UPSC-CMS 2025 Practice Questions

Q: Under the Stepwise Approach to the management of Bronchial Asthma, which one of the following is the correct initial treatment at Step 1 for a patient diagnosed with Asthma?

Low dose inhaled corticosteroid only. ***Low dose inhaled corticosteroid only*** - For newly diagnosed asthma patients requiring daily controller therapy (Step 1 or 2 as per GINA 2021+), a **low-dose inhaled corticosteroid (ICS)** is the recommended initial monotherapy [1]. - ICS addresses the underlying inflammation in asthma, which is crucial even in mild persistent cases. *Low dose inhaled corticosteroid plus leukotriene antagonist* - This combination is typically considered at **higher steps** (e.g., Step 3 or 4) if control is not achieved with low-dose ICS alone or if there are specific indications like **aspirin-exacerbated respiratory disease** [1]. - Initiating with two controller medications at Step 1 is generally not recommended as per guideline. *Low dose inhaled corticosteroid plus long acting anti-muscarinic agents* - **Long-acting muscarinic antagonists (LAMAs)** are primarily used in **severe asthma** that remains uncontrolled despite ICS/LABA therapy, usually at Step 4 or 5. - They are not considered a first-line addition to ICS at Step 1. *Low dose inhaled corticosteroid plus oral corticosteroid* - **Oral corticosteroids** are reserved for asthma **exacerbations** or very severe, uncontrolled asthma, used for short periods due to significant systemic side effects [1]. - They are never used as initial daily maintenance therapy at Step 1 due to their high side effect profile.

Q: A 62-year old male chronic smoker has been diagnosed with Chronic Obstructive Pulmonary Disease (COPD). On pulmonary function testing, the ratio of Forced Expiratory Volume in 1 second (FEV1) to Forced Vital Capacity (FVC) was 0.6 and FEV1 was 70 % of predicted. What is the severity of airflow obstruction in this patient as per GOLD criteria?

Stage II - Moderate. **Stage II - Moderate** - According to GOLD criteria, an FEV1/FVC ratio of less than 0.70 confirms airflow obstruction [1]. In this case, the ratio is 0.6. - A predicted FEV1 between 50% and 79% (inclusive) indicates **moderate COPD**, which aligns with the patient's FEV1 of 70% predicted [1]. *Stage III - Severe* - This stage is characterized by a **post-bronchodilator FEV1** between 30% and 49% of predicted [1]. - The patient's FEV1 of 70% predicted is too high for Stage III, indicating less severe obstruction. *Stage IV - Very severe* - This is the most severe stage, defined by a **post-bronchodilator FEV1** less than 30% of predicted, or FEV1 less than 50% predicted with signs of respiratory failure [1]. - The patient's FEV1 of 70% predicted is significantly higher than the threshold for very severe COPD. *Stage I - Mild* - Stage I is diagnosed when the **post-bronchodilator FEV1** is 80% or greater than predicted [1]. - The patient's FEV1 of 70% predicted falls below this criterion, indicating a more significant obstruction than mild.

Q: Which of the following conditions are contraindications for noninvasive positive-pressure ventilation in patients with respiratory failure? I. Craniofacial abnormalities II. Significant burns III. Respiratory failure with PaCO_2 of 60 mm Hg IV. Cardiovascular instability Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - **Craniofacial abnormalities** (I) can prevent a proper mask seal, leading to air leaks and ineffective ventilation. - **Significant burns** (II), especially on the face, can make mask application impossible due to pain, skin integrity issues, and infection risk. - **Cardiovascular instability** (IV), such as severe hypotension or active myocardial ischemia, can be worsened by the positive intrathoracic pressure applied by NPPV, which can decrease venous return and cardiac output. *I, III and IV* - While **craniofacial abnormalities** (I) and **cardiovascular instability** (IV) are contraindications, NPPV can be beneficial for **respiratory failure with a PaCO2 of 60 mm Hg** (III) as it helps reduce CO2 levels and avoids intubation. - Therefore, including III as a contraindication makes this option incorrect. *II, III and IV* - **Significant burns** (II) and **cardiovascular instability** (IV) are clear contraindications. However, **respiratory failure with a PaCO2 of 60 mm Hg** (III) is often an indication for NPPV, not a contraindication. - This option incorrectly identifies a key indication as a contraindication. *I, II and III* - **Craniofacial abnormalities** (I) and **significant burns** (II) are valid contraindications for NPPV. - However, **respiratory failure with a PaCO2 of 60 mm Hg** (III) is a common indication for NPPV, especially in conditions like COPD exacerbations, as it helps improve ventilation and reduce hypercapnia.

Q: Which one of the following terms denotes the extensive sclerosis of the skin of the chest wall which restricts chest wall movement and is seen as a rare complication of systemic sclerosis?

Hidebound Chest. ***Hidebound Chest*** - This term precisely describes the **extensive cutaneous sclerosis** over the chest wall seen in **systemic sclerosis**, leading to restricted chest movement [1]. - The hardened, thickened skin reduces chest wall compliance, making breathing difficult [1]. *Barrel Chest* - Characterized by an **increased anterior-posterior diameter** of the chest, commonly seen in chronic obstructive pulmonary disease (COPD) due to hyperinflation. - It is not primarily caused by skin sclerosis but rather by lung pathology. *Flail Chest* - Occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. - This results in **paradoxical movement** of the chest wall during respiration, and is an acute traumatic injury. *Pigeon Chest* - Also known as **Pectus Carinatum**, this chest wall deformity is characterized by a **protrusion of the sternum and costal cartilages**. - It is typically a developmental anomaly rather than a consequence of skin sclerosis.

Q: In clinical assessment of an elderly patient, 'the get up and go test' is used to evaluate which of the following?

Gait and balance. Gait and balance - The **Timed Up and Go (TUG) test** is a widely used clinical tool designed to assess a person's **mobility**, **balance**, and **fall risk**. [2] - It measures the time taken for an individual to rise from a chair, walk 3 meters, turn, walk back, and sit down again. *Cognition* - While physical and cognitive functions are related, the TUG test does not directly assess **cognitive abilities** like memory, executive function, or language. - Cognitive assessment typically involves tools such as the **Mini-Mental State Examination (MMSE)** or **Montreal Cognitive Assessment (MoCA)**. [1] *Urinary incontinence* - The TUG test does not evaluate **urinary function** or the presence of incontinence. - Assessment of urinary incontinence involves patient history, bladder diaries, and physical examination. *Driving ability* - Although mobility and balance are important for driving, the TUG test alone is not a direct measure of **driving ability**. - Driving assessments are more comprehensive, often involving on-road tests and specialized cognitive and visual evaluations.

Q: Which one of the following correctly denotes the inheritance pattern of cystic fibrosis?

Autosomal Recessive. ***Autosomal Recessive*** - Cystic fibrosis is an **autosomal recessive** disorder, meaning an individual must inherit **two copies** of the defective gene (one from each parent) to develop the condition. - Parents who are **carriers** (having one normal and one defective gene) typically do not show symptoms but can pass the gene to their children. *X-linked Dominant* - In **X-linked dominant** inheritance, a single copy of a mutated gene on the X chromosome is sufficient to cause the disorder. - This pattern would show common inheritance in females and often more severe phenotypes in males, which is not characteristic of cystic fibrosis. *Autosomal Dominant* - **Autosomal dominant** disorders require only **one copy** of a mutated gene on a non-sex chromosome for the disease to manifest. - If cystic fibrosis were autosomal dominant, affected individuals would typically have an affected parent, and the disease would be much more prevalent than observed. *X-linked Recessive* - **X-linked recessive** disorders primarily affect males, as they have only one X chromosome. Females are typically carriers and less severely affected. - Cystic fibrosis affects males and females nearly equally, which rules out an X-linked recessive inheritance pattern.

Q: Consider the following steps for using a metered dose inhaler (MDI) : I. Incline the head backward to minimize oropharyngeal deposition II. Remove the cap and shake the inhaler III. Breathe out gently and place the mouthpiece into the mouth IV. Hold the breath for 10 seconds V. Simultaneously, begin a slow deep inspiration, depress the canister and continue to inhale Which one of the following is the correct sequence of using MDI?

II, III, I, V, IV. ***II, III, I, V, IV*** - The correct sequence for using an MDI starts with **preparing the inhaler** (shaking it and removing the cap), followed by **proper positioning** and **breathing technique** to maximize drug delivery. - After preparing and positioning, the patient should inhale deeply while actuating the device, then **hold their breath** to allow for drug deposition. - **Note:** In standard MDI technique, the head should be in a **neutral or slightly upright position**, not inclined backward. Inclining the head backward would actually **increase** oropharyngeal deposition, contrary to what step I suggests. However, given the options provided in this question, this is the correct sequence. *III, II, I, V, IV* - This sequence incorrectly places **removing the cap and shaking the inhaler** (II) after beginning to breathe out and placing the mouthpiece (III), which means the inhaler isn't properly prepared before use. - The MDI needs to be shaken well before each use to ensure the medication is evenly distributed and delivered at the correct dose. *II, I, IV, III, V* - This sequence incorrectly places **holding the breath for 10 seconds** (IV) before placing the mouthpiece into the mouth and inhaling (III and V). - The breath hold should occur *after* inhalation to maximize drug deposition in the lungs. *III, I, II, IV, V* - This sequence places **removing the cap and shaking the inhaler** (II) very late, after preparing to breathe and inclining the head, which is incorrect. - The inhaler must be properly shaken *before* it is placed in the mouth and activated to ensure proper medication delivery.

Question 1

Which of the following statements is correct regarding the Opening Snap (OS) in a patient of mitral stenosis?

Accepted Answer

OS moves closer to the second sound (S2) as the stenosis becomes more severe

Answer

OS is best heard at the second left intercostal space

Answer

OS is best heard with the bell of stethoscope

Answer

Intensity of OS becomes louder when the valve is calcified

Question 2

Under the Stepwise Approach to the management of Bronchial Asthma, which one of the following is the correct initial treatment at Step 1 for a patient diagnosed with Asthma?

Accepted Answer

Low dose inhaled corticosteroid only

Answer

Low dose inhaled corticosteroid plus leukotriene antagonist

Answer

Low dose inhaled corticosteroid plus long acting anti-muscarinic agents

Answer

Low dose inhaled corticosteroid plus oral corticosteroid

Question 3

A 62-year old male chronic smoker has been diagnosed with Chronic Obstructive Pulmonary Disease (COPD). On pulmonary function testing, the ratio of Forced Expiratory Volume in 1 second (FEV1) to Forced Vital Capacity (FVC) was 0.6 and FEV1 was 70 % of predicted. What is the severity of airflow obstruction in this patient as per GOLD criteria?

Accepted Answer

Stage II - Moderate

Answer

Stage III - Severe

Answer

Stage IV - Very severe

Answer

Stage I - Mild

Question 4

Which of the following conditions are contraindications for noninvasive positive-pressure ventilation in patients with respiratory failure?
I. Craniofacial abnormalities
II. Significant burns
III. Respiratory failure with PaCO_2 of 60 mm Hg
IV. Cardiovascular instability

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and III

Question 5

Which one of the following terms denotes the extensive sclerosis of the skin of the chest wall which restricts chest wall movement and is seen as a rare complication of systemic sclerosis?

Accepted Answer

Hidebound Chest

Answer

Barrel Chest

Answer

Flail Chest

Answer

Pigeon Chest

Question 6

In clinical assessment of an elderly patient, 'the get up and go test' is used to evaluate which of the following?

Accepted Answer

Gait and balance

Answer

Cognition

Answer

Urinary incontinence

Answer

Driving ability

Question 7

Which one of the following statements is correct in the diagnosis of Giardiasis?

Accepted Answer

Stool sample at 2-3 days interval should be examined for cysts

Answer

String test is done to find out cysts of Giardia lamblia

Answer

Jejunal biopsy samples can show presence of larvae of Giardia lamblia

Answer

Cystic form of Giardia lamblia remains viable in water upto 1 week only

Question 8

Which one of the following correctly denotes the inheritance pattern of cystic fibrosis?

Accepted Answer

Autosomal Recessive

Answer

X-linked Dominant

Answer

Autosomal Dominant

Answer

X-linked Recessive

Question 9

Which one of the following responses to intravenous adenosine is correctly matched?

Accepted Answer

Atrio-ventricular nodal reentrant tachycardia - Termination and complete recovery

Answer

Atrial flutter - Termination and complete recovery

Answer

Ventricular tachycardia - Termination and complete recovery

Answer

Atrial fibrillation - Termination

Question 10

Consider the following steps for using a metered dose inhaler (MDI) :
I. Incline the head backward to minimize oropharyngeal deposition
II. Remove the cap and shake the inhaler
III. Breathe out gently and place the mouthpiece into the mouth
IV. Hold the breath for 10 seconds
V. Simultaneously, begin a slow deep inspiration, depress the canister and continue to inhale

Which one of the following is the correct sequence of using MDI?

Accepted Answer

II, III, I, V, IV

Answer

III, II, I, V, IV

Answer

II, I, IV, III, V

Answer

III, I, II, IV, V

UPSC-CMS 2025

Internal Medicine

Microbiology

Pathology

Pharmacology