UPSC-CMS 2021
107 Previous Year Questions with Answers & Explanations
Internal Medicine
2 questionsA 50 year old female presents to the emergency with pain, swelling and redness over the left foot following a trivial trauma 3 days back. On examination, the swelling over the left foot is poorly localised; local tenderness and erythema are present and crepitus is absent; distal pulsations are palpable. The most likely clinical diagnosis is
Serum thyroglobulin level is an important tumor marker for
UPSC-CMS 2021 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 1: A 50 year old female presents to the emergency with pain, swelling and redness over the left foot following a trivial trauma 3 days back. On examination, the swelling over the left foot is poorly localised; local tenderness and erythema are present and crepitus is absent; distal pulsations are palpable. The most likely clinical diagnosis is
- A. Abscess
- B. Fasciitis
- C. Compartment syndrome
- D. Cellulitis (Correct Answer)
Explanation: **Cellulitis** - The clinical presentation of **pain, swelling, redness, poorly localized swelling**, and local tenderness following a minor trauma strongly suggests **cellulitis** [1]. - The absence of crepitus and presence of palpable distal pulses argue against severe infections like necrotizing fasciitis or compartment syndrome. *Abscess* - An abscess typically presents as a **localized, fluctuant** collection of pus, distinct from the poorly localized swelling described. - While an abscess can cause pain, swelling, and redness, its **well-demarcated nature** would differentiate it from the diffuse presentation of cellulitis [1]. *Fasciitis* - **Necrotizing fasciitis** is characterized by severe pain out of proportion to examination findings, rapid progression, systemic toxicity, and often **crepitus** due to gas production by bacteria. - The description lacks signs of overwhelming infection and crepitus, making fasciitis less likely. *Compartment syndrome* - Compartment syndrome involves severe pain, **pallor, paresthesia, pulselessness**, and paralysis (the 5 Ps), caused by increased pressure within a fascial compartment. - The presence of **palpable distal pulsations** makes compartment syndrome highly unlikely, as it typically impairs blood flow.
Question 2: Serum thyroglobulin level is an important tumor marker for
- A. Thyroid lymphoma
- B. Medullary carcinoma thyroid
- C. Papillary carcinoma thyroid (Correct Answer)
- D. Anaplastic carcinoma thyroid
Explanation: ***Papillary carcinoma thyroid*** - **Serum thyroglobulin** is produced by follicular cells of the thyroid and serves as an excellent tumor marker for **differentiated thyroid cancers**, including papillary carcinoma, particularly after thyroidectomy [1]. - Elevated thyroglobulin levels in a patient with a history of papillary thyroid cancer, especially after removal of the thyroid gland, suggest **recurrence or persistent disease**. *Thyroid lymphoma* - **Thyroid lymphoma** is a lymphoid malignancy, and its primary tumor marker is typically associated with lymphocytic origin, such as **beta-2 microglobulin** or **LDH**, not thyroglobulin. - Thyroglobulin is a product of thyroid follicular cells, which are not the cell of origin for lymphoma. *Medullary carcinoma thyroid* - **Medullary thyroid carcinoma** originates from the parafollicular C cells, which produce **calcitonin**. - **Calcitonin** is the primary tumor marker for medullary thyroid carcinoma, not thyroglobulin. *Anaplastic carcinoma thyroid* - **Anaplastic thyroid carcinoma** is an undifferentiated tumor with very aggressive behavior and often does not produce significant amounts of thyroglobulin. - While some anaplastic carcinomas may have elevated thyroglobulin, it's not a reliable or specific marker due to the **dedifferentiated nature** of the cells.
Pathology
2 questionsWhich one of the following is NOT associated with BRCA1/BRCA2 genes?
The malignancy associated with Stewart-Treves syndrome is
UPSC-CMS 2021 - Pathology UPSC-CMS Practice Questions and MCQs
Question 1: Which one of the following is NOT associated with BRCA1/BRCA2 genes?
- A. Ovarian cancer
- B. Liver cancer (Correct Answer)
- C. Prostate cancer
- D. Breast cancer
Explanation: ***Liver cancer*** - **BRCA1/BRCA2 mutations** are primarily associated with an increased risk of breast, ovarian, and prostate cancers, but not typically with **liver cancer**. - While liver cancer does have genetic predispositions, they are generally linked to other genes and environmental factors like chronic viral hepatitis or alcohol abuse. *Ovarian cancer* - **BRCA1/BRCA2 gene mutations** significantly increase the risk of developing **hereditary ovarian cancer**, particularly serous ovarian carcinoma [2]. - Individuals with these mutations often undergo prophylactic oophorectomy to reduce their risk [2]. *Prostate cancer* - **BRCA1/BRCA2 mutations**, especially **BRCA2**, are associated with an increased risk of developing **prostate cancer**, often an aggressive form, particularly in younger men. - Screening guidelines for men with BRCA mutations may include earlier and more frequent PSA testing. *Breast cancer* - **BRCA1 and BRCA2 genes** are tumor suppressor genes, and mutations in these genes are the most common cause of **hereditary breast cancer** [1], [2]. - Individuals with BRCA mutations have a significantly higher lifetime risk of developing breast cancer, and often have a higher incidence of bilateral breast cancer [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1058. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1058-1059.
Question 2: The malignancy associated with Stewart-Treves syndrome is
- A. Basal cell carcinoma
- B. Liposarcoma
- C. Lymphangiosarcoma (Correct Answer)
- D. Malignant melanoma
Explanation: ***Lymphangiosarcoma*** - **Stewart-Treves syndrome** is characterized by the development of **lymphangiosarcoma** in a setting of chronic lymphedema, most commonly following a radical mastectomy for breast cancer [2]. - The chronic lymphatic obstruction and subsequent lymphedema [2] are thought to create an environment conducive to the development of this rare and aggressive **vascular malignancy** [1]. *Basal cell carcinoma* - This is a common **skin cancer** that typically arises from the basal cells of the epidermis and is primarily associated with **ultraviolet (UV) radiation exposure**, not chronic lymphedema [4]. - While it can occur in individuals with a history of radiation therapy (which might be part of breast cancer treatment), it is not the specific malignancy defining Stewart-Treves syndrome [3]. *Liposarcoma* - **Liposarcoma** is a malignant tumor of **adipose tissue** and does not have a direct association with chronic lymphedema or Stewart-Treves syndrome. - It arises from fat cells and can occur in various locations but is not typically linked to impaired lymphatic drainage. *Malignant melanoma* - This highly aggressive **skin cancer** arises from **melanocytes** and is strongly associated with **UV radiation exposure** and genetic predisposition. - While skin cancers can occur in patients with breast cancer, **melanoma** is not the specific malignancy that defines Stewart-Treves syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 527-528. [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. 125-126. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1157-1158. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 643-644.
Surgery
6 questionsWhich of the following are types of wound healing? 1. Primary Intention 2. Secondary Intention 3. Tertiary Intention 4. Quaternary Intention
A 60 year old lady underwent total abdominal hysterectomy. On the 3rd post operative day she suddenly became breathless while returning from washroom. Her blood pressure recorded was 80/50 mm of Hg. The most probable diagnosis is
A 52 year old female underwent MRM (Modified Radical Mastectomy). After few years, she developed lymphedema of the ipsilateral arm. Which of the following malignancies can develop in her arm?
A gentleman of 60 years presented with a brawny swelling of the submandibular region with inflammatory edema of mouth and putrid halitosis. Most likely he is suffering from
A 25 year old female patient with previous history of neck irradiation presents with thyroid swelling for last 6 months. The patient is clinically euthyroid. On examination, the right lobe of thyroid gland is enlarged with presence of ipsilateral cervical lymphadenopathy. The most probable clinical diagnosis in this patient is
An infant presented in the surgical OPD with complaints of a unilateral swelling in the neck. The swelling was soft, cystic, partially compressible and brilliantly transilluminant. The most probable diagnosis is
UPSC-CMS 2021 - Surgery UPSC-CMS Practice Questions and MCQs
Question 1: Which of the following are types of wound healing? 1. Primary Intention 2. Secondary Intention 3. Tertiary Intention 4. Quaternary Intention
- A. 1, 2 and 4
- B. 1, 2 and 3 (Correct Answer)
- C. 2, 3 and 4
- D. 1, 3 and 4
Explanation: ***1, 2 and 3*** - These options correctly identify the three recognized types of **wound healing** in surgical practice. - **Primary intention (healing by first intention)**: Clean wounds with approximated edges, minimal tissue loss, heals with minimal scarring (e.g., surgical incisions). - **Secondary intention (healing by second intention)**: Wounds with significant tissue loss that heal by granulation tissue formation, wound contraction, and epithelialization (e.g., pressure ulcers, large traumatic wounds). - **Tertiary intention (delayed primary closure)**: Contaminated wounds initially left open for 3-5 days, then closed after infection risk decreases. *1, 2 and 4* - This option incorrectly includes **"Quaternary Intention,"** which is **not a recognized classification** in wound healing. - Only primary, secondary, and tertiary intention are standard types described in surgical textbooks. *2, 3 and 4* - This option omits **"Primary Intention,"** the most common type of wound healing for clean surgical incisions. - It also incorrectly includes "Quaternary Intention," which does not exist in wound healing classification. *1, 3 and 4* - This option omits **"Secondary Intention,"** a crucial healing process for wounds with substantial tissue loss that cannot be primarily closed. - "Quaternary Intention" is not a valid wound healing type and represents a distractor in this question.
Question 2: A 60 year old lady underwent total abdominal hysterectomy. On the 3rd post operative day she suddenly became breathless while returning from washroom. Her blood pressure recorded was 80/50 mm of Hg. The most probable diagnosis is
- A. Postural hypotension
- B. Thromboembolism (Correct Answer)
- C. Transient ischaemic attack
- D. Secondary haemorrhage
Explanation: ***Thromboembolism*** - Sudden onset **breathlessness** and **hypotension** in a postoperative patient are classic signs of a **pulmonary embolism (PE)**, a severe form of thromboembolism. - Surgical procedures, especially pelvic surgeries like hysterectomy, are **risk factors** for deep vein thrombosis (DVT) which can lead to PE. *Postural hypotension* - While it can cause lightheadedness or dizziness upon standing, it typically doesn't present as sudden, severe **breathlessness** and sustained **hypotension**. - Its onset is directly related to a change in position, and the patient's symptoms are more severe than usually seen with postural changes. *Transient ischaemic attack* - A TIA involves **neurological deficits** such as weakness, speech disturbance, or visual changes, which are temporary. - It does not present with sudden **breathlessness** or profound **hypotension**. *Secondary haemorrhage* - This would typically manifest as signs of **blood loss**, such as fresh bleeding from the surgical site or distended abdomen, along with features of hypovolemic shock. - While hypotension would be present, the primary symptom would not be sudden **breathlessness**.
Question 3: A 52 year old female underwent MRM (Modified Radical Mastectomy). After few years, she developed lymphedema of the ipsilateral arm. Which of the following malignancies can develop in her arm?
- A. Malignant Melanoma
- B. Lymphangiosarcoma (Correct Answer)
- C. Lymphoma
- D. Malignant fibrous histiocytoma
Explanation: ***Lymphangiosarcoma*** - This is a rare, aggressive **vascular tumor** that can develop in chronically lymphedematous limbs, particularly after **mastectomy** for breast cancer. - The chronic lymphatic obstruction and inflammation are thought to be predisposing factors, leading to the condition known as **Stewart-Treves syndrome**. *Malignant Melanoma* - This cancer arises from **melanocytes** in the skin and is primarily associated with UV radiation exposure or existing nevi, not chronic lymphedema. - While it can occur anywhere on the body, there is no direct causal link between modified radical mastectomy and the development of melanoma in the arm. *Lymphoma* - Lymphoma is a cancer of the **lymphocytes** within the lymphatic system, typically presenting as swollen lymph nodes or B-symptoms. - Although lymphedema involves the lymphatic system, it generally predisposes to angiosarcoma rather than lymphoma in this specific clinical context. *Malignant fibrous histiocytoma* - This is a type of **soft tissue sarcoma** that can occur in various locations, but it is not specifically linked to chronic lymphedema following mastectomy. - While its etiology can be complex, it does not have the well-established association with chronic lymphedema that lymphangiosarcoma does.
Question 4: A gentleman of 60 years presented with a brawny swelling of the submandibular region with inflammatory edema of mouth and putrid halitosis. Most likely he is suffering from
- A. Ludwig's angina (Correct Answer)
- B. Acute lymphadenitis
- C. Tubercular adenitis
- D. Chronic lymphadenitis
Explanation: ***Ludwig's angina*** - This is a **rapidly progressive cellulitis** of the submandibular, sublingual, and submental spaces, commonly originating from **odontogenic infections**. - The classic presentation includes **brawny edema** (firm, woody induration) of the submandibular region, inflammatory edema of the mouth, and **putrid halitosis** indicative of an anaerobic infection. *Acute lymphadenitis* - This involves inflammation of the lymph nodes, typically characterized by **tender, enlarged nodes**. - While it can be associated with infection, it usually does not present with the diffuse, *brawny* swelling of the floor of the mouth and submandibular area as described, nor the severe systemic symptoms often linked to Ludwig's angina. *Tubercular adenitis* - This is a **chronic granulomatous inflammation** of lymph nodes, typically presenting as slowly enlarging, **non-tender masses**. - It does not cause acute, rapidly spreading cellulitis or *brawny* edema with severe halitosis, which are hallmark features of Ludwig's angina. *Chronic lymphadenitis* - This refers to persistent or recurrent inflammation of lymph nodes, often due to protracted infection or inflammatory processes. - It usually manifests as **enlarged, firm, sometimes mobile lymph nodes**, but does not involve the acute, diffuse, and rapidly spreading *brawny* edema characteristic of a severe fascial space infection like Ludwig's angina.
Question 5: A 25 year old female patient with previous history of neck irradiation presents with thyroid swelling for last 6 months. The patient is clinically euthyroid. On examination, the right lobe of thyroid gland is enlarged with presence of ipsilateral cervical lymphadenopathy. The most probable clinical diagnosis in this patient is
- A. Papillary carcinoma thyroid (Correct Answer)
- B. Lymphoma
- C. Medullary carcinoma thyroid
- D. Follicular carcinoma thyroid
Explanation: ***Papillary carcinoma thyroid*** - A history of **neck irradiation** is a significant risk factor for **papillary thyroid carcinoma**. - **Cervical lymphadenopathy** is a common presentation, as papillary carcinoma frequently metastasizes to regional lymph nodes, and the patient is **euthyroid**. *Lymphoma* - While neck mass and lymphadenopathy can occur with lymphoma, a history of **previous neck irradiation** is a stronger predisposing factor for thyroid carcinoma, and **thyroid lymphoma** often presents with a rapidly enlarging goiter or compressive symptoms. - Though irradiation can increase the risk of some lymphomas, it's a more direct and strong risk factor for thyroid cancer in the setting of thyroid swelling. *Medullary carcinoma thyroid* - **Medullary thyroid carcinoma** typically arises from **parafollicular C cells** and is often associated with elevated **calcitonin levels** and may be familial (e.g., MEN 2 syndromes), which are not mentioned. - While it can present with lymphadenopathy, the history of irradiation points more strongly towards papillary carcinoma. *Follicular carcinoma thyroid* - **Follicular carcinoma** is less commonly associated with a history of **neck irradiation** compared to papillary carcinoma and tends to metastasize hematogenously rather than primarily to regional lymph nodes. - It often presents as a solitary nodule, and while lymph node involvement can occur, it's less characteristic than in papillary carcinoma.
Question 6: An infant presented in the surgical OPD with complaints of a unilateral swelling in the neck. The swelling was soft, cystic, partially compressible and brilliantly transilluminant. The most probable diagnosis is
- A. Branchial fistula
- B. Branchial cyst
- C. Thyroglossal cyst
- D. Cystic Hygroma (Correct Answer)
Explanation: ***Cystic Hygroma*** - A **cystic hygroma (lymphangioma)** is a congenital malformation of the lymphatic system, typically presenting in infants as a soft, compressible, and **brilliantly transilluminant** neck mass. - The hallmark feature is **brilliant transillumination** due to the clear lymphatic fluid within the multiloculated cystic spaces. - Commonly located in the **posterior triangle of the neck** (75%) or submandibular region, though can occur anywhere in the neck. - The presentation of a soft, cystic, partially compressible, and brilliantly transilluminant unilateral neck swelling in an infant is classic for cystic hygroma. *Branchial cyst* - A **branchial cyst** arises from incomplete obliteration of the branchial apparatus during embryonic development. - Typically presents in **older children or young adults** (late childhood to third decade), not commonly in infancy. - Located in the **lateral neck** along the anterior border of the sternocleidomastoid muscle. - While it can be soft and cystic, **brilliant transillumination is not a hallmark feature** of branchial cysts, making this less likely in an infant with this classic presentation. *Branchial fistula* - A **branchial fistula** is an abnormal tract connecting the skin to the pharynx, presenting with a small external opening that may discharge mucus or saliva. - It is **not a cystic swelling** and does not present with transillumination, as it is a communicating tract rather than a closed cystic mass. *Thyroglossal cyst* - A **thyroglossal cyst** is a **midline neck swelling** that moves with protrusion of the tongue and swallowing, reflecting its embryonic origin from the thyroglossal duct. - The question specifically mentions a **unilateral swelling**, which rules out thyroglossal cyst as it characteristically occurs in the midline.