UPSC-CMS 2023
227 Previous Year Questions with Answers & Explanations
Anatomy
1 questionsMatch List-I with List-II and select the correct answer using the code given below the Lists: (Refer to the image below for the lists)
UPSC-CMS 2023 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 1: Match List-I with List-II and select the correct answer using the code given below the Lists: (Refer to the image below for the lists)
- A. A→4 B→3 C→1 D→2
- B. A→3 B→2 C→4 D→1
- C. A→4 B→3 C→2 D→1 (Correct Answer)
- D. A→3 B→2 C→1 D→4
Explanation: ***A→4 B→3 C→2 D→1*** - **Atrial fibrillation** is characterized by **irregularly irregular rhythm** without distinct P waves, making the R-R interval highly variable. It is a supraventricular tachyarrhythmia, originating above the ventricles. - **Ventricular tachycardia** typically presents with a **wide QRS complex** (>0.12 s) and a **rapid, regular heart rate**, as it originates from the ventricles. - **Complete heart block** is characterized by complete dissociation between **P waves and QRS complexes**, meaning the atria and ventricles beat independently. This is reflected in an irregular P-P interval and a regular but slower R-R interval often due to an escape rhythm. - **Ventricular fibrillation** is an ECG emergency characterized by chaotic, **irregular electrical activity** and an absence of discernible P waves, QRS complexes, or T waves, leading to cardiac arrest. *A→4 B→3 C→1 D→2* - This option correctly matches A (Atrial fibrillation) with 4 (Irregular R-R interval without P waves) and B (Ventricular tachycardia) with 3 (Wide QRS complexes and regular rapid rate). However, it incorrectly matches C (Complete heart block) with 1 (Chaotic rhythm) and D (Ventricular fibrillation) with 2 (Dissociation of P and QRS waves). - **Complete heart block** involves **dissociation of P and QRS waves**, and **Ventricular fibrillation** is defined by a **chaotic rhythm**, not the other way around as suggested by C→1 and D→2. *A→3 B→2 C→4 D→1* - This option incorrectly matches A (Atrial fibrillation) with 3 (Wide QRS complexes and regular rapid rate), which describes ventricular tachycardia. - It also incorrectly matches C (Complete heart block) with 4 (Irregular R-R interval without P waves) and D (Ventricular fibrillation) with 1 (Chaotic rhythm), instead of the correct associations. *A→3 B→2 C→1 D→4* - This option incorrectly matches A (Atrial fibrillation) with 3 (Wide QRS complexes and regular rapid rate) which is characteristic of ventricular tachycardia. - It also incorrectly matches B (Ventricular tachycardia) with 2 (Dissociation of P and QRS waves), which is a characteristic of complete heart block, not ventricular tachycardia.
Internal Medicine
5 questionsThe following statements regarding small bowel tuberculosis are correct except
Systemic Inflammatory Response Syndrome (SIRS) diagnostic criteria include the following except
When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...
Which of the following most strongly suggests the diagnosis of primary hyper-parathyroidism ?
A young patient presented in the emergency with haematemesis and was found to have massive splenomegaly. The following conditions are associated with the above clinical presentation except
UPSC-CMS 2023 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 1: The following statements regarding small bowel tuberculosis are correct except
- A. There are two types : ulcerative and hyperplastic
- B. In the ulcerative type, the bowel serosa is studded with tubercles
- C. The ulcerative type occurs when the virulence of the organism is greater than the host defence
- D. The strictures are common in the ulcerative type (Correct Answer)
Explanation: ***The strictures are common in the ulcerative type*** - While both ulcerative and hyperplastic types of small bowel tuberculosis can lead to complications, **strictures are more characteristic of the hyperplastic type**. - In the **hyperplastic form**, chronic inflammation, fibrosis, and granuloma formation cause wall thickening and luminal narrowing, resulting in strictures. *There are two types : ulcerative and hyperplastic* - This statement is correct. Small bowel tuberculosis is broadly classified into **ulcerative** and **hyperplastic** forms, with mixed types also occurring. - The type is often determined by the interplay between the virulence of the organism and the host's immune response. *In the ulcerative type, the bowel serosa is studded with tubercles* - This statement is correct. The **ulcerative type** is often associated with the **spread of infection to the serosa**, leading to the formation of visible **tubercles**. - This indicates more extensive disease and possible peritoneal involvement. *The ulcerative type occurs when the virulence of the organism is greater than the host defence* - This statement is correct. The **ulcerative form** is often observed when the **organism's virulence is high** and/or the host's **immune response is weak**, leading to destructive lesions. - This imbalance results in caseating necrosis and ulceration of the bowel wall.
Question 2: Systemic Inflammatory Response Syndrome (SIRS) diagnostic criteria include the following except
- A. Temperature > 38°C or < 36°C
- B. Tachycardia with a heart rate of more than 90/min.
- C. White cell count < 4000/mm³ (Correct Answer)
- D. Tachypnoea with a respiratory rate of > 20/min.
Explanation: ***White cell count < 4000/mm³*** - The correct SIRS criterion regarding white blood cell count is either > 12,000/mm³ or < 4,000/mm³ or the presence of > 10% **immature (band) forms**. [2] - This option correctly states a **WBC count below 4000/mm³**, which is indeed a criterion for SIRS. *Temperature > 38°C or < 36°C* - This is a correct criterion for SIRS, indicating a significant deviation from normal body temperature. [1] - Both **fever (hyperthermia)** and **hypothermia** are signs of systemic inflammation. *Tachycardia with a heart rate of more than 90/min.* - This is a correct criterion for SIRS, reflecting the increased metabolic demand and sympathetic activation during systemic inflammation. [2] - A persistent **heart rate above 90 bpm** is considered indicative of such stress. *Tachypnoea with a respiratory rate of > 20/min.* - This is a correct criterion for SIRS, showing the body's attempt to compensate for metabolic disturbances or increased oxygen demand. [2] - A **respiratory rate greater than 20 breaths per minute** or a PaCO2 less than 32 mmHg are both SIRS criteria.
Question 3: When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...
- A. 0.7
- B. 1.0
- C. 0.9
- D. 0.3 (Correct Answer)
Explanation: ***0.3*** - A value of **less than 0.3** indicates **severe blood flow impairment**, consistent with critical limb ischemia, necessitating urgent intervention [1]. - This extremely low ABPI reflects a profound decrease in perfusion to the lower extremity [1]. *0.7* - An ABPI of **less than 0.7** typically suggests **moderate peripheral artery disease (PAD)**, which could cause claudication but is not usually indicative of critical limb ischemia [1]. - While concerning, it does not represent the severe, limb-threatening ischemia implied by the term "critical." *1.0* - An ABPI of around **1.0 (0.9-1.3)** is considered **normal**, indicating healthy blood flow without significant arterial obstruction. - This value would rule out any significant peripheral artery disease, including critical limb ischemia. *0.9* - An ABPI of **less than 0.9** generally suggests **peripheral artery disease (PAD)**, which can cause symptoms like intermittent claudication [1]. - However, it is not low enough to diagnose critical limb ischemia, which represents a more severe state of arterial insufficiency [1].
Question 4: Which of the following most strongly suggests the diagnosis of primary hyper-parathyroidism ?
- A. Serum calcium above 11 mg/dL (Correct Answer)
- B. Serum acid phosphatase above 120 IU/L
- C. Urinary calcium below 100 mg/day
- D. Serum alkaline phosphatase above 120 IU/L
Explanation: ***Serum calcium above 11 mg/dL*** - **Hypercalcemia** is the hallmark of primary hyperparathyroidism, as excessive parathyroid hormone (PTH) leads to increased calcium reabsorption from bones and kidneys [1, 3]. - A serum calcium level significantly above the normal range (typically 8.5-10.2 mg/dL) strongly suggests a parathyroid-related issue; specifically, levels exceeding 11.4 mg/dL (2.85 mmol/L) often warrant surgical consideration [1]. *Serum acid phosphatase above 120 IU/L* - **Elevated acid phosphatase** is more commonly associated with conditions like **prostatic carcinoma** with bone metastases or certain hematologic malignancies. - It is not a primary diagnostic marker for hyperparathyroidism. *Urinary calcium below 100 mg/day* - **Low urinary calcium** (hypocalciuria) is characteristic of **familial hypocalciuric hypercalcemia (FHH)**, a genetic condition that can mimic primary hyperparathyroidism [1]. - In primary hyperparathyroidism, **urinary calcium excretion is typically normal or high** due to the PTH-mediated increase in filtered calcium load. *Serum alkaline phosphatase above 120 IU/L* - **Elevated alkaline phosphatase** can indicate increased **bone turnover**, which can be seen in severe, prolonged primary hyperparathyroidism as an indicator of bone resorption [1, 2]. - However, it is a non-specific marker and can also be elevated in various liver diseases or other bone disorders; it is not as specific as hypercalcemia for diagnosing primary hyperparathyroidism [2].
Question 5: A young patient presented in the emergency with haematemesis and was found to have massive splenomegaly. The following conditions are associated with the above clinical presentation except
- A. Kala-azar
- B. Portal hypertension
- C. Idiopathic thrombocytopenic purpura (Correct Answer)
- D. Malaria
Explanation: ***Idiopathic thrombocytopenic purpura*** - While ITP can cause **bleeding** (including hematemesis) due to **thrombocytopenia**, it is generally **not associated with massive splenomegaly**. Splenomegaly, if present, is usually mild. - The primary defect in ITP is **immune-mediated platelet destruction**, not a cause of massive splenic enlargement, which typically results from conditions involving portal congestion, infiltrative diseases, or hemolytic processes. *Kala-azar* - **Kala-azar (visceral leishmaniasis)** is notoriously associated with **massive splenomegaly** and can cause **hematemesis** due to complications like **esophageal varices** or coagulopathy. - The parasite (Leishmania donovani) infiltrates the reticuloendothelial system, leading to profound splenomegaly. *Portal hypertension* - **Portal hypertension** is a direct cause of **massive splenomegaly** due to congestion and can lead to **hematemesis** from **ruptured esophageal varices**. - The increased pressure in the portal venous system causes blood to back up into the splenic vein, enlarging the spleen. *Malaria* - **Chronic malaria**, particularly from *Plasmodium falciparum* or *Plasmodium vivax*, can lead to significant, often **massive splenomegaly** (hyperreactive malarial splenomegaly). - While hematemesis is not a primary symptom, severe malaria can cause **coagulopathy** or contribute to **gastrointestinal bleeding** in complicated cases, though massive splenomegaly itself is a prominent feature.
Pathology
1 questionsThe histological grade best correlates with the prognosis in which one of the following malignancies?
UPSC-CMS 2023 - Pathology UPSC-CMS Practice Questions and MCQs
Question 1: The histological grade best correlates with the prognosis in which one of the following malignancies?
- A. Soft tissue sarcoma (Correct Answer)
- B. Melanoma
- C. Colonic adenocarcinoma
- D. Prostate cancer
Explanation: ***Soft tissue sarcoma*** - **Histological grade is THE MOST IMPORTANT prognostic factor** for soft tissue sarcomas, more significant than size or depth in many cases. - The **FNCLCC (French Federation of Cancer Centers) grading system** is the gold standard, which grades tumors based on differentiation, mitotic count, and necrosis. - Grade directly predicts metastatic potential and survival - high-grade sarcomas have significantly worse prognosis than low-grade tumors [2]. - This is consistently emphasized in **WHO classification of soft tissue tumors** and oncology guidelines. *Colonic adenocarcinoma* - While histological grade (well, moderate, poorly differentiated) is assessed, **TNM staging** (particularly T stage - depth of invasion, and N stage - lymph node involvement) is far more important for prognosis. - Stage is the primary determinant of treatment and survival, not grade. *Melanoma* - Prognosis is primarily determined by **Breslow thickness** (tumor depth in mm), presence of **ulceration**, and **mitotic rate**. - Histological grade per se is not the primary prognostic factor - tumor thickness is paramount. *Prostate cancer* - Uses the **Gleason score/Grade Group system**, which assesses architectural patterns rather than traditional cytological differentiation [1]. - While the Gleason score is crucial, this is a specific grading system, not conventional "histological grade" as understood in general pathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 993-994. [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. 207-208.
Radiology
1 questionsThe sonographic finding of a cyst containing clear fluid is described as
UPSC-CMS 2023 - Radiology UPSC-CMS Practice Questions and MCQs
Question 1: The sonographic finding of a cyst containing clear fluid is described as
- A. Isoechoic
- B. Hypoechoic
- C. Hyperechoic
- D. Anechoic (Correct Answer)
Explanation: ***Anechoic*** - **Anechoic** refers to structures that do not produce echoes, appearing **black** on ultrasound. - A simple cyst with clear fluid allows sound waves to pass through without reflection, making it appear anechoic. *Isoechoic* - **Isoechoic** describes structures that have the same echogenicity as surrounding tissues. - This term is typically used for solid tissues rather than fluid-filled cysts. *Hypoechoic* - **Hypoechoic** structures produce fewer echoes than surrounding tissues, appearing darker but not completely black. - This is often seen in solid lesions or complex cysts with internal debris, not clear fluid. *Hyperechoic* - **Hyperechoic** structures produce many echoes, appearing brighter than surrounding tissues. - This can be indicative of calcifications, fat, or certain solid masses, not clear fluid.
Surgery
2 questionsTidy wounds inflicted by sharp instruments and containing no devitalised tissues are expected to heal by
A patient has a 6-cm breast tumor with mobile, clinically positive, ipsilateral axillary lymph nodes and no evidence of distant metastasis. The stage of the breast cancer is
UPSC-CMS 2023 - Surgery UPSC-CMS Practice Questions and MCQs
Question 1: Tidy wounds inflicted by sharp instruments and containing no devitalised tissues are expected to heal by
- A. Primary healing (Correct Answer)
- B. Skin grafting
- C. Secondary healing
- D. Formation of contracture
Explanation: ***Primary healing*** - This mode of healing occurs in **clean, surgically incised, or sharply cut wounds** with minimal tissue loss and edges that can be approximated. - Features include minimal scarring and rapid re-epithelialization without granulation tissue formation. *Skin grafting* - This is a surgical procedure used to cover large wounds where **primary closure is not possible** or to repair areas with significant tissue loss. - It involves transplanting skin from one area of the body to another, not a natural healing process for tidy wounds. *Secondary healing* - This occurs in wounds with **significant tissue loss, infection, or edges that cannot be approximated**, requiring the formation of granulation tissue to fill the defect. - It results in a larger scar and takes longer to heal compared to primary healing. *Formation of contracture* - **Wound contracture** is a process that occurs during secondary healing, where myofibroblasts pull the wound edges together, leading to a reduction in wound size. - While it's a part of the healing process for certain wounds, it is not the primary mode of healing for tidy, sharp wounds and can lead to functional impairment if severe.
Question 2: A patient has a 6-cm breast tumor with mobile, clinically positive, ipsilateral axillary lymph nodes and no evidence of distant metastasis. The stage of the breast cancer is
- A. Stage IIIb
- B. Stage I
- C. Stage IIb (Correct Answer)
- D. Stage IIIa
Explanation: ***Stage IIb*** - A 6-cm tumor (T3) in the presence of mobile, clinically positive, ipsilateral axillary lymph nodes (N1) and no distant metastasis (M0) fits the criteria for **Stage IIB** according to the AJCC 8th edition TNM classification. - The TNM classification defines T3 as a tumor >5 cm and N1 as metastasis to **ipsilateral movable axillary lymph nodes**. - **T3N1M0 = Stage IIB** definitively. *Stage IIIa* - Stage IIIA would require **T3 with N2 nodes** (fixed/matted axillary nodes or clinically detected internal mammary nodes without axillary involvement), or **T0-T2 with N2**, or **T4 with N1**. - N2 nodes refer to **fixed/matted axillary nodes** or internal mammary nodes, which are not described here. - The patient has **N1 nodes** (mobile), not N2. *Stage IIIb* - Stage IIIB would involve **T4 disease** (tumor of any size with direct extension to chest wall or skin involvement like ulceration, ipsilateral satellite nodules, or inflammatory breast cancer). - The given tumor does not show signs of **locally advanced disease** such as chest wall invasion or skin involvement. *Stage I* - Stage I describes **small tumors** (T1, ≤2 cm) with no lymph node involvement (N0) or micrometastases only (N1mi). - The tumor size of 6 cm and presence of **clinically evident axillary lymph node involvement** preclude a Stage I diagnosis.