UPSC-CMS 2020

Q: Consider the following statements regarding needle stick injuries: 1. Injured part should be washed under running water 2. Dominant index finger is the commonest site for needle stick injury 3. All needle stick injuries should be reported 4. Hepatitis/HIV testing should be done after needle stick injury Which of the statements given above are correct?

1, 3 and 4. ***1, 3 and 4*** - All **needle stick injuries** expose healthcare workers to potential bloodborne pathogens, making immediate action, reporting, and testing crucial for **risk assessment** and **post-exposure prophylaxis**. - **Washing the injured part** helps reduce pathogen load, reporting ensures proper investigation and documentation, and testing helps monitor for infection and guide treatment. *1, 2 and 3* - While statements 1 and 3 are correct, statement 2, claiming the **dominant index finger** is the commonest site, is generally incorrect; the **non-dominant hand** is often at higher risk during procedures. - Furthermore, statement 4 regarding **Hepatitis/HIV testing** is a critical component of post-exposure management that is omitted from this option. *1, 2 and 4* - Statements 1 and 4 are correct, but as noted, statement 2 about the **dominant index finger** being the commonest site is typically false, with **non-dominant hand** injuries being more frequent. - This option also incorrectly omits the essential step of **reporting all needle stick injuries**, which is vital for surveillance and appropriate follow-up. *2, 3 and 4* - This option incorrectly includes the statement that the **dominant index finger** is the commonest site for needle stick injury. - It also fails to include the crucial first step of immediately **washing the injured part** under running water, which is fundamental to initial management. [Practice more UPSC-CMS 2020 questions on OnCourse]

Q: A 22-year female has presented with a history of malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for last 6 months. She also complains of abdominal distension for last 2 days. On examination her abdomen has a doughy feel along with an ill defined mass over the right lower quadrant. She is most likely suffering from:

Ileocaecal tuberculosis. ***Ileocaecal tuberculosis*** - The combination of **constitutional symptoms** (malaise, cough), chronic gastrointestinal complaints (alternating constipation/diarrhea, abdominal pain), a **doughy abdomen**, and an **ill-defined right lower quadrant mass** is highly characteristic of ileocecal tuberculosis. - This presentation suggests chronic inflammation and potential **mass formation** in the ileocecal region, which is the most common site for intestinal tuberculosis. *Ovarian mass* - While an ovarian mass can cause abdominal distension and pain, it typically does not present with a **doughy feel** or the specific long-standing cough and alternating bowel habits described. - A definitive ovarian mass would usually be palpable as a more distinct, often mobile, pelvic mass rather than an ill-defined right lower quadrant mass that is sometimes seen with ileocecal tuberculosis. *Appendicular lump* - An appendicular lump is usually associated with **acute appendicitis** that has localized, leading to a firm, tender mass. - The patient's chronic symptoms over 6 months, fluctuating bowel habits, and doughy feel are not typical for an appendicular lump which is generally an acute or subacute process. *Carcinoma caecum* - Carcinoma of the caecum can present with an abdominal mass, changes in bowel habits, and abdominal pain. - However, the **doughy feel** and the presence of significant constitutional symptoms like persistent cough are less typical for early-stage caecal carcinoma and point more towards a chronic inflammatory or infectious process like tuberculosis. [Practice more UPSC-CMS 2020 questions on OnCourse]

Q: Consider the following statements regarding claudication: 1. It is a marker for silent coronary disease 2. Structured exercise program ( 2 hours per week for 3 months) leads to improvement in symptoms 3. Diabetes mellitus increases the risk and severity of claudication 4. Beta blockers may exacerbate claudication Which of the above statements are correct?

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All four statements are correct regarding **claudication**, a symptom of **peripheral arterial disease (PAD)**, where reduced blood flow to the limbs causes pain during exercise [1]. - **Claudication** is a significant marker for systemic **atherosclerosis** and **coronary artery disease**, increasing the risk of cardiovascular events, and **structured exercise programs** are a cornerstone of treatment [1]. *1, 3 and 4 only* - This option is incorrect because it omits statement 2. **Structured exercise programs** are unequivocally beneficial in improving claudication symptoms and functional capacity. - Omitting the beneficial effect of exercise contradicts current clinical guidelines for managing **PAD**. *1 and 2 only* - This option is incorrect as it fails to include statements 3 and 4. **Diabetes mellitus** is a major risk factor that significantly worsens PAD and claudication, while **beta-blockers** can indeed exacerbate symptoms in some patients due to their vasoconstrictive effects. - Ignoring the impact of **diabetes** and the potential adverse effects of **beta-blockers** provides an incomplete understanding of claudication management. *2, 3 and 4 only* - This option is incorrect because it excludes statement 1. **Claudication** is a strong indicator of widespread **atherosclerosis** and thus a marker for **silent coronary disease**, warranting investigation for broader cardiovascular risk [1]. - Failing to recognize claudication as a marker for **coronary disease** overlooks a critical aspect of its clinical significance and patient management. [Practice more UPSC-CMS 2020 questions on OnCourse]

Q: Medical management of thyrotoxic crisis includes all of the following EXCEPT:

IV antibiotics. ***IV antibiotics*** - **Antibiotics** are not a primary treatment for **thyrotoxic crisis** itself unless there's an underlying infection triggering the crisis, which is not indicated as a universal management step [1]. - The crisis is caused by an acute exacerbation of **hyperthyroidism**, not bacterial infection, so antibiotics would not address the core pathophysiology. *IV propanolol* - **Propranolol** (or other beta-blockers) helps control the adrenergic symptoms of thyrotoxic crisis, such as **tachycardia**, **tremors**, and **anxiety** [1]. - It also inhibits the peripheral conversion of **T4 to T3**, providing an additional therapeutic effect. *IV hydrocortisone* - **Glucocorticoids** like **hydrocortisone** are crucial in thyrotoxic crisis to inhibit the peripheral conversion of **T4 to T3**, stabilize cell membranes, and provide adrenal support. - They also help manage potential adrenal insufficiency, which can be an exacerbating factor or complication. *IV fluids* - **Intravenous fluids** are essential for correcting **dehydration**, which is often present due to increased metabolic rate, fever, sweating, and vomiting in patients with thyrotoxic crisis [1]. - They also help address **electrolyte imbalances** and support cardiovascular stability. [Practice more UPSC-CMS 2020 questions on OnCourse]

Q: First line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:

Anastrazole. ***Anastrazole*** - **Aromatase inhibitors** like anastrozole are the preferred first-line hormone therapy for **post-menopausal women** with **hormone-receptor-positive metastatic breast cancer**. - They work by **blocking the aromatase enzyme**, which is responsible for estrogen production in peripheral tissues in post-menopausal women. *Ovarian suppression by surgery* - Ovarian suppression is primarily used in **pre-menopausal women** to reduce estrogen production by the ovaries. - Since the patient is **post-menopausal**, her ovaries are no longer the primary source of estrogen production. *Antiprogestins* - **Antiprogestins** are not standard first-line hormone therapy for metastatic breast cancer. - While some progestational agents have been used in breast cancer treatment, **antiprogestins** are not established as a primary treatment. *Tamoxifen* - **Tamoxifen** is a **selective estrogen receptor modulator (SERM)** that has been widely used in breast cancer treatment. - While effective, **aromatase inhibitors** are generally preferred over tamoxifen as first-line therapy for **post-menopausal metastatic breast cancer** due to superior efficacy and tolerability profiles in this demographic. [Practice more UPSC-CMS 2020 questions on OnCourse]

119 Previous Year Questions with Answers & Explanations

119

Questions

Subjects

All (119)Anatomy (2)Anesthesiology (1)Biochemistry (1)Community Medicine (30)Dermatology (1)Forensic Medicine (2)Internal Medicine (13)Microbiology (3)Obstetrics and Gynecology (35)Orthopaedics (2)Pathology (2)Pharmacology (4)Radiology (3)Surgery (20)

Community Medicine

1 questions

Consider the following statements regarding needle stick injuries: 1. Injured part should be washed under running water 2. Dominant index finger is the commonest site for needle stick injury 3. All needle stick injuries should be reported 4. Hepatitis/HIV testing should be done after needle stick injury Which of the statements given above are correct?

Internal Medicine

4 questions

A 22-year female has presented with a history of malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for last 6 months. She also complains of abdominal distension for last 2 days. On examination her abdomen has a doughy feel along with an ill defined mass over the right lower quadrant. She is most likely suffering from:

Consider the following statements regarding claudication: 1. It is a marker for silent coronary disease 2. Structured exercise program ( 2 hours per week for 3 months) leads to improvement in symptoms 3. Diabetes mellitus increases the risk and severity of claudication 4. Beta blockers may exacerbate claudication Which of the above statements are correct?

Medical management of thyrotoxic crisis includes all of the following EXCEPT:

First line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:

UPSC-CMS 2020 - Internal Medicine UPSC-CMS Practice Questions and MCQs

Question 1: A 22-year female has presented with a history of malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for last 6 months. She also complains of abdominal distension for last 2 days. On examination her abdomen has a doughy feel along with an ill defined mass over the right lower quadrant. She is most likely suffering from:

A. Ileocaecal tuberculosis (Correct Answer)
B. Ovarian mass
C. Appendicular lump
D. Carcinoma caecum

Explanation: ***Ileocaecal tuberculosis*** - The combination of **constitutional symptoms** (malaise, cough), chronic gastrointestinal complaints (alternating constipation/diarrhea, abdominal pain), a **doughy abdomen**, and an **ill-defined right lower quadrant mass** is highly characteristic of ileocecal tuberculosis. - This presentation suggests chronic inflammation and potential **mass formation** in the ileocecal region, which is the most common site for intestinal tuberculosis. *Ovarian mass* - While an ovarian mass can cause abdominal distension and pain, it typically does not present with a **doughy feel** or the specific long-standing cough and alternating bowel habits described. - A definitive ovarian mass would usually be palpable as a more distinct, often mobile, pelvic mass rather than an ill-defined right lower quadrant mass that is sometimes seen with ileocecal tuberculosis. *Appendicular lump* - An appendicular lump is usually associated with **acute appendicitis** that has localized, leading to a firm, tender mass. - The patient's chronic symptoms over 6 months, fluctuating bowel habits, and doughy feel are not typical for an appendicular lump which is generally an acute or subacute process. *Carcinoma caecum* - Carcinoma of the caecum can present with an abdominal mass, changes in bowel habits, and abdominal pain. - However, the **doughy feel** and the presence of significant constitutional symptoms like persistent cough are less typical for early-stage caecal carcinoma and point more towards a chronic inflammatory or infectious process like tuberculosis.

Question 2: Consider the following statements regarding claudication: 1. It is a marker for silent coronary disease 2. Structured exercise program ( 2 hours per week for 3 months) leads to improvement in symptoms 3. Diabetes mellitus increases the risk and severity of claudication 4. Beta blockers may exacerbate claudication Which of the above statements are correct?

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

Explanation: ***1, 2, 3 and 4*** - All four statements are correct regarding **claudication**, a symptom of **peripheral arterial disease (PAD)**, where reduced blood flow to the limbs causes pain during exercise [1]. - **Claudication** is a significant marker for systemic **atherosclerosis** and **coronary artery disease**, increasing the risk of cardiovascular events, and **structured exercise programs** are a cornerstone of treatment [1]. *1, 3 and 4 only* - This option is incorrect because it omits statement 2. **Structured exercise programs** are unequivocally beneficial in improving claudication symptoms and functional capacity. - Omitting the beneficial effect of exercise contradicts current clinical guidelines for managing **PAD**. *1 and 2 only* - This option is incorrect as it fails to include statements 3 and 4. **Diabetes mellitus** is a major risk factor that significantly worsens PAD and claudication, while **beta-blockers** can indeed exacerbate symptoms in some patients due to their vasoconstrictive effects. - Ignoring the impact of **diabetes** and the potential adverse effects of **beta-blockers** provides an incomplete understanding of claudication management. *2, 3 and 4 only* - This option is incorrect because it excludes statement 1. **Claudication** is a strong indicator of widespread **atherosclerosis** and thus a marker for **silent coronary disease**, warranting investigation for broader cardiovascular risk [1]. - Failing to recognize claudication as a marker for **coronary disease** overlooks a critical aspect of its clinical significance and patient management.

Question 3: Medical management of thyrotoxic crisis includes all of the following EXCEPT:

A. IV propanolol
B. IV antibiotics (Correct Answer)
C. IV hydrocortisone
D. IV fluids

Explanation: ***IV antibiotics*** - **Antibiotics** are not a primary treatment for **thyrotoxic crisis** itself unless there's an underlying infection triggering the crisis, which is not indicated as a universal management step [1]. - The crisis is caused by an acute exacerbation of **hyperthyroidism**, not bacterial infection, so antibiotics would not address the core pathophysiology. *IV propanolol* - **Propranolol** (or other beta-blockers) helps control the adrenergic symptoms of thyrotoxic crisis, such as **tachycardia**, **tremors**, and **anxiety** [1]. - It also inhibits the peripheral conversion of **T4 to T3**, providing an additional therapeutic effect. *IV hydrocortisone* - **Glucocorticoids** like **hydrocortisone** are crucial in thyrotoxic crisis to inhibit the peripheral conversion of **T4 to T3**, stabilize cell membranes, and provide adrenal support. - They also help manage potential adrenal insufficiency, which can be an exacerbating factor or complication. *IV fluids* - **Intravenous fluids** are essential for correcting **dehydration**, which is often present due to increased metabolic rate, fever, sweating, and vomiting in patients with thyrotoxic crisis [1]. - They also help address **electrolyte imbalances** and support cardiovascular stability.

Question 4: First line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:

A. Ovarian suppression by surgery
B. Antiprogestins
C. Tamoxifen
D. Anastrazole (Correct Answer)

Explanation: ***Anastrazole*** - **Aromatase inhibitors** like anastrozole are the preferred first-line hormone therapy for **post-menopausal women** with **hormone-receptor-positive metastatic breast cancer**. - They work by **blocking the aromatase enzyme**, which is responsible for estrogen production in peripheral tissues in post-menopausal women. *Ovarian suppression by surgery* - Ovarian suppression is primarily used in **pre-menopausal women** to reduce estrogen production by the ovaries. - Since the patient is **post-menopausal**, her ovaries are no longer the primary source of estrogen production. *Antiprogestins* - **Antiprogestins** are not standard first-line hormone therapy for metastatic breast cancer. - While some progestational agents have been used in breast cancer treatment, **antiprogestins** are not established as a primary treatment. *Tamoxifen* - **Tamoxifen** is a **selective estrogen receptor modulator (SERM)** that has been widely used in breast cancer treatment. - While effective, **aromatase inhibitors** are generally preferred over tamoxifen as first-line therapy for **post-menopausal metastatic breast cancer** due to superior efficacy and tolerability profiles in this demographic.

Surgery

5 questions

Indications for fasciotomy in compartment syndrome include all EXCEPT:

Which one of the following statements is NOT correct regarding Necrotising Soft Tissue infections?

Which type of surgery is laparoscopic cholecystectomy classified as?

A 50-year old lady underwent uneventful bariatric surgery for morbid obesity. On the third post operative day, she develops breathlessness and pulmonary embolism is suspected. The next investigation to confirm the diagnosis will be:

A patient operated for a parotid gland tumour developed symptoms of sweating and erythema (flushing) over the region of surgical excision while eating. The probable diagnosis is:

UPSC-CMS 2020 - Surgery UPSC-CMS Practice Questions and MCQs

Question 1: Indications for fasciotomy in compartment syndrome include all EXCEPT:

A. Compartment pressure > 30 mm Hg
B. Distal sensory disturbance
C. Palpable distal pulses (Correct Answer)
D. Pain on passive movement of affected muscles

Explanation: ***Palpable distal pulses*** - The presence of **palpable distal pulses is NOT an indication for fasciotomy** and does not rule out compartment syndrome. - **Vascular compromise is a late sign** in compartment syndrome - pulses often remain palpable even with significant nerve and muscle ischemia. - Fasciotomy decisions should be based on **clinical signs** (pain, sensory changes) and **pressure measurements**, not the presence of pulses. - This is the correct answer because it is NOT an indication for the procedure. *Compartment pressure > 30 mm Hg* - **Absolute indication for fasciotomy** when compartment pressure exceeds 30 mmHg, or when the **delta pressure** (diastolic BP minus compartment pressure) is less than 30 mmHg. - This pressure level impairs capillary perfusion and leads to tissue ischemia. *Distal sensory disturbance* - **Early and reliable indication** for fasciotomy showing nerve ischemia. - Paresthesia or numbness in the distribution of nerves running through the affected compartment indicates neurological compromise from elevated intracompartmental pressure. *Pain on passive movement of affected muscles* - **Most sensitive and earliest clinical sign** of compartment syndrome (part of "the 6 P's"). - Pain on passive stretch is typically **out of proportion to the injury** and indicates underlying muscle ischemia. - This is a clear indication for fasciotomy.

Question 2: Which one of the following statements is NOT correct regarding Necrotising Soft Tissue infections?

A. Treatment consists of wide local excision and appropriate antibiotics
B. They are monomicrobial in nature (Correct Answer)
C. Tissue biopsy is required for culture and diagnosis
D. Crepitus, skin blistering and focal skin gangrene are typical presenting features

Explanation: ***They are monomicrobial in nature*** - Necrotizing soft tissue infections (NSTIs) are predominantly **polymicrobial**, involving a mix of aerobic and anaerobic bacteria. - While some cases can be monomicrobial (e.g., due to *Streptococcus pyogenes* or *Clostridium perfringens*), the statement that they *are* monomicrobial is generally false. *Treatment consists of wide local excision and appropriate antibiotics* - This statement is **correct**. **Aggressive surgical debridement** (wide local excision) to remove all necrotic tissue is the cornerstone of treatment for NSTIs. - **Broad-spectrum antibiotics** are also essential to cover the polymicrobial nature of these infections, but they are insufficient without surgical intervention. *Tissue biopsy is required for culture and diagnosis* - This statement is **correct**. While the diagnosis is primarily clinical, **tissue biopsy** for gram stain, culture, and histopathology is crucial for identifying the causative organisms and guiding definitive antibiotic therapy. - This helps differentiate NSTIs from other severe soft tissue infections and improves treatment accuracy. *Crepitus, skin blistering and focal skin gangrene are typical presenting features* - This statement is **correct**. These are classic signs of advanced necrotizing soft tissue infections. - **Crepitus** indicates gas production by bacteria, **skin blistering** (bullae) suggests dermal involvement, and **focal skin gangrene** is a direct sign of tissue necrosis, all pointing to the severity and rapid progression of NSTIs.

Question 3: Which type of surgery is laparoscopic cholecystectomy classified as?

A. Clean contaminated (Correct Answer)
B. Dirty
C. Contaminated
D. Clean

Explanation: ***Clean contaminated*** - This classification applies to surgeries that involve a **viscus** (e.g., gallbladder, gastrointestinal tract, respiratory tract) but with **no unusual contamination** encountered. - While the gallbladder contains bile, which harbors bacteria, in an uncomplicated laparoscopic cholecystectomy, spillage is controlled, and there's no pre-existing infection. *Dirty* - This category is reserved for procedures performed in the presence of **established infection**, such as an abdominal abscess or perforated viscus with gross spillage. - There is evidence of **pus** or a **perforated hollow viscus** encountered during the operation. *Contaminated* - This classification is used when there is a **major break in sterile technique** or a significant spillage from the gastrointestinal contents or infected bile. - It also includes procedures where **acute, non-purulent inflammation** is encountered, or an open, traumatic wound is less than 4 hours old. *Clean* - These are procedures in which there is **no inflammation**, the gastrointestinal, genitourinary, or respiratory tracts are **not entered**, and there is no break in aseptic technique. - Examples include breast biopsies, hernia repairs without bowel resection, and thyroidectomies.

Question 4: A 50-year old lady underwent uneventful bariatric surgery for morbid obesity. On the third post operative day, she develops breathlessness and pulmonary embolism is suspected. The next investigation to confirm the diagnosis will be:

A. MR angiography
B. Echocardiography
C. Duplex venography
D. CT pulmonary angiography (Correct Answer)

Explanation: ***CT pulmonary angiography*** - **CT pulmonary angiography (CTPA)** is the **gold standard** for diagnosing pulmonary embolism due to its high sensitivity and specificity in visualizing pulmonary arteries. - It rapidly provides detailed images of the pulmonary vasculature, allowing for the direct visualization of **thrombi** within the vessels. *MR angiography* - **MR angiography (MRA)** can be used for diagnosing pulmonary embolism but is generally less available and often takes longer than CTPA. - It is usually reserved for patients with contraindications to CT, such as **renal impairment** or **iodine allergy**, which are not indicated in this case. *Echocardiography* - **Echocardiography** can help assess the **right ventricular strain** caused by pulmonary embolism, but it is not diagnostic for the embolism itself. - It is more useful in evaluating the **hemodynamic impact** of the PE and ruling out other cardiac causes of breathlessness. *Duplex venography* - **Duplex venography** (or ultrasound of the lower extremities) is used to detect **deep vein thrombosis (DVT)** in the legs. - While DVT is a common cause of pulmonary embolism, this investigation does not directly visualize the embolism in the **pulmonary arteries**.

Question 5: A patient operated for a parotid gland tumour developed symptoms of sweating and erythema (flushing) over the region of surgical excision while eating. The probable diagnosis is:

A. Sialadenitis
B. Parotid gland fistula
C. Frey's syndrome (Correct Answer)
D. Chronic wound infection

Explanation: ***Frey's syndrome*** - **Frey's syndrome**, also known as auriculotemporal syndrome, is characterized by gustatory sweating and flushing in the preauricular or temporal region during mastication (eating). - This occurs due to aberrant regeneration of damaged postganglionic parasympathetic fibers that previously supplied the parotid gland. These fibers mistakenly reinnervate sweat glands and blood vessels in the skin, leading to sweating and flushing when salivary stimulation occurs. *Sialadenitis* - **Sialadenitis** is inflammation of a salivary gland, typically presenting with pain, swelling, and sometimes fever, and is not directly linked to sweating while eating. - It is usually caused by infection or obstruction, and its symptoms would not be localized to the surgical excision site with flushing and sweating upon eating. *Parotid gland fistula* - A **parotid gland fistula** involves the leakage of saliva through an opening in the skin, which would manifest as continuous or intermittent salivary drainage, not sweating and flushing. - This condition is a direct communication between the parotid duct or gland parenchyma and the skin surface. *Chronic wound infection* - A **chronic wound infection** would present with persistent pain, redness, warmth, swelling, and possibly purulent discharge at the surgical site. - Sweating and flushing specifically triggered by eating are not characteristic symptoms of a wound infection.