UPSC-CMS 2022
120 Previous Year Questions with Answers & Explanations
Anatomy
1 questionsWhich of the following statements regarding annular pancreas is INCORRECT? 1. It results from failure of rotation of ventral pancreatic bud during development. 2. A ring of pancreatic tissue surrounds the second or third part of duodenum. 3. It presents with vomiting due to duodenal obstruction. 4. Duodenoduodenostomy is the preferred treatment of this condition.
UPSC-CMS 2022 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 1: Which of the following statements regarding annular pancreas is INCORRECT? 1. It results from failure of rotation of ventral pancreatic bud during development. 2. A ring of pancreatic tissue surrounds the second or third part of duodenum. 3. It presents with vomiting due to duodenal obstruction. 4. Duodenoduodenostomy is the preferred treatment of this condition.
- A. 4. Duodenoduodenostomy is the preferred treatment of this condition. (Correct Answer)
- B. 3. It presents with vomiting due to duodenal obstruction.
- C. 1. It results from failure of rotation of ventral pancreatic bud during development.
- D. 2. A ring of pancreatic tissue surrounds the second part of duodenum.
Explanation: ***Correct Answer: 4. Duodenoduodenostomy is the preferred treatment of this condition.*** - This statement is **INCORRECT** and hence the correct answer to this question. - The preferred surgical treatment for symptomatic annular pancreas is a **bypass procedure** such as **duodenojejunostomy** or **gastrojejunostomy**, NOT duodenoduodenostomy. [1], [3] - The goal is to **relieve duodenal obstruction** without resecting pancreatic tissue, which carries high risk of complications including pancreatitis and pancreatic fistula. *Incorrect Option 1: It results from failure of rotation of ventral pancreatic bud during development.* - This statement is **correct**. - Annular pancreas is a rare **congenital anomaly** caused by abnormal **rotation and fusion of the ventral pancreatic bud** with the dorsal bud during embryonic development, resulting in pancreatic tissue encircling the duodenum. *Incorrect Option 2: A ring of pancreatic tissue surrounds the second or third part of duodenum.* - This statement is **correct**. - Annular pancreas is characterized by a **ring of pancreatic tissue** that encircles the **second part of the duodenum** (most commonly), though the third part can occasionally be involved. *Incorrect Option 3: It presents with vomiting due to duodenal obstruction.* - This statement is **correct**. - The classic presentation includes **vomiting due to duodenal obstruction**, which can be complete or partial. [2] - In neonates, this manifests as **bilious vomiting** and feeding intolerance; in adults, postprandial fullness and recurrent vomiting are common. [2]
Internal Medicine
4 questionsMycetoma, a chronic, specific, granulomatous, destructive disease involving the skin and subcutaneous tissue:
Which of the following statements are correct regarding Buerger's disease? 1. It involves small to medium arteries. 2. It is common in smokers. 3. It commonly involves lower limb vessels. 4. Cessation of smoking reverses the disease process.
The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is
Which of the following statements about peptic ulcers is correct?
UPSC-CMS 2022 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 1: Mycetoma, a chronic, specific, granulomatous, destructive disease involving the skin and subcutaneous tissue:
- A. may be caused by fungi or bacteria (Correct Answer)
- B. involves the superficial structure only
- C. frequently causes trophic changes
- D. is a blood-borne infection
Explanation: ***may be caused by fungi or bacteria*** - Mycetoma can be caused by either **eumycetes (true fungi)**, leading to **eumycetoma**, or by certain **aerobic actinomycetes (bacteria)**, resulting in **actinomycetoma** [1]. - Both forms present with similar clinical features, including **granulomatous inflammation** and the formation of **grains** or granules. *involves the superficial structure only* - Mycetoma is characterized by its **destructive nature**, progressively involving **deep tissues** like fascia, muscle, and even bone, not just superficial structures [1]. - The disease often leads to **deformity** and **loss of function** due to deep tissue invasion. *frequently causes trophic changes* - While mycetoma leads to significant tissue destruction and deformity, **trophic changes** (e.g., changes in skin, hair, and nails due to nerve damage) are not its primary or most characteristic feature. - The main complications are related to **tissue destruction**, **secondary infections**, and **amputation**. *is a blood-borne infection* - Mycetoma is acquired through **traumatic inoculation** of the causative organism into the skin, typically via thorns or splinters. - It is a **localized infection** and does not spread via the bloodstream; systemic dissemination is very rare.
Question 2: Which of the following statements are correct regarding Buerger's disease? 1. It involves small to medium arteries. 2. It is common in smokers. 3. It commonly involves lower limb vessels. 4. Cessation of smoking reverses the disease process.
- A. 1, 2 and 3 (Correct Answer)
- B. 1, 3 and 4
- C. 1, 2 and 4
- D. 2, 3 and 4
Explanation: ***1, 2 and 3*** - Buerger's disease, or **thromboangiitis obliterans**, primarily affects **small to medium-sized arteries and veins** in the upper and lower extremities. - It is **strongly associated with tobacco use** and commonly affects the **distal arteries** of the limbs, leading to ischemia and potential gangrene. *1, 3 and 4* - While Buerger's disease involves small to medium arteries and commonly affects lower limb vessels, **cessation of smoking does not reverse the disease process** but rather stops its progression. - The damage caused to the vessels by inflammation and thrombosis is largely irreversible. *1, 2 and 4* - This option incorrectly states that cessation of smoking reverses the disease process, which is not true. - While smoking cessation is crucial for preventing progression, existing vascular damage is permanent. *2, 3 and 4* - This option misses that Buerger's disease involves **small to medium arteries**, which is a key characteristic of the condition. - Additionally, it incorrectly suggests that smoking cessation reverses the disease.
Question 3: The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is
- A. upper GI endoscopy
- B. 24-hour pH recording (Correct Answer)
- C. CT scan
- D. barium meal follow through
Explanation: ***24-hour pH recording*** - This method directly measures the **frequency** and **duration of acid exposure** in the esophagus, providing objective evidence of reflux. - It is considered the gold standard because it can **quantify reflux episodes** and correlate them with patient symptoms. *upper GI endoscopy* - While useful for visualizing **mucosal damage** [1] (esophagitis, strictures, Barrett's esophagus) caused by reflux, it does not directly measure or confirm reflux itself. - Many patients with GORD symptoms have **normal endoscopic findings**, making it unsuitable as the gold standard for diagnosis. *CT scan* - A CT scan is not typically used for diagnosing GORD. - It is more useful for identifying **structural abnormalities** or **complications** of reflux, such as tumors or hiatal hernias. *barium meal follow through* - This imaging technique can identify **structural abnormalities** like hiatal hernia or severe reflux events, but it is not sensitive enough to detect intermittent or mild reflux. - It provides a **snapshot** of reflux and cannot quantify the total acid exposure over a prolonged period.
Question 4: Which of the following statements about peptic ulcers is correct?
- A. It is more commonly seen in females.
- B. The most common location is the third part of duodenum.
- C. Anteriorly located duodenal ulcers are 'more prone for perforation'. (Correct Answer)
- D. There is no risk of malignancy in gastric ulcers.
Explanation: Anteriorly located duodenal ulcers are 'more prone for perforation' - The duodenal bulb is largely peritonealized, and an **anterior ulcer** perforates into the peritoneal cavity, leading to **peritonitis**. - Posterior ulcers, in contrast, are more likely to erode into vessels like the **gastroduodenal artery**, causing **hemorrhage** rather than perforation. *It is more commonly seen in females* - Peptic ulcers, particularly **duodenal ulcers**, are generally more common in **men** than women, though the incidence in women has increased. - The prevalence largely depends on risk factors like **NSAID use** and **H. pylori infection**, which do not show a strong female predominance [1]. *The most common location is the third part of duodenum* - The most common location for **duodenal ulcers** is the **first part of the duodenum** (duodenal bulb) [1]. - Ulcers in the third part of the duodenum are less common and may suggest underlying conditions like **Zollinger-Ellison syndrome**. *There is no risk of malignancy in gastric ulcers* - While not all gastric ulcers are malignant, there is a definite **risk of malignancy** associated with **gastric ulcers**, especially within the setting of chronic inflammation or H. pylori infection [1]. - All gastric ulcers, once identified, require follow-up and **biopsy to rule out malignancy**; this is less of a concern for duodenal ulcers.
Pathology
1 questionsWhich of the following statements regarding papillary thyroid cancer is correct? 1. It is the most common malignant tumour of thyroid gland. 2. It is more common in young females. 3. It has propensity for haematogenous spread. 4. Distant metastases are uncommon.
UPSC-CMS 2022 - Pathology UPSC-CMS Practice Questions and MCQs
Question 1: Which of the following statements regarding papillary thyroid cancer is correct? 1. It is the most common malignant tumour of thyroid gland. 2. It is more common in young females. 3. It has propensity for haematogenous spread. 4. Distant metastases are uncommon.
- A. 2. It is more common in young females.
- B. 4. Distant metastases are uncommon.
- C. 3. It has propensity for haematogenous spread.
- D. 1. It is the most common malignant tumour of thyroid gland. (Correct Answer)
Explanation: ***1. It is the most common malignant tumour of thyroid gland.*** - **Papillary thyroid cancer (PTC)** accounts for approximately **80-85% of all thyroid cancers**, making it the most prevalent type [1]. - This is the definitive correct statement among the options provided. *2. It is more common in young females.* - While PTC is indeed **more common in females** (3:1 female-to-male ratio), the term "young" is imprecise for exam purposes [3]. - PTC typically occurs in the **3rd to 5th decades** (30-50 years), which is more accurately described as "middle-aged" rather than "young" [1], [2]. - The statement lacks specificity needed for a definitive answer. *3. It has propensity for haematogenous spread.* - This is **incorrect**. PTC primarily spreads via the **lymphatic system** to regional cervical lymph nodes [2]. - **Hematogenous spread** is characteristic of **follicular thyroid carcinoma**, not papillary type [2]. - While distant hematogenous metastases can occur in advanced PTC, it is **not** the characteristic pattern of spread. *4. Distant metastases are uncommon.* - While this statement has merit (distant metastases occur in only 5-10% at presentation), it is less definitively correct than statement 1. - The majority of PTC metastases are **locoregional lymphatic** spread rather than distant. - However, when distant metastases do occur, it affects prognosis significantly (lungs > bones). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1100. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-430. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1095-1096.
Radiology
1 questionsThe most difficult area to visualize using duplex scanning (B-mode ultrasound), especially in an obese patient, is
UPSC-CMS 2022 - Radiology UPSC-CMS Practice Questions and MCQs
Question 1: The most difficult area to visualize using duplex scanning (B-mode ultrasound), especially in an obese patient, is
- A. abdominal aorta above renal vessels
- B. carotid vessels
- C. aortoiliac segment (Correct Answer)
- D. iliofemoral segment
Explanation: ***aortoiliac segment*** - The **aortoiliac segment** is often challenging to visualize due to its deep location within the **pelvis** and the presence of overlying **bowel gas**, which scatters ultrasound waves. - In obese patients, increased **adipose tissue** further attenuates the ultrasound signal, making imaging of this specific segment particularly difficult. *abdominal aorta above renal vessels* - While the **abdominal aorta** can be challenging, particularly the segment above the renal vessels due to the diaphragm and lung bases, it is generally more accessible than the deep pelvic structures. - Visualization can be improved by optimizing patient position and using specific transducer angles. *carotid vessels* - **Carotid vessels** are superficial and easily accessible for duplex scanning, making them one of the easiest vascular beds to image. - There is minimal tissue attenuation, and bowel gas is not a factor. *iliofemoral segment* - The **iliofemoral segment** is more superficial than the aortoiliac segment and is generally well visualized, especially the femoral arteries in the groin. - While obesity can increase the scanning depth, it does not pose the same challenges as the deeper and often gas-obscured pelvic vessels.
Surgery
3 questionsWhich of the following vital structures in the axilla should always be preserved in modified radical mastectomy?
The most common metabolic abnormality associated with gastric outlet obstruction is
Which of the following is the PRIMARY factor that predisposes to the development of incisional hernia?
UPSC-CMS 2022 - Surgery UPSC-CMS Practice Questions and MCQs
Question 1: Which of the following vital structures in the axilla should always be preserved in modified radical mastectomy?
- A. Intercostobrachial nerves
- B. Nerve to serratus anterior
- C. Nerve to latissimus dorsi
- D. Axillary vein (Correct Answer)
Explanation: ***Axillary vein*** - The **axillary vein** is the only structure that must be preserved in **all cases** of modified radical mastectomy without exception. - It is a major conduit for venous return from the upper limb; its injury or sacrifice would cause **severe venous congestion** and **marked lymphedema** of the arm, representing a major surgical complication. - Unlike the nerves listed below, there is **no acceptable clinical scenario** where the axillary vein can be intentionally sacrificed during MRM. *Intercostobrachial nerves* - The **intercostobrachial nerves** provide sensation to the axilla and medial aspect of the arm. - While their preservation minimizes **postoperative numbness** and discomfort, they are **frequently sacrificed** during level II axillary dissection to achieve adequate lymph node clearance. - Their sacrifice is an accepted consequence of thorough axillary dissection. *Nerve to serratus anterior (Long thoracic nerve)* - The **long thoracic nerve** innervates the serratus anterior muscle, which is crucial for scapular stability. - Its injury causes **winged scapula**, significantly impairing shoulder movement. - While preservation is **attempted and highly desirable**, it may need to be sacrificed if there is **direct tumor involvement** or to achieve adequate oncologic clearance. - Preservation is the goal but not absolute in all cases. *Nerve to latissimus dorsi (Thoracodorsal nerve)* - The **thoracodorsal nerve** innervates the latissimus dorsi muscle, important for shoulder function and potential breast reconstruction. - While preservation is **strongly preferred**, it may need to be sacrificed if there is **lymph node involvement along its course** or direct tumor invasion. - Like the long thoracic nerve, preservation is attempted but not guaranteed in all cases. **Key Distinction:** The question asks what "should **always** be preserved" - the axillary vein is the only structure where preservation is absolute and non-negotiable. The motor nerves (long thoracic and thoracodorsal) are critical structures that surgeons attempt to preserve, but their sacrifice may be necessary for oncologic reasons in some cases.
Question 2: The most common metabolic abnormality associated with gastric outlet obstruction is
- A. hyperchloraemic alkalosis
- B. hypochloraemic acidosis
- C. hyperchloraemic acidosis
- D. hypochloraemic alkalosis (Correct Answer)
Explanation: ***Hypochloraemic alkalosis*** - Gastric outlet obstruction leads to **persistent vomiting of gastric contents**, rich in **hydrochloric acid (HCl)**. - The loss of HCl causes a decrease in plasma chloride (**hypochloraemia**) and an increase in bicarbonate, leading to **metabolic alkalosis**. - This is the **classic metabolic abnormality** seen in pyloric stenosis and other causes of gastric outlet obstruction. *Hyperchloraemic alkalosis* - This is an incorrect combination of electrolyte and acid-base disturbances; hyperchloraemia typically accompanies **acidosis**, not alkalosis. - Hyperchloraemic alkalosis would imply an excess of chloride and base, which does not result from the vomiting of acidic gastric contents. *Hypochloraemic acidosis* - Hypochloraemia can occur with acidosis (e.g., from severe diarrhea with bicarbonate loss), but the primary acid-base disturbance in gastric outlet obstruction is **alkalosis** due to hydrogen ion loss. - Vomiting primarily causes a loss of acid, leading to an increase in blood pH, not a decrease. *Hyperchloraemic acidosis* - This condition is often seen in situations like **renal tubular acidosis** or with the administration of large amounts of **saline solutions**, where chloride intake is high and bicarbonate is lost or diluted. - It specifically does not occur with the loss of highly acidic gastric contents, which would decrease chloride levels and increase pH.
Question 3: Which of the following is the PRIMARY factor that predisposes to the development of incisional hernia?
- A. Immunocompromised patient
- B. Malnutrition
- C. Non-absorbable suture material
- D. Postoperative wound infection (Correct Answer)
Explanation: ***Postoperative wound infection*** - **Postoperative wound infection** is the **PRIMARY and most important modifiable risk factor** for incisional hernia development, increasing the risk by **2-4 fold**. - Infection causes **tissue necrosis**, **fascial disruption**, and **impaired collagen synthesis**, directly compromising the structural integrity of the wound closure. - The inflammatory response and proteolytic enzymes released during infection destroy newly formed collagen and prevent proper fascial healing. - This is consistently cited in major surgical textbooks (Sabiston, Schwartz) as the leading preventable cause of incisional hernias. *Malnutrition* - While malnutrition impairs wound healing by reducing collagen synthesis and tissue strength, it acts as a **background predisposing factor** rather than the primary cause [1]. - Protein deficiency affects overall tissue quality but typically requires additional factors (like infection) to result in hernia formation [1]. - Nutritional optimization is important perioperatively but is less directly causative than acute wound complications. *Immunocompromised patient* - Immunocompromise increases susceptibility to infection and impairs healing, but it is an indirect risk factor [1]. - The mechanism primarily operates through **increased infection risk** rather than being an independent primary cause [1]. *Non-absorbable suture material* - Suture material choice affects long-term stability and may influence chronic pain or foreign body reactions. - Current evidence shows **continuous non-absorbable sutures** are actually preferred for fascial closure to reduce hernia risk [1]. - This is a technical consideration but not a primary predisposing factor compared to wound complications.