease, as it commonly manifests with **perianal disease** including fistulas and abscesses [1]. ### Ileocaecal Tuberculosis - While ileocaecal tuberculosis can present with abdominal pain, diarrhea, fever, and weight loss, **perianal sinuses** are a less common feature compared to Crohn disease. - Diagnosis typically requires **histopathological evidence** of granulomas with caseous necrosis and acid-fast bacilli, which is not suggested by the initial presentation. ### Ulcerative colitis - **Ulcerative colitis** primarily affects the colon and rectum, leading to bloody diarrhea, abdominal pain, and tenesmus, but rarely causes **perianal fistulas** or sinuses [1]. - The disease typically presents with **continuous inflammation** extending proximally from the rectum, unlike the skip lesions seen in Crohn disease. ### Amoebic colitis - **Amoebic colitis** is an infectious cause of diarrhea, often bloody, with abdominal pain, but typically presents with a more **acute course** and is less commonly associated with chronic weight loss or perianal disease. - Diagnosis is confirmed by identifying **_Entamoeba histolytica_ trophozoites** or cysts in stool or tissue, and the presence of chronic discharging sinuses is not typical.

Question 14: A gentleman of 48 years was being worked up for hepatocellular function. He had no history or signs of encephalopathy. His serum bilirubin was 5 mg%, serum albumin was 3.9 gm%, International normalized ratio was 1.6. On ultrasound no free fluid was detected inside abdomen. As per Child-Turcotte-Pugh (CTP) classification, he was in:

A. CTP–D
B. CTP–A
C. CTP–B (Correct Answer)
D. CTP–C

Explanation: CTP–B - This patient scores 2 points for bilirubin (3.5-5 mg%), 1 point for albumin (>3.5 gm%), 2 points for INR (1.7-2.3), 1 point for no encephalopathy, and 1 point for no ascites. This sums to **7 points**, which falls into the **CTP Class B** range (7-9 points). - The CTP classification is used to assess the prognosis of **chronic liver disease**, primarily **cirrhosis**, based on five clinical and laboratory criteria [1]. CTP–D - The CTP classification only includes A, B, and C; there is no CTP–D class. - This option is incorrect as it represents a classification that does not exist within the CTP scoring system. CTP–A - CTP Class A requires a total score of 5-6 points, indicating **mild liver dysfunction**. - This patient's calculated score of 7 points places him beyond the Class A category. CTP–C - CTP Class C requires a total score of 10-15 points, indicating **severe liver dysfunction**. - This patient's score of 7 points is considerably lower than the range for Class C.

Question 15: Consider the following statements regarding Opportunistic post-splenectomy infections (OPSI): 1. Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae are the most common causative agents 2. Risk is greatest in the patients who have undergone splenectomy for trauma 3. Risk is greatest within the first 2–3 years following splenectomy 4. Prophylactic vaccination should be done 2 weeks prior to elective splenectomy Which of the statements given above are correct?

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

Explanation: ***1, 2 and 3*** - **_Haemophilus influenzae, Neisseria meningitidis_**, and **_Streptococcus pneumoniae_** are encapsulated bacteria, making them the most common causative agents of **overwhelming post-splenectomy infection (OPSI)**. The spleen plays a crucial role in filtering these organisms. - The risk of OPSI is indeed **greatest** in patients who have undergone splenectomy for **trauma**, likely due to both the acute physiological stress and potentially less structured pre-operative vaccination protocols compared to elective splenectomies. - While OPSI can occur at any time, the risk is **highest** within the first **2–3 years** following splenectomy, but it remains a lifelong risk. *1, 2 and 4* - This option is incorrect because statement 3 is correct, and statement 4 is incorrect. - Prophylactic vaccination should optimally be done **2 weeks prior** to an elective splenectomy, but doing it **4-6 weeks prior** allows for a more robust immune response to develop. *1, 3 and 4* - This option is incorrect because statement 2 is correct, and statement 4 is incorrect. - The risk of OPSI is indeed highest in trauma patients, as they often undergo emergent splenectomy without prior vaccination. *2, 3 and 4* - This option is incorrect because statement 1 is correct, and statement 4 is incorrect. - _Haemophilus influenzae, Neisseria meningitidis_, and _Streptococcus pneumoniae_ are well-established primary pathogens responsible for OPSI.

Pathology

2 questions

Q11

No increased relative risk of invasive breast carcinoma based on histopathological examination of benign breast tissue is for all of the following EXCEPT:

Q12

Which of the following statements regarding Paget's disease of nipple are correct? 1. It represents benign pathology of nipple areola complex 2. It is eczema like condition of nipple and areola 3. Erosion of nipple is seen 4. Nipple biopsy is required for definitive diagnosis Select the correct answer using the code given below:

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

Question 11: No increased relative risk of invasive breast carcinoma based on histopathological examination of benign breast tissue is for all of the following EXCEPT:

A. Squamous metaplasia
B. Solitary papilloma of lactiferous sinus (Correct Answer)
C. Usual ductal hyperplasia
D. Periductal mastitis

Explanation: ***Solitary papilloma of lactiferous sinus*** - A **solitary papilloma of the lactiferous sinus** is a proliferative breast lesion that is associated with a **slightly increased relative risk (approximately 1.5-2x)** for subsequent invasive breast carcinoma [2]. - Classified under **proliferative disease without atypia** in WHO classification of breast lesions [2]. - The risk is further elevated if there is associated **atypia** present [3]. - This is the **EXCEPTION** - it DOES carry increased risk, unlike the other options listed. *Squamous metaplasia* - **Squamous metaplasia** is a benign metaplastic change in breast tissue where glandular epithelium is replaced by squamous epithelium. - Typically seen in conditions like **periductal mastitis** or chronic inflammation. - Classified as a **non-proliferative lesion** and is **not associated** with an increased risk of invasive breast carcinoma [1]. *Usual ductal hyperplasia* - **Usual ductal hyperplasia (UDH)**, also known as **mild ductal hyperplasia**, is a proliferative lesion but historically has been considered to confer **minimal to no significantly increased risk** when mild [4]. - However, more recent studies suggest mild UDH may carry a **slight increase (1.3-1.5x)** compared to non-proliferative lesions, though this is **less established** than the risk from papillomas. - For exam purposes, **solitary papilloma** is the more definitive answer as a proliferative lesion with established increased risk. *Periductal mastitis* - **Periductal mastitis** is a chronic inflammatory condition of the breast ducts, often associated with smoking. - Characterized by inflammation, fibrosis, and squamous metaplasia of the ductal epithelium. - It is a **non-proliferative inflammatory condition** and is **not considered a risk factor** for invasive breast carcinoma [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1052-1054. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1054-1056. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 446-447.

Question 12: Which of the following statements regarding Paget's disease of nipple are correct? 1. It represents benign pathology of nipple areola complex 2. It is eczema like condition of nipple and areola 3. Erosion of nipple is seen 4. Nipple biopsy is required for definitive diagnosis Select the correct answer using the code given below:

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

Explanation: ***2, 3 and 4*** - **Paget's disease** presents as an **eczema-like rash** on the nipple and areola, and is characterized by **nipple erosion** [1] and ulceration. - It is an **intraepithelial adenocarcinoma** of the nipple [1], and a definitive diagnosis requires a **nipple biopsy** [1] to identify Paget's cells [2]. *2 and 4 only* - This option is incomplete as it misses the important clinical feature of **nipple erosion**, which is a common presentation of Paget's disease. - While it correctly identifies the eczema-like appearance and the need for biopsy, it understates the full clinical picture. *1, 2 and 3* - Statement 1 is incorrect because Paget's disease of the nipple is a **malignant condition** [2], not a benign one. - It arises from **ductal carcinoma in situ** [1] or invasive breast cancer extending to the nipple epidermis. *1, 3 and 4* - Statement 1 is incorrect as **Paget's disease is malignant**, representing an underlying breast cancer [2], not a benign pathology. - This option incorrectly classifies the disease as benign, which is a critical misunderstanding of its nature. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 456-457.

Surgery

2 questions

Q11

A 48 year old male with the history of chronic duodenal ulcer presented in surgical emergency with the complaints of sudden severe pain in the abdomen. At presentation: Pulse = 120/m, BP = 90/60 mm of Hg Abdomen: Tenderness (+), Rigidity (+), Guarding (+) Respiratory Rate: 20/m X-ray: Gas under right dome of diaphragm The probable diagnosis is:

Q12

A young sports person presented in surgical emergency with the complaints of severe pain in the groin area, extending into the scrotum and upper thigh. The pain is debilitating and he is not able to exercise. On examination there is tenderness in the region of Inguinal canal and pubic tubercle. He is probably suffering from:

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

Question 11: A 48 year old male with the history of chronic duodenal ulcer presented in surgical emergency with the complaints of sudden severe pain in the abdomen. At presentation: Pulse = 120/m, BP = 90/60 mm of Hg Abdomen: Tenderness (+), Rigidity (+), Guarding (+) Respiratory Rate: 20/m X-ray: Gas under right dome of diaphragm The probable diagnosis is:

A. Acute appendicitis
B. Perforation Peritonitis (Correct Answer)
C. Acute Pancreatitis
D. Acute Myocardial infarction

Explanation: ***Perforation Peritonitis*** - The patient's history of **chronic duodenal ulcer**, sudden severe abdominal pain, signs of **peritonitis** (**tenderness, rigidity, guarding**), and especially the X-ray finding of **gas under the right dome of the diaphragm** (indicating **pneumoperitoneum**) are all classic for a perforated viscus. - The **tachycardia** (Pulse = 120/m) and **hypotension** (BP = 90/60 mm Hg) further suggest a systemic inflammatory response syndrome (SIRS) or even **septic shock** due to peritonitis. *Acute appendicitis* - This typically presents with peri-umbilical pain migrating to the right lower quadrant, with localized tenderness and guarding, not diffuse peritonitis. - **Gas under the diaphragm** is not a feature of uncomplicated appendicitis but occurs with perforation of a hollow viscus. *Acute Pancreatitis* - While it can cause severe abdominal pain and signs of peritonitis, the pain often radiates to the back and is associated with elevated pancreatic enzymes. - **Gas under the diaphragm** is not a typical finding in acute pancreatitis unless there's a complication like colonic perforation. *Acute Myocardial infarction* - Though an MI can present with epigastric pain, it would not typically cause **diffuse abdominal tenderness, rigidity, guarding**, or **pneumoperitoneum**. - The primary symptoms would generally involve chest discomfort, and diagnostic tests would show cardiac enzyme elevation and EKG changes.

Question 12: A young sports person presented in surgical emergency with the complaints of severe pain in the groin area, extending into the scrotum and upper thigh. The pain is debilitating and he is not able to exercise. On examination there is tenderness in the region of Inguinal canal and pubic tubercle. He is probably suffering from:

A. Inguinal hernia
B. Femoral hernia
C. Varicocele
D. Sportsman hernia (Correct Answer)

Explanation: ***Sportsman hernia*** - The presentation of severe, debilitating groin pain extending to the scrotum and upper thigh, especially in a young sports person, is highly characteristic of a **sportsman's hernia** (also known as athletic pubalgia or Gilmore's groin). - This condition involves a **tear or weakening** of the posterior inguinal wall or associated musculature, leading to chronic groin pain exacerbated by physical activity. *Inguinal hernia* - This typically presents with a **visible bulge** in the groin that may or may not be painful, often increasing with straining but usually not as debilitating without incarceration. - While pain can extend to the scrotum, the primary complaint is usually the bulge and the pain is frequently relieved by lying down, unlike the chronic, activity-related pain described. *Femoral hernia* - A femoral hernia usually presents as a **lump below the inguinal ligament**, often more common in women, and can be easily confused with lymphadenopathy or a saphena varix. - While it can cause pain, it is less likely to produce the widespread, debilitating pain described as a primary symptom without signs of complications like incarceration. *Varicocele* - A varicocele is a condition of **enlarged veins within the scrotum** and typically presents as a "bag of worms" sensation or dull ache in the scrotum, often worse after standing for prolonged periods. - The pain is usually scrotal and not described as severe, debilitating groin pain extending to the upper thigh with tenderness in the inguinal canal, as seen in this case.