UPSC-CMS 2021

107 Questions — Page 2 of 11

All (107)Anatomy (2)Anesthesiology (3)Biochemistry (2)Community Medicine (27)Internal Medicine (10)Obstetrics and Gynecology (32)Pathology (3)Pediatrics (4)Pharmacology (7)Physiology (2)Radiology (1)Surgery (14)

Internal Medicine

5 questions

Q11

Which of the following statements regarding Ogilvie’s syndrome are correct? 1. It presents as acute large bowel mechanical obstruction 2. Marked caecal dilatation is a common feature on X-ray abdomen 3. Caecal perforation is a well recognized complication of this condition 4. Intravenous Neostigmine is used for the treatment of this condition

Q12

A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = 106/min, BP = 100/70 mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size 13 x 8 cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is

Q13

Among the extra intestinal manifestations of Crohn’s disease which one of the following is related to the disease activity ?

Q14

The Model for End Stage Liver Disease (MELD) score includes which of the following variables? 1. Serum bilirubin 2. Serum albumin 3. Serum creatinine 4. International Normalised Ratio (INR)

Q15

Which of the following statements with regard to Enteric perforation are correct? 1. Salmonella typhi is the causative organism for Enteric fever 2. Enteric perforation characteristically occurs during the third week of illness 3. Typhoid ulcers are placed transversely to the long axis of the gut 4. Terminal ileum is the most common site for enteric perforation

UPSC-CMS 2021 - Internal Medicine UPSC-CMS Practice Questions and MCQs

Question 11: Which of the following statements regarding Ogilvie’s syndrome are correct? 1. It presents as acute large bowel mechanical obstruction 2. Marked caecal dilatation is a common feature on X-ray abdomen 3. Caecal perforation is a well recognized complication of this condition 4. Intravenous Neostigmine is used for the treatment of this condition

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

Explanation: **2, 3 and 4** - **Marked caecal dilatation** is a hallmark of Ogilvie's syndrome on X-ray, indicating the pseudo-obstruction. - **Caecal perforation** is a serious and well-recognized complication, especially if the caecal diameter exceeds 12-14 cm. - **Intravenous Neostigmine** is a parasympathomimetic drug used to stimulate colonic motility and is an effective treatment for Ogilvie's syndrome. *1, 3 and 4* - Ogilvie's syndrome is characterized by **acute large bowel pseudo-obstruction**, meaning it mimics a mechanical obstruction without an actual physical blockage. - Therefore, statement 1, which claims it presents as acute large bowel *mechanical* obstruction, is incorrect. *1, 2 and 3* - As noted, Ogilvie's syndrome is a **pseudo-obstruction**, not a mechanical one, making statement 1 incorrect. - The other statements regarding caecal dilatation and perforation are correct. *1, 2 and 4* - Again, the key differentiating factor is that Ogilvie's syndrome is a **pseudo-obstruction**, not a mechanical obstruction, rendering statement 1 inaccurate. - Statements 2 and 4 are accurate descriptions of the condition and its treatment.

Question 12: A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = 106/min, BP = 100/70 mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size 13 x 8 cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is

A. Carcinoid tumor
B. Gastric lymphoma
C. Carcinoma stomach
D. Gastrointestinal stromal tumor (Correct Answer)

Explanation: ***Gastrointestinal stromal tumor*** - The rapid onset of symptoms like **upper abdominal pain**, **nausea**, **vomiting**, and **hematemesis**, along with signs of **hypovolemia** (tachycardia, hypotension, pallor), suggests acute gastrointestinal bleeding from a tumor [1]. - A **large exophytic tumor** in the stomach fundus with **intact overlying mucosa** on endoscopy points to a **submucosal lesion**, and **positive CD117 (c-Kit)** staining is a hallmark diagnostic feature of GISTs. *Carcinoid tumor* - While carcinoid tumors can occur in the gastrointestinal tract, they are typically **neuroendocrine tumors** and less commonly present as large, exophytic masses causing acute massive bleeding with the same frequency as GISTs. - Carcinoid tumors typically stain positive for **chromogranin A** and **synaptophysin**, not CD117. *Gastric lymphoma* - Gastric lymphoma commonly presents with **ulcerations** or infiltrative lesions of the gastric wall, which would typically cause mucosal disruption on endoscopy [2]. - Lymphomas are characterized by lymphoid markers like **CD20** or **CD3**, and not CD117 [2]. *Carcinoma stomach* - **Gastric carcinoma** often presents with **mucosal irregularities**, **ulcerations**, or **masses** that arise directly from the gastric epithelium, which would be visible on endoscopy as an invasive lesion [3]. - Gastric carcinomas are typically epithelial in origin and would not stain positive for **CD117**.

Question 13: Among the extra intestinal manifestations of Crohn’s disease which one of the following is related to the disease activity ?

A. Eye complications (Iritis/Uveitis) (Correct Answer)
B. Primary sclerosing cholangitis
C. Renal calculi
D. Chronic active hepatitis

Explanation: ***Eye complications (Iritis/Uveitis)*** - **Uveitis and iritis** in Crohn's disease often correlate with disease activity, meaning flares in the bowel disease can trigger or worsen these ocular manifestations [1]. - Successful treatment of the underlying intestinal inflammation frequently leads to improvement or resolution of these **eye complications** [1]. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic liver disease associated with inflammatory bowel disease, particularly ulcerative colitis, but its course is largely **independent of IBD activity**. - It progresses irrespective of intestinal disease flares and often requires its **own specific management**. *Renal calculi* - **Renal calculi (kidney stones)** can be a complication of Crohn's disease, linked to fluid loss and changes in oxalate absorption, but their occurrence is generally **not directly correlated with the inflammatory activity** of the bowel disease. - Instead, factors like **dehydration** and calcium/oxalate metabolism are more significant drivers. *Chronic active hepatitis* - While various hepatic manifestations can occur in Crohn's disease, **chronic active hepatitis** is not one of the well-established extraintestinal manifestations directly linked to disease activity. - Other liver conditions like **fatty liver disease** or **drug-induced liver injury** are more commonly seen, but their presence doesn't typically parallel intestinal inflammation.

Question 14: The Model for End Stage Liver Disease (MELD) score includes which of the following variables? 1. Serum bilirubin 2. Serum albumin 3. Serum creatinine 4. International Normalised Ratio (INR)

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

Explanation: ***1, 3 and 4*** - The **MELD score** calculates a patient's risk of death due to **end-stage liver disease** using **serum bilirubin**, **serum creatinine**, and **INR** [1]. - These variables reflect important aspects of **liver function** (bilirubin and INR) and **renal function** (creatinine), which is often compromised in advanced liver disease [1]. *1, 2 and 4* - This option correctly includes **serum bilirubin** and **INR** but incorrectly includes **serum albumin** as a component of the MELD score. - While **albumin** is a measure of **liver synthetic function** and is used in the **Child-Pugh score**, it is not part of the MELD calculation [1]. *2, 3 and 4* - This option incorrectly includes **serum albumin** and omits **serum bilirubin**, which are critical components of the MELD score. - **Serum bilirubin** is a direct indicator of the liver's ability to process and excrete bile. *1, 2 and 3* - This option includes **serum albumin** while omitting **INR**, a crucial indicator of the liver's **synthetic function** and its ability to produce clotting factors. - The **INR** directly reflects the liver's capacity to synthesize **coagulation proteins**.

Question 15: Which of the following statements with regard to Enteric perforation are correct? 1. Salmonella typhi is the causative organism for Enteric fever 2. Enteric perforation characteristically occurs during the third week of illness 3. Typhoid ulcers are placed transversely to the long axis of the gut 4. Terminal ileum is the most common site for enteric perforation

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

Explanation: ***1, 2 and 4*** * **Salmonella typhi** is indeed the causative organism for **enteric fever**, often known as typhoid fever. * **Enteric perforation** characteristically occurs during the **third week of illness** due to progressive ulceration of **Peyer's patches** [1]. * The **terminal ileum** is the **most common site** for enteric perforation because it has the highest concentration of **Peyer's patches**, which are target sites for Salmonella typhi [1]. *2, 3 and 4* * While enteric perforation typically occurs in the third week and the terminal ileum is the most common site, the statement about **typhoid ulcers** being placed transversely is incorrect. * **Typhoid ulcers** are characteristically oriented **longitudinally** along the long axis of the gut, following the orientation of the underlying Peyer's patches [1]. *1, 3 and 4* * Although Salmonella typhi is the causative organism and the terminal ileum is the most common site, the statement about **typhoid ulcers** being placed **transversely** is incorrect. * Perforation typically occurs during the **third week of illness**, which is an important clinical detail missed in this option [1]. *1, 2 and 3* * **Salmonella typhi** is the causative organism for enteric fever, and perforation does occur during the **third week of illness** [1]. * However, the statement that **typhoid ulcers** are placed **transversely** is incorrect; they are **longitudinal** in orientation.

Obstetrics and Gynecology

1 questions

Q11

A 43 year old woman presented with serous discharge from a single duct of the nipple of her right breast which was sent for evaluation. She is unlikely to be suffering from

Pathology

1 questions

Q11

Which of the following statements regarding hepatic adenomas are correct? 1. They are almost exclusively seen in females aged 25-50 years 2. They are associated with the use of oral contraceptive pills 3. They do not have any malignant potential 4. Majority are detected incidentally on imaging

Pediatrics

1 questions

Q11

An eight month old male child is brought to the emergency with recurrent episodes of screaming and drawing up of legs. The child appears to be listless in between the attacks. Local examination of abdomen reveals feeling of emptiness in the right iliac fossa and blood stained mucus is found on the finger on rectal examination. The most probable clinical diagnosis in this child is

Surgery

2 questions

Q11

Which of the following is NOT a classical symptom of acute appendicitis ?

Q12

A 35 year old male patient with enteric fever presents to the emergency with sudden onset of generalised abdominal pain, abdominal distension, nausea, vomiting and constipation for last 48 hours. On examination, patient is dehydrated with PR = 110/min and BP = 100/60 mm Hg. There is generalised tenderness, rebound tenderness present and board like rigidity on per abdomen examination. The most likely complication of enteric fever in this patient is

UPSC-CMS 2021 - Surgery UPSC-CMS Practice Questions and MCQs

Question 11: Which of the following is NOT a classical symptom of acute appendicitis ?

A. Periumbilical colic
B. Anorexia
C. Constipation (Correct Answer)
D. Nausea

Explanation: ***Constipation*** - While patients with appendicitis may experience altered bowel habits, **constipation is not a classic or defining symptom**; **diarrhea** can even be present. - The primary symptoms relate to inflammation and irritation of the appendix, not typically leading to significant constipation. *Periumbilical colic* - This is a very common early symptom, often described as a **vague, dull pain around the umbilicus** as the appendix initially becomes inflamed. - The pain later **migrates to the right lower quadrant** as the inflammation localizes to the parietal peritoneum. *Anorexia* - **Loss of appetite** is a highly characteristic and almost universal symptom in patients with acute appendicitis. - It often precedes the onset of abdominal pain and is considered a significant diagnostic indicator. *Nausea* - **Nausea and vomiting** are very common symptoms, often following the onset of abdominal pain. - These gastrointestinal symptoms are due to the visceral irritation caused by the inflamed appendix.

Question 12: A 35 year old male patient with enteric fever presents to the emergency with sudden onset of generalised abdominal pain, abdominal distension, nausea, vomiting and constipation for last 48 hours. On examination, patient is dehydrated with PR = 110/min and BP = 100/60 mm Hg. There is generalised tenderness, rebound tenderness present and board like rigidity on per abdomen examination. The most likely complication of enteric fever in this patient is

A. Small bowel perforation (Correct Answer)
B. Cholecystitis
C. Small bowel enteritis
D. Small bowel obstruction

Explanation: ***Small bowel perforation*** - The sudden onset of **generalised abdominal pain**, **distension**, **rebound tenderness**, and **board-like rigidity** in a patient with enteric fever strongly indicate **peritoneal irritation** due to perforation. - **Enteric fever** (typhoid) commonly causes **Peyer's patch hyperplasia and necrosis**, leading to full-thickness bowel wall damage and perforation, typically in the **ileum**. *Cholecystitis* - While cholecystitis can occur with enteric fever, it usually presents with **right upper quadrant pain**, **fever**, and **leukocytosis**, not generalized abdominal pain or peritoneal signs. - It does not typically cause **board-like rigidity** or signs of **perforation**. *Small bowel enteritis* - Small bowel enteritis causes **crampy abdominal pain**, **diarrhea**, and **vomiting**, but usually without the severe peritoneal signs like generalized tenderness and board-like rigidity. - It does not typically lead to systemic signs of shock and severe peritonitis as seen in this patient. *Small bowel obstruction* - Small bowel obstruction presents with **abdominal pain**, **distension**, **vomiting**, and **constipation**, but usually with **hyperactive bowel sounds** initially, progressing to absent. - The presence of **rebound tenderness** and **board-like rigidity** points more towards peritonitis from perforation rather than uncomplicated obstruction.