UPSC-CMS 2009 Previous Year Questions Practice Questions

Q: In a patient of carcinoma tongue, the infiltration of which muscle causes ankyloglossia ?

Genioglossus muscle. ***Genioglossus muscle*** - Infiltration of the **genioglossus muscle** by carcinoma of the tongue restricts tongue protrusion and movement, functionally mimicking **ankyloglossia** [1]. - The genioglossus is the **primary protrusor** of the tongue, originating from the mental spine of the mandible and inserting into the entire length of the tongue. - When infiltrated by tumor, it causes **inability to protrude the tongue** beyond the lower incisor teeth and deviation toward the affected side [1]. - Though true ankyloglossia is a congenital condition involving the lingual frenulum, this term is used clinically to describe **acquired restriction of tongue mobility**. *Palatoglossus muscle* - The palatoglossus muscle primarily **elevates the posterior tongue** and assists in closing the oropharyngeal isthmus. - Its infiltration would affect **swallowing and palatine arch function** rather than tongue protrusion. - Not the primary cause of restricted tongue protrusion seen in this clinical scenario. *Styloglossus muscle* - The styloglossus muscle **retracts and elevates the sides of the tongue**. - Its involvement would impair retraction and lateral movements but would **not restrict protrusion**, which is the hallmark of ankyloglossia. *Mylohyoid muscle* - The mylohyoid forms the **muscular floor of the mouth** and elevates the hyoid bone and tongue during swallowing. - It is not an intrinsic tongue muscle; infiltration would cause **floor of mouth issues** and dysphagia rather than specific restriction of tongue protrusion. [Practice more UPSC-CMS 2009 questions on OnCourse]

Q: Which one of the following is not a correct statement regarding Raynaud's disease ?

The lower extremity involvement is symmetrical. ***The lower extremity involvement is symmetrical*** - **Raynaud's phenomenon** primarily affects the **fingers and toes**, but it is characterized by **asymmetrical involvement**, affecting different digits or limbs to varying degrees. Symmetrical involvement of the lower extremities is not a typical characteristic. - While it can affect the lower extremities, the hallmark of Raynaud's is its **episodic, asymmetrical, and often acral distribution** in response to triggers. *It commonly affects women* - **Raynaud's phenomenon** is indeed more prevalent in **women** than men, with an estimated prevalence of 5-10% in the general population. - This higher incidence in women is a well-documented epidemiological feature of the condition. *Exposure to cold precipitates vasoconstriction* - **Cold exposure** is the most common and classic trigger for **Raynaud's phenomenon**, leading to an exaggerated **vasoconstrictive response** in the small arteries and arterioles of the extremities. - This extreme vasoconstriction results in the characteristic color changes (pallor, cyanosis, and rubor) due to reduced blood flow. *It is idiopathic* - **Raynaud's disease**, also known as **primary Raynaud's phenomenon**, is indeed considered **idiopathic**, meaning its cause is unknown. - It occurs in the absence of any underlying medical condition, distinguishing it from secondary Raynaud's phenomenon, which is associated with autoimmune diseases or other factors. [Practice more UPSC-CMS 2009 questions on OnCourse]

Q: What is the best and most sensitive investigation for hypothyroidism ?

TSH levels. TSH levels - **Thyroid-Stimulating Hormone (TSH)** is the most sensitive and specific test for diagnosing **primary hypothyroidism** because even slight decreases in thyroid hormone levels cause significant increases in TSH [1]. - TSH is released from the **pituitary gland** and acts as a direct feedback mechanism to regulate thyroid hormone production [1]. A high TSH level indicates that the thyroid gland is not producing enough hormones. *T3, T4 levels* - While **T3 (triiodothyronine)** and **T4 (thyroxine)** levels are direct measures of thyroid hormones, their values may remain within the normal range in early or subclinical hypothyroidism [1]. - They are less sensitive than TSH for initial screening and often become abnormal only after hypothyroidism is well-established [1]. *TRH levels* - **Thyrotropin-Releasing Hormone (TRH)** is produced by the hypothalamus and stimulates TSH release from the pituitary [1]. - Measuring TRH levels is generally not used as a primary diagnostic test for hypothyroidism due to its complexity and lack of direct clinical utility in routine screening. *Radioactive I2 uptake* - **Radioactive iodine uptake (RAIU)** measures the thyroid gland's ability to take up iodine, which is used to produce thyroid hormones. - It is primarily used to differentiate causes of hyperthyroidism (e.g., Graves' disease vs. thyroiditis), not as a diagnostic test for hypothyroidism [1]. [Practice more UPSC-CMS 2009 questions on OnCourse]

Q: In a patient with breast cancer, the following are poor prognostic factors except

Absence of epidermal growth factor receptor. ***Absence of epidermal growth factor receptor*** - The **absence of epidermal growth factor receptor (EGFR/HER1) overexpression** is associated with a **better prognosis** in breast cancer. - **EGFR overexpression** is more commonly seen in aggressive breast cancers, particularly **triple-negative breast cancers** (ER-negative, PR-negative, HER2-negative), and is associated with poor outcomes [2]. - When EGFR is absent or not overexpressed, the tumor tends to have less aggressive biological behavior. *Aneuploid status* - **Aneuploid status** (abnormal chromosome number) is a well-recognized **poor prognostic factor** in breast cancer, indicating genetic instability and aggressive tumor behavior [2]. - It is associated with **increased risk of recurrence** and poorer response to therapy. *Age less than 35 years* - **Younger age** (less than 35 years) at diagnosis is a **poor prognostic factor** for breast cancer. - This is often due to more aggressive tumor biology, **higher grade tumors**, hormone receptor negativity, and delayed diagnosis in younger women. *High grade* - A **high histological grade** (Grade III) indicates a more aggressive tumor with rapid cell division, marked nuclear pleomorphism, and poor differentiation, signifying a **poor prognosis** [1]. - High-grade tumors are more likely to metastasize and have higher recurrence rates. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 458-459. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066. [Practice more UPSC-CMS 2009 questions on OnCourse]

Question 1

In a patient of carcinoma tongue, the infiltration of which muscle causes ankyloglossia ?

Accepted Answer

Genioglossus muscle

Answer

Palatoglossus muscle

Answer

Styloglossus muscle

Answer

Mylohyoid muscle

Question 2

Following the immunotherapy, in patients undergoing renal transplantation, the skin cancer most commonly seen is

Accepted Answer

Non-melanoma skin cancers (Squamous cell carcinoma and Basal cell carcinoma)

Answer

Hepatomas

Answer

Kaposi's sarcoma

Answer

Mycosis fungoides

Question 3

Which one of the following is not a correct statement regarding Raynaud's disease ?

Accepted Answer

The lower extremity involvement is symmetrical

Answer

It commonly affects women

Answer

Exposure to cold precipitates vasoconstriction

Answer

It is idiopathic

Question 4

What is the best and most sensitive investigation for hypothyroidism ?

Accepted Answer

TSH levels

Answer

T3, T4 levels

Answer

TRH levels

Answer

Radioactive I2 uptake

Question 5

In a patient with breast cancer, the following are poor prognostic factors except

Accepted Answer

Absence of epidermal growth factor receptor

Answer

Aneuploid status

Answer

Age less than 35 years

Answer

High grade

Question 6

Which of the following is a scoring system for severity of wound infection, and is particularly useful for surveillance and research ?

Accepted Answer

Southampton grading system

Answer

Apgar score

Answer

Glasgow scoring system

Answer

ASA classification

Question 7

Which one of the following statements is correct in case of squamous cell carcinoma of the lip?

Accepted Answer

Lesion often arises in the areas of persistent hyperkeratosis

Answer

Lymph node metastases occur early

Answer

Radiotherapy is considered inappropriate treatment for these lesions

Answer

More than 90 per cent of cases occur on the upper lip

Question 8

Which one of the following is not a correct statement with reference to locally advanced carcinoma breast ?

Accepted Answer

Radical Mastectomy is the treatment of choice

Answer

Patients are staged as T3 or T4 with any N, without distant metastasis (M0)

Answer

It constitutes the bulk of patients of carcinoma breast in India

Answer

Neoadjuvant chemotherapy downgrades the disease

Question 9

Consider the following statements regarding splenectomy :

1. It corrects anemia in congenital hereditary spherocytosis.
2. Postponed until the age of 4 years if possible.
3. Polyvalent pneumococcal vaccine to be administered to all before the surgery. Which of the statements given above are correct ?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Question 10

Which one of the following is not a common feature of bile duct stone ?

Accepted Answer

Distended gall bladder

Answer

Clay colored stools

Answer

Itching

Answer

Obstructive jaundice

UPSC-CMS 2009

Anatomy

Internal Medicine

Pathology

Surgery