UPSC-CMS 2024 Practice Questions

Q: A 56-year-old female has been diagnosed with gallstones and is undergoing a preanaesthesia checkup. She has been a diabetic since last 15 years, but sugar levels are within the limits. Which category of physical status does she fit into?

ASA 2. ***ASA 2*** - The patient has **well-controlled diabetes**, which is considered a mild systemic disease. - An ASA 2 patient has mild systemic disease that does not significantly limit activity. *ASA 1* - This category is for a **healthy person** with no systemic disease. - The patient's diabetes, even if controlled, precludes her from being classified as ASA 1. *ASA 4* - This category indicates a patient with **severe systemic disease** that is a constant threat to life. - Well-controlled diabetes does not pose an immediate threat to life. *ASA 3* - This category is for a patient with **severe systemic disease** that limits activity but is not incapacitating. - Well-controlled diabetes is generally considered a mild, not severe, systemic disease in the absence of complications.

Q: Which of the following are features of autosomal dominant polycystic kidney disease? 1. Cyst may also occur in liver, pancreas and arachnoid membrane. 2. Most commonly manifests between 20-30 years of age. 3. Clinical manifestations are renal and extrarenal. 4. Men tend to progress to renal failure more rapidly than women. Select the correct answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - **Autosomal dominant polycystic kidney disease (ADPKD)** is characterized by the growth of numerous cysts in the kidneys [1], but can also lead to **extrarenal cysts** in organs such as the **liver, pancreas, and arachnoid membrane**. - **ADPKD** causes both renal and extrarenal manifestations, and **men typically progress to renal failure more rapidly than women**. *1, 2 and 4* - This option correctly identifies the presence of cysts in other organs and the rapid progression to renal failure in men, but it incorrectly states that the disease most commonly manifests between **20-30 years of age**. - While symptoms can appear at any age, **ADPKD** often manifests with symptoms such as pain due to cysts or hypertension later in life [1], and **renal function decline** is typically observed in middle age. *1, 2 and 3* - This option incorrectly includes the statement that the disease most commonly manifests between **20-30 years of age**. - Although the genetic defect is present from birth, significant clinical symptoms leading to diagnosis or renal failure often develop later, typically in the **4th to 6th decades of life**. *2, 3 and 4* - This option incorrectly states that the disease most commonly manifests between **20-30 years of age**. - It also omits the key feature that cysts can occur in other organs like the **liver, pancreas, and arachnoid membrane**, which is a crucial aspect of ADPKD.

Q: Consider the following clinical features : 1. Raised ICP 2. Seizures 3. Focal deficit 4. Headache Which of the above clinical features are related to most brain tumours?

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All four clinical features—**raised ICP**, **seizures**, **focal neurological deficits**, and **headache**—are commonly associated with brain tumors [1]. - Brain tumors can cause **increased intracranial pressure** through mass effect, edema, or CSF flow obstruction, leading to headaches and, less commonly, seizures [1]. **Focal deficits** result from direct tissue destruction or compression depending on the tumor's location [2]. *2, 3 and 4 only* - This option incorrectly omits **raised ICP**, which is a frequent and significant symptom of brain tumors, contributing to headaches, nausea, vomiting, and altered mental status [1]. - While seizures, focal deficits, and headaches are common, **raised ICP** often underlies many of these symptoms. *1 and 2 only* - This option excludes **focal deficits** and **headache**, both of which are very common presentations of brain tumors. - The specific location of a tumor often dictates **focal deficits** [2], and **headache** is one of the most prevalent symptoms. *1, 2 and 3 only* - This option incorrectly omits **headache**, which is a classic and highly prevalent symptom in patients with brain tumors, often severe and resistant to common analgesics. - Headaches can result from **mass effect**, **increased ICP** [1], or irritation of pain-sensitive structures within the brain.

Q: A 40-year-old lady complains of progressive deformities of her hands and fingers associated with stiffness which is present in both the hands and improves as the day progresses. On examination, there is symmetrical involvement of hands and fingers of both the upper limbs with flexion and ulnar deviation at the metacarpophalangeal joints. What is the most likely diagnosis in this lady?

Rheumatoid arthritis. ***Rheumatoid arthritis*** - The combination of **symmetrical polyarthritis** affecting the hands and fingers, **morning stiffness** that improves with activity ("improves as the day progresses" not as severe as morning stiffness) [1][4], and characteristic **flexion and ulnar deviation at the metacarpophalangeal joints** (Swan-neck, Boutonniere's, and Z-thumb deformities) are classic features of rheumatoid arthritis (RA) [3]. - RA is an **autoimmune disease** causing chronic inflammation of the synovial lining of joints, leading to progressive joint damage and characteristic deformities [3]. *Ankylosing spondylitis* - This condition primarily affects the **axial skeleton** (spine and sacroiliac joints), causing **back pain and stiffness**, not typically significant small joint deformities of the hands. - While it can involve peripheral joints, it is often **asymmetrical** and doesn't present with the specific hand deformities described. *Osteoarthritis* - **Osteoarthritis** is a degenerative joint disease characterized by **cartilage breakdown**, leading to pain that **worsens with activity** and improves with rest [2]. - Joint involvement is often **asymmetrical** and typically affects weight-bearing joints or causes **Heberden's** and **Bouchard's nodes** in the fingers, not the symmetrical MCP involvement and specific deformities seen here [2]. *Tenosynovitis* - **Tenosynovitis** is an inflammation of the **synovial sheath surrounding a tendon**, causing localized pain, swelling, and difficulty moving the affected digit or limb. - It does not explain the widespread, symmetrical joint involvement, progressive deformities of multiple joints, or systemic nature of the symptoms described.

Q: Upper motor neuron lesions are characterized by which of the following? 1. Increased tone (spasticity) 2. Hyperreflexia 3. Absent plantar response 4. Motor weakness Select the correct answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** - **Upper motor neuron (UMN) lesions** typically present with **increased muscle tone (spasticity)** due to the loss of inhibitory input from higher cortical centers [1]. - They also lead to **hyperreflexia** (exaggerated deep tendon reflexes) and **motor weakness** as the descending pathways controlling voluntary movement are damaged [1]. *1, 3 and 4* - This option incorrectly includes an **absent plantar response**, whereas UMN lesions are associated with an **extensor plantar response (Babinski sign)** [1]. - While **spasticity** and **motor weakness** are correct, the inclusion of an absent plantar response makes this option incorrect. *2, 3 and 4* - This option incorrectly includes an **absent plantar response**, as **hyperreflexia** and **motor weakness** are characteristic of UMN lesions [1]. - The absence of **increased tone (spasticity)**, a key feature of UMN lesions, also makes this option incorrect. *1, 2 and 3* - This option incorrectly includes an **absent plantar response**, which is not typical for UMN lesions. - While **increased tone (spasticity)** and **hyperreflexia** are correct, the lack of **motor weakness**, another hallmark of UMN lesions, renders this option incomplete.

Q: A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?

Frozen shoulder. ***Frozen shoulder*** - The patient's presentation with **increasing pain** and **difficulty with overhead abduction** of the shoulder, especially in the context of long-standing **diabetes**, is highly characteristic of **adhesive capsulitis** (frozen shoulder). - This condition is marked by **progressive stiffness** and **restricted range of motion** in the shoulder joint due to inflammation and fibrosis of the joint capsule. *Bacterial arthritis* - **Bacterial arthritis** typically presents with an **acutely painful**, **swollen**, and **erythematous joint**, often accompanied by systemic symptoms like **fever** and **malaise**. - The chronic, progressive nature of the patient's symptoms and the absence of acute inflammatory signs or fever make bacterial arthritis less likely. *Osteoarthritis* - While **osteoarthritis** can cause shoulder pain and stiffness, it usually presents with **pain that worsens with activity** and is relieved by rest, often with **crepitus** and a more gradual loss of range of motion. - The pronounced restriction in **overhead abduction** in this patient, particularly given the diabetic history, points away from primary osteoarthritis as the most likely cause. *Rotator cuff tear* - A **rotator cuff tear** typically presents with pain and weakness, especially during **abduction** or **external rotation**, and may have a specific mechanism of injury. - While abduction can be difficult, the classic presentation of a frozen shoulder with severe, global restriction of both active and passive range of motion is a stronger fit for the described symptoms.

Q: A 20-year-old girl presents to the OPD with complaints of a progressively increasing swelling on the dorsum of the left wrist. The swelling is cystic and nontender on examination and becomes more prominent on plantar flexion of the wrist. The swelling is 2 cm × 1 cm in size. What is the likely diagnosis in this case?

Ganglion cyst. ***Ganglion cyst*** - A **ganglion cyst** is the most common mass of the hand and wrist. It presents as a **smooth, firm, mobile cystic mass** that transilluminates. - It classically appears on the **dorsum of the wrist** and often becomes more prominent with wrist flexion (or plantar flexion of the wrist, as stated in the question, though dorsiflexion/flexion are more common terms for the wrist). *Dermoid cyst* - **Dermoid cysts** are congenital and result from entrapment of ectodermal and mesodermal elements. They are typically found in areas of **embryonic fusion lines** (e.g., face, scalp). - While they can be cystic, they are usually **immobile** and do not typically fluctuate in prominence with wrist movement. *Sebaceous cyst* - Also known as an **epidermoid cyst** (when arising from epidermis) or a **pilar cyst** (when arising from hair follicle), these are typically filled with keratin and sebum. - They tend to occur in areas with **hair follicles** (e.g., scalp, trunk, face) and often have a visible central punctum; they are less common on the dorsum of the wrist. *Epidermoid cyst* - **Epidermoid cysts** are subepidermal nodules formed by the cystic enclosure of epidermal cells. They are typically firm and mobile. - While they can occur anywhere, they are less characteristic of the dorsum of the wrist, and their prominence is generally **not affected by wrist movement**.

Q: The most common type of brain tumour associated with neurofibromatosis type 1 is

astrocytoma. ***Astrocytoma*** - **Pilocytic astrocytoma** is the most common brain tumor associated with **Neurofibromatosis type 1 (NF1)**, particularly in children and young adults [1]. - These tumors often occur in the **optic pathways**, **brainstem**, or **cerebellum** in patients with NF1. *Acoustic neuroma* - **Vestibular schwannomas** (acoustic neuromas) are characteristic of **Neurofibromatosis type 2 (NF2)**, not NF1 [2]. - NF2 typically involves **bilateral vestibular schwannomas** and other cranial nerve tumors [2]. *Meningioma* - Meningiomas are also more commonly associated with **NF2**, though they can occur sporadically [2]. - They are generally less common in NF1 patients and are not considered the hallmark brain tumor. *Medulloblastoma* - Medulloblastoma is a **highly malignant primary brain tumor** that occurs predominantly in children but is not specifically linked to NF1 [1]. - Its presence is not a defining feature of the NF1 syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1319-1320. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 724-728.

Q: Extracorporeal Shock Wave Lithotripsy (ESWL) is most commonly used for the treatment of

urinary tract stones. ***Urinary tract stones*** - **Extracorporeal Shock Wave Lithotripsy (ESWL)** is a non-invasive procedure primarily used to break down **kidney stones** and **ureteral stones** into smaller fragments. - The shock waves are generated outside the body and focused on the stone, allowing the fragments to be passed naturally in the urine. *Gallbladder stones* - **Gallbladder stones (cholelithiasis)** are typically treated with **cholecystectomy** (surgical removal of the gallbladder) or medications for dissolution, not ESWL. - While some research has explored ESWL for gallbladder stones, it is not the most common or preferred treatment due to high recurrence rates and limited efficacy. *Abdominal stony-hard tumour* - ESWL is designed to fragment **calcifications or stones**, not cellular masses or tumors. - Abdominal tumors, regardless of their consistency, require **biopsy for diagnosis** and subsequent treatment such as surgery, chemotherapy, or radiation, specialized based on pathophysiology. *Salivary gland stones* - **Sialolithiasis** (salivary gland stones) can sometimes be treated with **lithotripsy**, but this typically involves specific techniques like **endoscopic lithotripsy** or **interventional removal**, distinct from the general application of ESWL for urinary stones. - The most common treatments for salivary gland stones focus on hydration, massage, and, if necessary, surgical removal of the stone or gland.

Q: Which of the following are correct for herniation via foramen of Morgagni? 1. It occurs posteriorly in chest. 2. Transverse colon is the commonest content. 3. Defect is between sternal and costal attachments. 4. It is a type of congenital hernia. Select the answer using the code given below.

2, 3 and 4. ***2, 3 and 4*** - The **foramen of Morgagni** hernia (also known as a parasternal or retrosternal hernia) is a type of **congenital diaphragmatic hernia (CDH)** - statement 4 is **correct**. - The defect is located in the **anterior diaphragm**, specifically between the **sternal and costal attachments** - statement 3 is **correct**. - The **transverse colon** is indeed a common content (most common visceral organ), though omentum is actually the most frequent overall content - statement 2 is considered **correct** in clinical practice. - Statement 1 is **incorrect** as Morgagni hernias occur **anteriorly**, not posteriorly. *1, 3 and 4* - This option incorrectly includes statement 1, which claims the herniation occurs **posteriorly** in the chest. - **Morgagni hernias** are **anterior** diaphragmatic defects (parasternal location). - Posterior diaphragmatic hernias are **Bochdalek hernias**, not Morgagni hernias. *1, 2 and 4* - This option is incorrect because statement 1 states the hernia occurs **posteriorly**, which is wrong. - **Morgagni hernias** are located in the **anterior diaphragm** between sternal and costal attachments. - While statements 2 and 4 are correct, the inclusion of statement 1 makes this option incorrect. *1, 2 and 3* - This option is incorrect because statement 1 claims the hernia occurs **posteriorly**, which is inaccurate. - **Morgagni hernias** are **anterior** defects, representing only 2-3% of congenital diaphragmatic hernias. - The key distinguishing feature is the anterior parasternal location, not posterior.

Question 1

A 56-year-old female has been diagnosed with gallstones and is undergoing a preanaesthesia checkup. She has been a diabetic since last 15 years, but sugar levels are within the limits. Which category of physical status does she fit into?

Accepted Answer

ASA 2

Answer

ASA 1

Answer

ASA 4

Answer

ASA 3

Question 2

Which of the following are features of autosomal dominant polycystic kidney disease?

1. Cyst may also occur in liver, pancreas and arachnoid membrane.
2. Most commonly manifests between 20-30 years of age.
3. Clinical manifestations are renal and extrarenal.
4. Men tend to progress to renal failure more rapidly than women.

Select the correct answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 3

Consider the following clinical features :

1. Raised ICP
2. Seizures
3. Focal deficit
4. Headache Which of the above clinical features are related to most brain tumours?

Accepted Answer

1, 2, 3 and 4

Answer

2, 3 and 4 only

Answer

1 and 2 only

Answer

1, 2 and 3 only

Question 4

A 40-year-old lady complains of progressive deformities of her hands and fingers associated with stiffness which is present in both the hands and improves as the day progresses. On examination, there is symmetrical involvement of hands and fingers of both the upper limbs with flexion and ulnar deviation at the metacarpophalangeal joints. What is the most likely diagnosis in this lady?

Accepted Answer

Rheumatoid arthritis

Answer

Ankylosing spondylitis

Answer

Osteoarthritis

Answer

Tenosynovitis

Question 5

Upper motor neuron lesions are characterized by which of the following?

1. Increased tone (spasticity)
2. Hyperreflexia
3. Absent plantar response
4. Motor weakness

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 6

A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?

Accepted Answer

Frozen shoulder

Answer

Bacterial arthritis

Answer

Osteoarthritis

Answer

Rotator cuff tear

Question 7

A 20-year-old girl presents to the OPD with complaints of a progressively increasing swelling on the dorsum of the left wrist. The swelling is cystic and nontender on examination and becomes more prominent on plantar flexion of the wrist. The swelling is 2 cm × 1 cm in size. What is the likely diagnosis in this case?

Accepted Answer

Ganglion cyst

Answer

Dermoid cyst

Answer

Sebaceous cyst

Answer

Epidermoid cyst

Question 8

The most common type of brain tumour associated with neurofibromatosis type 1 is

Accepted Answer

astrocytoma

Answer

acoustic neuroma

Answer

meningioma

Answer

medulloblastoma

Question 9

Extracorporeal Shock Wave Lithotripsy (ESWL) is most commonly used for the treatment of

Accepted Answer

urinary tract stones

Answer

gallbladder stones

Answer

abdominal stony-hard tumour

Answer

salivary gland stones

Question 10

Which of the following are correct for herniation via foramen of Morgagni?

1. It occurs posteriorly in chest.
2. Transverse colon is the commonest content.
3. Defect is between sternal and costal attachments.
4. It is a type of congenital hernia. Select the answer using the code given below.

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

UPSC-CMS 2024

Anesthesiology

Internal Medicine

Orthopaedics

Pathology

Surgery