UPSC-CMS 2016 Previous Year Questions Practice Questions

Q: A patient has recurrent abdominal pain and jaundice. The blood investigations reveal reticulocytosis and hyperbilirubinemia. What is the clinical diagnosis?

Hereditary spherocytosis. ***Hereditary spherocytosis*** - The combination of **recurrent abdominal pain**, **jaundice**, **reticulocytosis**, and **hyperbilirubinemia** is highly suggestive of hereditary spherocytosis, which causes chronic hemolytic anemia [1, 3]. - **Jaundice** and **abdominal pain** can result from pigment gallstones (due to chronic hemolysis) and splenic enlargement, both common in this condition [2, 3]. *Mirizzi's syndrome* - Characterized by **extrinsic compression of the common hepatic duct** by a stone impacted in the cystic duct or gallbladder neck. - While it causes jaundice and abdominal pain, it does not typically present with **reticulocytosis** or **hemolysis** [1]. *Sclerosing cholangitis* - A chronic cholestatic liver disease characterized by **inflammation and fibrosis** of the bile ducts. - While it causes jaundice and abdominal pain, it is not associated with **reticulocytosis** or signs of **hemolysis** [1]. *Choledochal cyst* - A **congenital dilation of the bile ducts**, leading to recurrent abdominal pain, jaundice, and a palpable mass. - It does not involve **hemolysis** or **reticulocytosis**, making it less likely in this context. [Practice more UPSC-CMS 2016 questions on OnCourse]

Q: The most common route of spread in a case of pyogenic liver abscess is:

Haematogenous through portal vein. Haematogenous through portal vein - Pyogenic liver abscesses commonly result from bacterial translocation from the gut, reaching the liver via the portal venous system. - This route accounts for a significant proportion of cases, especially when associated with conditions like diverticulitis or appendicitis. *Hepatic artery* - While possible, spread via the hepatic artery is less common and usually seen in cases of septicemia or endocarditis. - It would imply a more generalized systemic infection rather than a localized abdominal source. *Ascending infection through biliary duct* - This mechanism is characteristic of cholangitis and often leads to multiple small abscesses or a subcapsular collection, not typically a solitary pyogenic liver abscess. - It occurs due to obstruction to biliary flow from stones or strictures. *Local spread* - Local spread can occur from adjacent infected organs like a subphrenic abscess or an infected gallbladder, but it is not the most common route for the initial development of a pyogenic liver abscess. - This typically results in direct extension into the liver parenchyma. [Practice more UPSC-CMS 2016 questions on OnCourse]

Q: Which of the following statements is not correct regarding sebaceous cyst?

Treatment is incision and drainage. ***Treatment is incision and drainage*** - The standard treatment for a sebaceous cyst (more accurately an **epidermoid cyst** or **pilar cyst**) is **surgical excision** of the entire cyst wall to prevent recurrence. - **Incision and drainage** only provides temporary relief by emptying the contents but leaves the cyst wall intact, leading to a high chance of the cyst refilling. *Found on hairy areas of the body* - This statement is generally correct as sebaceous cysts often arise from hair follicles and are common in **hair-bearing areas** like the scalp, face, neck, and trunk. - They occur due to the accumulation of **sebum** and keratin within a blocked or damaged sebaceous gland or hair follicle. *Not found on palms and soles* - This statement is correct because **palms and soles** generally **lack sebaceous glands** and hair follicles, hence sebaceous cysts are typically not found in these locations. - Cysts found in these areas are more likely to be **ganglion cysts** or other types of epidermal inclusion cysts. *It has a punctum* - This statement is often correct; many sebaceous cysts (especially epidermoid cysts) have a visible **central punctum** which represents the occluded pore from which the cyst originated. - This punctum is a **key diagnostic feature** and can sometimes exude a cheesy, foul-smelling material. [Practice more UPSC-CMS 2016 questions on OnCourse]

Q: Tumours of anterior mediastinum include the following except:

Schwannoma. ***Schwannoma*** - **Schwannomas** (neurilemmomas) are typically found in the **posterior mediastinum**, arising from **peripheral nerves** or nerve roots. - They are usually benign and grow slowly, presenting with symptoms due to compression of surrounding structures. *Lymphoma* - **Lymphoma** is a common tumor of the **anterior mediastinum**, often presenting as an **anterior mediastinal mass**. - Both Hodgkin and non-Hodgkin lymphomas can involve mediastinal lymph nodes. *Germ cell tumour* - **Germ cell tumors**, including **teratomas** and **seminomas**, frequently occur in the **anterior mediastinum**. - They arise from ectopic germ cell rests that migrate aberrantly during embryonic development. *Thymoma* - **Thymomas** are the most common primary tumor of the **anterior mediastinum**, originating from the **thymus gland**. - They are often associated with **myasthenia gravis** and other paraneoplastic syndromes. [Practice more UPSC-CMS 2016 questions on OnCourse]

Question 1

A patient has recurrent abdominal pain and jaundice. The blood investigations reveal reticulocytosis and hyperbilirubinemia. What is the clinical diagnosis?

Accepted Answer

Hereditary spherocytosis

Answer

Mirizzi's syndrome

Answer

Sclerosing cholangitis

Answer

Choledochal cyst

Question 2

The most common route of spread in a case of pyogenic liver abscess is:

Accepted Answer

Haematogenous through portal vein

Answer

Hepatic artery

Answer

Ascending infection through biliary duct

Answer

Local spread

Question 3

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→4  B→1  C→2  D→3

Answer

A→3  B→2  C→1  D→4

Answer

A→3  B→1  C→2  D→4

Answer

A→4  B→2  C→1  D→3

Question 4

Which of the following statements is not correct regarding sebaceous cyst?

Accepted Answer

Treatment is incision and drainage

Answer

Found on hairy areas of the body

Answer

Not found on palms and soles

Answer

It has a punctum

Question 5

Tumours of anterior mediastinum include the following except:

Accepted Answer

Schwannoma

Answer

Lymphoma

Answer

Germ cell tumour

Answer

Thymoma

Question 6

In India, the commonest cause of unilateral lymphoedema of lower limb is:

Accepted Answer

Filariasis

Answer

Tubercular lymphadenopathy

Answer

Carcinoma of penis

Answer

Lymphoedema tarda

Question 7

Nottingham prognostic Index is used for:

Accepted Answer

Cancer breast

Answer

Cancer stomach

Answer

Cancer colon

Answer

Cancer lung

Question 8

In gallstone ileus, obstruction most frequently occurs at:

Accepted Answer

Terminal ileum

Answer

Jejunum

Answer

Duodenum

Answer

Proximal ileum

Question 9

The following conditions are associated with high incidence of pigment gallstones except:

Accepted Answer

Prosthetic heart valve

Answer

Cirrhosis

Answer

Thalassemia

Answer

Ileal disease

Question 10

The most common complication of pancreas divisum is:

Accepted Answer

Recurrent acute pancreatitis

Answer

Obstructive jaundice

Answer

Peptic ulcer

Answer

Duodenal obstruction

UPSC-CMS 2016

Internal Medicine

Pathology

Surgery