Dermatology
1 questionsA 40 year old man with a known case of chronic pancreatitis presents to the OPD with complaint of skin pigmentation over the abdomen. The patient gives a history of chronic use of a hot water bottle to relieve the abdominal discomfort. Which one of the following is the most appropriate diagnosis?
UPSC-CMS 2025 - Dermatology UPSC-CMS Practice Questions and MCQs
Question 31: A 40 year old man with a known case of chronic pancreatitis presents to the OPD with complaint of skin pigmentation over the abdomen. The patient gives a history of chronic use of a hot water bottle to relieve the abdominal discomfort. Which one of the following is the most appropriate diagnosis?
- A. Erythema infectiosum
- B. Erythema marginatum
- C. Erythema ab igne (Correct Answer)
- D. Erythema nodosum
Explanation: ***Erythema ab igne*** - This condition is caused by **chronic exposure to moderate heat**, which aligns with the patient's history of using a hot water bottle for abdominal discomfort. - It presents as **reticulated erythema** and **hyperpigmentation** on the affected skin, precisely matching the description of skin pigmentation over the abdomen. *Erythema infectiosum* - This is also known as **Fifth disease** and is caused by **Parvovirus B19**. - It typically presents with a characteristic **"slapped cheek" rash** on the face and a lacy rash on the trunk and limbs, which is not consistent with the patient's presentation. *Erythema marginatum* - This is a rare, transient rash associated with **acute rheumatic fever**. - It presents as **pink-red macules with clear centers and serpiginous borders** that migrate, which does not fit the described chronic pigmentation. *Erythema nodosum* - This condition is characterized by **tender, red nodules** typically found on the **shins**. - It is a form of **panniculitis** (inflammation of subcutaneous fat) and is not caused by chronic heat exposure, nor does it present as diffuse pigmentation.
Internal Medicine
7 questionsWhich one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?
Consider the following with regard to Gilbert Syndrome : I. Autosomal recessive trait of a mutation in gene for UDPglucuronyl transferase enzyme II. Elevation of unconjugated bilirubin III. No stigmata of chronic liver disease other than jaundice IV. Early Liver biopsy recommended in patients with possible Gilbert Syndrome Which of the above are correct?
The single most important treatment and prognostic factor in alcohol-related liver disease is
Which of the following heart sounds are best heard with the bell of stethoscope? I. Opening snap II. Systolic click III. Third heart sound IV. Mid diastolic murmur Select the correct answer using the code given below :
Consider the following statements for diagnosing ventricular aneurysm in a patient with recent myocardial infarction : I. Paradoxical impulse on chest wall II. Persistent ST elevation on ECG III. Unusual bulge from cardiac silhouette on X-ray IV. Presence of pulsus paradoxsus Which of the above are correct?
Which one of the following statements is correct for subcutaneous nodules in Rheumatic fever?
Which one of the following is correct with regard to Carey Coombs murmur?
UPSC-CMS 2025 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 31: Which one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?
- A. Capsule endoscopy
- B. Computed Tomography
- C. Erect X ray of abdomen
- D. Transabdominal ultrasound (Correct Answer)
Explanation: ***Transabdominal ultrasound*** - It is an **accurate, non-invasive, and cost-effective** imaging modality for detecting gallstones [1]. - Ultrasound can visualize the stones, their size, number, and any associated complications like **gallbladder wall thickening** or **pericholecystic fluid**. *Capsule endoscopy* - This procedure is primarily used to visualize the **small intestine** and is not suitable for evaluating the gallbladder. - It works by capturing images as it passes through the digestive tract, an area where the gallbladder is not directly accessible. *Computed Tomography* - While CT can sometimes detect gallstones, especially those that are calcified, it is **less sensitive than ultrasound** for non-calcified stones [1]. - CT also exposes the patient to **ionizing radiation**, making it less favorable as a primary diagnostic tool for gallstones compared to ultrasound. *Erect X ray of abdomen* - An erect X-ray of the abdomen is **poor at detecting gallstones** as only about 10-20% of gallstones are radiopaque (calcified) and visible on X-ray. - This imaging technique is more useful for detecting conditions like **bowel obstruction** or **perforations**, rather than gallbladder pathology.
Question 32: Consider the following with regard to Gilbert Syndrome : I. Autosomal recessive trait of a mutation in gene for UDPglucuronyl transferase enzyme II. Elevation of unconjugated bilirubin III. No stigmata of chronic liver disease other than jaundice IV. Early Liver biopsy recommended in patients with possible Gilbert Syndrome Which of the above are correct?
- A. I and II only
- B. III and IV
- C. I, II and III
- D. II and III only (Correct Answer)
Explanation: ***II and III only*** - **Gilbert Syndrome** is characterized by an **elevation of unconjugated bilirubin** [1] due to reduced activity of the UGT1A1 enzyme [2]. - Patients typically present with **no stigmata of chronic liver disease** other than mild, fluctuating jaundice, often triggered by stress or fasting [2]. *I and II only* - While it involves **elevation of unconjugated bilirubin (II)** [1], Gilbert syndrome is an **autosomal recessive** condition due to a **polymorphism** in the promoter region of the **UGT1A1 gene**, leading to reduced enzyme activity [2], not a mutation that completely abolishes it. - The reduced enzyme activity is typically mild, resulting in only intermittent, mild hyperbilirubinemia. *III and IV* - **No stigmata of chronic liver disease other than jaundice (III)** is correct [2]. However, **early liver biopsy (IV)** is **not recommended** in patients with suspected Gilbert Syndrome. - Gilbert syndrome is a benign condition [1], and a liver biopsy is generally unnecessary and invasive for diagnosis in the absence of other liver disease signs. *I, II and III* - Although it features **elevation of unconjugated bilirubin (II)** and **no stigmata of chronic liver disease (III)**, the description of **I** is partially incorrect. - Gilbert syndrome is due to a **polymorphism** in the UGT1A1 gene promoter resulting in reduced enzyme activity [1], and it follows an **autosomal recessive inheritance pattern**, but the core issue is the **polymorphism**, not a standard mutation that significantly impairs the enzyme.
Question 33: The single most important treatment and prognostic factor in alcohol-related liver disease is
- A. N -acetyl cysteine
- B. High dose vitamin E
- C. Cessation of alcohol consumption (Correct Answer)
- D. Liver transplantation
Explanation: ***Cessation of alcohol consumption*** - **Abstinence from alcohol** is the fundamental and most effective intervention for halting the progression of **alcohol-related liver disease (ARLD)** and significantly improving patient prognosis [1]. - Continued alcohol intake directly fuels liver damage, whereas stopping consumption allows the **liver to regenerate** and reduces inflammation, often leading to clinical improvement [1]. *N-acetyl cysteine* - While **N-acetyl cysteine (NAC)** is used in some liver conditions, particularly paracetamol overdose, its routine use for chronic ARLD is not supported by strong evidence as a primary treatment [3]. - It functions as an antioxidant and glutathione precursor, but **does not address the root cause** of alcohol-induced liver injury. *High dose vitamin E* - **High-dose vitamin E** is an antioxidant that has been investigated for various liver diseases, particularly non-alcoholic fatty liver disease (NAFLD) [2]. - However, there is **insufficient evidence** to support its widespread use as a primary or prognostic treatment in **alcohol-related liver disease** [2]. *Liver transplantation* - While **liver transplantation** can be a definitive treatment for end-stage ARLD, it is a **major surgical procedure** with strict criteria and is only considered after prolonged alcohol abstinence (typically 6 months) [1]. - It is a **salvage therapy** for irreversible damage, not the "single most important treatment and prognostic factor" in managing the disease from its earlier stages [1].
Question 34: Which of the following heart sounds are best heard with the bell of stethoscope? I. Opening snap II. Systolic click III. Third heart sound IV. Mid diastolic murmur Select the correct answer using the code given below :
- A. II and III only
- B. I, II and III
- C. III and IV (Correct Answer)
- D. I and IV
Explanation: ***III and IV*** - The **bell of the stethoscope** is designed to auscultate **low-pitched sounds** due to its larger surface area and lighter application to the skin. - The **third heart sound (S3)** and **mid-diastolic murmurs** (e.g., from mitral stenosis) are classic examples of low-pitched sounds best heard with the bell [2]. *II and III only* - While the **third heart sound (S3)** is correctly identified as being heard with the bell, the **systolic click** is a high-pitched sound [1]. - **Systolic clicks**, often associated with mitral valve prolapse, are best heard with the **diaphragm** of the stethoscope [1]. *I, II and III* - This option incorrectly includes both the **opening snap** and **systolic click** as being best heard with the bell. - The **opening snap** (related to mitral stenosis) and **systolic click** (related to mitral valve prolapse) are typically **high-pitched sounds** and are better heard with the **diaphragm** [1], [3]. *I and IV* - This option incorrectly states that the **opening snap** is best heard with the bell. - Although the **mid-diastolic murmur** is correctly identified as a low-pitched sound [2], the **opening snap** is a high-pitched sound [1], [3], making the entire option incorrect.
Question 35: Consider the following statements for diagnosing ventricular aneurysm in a patient with recent myocardial infarction : I. Paradoxical impulse on chest wall II. Persistent ST elevation on ECG III. Unusual bulge from cardiac silhouette on X-ray IV. Presence of pulsus paradoxsus Which of the above are correct?
- A. II, III and IV
- B. I and II only
- C. I and IV
- D. I, II and III (Correct Answer)
Explanation: ***I, II and III*** - A **paradoxical impulse** on the chest wall (statement I) is a classic physical finding, indicating dyskinetic movement of the aneurysm during systole [1]. - **Persistent ST segment elevation** on ECG weeks to months after a myocardial infarction (statement II) is a hallmark sign, often reflecting the fibrous scar tissue of the aneurysm [1]. - An **unusual bulge** from the cardiac silhouette on X-ray (statement III) can indicate an enlarged left ventricular contour due to the aneurysm [1]. *II, III and IV* - While statements II and III are correct for diagnosing ventricular aneurysm, **pulsus paradoxus** (statement IV) is typically associated with **cardiac tamponade** or severe asthma/COPD, not directly with ventricular aneurysms. *I and II only* - Statements I and II are indeed correct indicators, but statement III, the **cardiac silhouette bulge on X-ray**, is also a valid and often observed finding for ventricular aneurysm [1]. *I and IV* - Statement I is correct, but **pulsus paradoxus** (statement IV) is not a diagnostic feature of ventricular aneurysm; it suggests conditions like **pericardial effusion** with tamponade.
Question 36: Which one of the following statements is correct for subcutaneous nodules in Rheumatic fever?
- A. They are present over flexor aspect of forearm
- B. They are painful tender nodules
- C. They typically appear more than 3 weeks after onset of other clinical manifestations (Correct Answer)
- D. The usual size of these nodules is 3-5 cm
Explanation: ***They typically appear more than 3 weeks after onset of other clinical manifestations*** - Subcutaneous nodules in **rheumatic fever** are a late manifestation, typically appearing several weeks into the disease course. - Their presence often indicates **severe carditis**, particularly in recurrent attacks [1]. *They are present over flexor aspect of forearm* - These nodules are characteristically found over **bony prominences** and/or attached to **tendons**, such as over the knuckles, elbows, knees, ankles, and along the spine, not specifically the flexor aspect of the forearm. - Their location is often related to areas subject to pressure or friction. *They are painful tender nodules* - Subcutaneous nodules in rheumatic fever are typically described as **firm, discrete, and painless**. - Their lack of tenderness helps differentiate them from other nodular lesions. *The usual size of these nodules is 3-5 cm* - The nodules are usually **small**, ranging from a few millimeters to about 2 cm in diameter. - They are often **non-erythematous** and not easily visible unless specifically looked for or palpated.
Question 37: Which one of the following is correct with regard to Carey Coombs murmur?
- A. Harsh early diastolic murmur due to aortic regurgitation
- B. Soft systolic murmur due to mitral regurgitation
- C. Soft mid-diastolic murmur due to mitral valvulitis (Correct Answer)
- D. Blowing late systolic murmur due to aortic stenosis
Explanation: ***Soft mid-diastolic murmur due to mitral valvulitis*** - The **Carey Coombs murmur** is a soft, mid-diastolic murmur heard in acute rheumatic fever, characterized by inflammation of the mitral valve (mitral valvulitis) [4]. - It is distinct from the Austin Flint murmur and indicates active **rheumatic carditis** [4]. *Harsh early diastolic murmur due to aortic regurgitation* - An early diastolic murmur, especially a harsh one, typically indicates **aortic regurgitation**, which is a different valvular pathology [3]. - The Carey Coombs murmur is described as soft and mid-diastolic, not harsh and early diastolic. *Soft systolic murmur due to mitral regurgitation* - A soft systolic murmur suggests **mitral regurgitation**, which is a backflow of blood during systole [2]. - The Carey Coombs murmur is specifically a diastolic murmur, differentiating it from systolic murmurs [3]. *Blowing late systolic murmur due to aortic stenosis* - A blowing late systolic murmur is characteristic of **aortic stenosis**, where there is narrowing of the aortic valve. - The Carey Coombs murmur is an early to mid-diastolic murmur, related to mitral valve inflammation, not aortic stenosis [1].
Pathology
1 questionsMelanosis coli, which occurs due to long term consumption of stimulant laxatives, presents as brown discolouration of colonic mucosa due to deposition of which one of the following pigments?
UPSC-CMS 2025 - Pathology UPSC-CMS Practice Questions and MCQs
Question 31: Melanosis coli, which occurs due to long term consumption of stimulant laxatives, presents as brown discolouration of colonic mucosa due to deposition of which one of the following pigments?
- A. Lipofuscin (Correct Answer)
- B. Haemoglobin
- C. Haemosiderin
- D. Melanin
Explanation: ***Lipofuscin*** - **Melanosis coli** is characterized by the accumulation of **lipofuscin** in macrophages within the lamina propria of the colon. - This accumulation is typically induced by the long-term use of **stimulant laxatives**, particularly those containing anthraquinones (e.g., senna, cascara). *Haemoglobin* - **Haemoglobin** is the protein in red blood cells responsible for oxygen transport and does not deposit in the colonic mucosa to cause brown discoloration in melanosis coli. - Its presence in stool typically indicates **gastrointestinal bleeding**, which is a distinct condition from melanosis coli. *Haemosiderin* - **Haemosiderin** is an iron-storage complex that can accumulate in tissues as a result of **hemorrhage** or increased iron load [1]. - While it can cause brown discoloration, it is not the pigment responsible for the characteristic appearance of melanosis coli. *Melanin* - **Melanin** is the pigment primarily responsible for skin and hair color, produced by melanocytes [1]. - It is not found in significant amounts in the colonic mucosa and is not involved in the pathogenesis of melanosis coli. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 75.
Pharmacology
1 questionsWhich one of the following agents used in the treatment of inflammatory Bowel Disease acts by inhibiting the enzyme 'Janus Kinase'?
UPSC-CMS 2025 - Pharmacology UPSC-CMS Practice Questions and MCQs
Question 31: Which one of the following agents used in the treatment of inflammatory Bowel Disease acts by inhibiting the enzyme 'Janus Kinase'?
- A. Adalimumab
- B. Vedolizumab
- C. Tofacitinib (Correct Answer)
- D. Infliximab
Explanation: ***Tofacitinib*** - **Tofacitinib** is an oral medication that functions as a small molecule **Janus Kinase (JAK) inhibitor**, primarily targeting JAK1 and JAK3. - By inhibiting JAK enzymes, tofacitinib disrupts the signaling pathways of several **cytokines** involved in inflammation, including those implicated in **inflammatory bowel disease (IBD)**. *Adalimumab* - **Adalimumab** is a monoclonal antibody that targets and neutralizes **tumor necrosis factor-alpha (TNF-α)**, a key inflammatory cytokine. - It is not a JAK inhibitor but rather works by blocking the interaction of TNF-α with its receptors on cell surfaces. *Vedolizumab* - **Vedolizumab** is an anti-integrin monoclonal antibody that selectively blocks the α4β7 integrin on lymphocytes. - This action prevents lymphocytes from migrating into the gastrointestinal tract, thereby reducing inflammation in IBD. *Infliximab* - **Infliximab** is a chimeric monoclonal antibody that, like adalimumab, targets and neutralizes **tumor necrosis factor-alpha (TNF-α)**. - It works by binding to soluble and transmembrane forms of TNF-α, preventing its pro-inflammatory effects.