UPSC-CMS 2021 Previous Year Questions Practice Questions

Q: 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

Cellulitis. **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. [Practice more UPSC-CMS 2021 questions on OnCourse]

Q: Serum thyroglobulin level is an important tumor marker for

Papillary carcinoma thyroid. ***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. [Practice more UPSC-CMS 2021 questions on OnCourse]

Q: Which one of the following is NOT associated with BRCA1/BRCA2 genes?

Liver cancer. ***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. [Practice more UPSC-CMS 2021 questions on OnCourse]

Q: Which of the following are types of wound healing? 1. Primary Intention 2. Secondary Intention 3. Tertiary Intention 4. Quaternary Intention

1, 2 and 3. ***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. [Practice more UPSC-CMS 2021 questions on OnCourse]

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

Accepted Answer

Cellulitis

Answer

Abscess

Answer

Fasciitis

Answer

Compartment syndrome

Question 2

Serum thyroglobulin level is an important tumor marker for

Accepted Answer

Papillary carcinoma thyroid

Answer

Thyroid lymphoma

Answer

Medullary carcinoma thyroid

Answer

Anaplastic carcinoma thyroid

Question 3

Which one of the following is NOT associated with BRCA1/BRCA2 genes?

Accepted Answer

Liver cancer

Answer

Ovarian cancer

Answer

Prostate cancer

Answer

Breast cancer

Question 4

The malignancy associated with Stewart-Treves syndrome is

Accepted Answer

Lymphangiosarcoma

Answer

Basal cell carcinoma

Answer

Liposarcoma

Answer

Malignant melanoma

Question 5

Which of the following are types of wound healing?

1. Primary Intention
2. Secondary Intention
3. Tertiary Intention
4. Quaternary Intention

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 6

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

Accepted Answer

Thromboembolism

Answer

Postural hypotension

Answer

Transient ischaemic attack

Answer

Secondary haemorrhage

Question 7

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?

Accepted Answer

Lymphangiosarcoma

Answer

Malignant Melanoma

Answer

Lymphoma

Answer

Malignant fibrous histiocytoma

Question 8

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

Accepted Answer

Ludwig's angina

Answer

Acute lymphadenitis

Answer

Tubercular adenitis

Answer

Chronic lymphadenitis

Question 9

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

Accepted Answer

Papillary carcinoma thyroid

Answer

Lymphoma

Answer

Medullary carcinoma thyroid

Answer

Follicular carcinoma thyroid

Question 10

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

Accepted Answer

Cystic Hygroma

Answer

Branchial fistula

Answer

Branchial cyst

Answer

Thyroglossal cyst

UPSC-CMS 2021

Internal Medicine

Pathology

Surgery

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