UPSC-CMS 2020 Previous Year Questions Practice Questions

Q: Consider the following statements regarding needle stick injuries: 1. Injured part should be washed under running water 2. Dominant index finger is the commonest site for needle stick injury 3. All needle stick injuries should be reported 4. Hepatitis/HIV testing should be done after needle stick injury Which of the statements given above are correct?

1, 3 and 4. ***1, 3 and 4*** - All **needle stick injuries** expose healthcare workers to potential bloodborne pathogens, making immediate action, reporting, and testing crucial for **risk assessment** and **post-exposure prophylaxis**. - **Washing the injured part** helps reduce pathogen load, reporting ensures proper investigation and documentation, and testing helps monitor for infection and guide treatment. *1, 2 and 3* - While statements 1 and 3 are correct, statement 2, claiming the **dominant index finger** is the commonest site, is generally incorrect; the **non-dominant hand** is often at higher risk during procedures. - Furthermore, statement 4 regarding **Hepatitis/HIV testing** is a critical component of post-exposure management that is omitted from this option. *1, 2 and 4* - Statements 1 and 4 are correct, but as noted, statement 2 about the **dominant index finger** being the commonest site is typically false, with **non-dominant hand** injuries being more frequent. - This option also incorrectly omits the essential step of **reporting all needle stick injuries**, which is vital for surveillance and appropriate follow-up. *2, 3 and 4* - This option incorrectly includes the statement that the **dominant index finger** is the commonest site for needle stick injury. - It also fails to include the crucial first step of immediately **washing the injured part** under running water, which is fundamental to initial management. [Practice more UPSC-CMS 2020 questions on OnCourse]

Q: Consider the following statements regarding claudication: 1. It is a marker for silent coronary disease 2. Structured exercise program ( 2 hours per week for 3 months) leads to improvement in symptoms 3. Diabetes mellitus increases the risk and severity of claudication 4. Beta blockers may exacerbate claudication Which of the above statements are correct?

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All four statements are correct regarding **claudication**, a symptom of **peripheral arterial disease (PAD)**, where reduced blood flow to the limbs causes pain during exercise [1]. - **Claudication** is a significant marker for systemic **atherosclerosis** and **coronary artery disease**, increasing the risk of cardiovascular events, and **structured exercise programs** are a cornerstone of treatment [1]. *1, 3 and 4 only* - This option is incorrect because it omits statement 2. **Structured exercise programs** are unequivocally beneficial in improving claudication symptoms and functional capacity. - Omitting the beneficial effect of exercise contradicts current clinical guidelines for managing **PAD**. *1 and 2 only* - This option is incorrect as it fails to include statements 3 and 4. **Diabetes mellitus** is a major risk factor that significantly worsens PAD and claudication, while **beta-blockers** can indeed exacerbate symptoms in some patients due to their vasoconstrictive effects. - Ignoring the impact of **diabetes** and the potential adverse effects of **beta-blockers** provides an incomplete understanding of claudication management. *2, 3 and 4 only* - This option is incorrect because it excludes statement 1. **Claudication** is a strong indicator of widespread **atherosclerosis** and thus a marker for **silent coronary disease**, warranting investigation for broader cardiovascular risk [1]. - Failing to recognize claudication as a marker for **coronary disease** overlooks a critical aspect of its clinical significance and patient management. [Practice more UPSC-CMS 2020 questions on OnCourse]

Q: Medical management of thyrotoxic crisis includes all of the following EXCEPT:

IV antibiotics. ***IV antibiotics*** - **Antibiotics** are not a primary treatment for **thyrotoxic crisis** itself unless there's an underlying infection triggering the crisis, which is not indicated as a universal management step [1]. - The crisis is caused by an acute exacerbation of **hyperthyroidism**, not bacterial infection, so antibiotics would not address the core pathophysiology. *IV propanolol* - **Propranolol** (or other beta-blockers) helps control the adrenergic symptoms of thyrotoxic crisis, such as **tachycardia**, **tremors**, and **anxiety** [1]. - It also inhibits the peripheral conversion of **T4 to T3**, providing an additional therapeutic effect. *IV hydrocortisone* - **Glucocorticoids** like **hydrocortisone** are crucial in thyrotoxic crisis to inhibit the peripheral conversion of **T4 to T3**, stabilize cell membranes, and provide adrenal support. - They also help manage potential adrenal insufficiency, which can be an exacerbating factor or complication. *IV fluids* - **Intravenous fluids** are essential for correcting **dehydration**, which is often present due to increased metabolic rate, fever, sweating, and vomiting in patients with thyrotoxic crisis [1]. - They also help address **electrolyte imbalances** and support cardiovascular stability. [Practice more UPSC-CMS 2020 questions on OnCourse]

Q: First line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:

Anastrazole. ***Anastrazole*** - **Aromatase inhibitors** like anastrozole are the preferred first-line hormone therapy for **post-menopausal women** with **hormone-receptor-positive metastatic breast cancer**. - They work by **blocking the aromatase enzyme**, which is responsible for estrogen production in peripheral tissues in post-menopausal women. *Ovarian suppression by surgery* - Ovarian suppression is primarily used in **pre-menopausal women** to reduce estrogen production by the ovaries. - Since the patient is **post-menopausal**, her ovaries are no longer the primary source of estrogen production. *Antiprogestins* - **Antiprogestins** are not standard first-line hormone therapy for metastatic breast cancer. - While some progestational agents have been used in breast cancer treatment, **antiprogestins** are not established as a primary treatment. *Tamoxifen* - **Tamoxifen** is a **selective estrogen receptor modulator (SERM)** that has been widely used in breast cancer treatment. - While effective, **aromatase inhibitors** are generally preferred over tamoxifen as first-line therapy for **post-menopausal metastatic breast cancer** due to superior efficacy and tolerability profiles in this demographic. [Practice more UPSC-CMS 2020 questions on OnCourse]

Q: Indications for fasciotomy in compartment syndrome include all EXCEPT:

Palpable distal pulses. ***Palpable distal pulses*** - The presence of **palpable distal pulses is NOT an indication for fasciotomy** and does not rule out compartment syndrome. - **Vascular compromise is a late sign** in compartment syndrome - pulses often remain palpable even with significant nerve and muscle ischemia. - Fasciotomy decisions should be based on **clinical signs** (pain, sensory changes) and **pressure measurements**, not the presence of pulses. - This is the correct answer because it is NOT an indication for the procedure. *Compartment pressure > 30 mm Hg* - **Absolute indication for fasciotomy** when compartment pressure exceeds 30 mmHg, or when the **delta pressure** (diastolic BP minus compartment pressure) is less than 30 mmHg. - This pressure level impairs capillary perfusion and leads to tissue ischemia. *Distal sensory disturbance* - **Early and reliable indication** for fasciotomy showing nerve ischemia. - Paresthesia or numbness in the distribution of nerves running through the affected compartment indicates neurological compromise from elevated intracompartmental pressure. *Pain on passive movement of affected muscles* - **Most sensitive and earliest clinical sign** of compartment syndrome (part of "the 6 P's"). - Pain on passive stretch is typically **out of proportion to the injury** and indicates underlying muscle ischemia. - This is a clear indication for fasciotomy. [Practice more UPSC-CMS 2020 questions on OnCourse]

Question 1

Consider the following statements regarding needle stick injuries:

1. Injured part should be washed under running water
2. Dominant index finger is the commonest site for needle stick injury
3. All needle stick injuries should be reported
4. Hepatitis/HIV testing should be done after needle stick injury Which of the statements given above are correct?

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 2

Consider the following statements regarding claudication:

1. It is a marker for silent coronary disease
2. Structured exercise program ( 2 hours per week for 3 months) leads to improvement in symptoms
3. Diabetes mellitus increases the risk and severity of claudication
4. Beta blockers may exacerbate claudication

Which of the above statements are correct?

Accepted Answer

1, 2, 3 and 4

Answer

1, 3 and 4 only

Answer

1 and 2 only

Answer

2, 3 and 4 only

Question 3

Medical management of thyrotoxic crisis includes all of the following EXCEPT:

Accepted Answer

IV antibiotics

Answer

IV propanolol

Answer

IV hydrocortisone

Answer

IV fluids

Question 4

First line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:

Accepted Answer

Anastrazole

Answer

Ovarian suppression by surgery

Answer

Antiprogestins

Answer

Tamoxifen

Question 5

Indications for fasciotomy in compartment syndrome include all EXCEPT:

Accepted Answer

Palpable distal pulses

Answer

Compartment pressure > 30 mm Hg

Answer

Distal sensory disturbance

Answer

Pain on passive movement of affected muscles

Question 6

Which one of the following statements is NOT correct regarding Necrotising Soft Tissue infections?

Accepted Answer

They are monomicrobial in nature

Answer

Treatment consists of wide local excision and appropriate antibiotics

Answer

Tissue biopsy is required for culture and diagnosis

Answer

Crepitus, skin blistering and focal skin gangrene are typical presenting features

Question 7

Which type of surgery is laparoscopic cholecystectomy classified as?

Accepted Answer

Clean contaminated

Answer

Dirty

Answer

Contaminated

Answer

Clean

Question 8

A 22-year female has presented with a history of malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for last 6 months. She also complains of abdominal distension for last 2 days. On examination her abdomen has a doughy feel along with an ill defined mass over the right lower quadrant. She is most likely suffering from:

Accepted Answer

Ileocaecal tuberculosis

Answer

Ovarian mass

Answer

Appendicular lump

Answer

Carcinoma caecum

Question 9

A 50-year old lady underwent uneventful bariatric surgery for morbid obesity. On the third post operative day, she develops breathlessness and pulmonary embolism is suspected. The next investigation to confirm the diagnosis will be:

Accepted Answer

CT pulmonary angiography

Answer

MR angiography

Answer

Echocardiography

Answer

Duplex venography

Question 10

A patient operated for a parotid gland tumour developed symptoms of sweating and erythema (flushing) over the region of surgical excision while eating. The probable diagnosis is:

Accepted Answer

Frey's syndrome

Answer

Sialadenitis

Answer

Parotid gland fistula

Answer

Chronic wound infection

UPSC-CMS 2020

Community Medicine

Internal Medicine

Orthopaedics

Surgery