Which types of cancer are associated with exposure to ionizing radiation? 1. Leukaemia 2. Lung cancer 3. Breast cancer 4. Lymphoma Select the correct answer using the code given below.

1, 2 and 3. ***1, 2 and 3*** - **Leukemia**, particularly acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), is one of the most strongly established radiation-induced cancers, with clear dose-response relationships observed in atomic bomb survivors and therapeutic radiation patients. - **Lung cancer** risk increases significantly with ionizing radiation exposure, especially from inhaled radioactive particles (radon), uranium mining, and external radiation exposure in atomic bomb survivors. - **Breast cancer** has a well-documented association with ionizing radiation, particularly with exposure during childhood and adolescence. Evidence comes from atomic bomb survivors, tuberculosis fluoroscopy studies, and therapeutic chest radiation (e.g., for Hodgkin lymphoma). Women exposed to radiation before age 30 show the highest risk. *1, 2 and 4* - While leukemia and lung cancer are correctly included, this option incorrectly includes lymphoma instead of breast cancer. - **Lymphoma's** association with ionizing radiation is less consistent and weaker compared to breast cancer. The evidence for radiation-induced lymphoma is limited and not as well-established as for the three solid tumors and leukemia listed above. *1, 3 and 4* - This option correctly includes leukemia and breast cancer but incorrectly excludes lung cancer, which has strong epidemiological evidence from radon exposure studies and atomic bomb survivor data. - Lymphoma is included but has weaker evidence than lung cancer for radiation association. *2, 3 and 4* - This option incorrectly excludes leukemia, which is historically the most strongly documented and earliest-appearing cancer following radiation exposure. - Leukemia was the first cancer type conclusively linked to ionizing radiation in atomic bomb survivors. [Practice more UPSC-CMS 2024 questions on OnCourse]

UPSC-CMS 2024 Previous Year Questions with Answers

Q: A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100-150 metres. The pain is relieved on taking rest for about 2-3 minutes and the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of

intermittent claudication. ***intermittent claudication*** - The classic presentation of **cramping pain in the calves** that occurs with exertion, particularly walking a specific distance, and is **relieved by rest** within a few minutes, is highly characteristic of **intermittent claudication** [1]. - This condition is a hallmark symptom of **peripheral artery disease (PAD)**, where narrowed arteries reduce blood flow to the limbs, and is exacerbated by risk factors such as **smoking** [1]. *osteoarthritis of the knee* - While osteoarthritis causes pain with activity, it typically describes a **mechanical joint pain worsened by movement** and often associated with stiffness, crepitus, and swelling [2]. - The pain from osteoarthritis is usually **localized to the joint** and less likely to be described as cramping in the calves or to have such a clear, immediate resolution with rest as seen in claudication [2]. *muscular fatigue* - Muscular fatigue can cause pain and discomfort with exertion, but it typically does not present with the **consistent, reproducible pattern** of pain onset at a specific distance and rapid relief with a short rest as described. - Fatigue-related pain is generally more diffuse and gradually improves with prolonged rest, rather than the quick resolution characteristic of claudication. *neurogenic claudication* - Neurogenic claudication also causes **leg pain with walking** but is typically associated with **spinal stenosis** and is often described as numbness, tingling, or weakness, rather than pure cramping. - Crucially, neurogenic claudication is often relieved by **bending forward or sitting**, rather than just standing still, and is less directly tied to the specific walking distance that defines intermittent claudication. [Practice more UPSC-CMS 2024 questions on OnCourse]

Q: Consider the following causes of visual loss : 1. Obstruction of the central retinal artery 2. Vitreous and retinal haemorrhage 3. Cataract 4. Retinal detachment Which of the above causes are associated with acute visual loss in a patient?

1, 2 and 4. ***1, 2 and 4*** - **Obstruction of the central retinal artery**, **vitreous and retinal haemorrhage**, and **retinal detachment** all present as sudden, acute vision loss. - **Central retinal artery occlusion** causes complete, sudden, painless monocular vision loss. **Vitreous hemorrhage** is acute, painless, and can present with floaters or red haze. **Retinal detachment** is acute, painless vision loss, often preceded by flashes and floaters, and can present as a "curtain" coming across the vision. *1, 3 and 4* - While **central retinal artery obstruction** and **retinal detachment** cause acute vision loss, **cataracts** typically cause gradual, progressive vision loss over months to years. - Cataracts primarily affect lens clarity, leading to blurry vision, glare, and dull colors rather than an abrupt onset of blindness. *1, 2 and 3* - **Central retinal artery obstruction** and **vitreous/retinal hemorrhage** lead to acute vision loss, but **cataracts** are a cause of *chronic* and *gradual* vision impairment. - The onset and progression of a **cataract** are distinctly different from the sudden nature of acute vision loss conditions. *2, 3 and 4* - **Vitreous and retinal haemorrhage** and **retinal detachment** are causes of acute vision loss, but a **cataract** is not. - The defining characteristic of acute vision loss is its rapid onset, which does not align with the slow development of a cataract. [Practice more UPSC-CMS 2024 questions on OnCourse]

Q: Which of the following genetic syndromes are associated with brain tumours? 1. Neurofibromatosis type 1 2. Neurofibromatosis type 2 3. Tuberous sclerosis 4. Wiskott-Aldrich syndrome Select the answer using the code given below.

1, 2 and 3. ***1, 2 and 3*** - **Neurofibromatosis type 1 (NF1)**, **Neurofibromatosis type 2 (NF2)**, and **Tuberous sclerosis (TSC)** are all well-established genetic syndromes associated with an increased risk of developing various brain tumors [1]. - NF1 is linked to **optic pathway gliomas**, NF2 to **schwannomas** and **meningiomas**, and TSC to **subependymal giant cell astrocytomas (SEGAs)** [1], [2]. *1 and 2 only* - This option is incomplete as it correctly identifies NF1 and NF2 but omits Tuberous sclerosis, which is also strongly associated with brain tumours [1]. - While NF1 and NF2 are major genetic risk factors for brain tumors, excluding TSC would be an inaccurate representation of conditions linked to these abnormalities [1]. *1, 3 and 4* - This option incorrectly includes **Wiskott-Aldrich syndrome (WAS)**, which is an **immunodeficiency disorder** and not typically associated with primary brain tumours. - Although WAS can lead to an increased risk of lymphomas, these are generally not considered primary brain tumors [1] in the context of genetic syndromes predisposing to such growths. *2, 3 and 4* - This option again incorrectly includes **Wiskott-Aldrich syndrome** while omitting **Neurofibromatosis type 1**, a significant genetic syndrome linked to brain tumors [1]. - Omitting NF1, a condition known for an increased risk of gliomas, renders this option incomplete and inaccurate. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 724-725. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1318-1319. [Practice more UPSC-CMS 2024 questions on OnCourse]

Internal Medicine

1 questions

Q1

A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100-150 metres. The pain is relieved on taking rest for about 2-3 minutes and the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of

UPSC-CMS 2024 - Internal Medicine UPSC-CMS Practice Questions and MCQs

Question 1: A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100-150 metres. The pain is relieved on taking rest for about 2-3 minutes and the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of

A. osteoarthritis of the knee
B. muscular fatigue
C. intermittent claudication (Correct Answer)
D. neurogenic claudication

Explanation: ***intermittent claudication*** - The classic presentation of **cramping pain in the calves** that occurs with exertion, particularly walking a specific distance, and is **relieved by rest** within a few minutes, is highly characteristic of **intermittent claudication** [1]. - This condition is a hallmark symptom of **peripheral artery disease (PAD)**, where narrowed arteries reduce blood flow to the limbs, and is exacerbated by risk factors such as **smoking** [1]. *osteoarthritis of the knee* - While osteoarthritis causes pain with activity, it typically describes a **mechanical joint pain worsened by movement** and often associated with stiffness, crepitus, and swelling [2]. - The pain from osteoarthritis is usually **localized to the joint** and less likely to be described as cramping in the calves or to have such a clear, immediate resolution with rest as seen in claudication [2]. *muscular fatigue* - Muscular fatigue can cause pain and discomfort with exertion, but it typically does not present with the **consistent, reproducible pattern** of pain onset at a specific distance and rapid relief with a short rest as described. - Fatigue-related pain is generally more diffuse and gradually improves with prolonged rest, rather than the quick resolution characteristic of claudication. *neurogenic claudication* - Neurogenic claudication also causes **leg pain with walking** but is typically associated with **spinal stenosis** and is often described as numbness, tingling, or weakness, rather than pure cramping. - Crucially, neurogenic claudication is often relieved by **bending forward or sitting**, rather than just standing still, and is less directly tied to the specific walking distance that defines intermittent claudication.

Ophthalmology

1 questions

Q1

Consider the following causes of visual loss : 1. Obstruction of the central retinal artery 2. Vitreous and retinal haemorrhage 3. Cataract 4. Retinal detachment Which of the above causes are associated with acute visual loss in a patient?

Pathology

2 questions

Q1

Which of the following are correct regarding Li-Fraumeni syndrome? 1. It has autosomal dominant inheritance and is associated with P53 gene. 2. It has autosomal recessive inheritance and is associated with P53 gene. 3. It is associated with an increased risk of sarcomas and leukaemia. 4. It is associated with an increased risk of brain tumours and osteosarcomas. Select the answer using the code given below.

Q2

Which of the following genetic syndromes are associated with brain tumours? 1. Neurofibromatosis type 1 2. Neurofibromatosis type 2 3. Tuberous sclerosis 4. Wiskott-Aldrich syndrome Select the answer using the code given below.

UPSC-CMS 2024 - Pathology UPSC-CMS Practice Questions and MCQs

Question 1: Which of the following are correct regarding Li-Fraumeni syndrome? 1. It has autosomal dominant inheritance and is associated with P53 gene. 2. It has autosomal recessive inheritance and is associated with P53 gene. 3. It is associated with an increased risk of sarcomas and leukaemia. 4. It is associated with an increased risk of brain tumours and osteosarcomas. Select the answer using the code given below.

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

Explanation: ***1, 3 and 4*** - Li-Fraumeni syndrome is characterized by **autosomal dominant inheritance** caused by germline mutations in the **TP53 tumor suppressor gene** (statement 1 is correct) [2]. - The syndrome is associated with a significantly increased risk of multiple cancers, including **sarcomas** (osteosarcomas and soft tissue sarcomas), **acute leukemias**, **brain tumors** (gliomas, medulloblastomas), **adrenocortical carcinomas**, and **breast cancer** - often referred to as the "SBLA" spectrum [2], [3]. - Statement 3 is correct: The syndrome IS associated with both **sarcomas and leukemia** (particularly acute leukemias in children) [3]. - Statement 4 is correct: **Brain tumors and osteosarcomas** are hallmark malignancies of Li-Fraumeni syndrome. *1 and 4 only* - While statements 1 and 4 are both correct, this option incorrectly excludes statement 3. - Statement 3 is medically accurate: **leukemias** (particularly acute leukemias) ARE part of the classic Li-Fraumeni cancer spectrum and represent one of the defining malignancies of the syndrome. - Excluding leukemia from the Li-Fraumeni spectrum is a significant medical error. *1 and 3 only* - Statement 1 is correct regarding **autosomal dominant inheritance** and the **TP53 gene** [2]. - Statement 3 is also correct regarding **sarcomas and leukemia** [1]. - However, this option incorrectly excludes statement 4, which correctly identifies **brain tumors and osteosarcomas** as part of the Li-Fraumeni spectrum. *1 only* - Statement 1 correctly identifies the **autosomal dominant inheritance** and involvement of the **TP53 gene** [2]. - However, this option is incomplete as it excludes statements 3 and 4, both of which accurately describe the characteristic cancer spectrum of Li-Fraumeni syndrome. - The specific cancer risks (sarcomas, leukemias, brain tumors, osteosarcomas) are essential defining features of the syndrome [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 297-298. [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. 227-228. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 298-300.

Question 2: Which of the following genetic syndromes are associated with brain tumours? 1. Neurofibromatosis type 1 2. Neurofibromatosis type 2 3. Tuberous sclerosis 4. Wiskott-Aldrich syndrome Select the answer using the code given below.

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

Explanation: ***1, 2 and 3*** - **Neurofibromatosis type 1 (NF1)**, **Neurofibromatosis type 2 (NF2)**, and **Tuberous sclerosis (TSC)** are all well-established genetic syndromes associated with an increased risk of developing various brain tumors [1]. - NF1 is linked to **optic pathway gliomas**, NF2 to **schwannomas** and **meningiomas**, and TSC to **subependymal giant cell astrocytomas (SEGAs)** [1], [2]. *1 and 2 only* - This option is incomplete as it correctly identifies NF1 and NF2 but omits Tuberous sclerosis, which is also strongly associated with brain tumours [1]. - While NF1 and NF2 are major genetic risk factors for brain tumors, excluding TSC would be an inaccurate representation of conditions linked to these abnormalities [1]. *1, 3 and 4* - This option incorrectly includes **Wiskott-Aldrich syndrome (WAS)**, which is an **immunodeficiency disorder** and not typically associated with primary brain tumours. - Although WAS can lead to an increased risk of lymphomas, these are generally not considered primary brain tumors [1] in the context of genetic syndromes predisposing to such growths. *2, 3 and 4* - This option again incorrectly includes **Wiskott-Aldrich syndrome** while omitting **Neurofibromatosis type 1**, a significant genetic syndrome linked to brain tumors [1]. - Omitting NF1, a condition known for an increased risk of gliomas, renders this option incomplete and inaccurate. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 724-725. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1318-1319.

Pediatrics

1 questions

Q1

Which of the following is correct regarding "witch's milk"?

Surgery

4 questions

Q1

Which of the following are risk factors for wound infection? 1. Malnutrition 2. Poor perfusion 3. Antibodies 4. Foreign body material Select the correct answer using the code given below.

Q2

A midline neck swelling just below the hyoid bone and managed by Sistrunk's operation leads to postoperative need for thyroxine replacement. The most likely diagnosis is

Q3

A 40-year-old smoker presents with soreness of tongue since last 2 months. On examination, it is found that the oral hygiene is poor and there is a white plaque over the lateral border of the tongue. What is the next step in the management of this patient?

Q4

A 60-year-old lady presents with a recent onset increase in a long standing swelling on the front of the neck. The swelling, which was small, had been present since last 30 years, but has now increased to more than twice the size in the last 2 months. On examination, the swelling is firm to hard in consistency and moves with deglutition. What is the most likely cause of this clinical presentation?

UPSC-CMS 2024 - Surgery UPSC-CMS Practice Questions and MCQs

Question 1: Which of the following are risk factors for wound infection? 1. Malnutrition 2. Poor perfusion 3. Antibodies 4. Foreign body material Select the correct answer using the code given below.

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

Explanation: ***Correct: 1, 2 and 4*** The risk factors for wound infection include: - **Malnutrition** impairs the immune system and wound healing processes, making the patient more susceptible to infection - **Poor perfusion** (reduced blood supply) leads to decreased oxygen and nutrient delivery to the wound, hindering healing and immune cell function - **Foreign body material** within the wound creates a nidus for bacterial colonization and protects bacteria from immune defenses and antibiotics Antibodies are part of the body's immune defense system and **protect against infection** rather than being a risk factor for it. *Incorrect: 1, 3 and 4* While malnutrition (1) and foreign bodies (4) are risk factors, antibodies (3) are part of the immune defense and protect against infection, not increase its risk. *Incorrect: 2, 3 and 4* Poor perfusion (2) and foreign bodies (4) are risk factors, but antibodies (3) are protective components of the immune system. *Incorrect: 1, 2 and 3* Malnutrition (1) and poor perfusion (2) are significant risk factors, but antibodies (3) are a component of the host's defense mechanism against infection, not a risk factor.

Question 2: A midline neck swelling just below the hyoid bone and managed by Sistrunk's operation leads to postoperative need for thyroxine replacement. The most likely diagnosis is

A. solitary thyroid nodule
B. thyroglossal cyst with only functioning thyroid tissue (Correct Answer)
C. thyroglossal cyst
D. lateral aberrant thyroid

Explanation: ***thyroglossal cyst with only functioning thyroid tissue*** - A midline neck swelling below the hyoid bone is characteristic of a **thyroglossal cyst**. The need for **thyroxine replacement** post-Sistrunk's operation indicates that this cyst contained the patient's **only functioning thyroid tissue**. - In such rare cases, the body's entire thyroid gland develops abnormally within the thyroglossal duct, explaining the subsequent **hypothyroidism** after its removal. *solitary thyroid nodule* - A **solitary thyroid nodule** is typically located within the thyroid gland itself, which is lower in the neck than "just below the hyoid bone." - Simple removal of a solitary benign thyroid nodule would not, on its own, necessitate **thyroxine replacement** unless a total thyroidectomy was performed for other reasons, or the patient had underlying thyroid dysfunction. *thyroglossal cyst* - While a **thyroglossal cyst** fits the description of a midline neck swelling below the hyoid, simply diagnosing it as a cyst doesn't explain the need for **thyroxine replacement**. - Most thyroglossal cysts are benign and contain no functional thyroid tissue, so their removal via a Sistrunk's operation does not typically lead to **hypothyroidism**. *lateral aberrant thyroid* - **Lateral aberrant thyroid tissue** is typically found in the lateral neck, often associated with a branchial cleft anomaly, not in the midline below the hyoid bone. - While it can contain functional thyroid tissue, its location and the specific context of a Sistrunk's operation pointing to a midline anomaly make this diagnosis less likely.

Question 3: A 40-year-old smoker presents with soreness of tongue since last 2 months. On examination, it is found that the oral hygiene is poor and there is a white plaque over the lateral border of the tongue. What is the next step in the management of this patient?

A. Edge biopsy of the lesion (Correct Answer)
B. Oral antifungal treatment
C. Local topical cauterization
D. Oral vitamin C supplementation

Explanation: ***Edge biopsy of the lesion*** - The patient's presentation with a **white plaque** on the lateral border of the tongue, coupled with **poor oral hygiene** and a history of **smoking**, raises high suspicion for **oral potentially malignant disorders**, including **leukoplakia** or early **squamous cell carcinoma**. - An **edge biopsy** is the most appropriate next step to obtain a definitive histological diagnosis, which is crucial for determining the correct management strategy and ruling out malignancy. - The lateral border of the tongue is a **high-risk site** for oral cancer, and any persistent lesion in a smoker warrants tissue diagnosis. *Oral antifungal treatment* - This would be indicated if the white plaque were consistent with **oral candidiasis (thrush)**, which typically presents as **scrapable** white patches with a cottage cheese-like appearance. - Given the patient's significant risk factors (smoking, 2-month duration) and the location (lateral tongue border), empirical antifungal treatment without a definitive diagnosis would inappropriately delay management if the lesion is precancerous or cancerous. *Local topical cauterization* - **Cauterization** is contraindicated for undiagnosed oral lesions, especially those suspected of having malignant potential, as it could obscure the true histology and destroy tissue needed for diagnosis. - This method is only suitable for small, confirmed benign lesions or for hemostasis, never as a diagnostic or first-line approach. *Oral vitamin C supplementation* - While **vitamin C** supports overall health and tissue repair, there is no evidence it would resolve a suspicious white plaque on the tongue, especially one with potential malignant transformation. - Delaying proper diagnostic evaluation with supplementation alone could lead to progression of a serious underlying condition such as oral cancer.

Question 4: A 60-year-old lady presents with a recent onset increase in a long standing swelling on the front of the neck. The swelling, which was small, had been present since last 30 years, but has now increased to more than twice the size in the last 2 months. On examination, the swelling is firm to hard in consistency and moves with deglutition. What is the most likely cause of this clinical presentation?

A. Myxomatous transformation
B. Haemorrhage
C. Cystic degeneration
D. Malignant transformation (Correct Answer)

Explanation: ***Malignant transformation*** - A long-standing **benign thyroid swelling** (like a nodular goiter or adenoma) in an older patient that suddenly and rapidly increases in size, becomes firm/hard, and is associated with new symptoms suggests **malignant transformation**. - Additionally, factors like age over 60, female sex and change in consistency are concerning for **thyroid carcinoma**. *Myxomatous transformation* - This typically refers to the accumulation of **mucinous material** and is not a common or principal cause of rapid, significant enlargement and hardening in a long-standing thyroid swelling. - It does not explain the **rapid increase in size** and **firm consistency** described. *Haemorrhage* - While hemorrhage into a thyroid nodule can cause a **sudden increase in size** and pain, it usually presents as an acutely painful, tender swelling, and the consistency might be tense but not typically described as "firm to hard." - The rapid change in size over **two months** is more suggestive of cellular proliferation rather than a resolving bleed. *Cystic degeneration* - Cystic degeneration can explain some fluctuation in size over time, but a **rapid increase to more than twice the size** within two months, especially accompanied by a **firm to hard consistency**, is not characteristic of simple cystic change. - Cysts are typically softer or fluctuant on palpation, not firm and hard.

UPSC-CMS 2024

Community Medicine

Internal Medicine

Ophthalmology

Pathology

Pediatrics

Surgery