UPSC-CMS 2022 Previous Year Questions Practice Questions

Q: The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is

24-hour pH recording. ***24-hour pH recording*** - This method directly measures the **frequency** and **duration of acid exposure** in the esophagus, providing objective evidence of reflux. - It is considered the gold standard because it can **quantify reflux episodes** and correlate them with patient symptoms. *upper GI endoscopy* - While useful for visualizing **mucosal damage** [1] (esophagitis, strictures, Barrett's esophagus) caused by reflux, it does not directly measure or confirm reflux itself. - Many patients with GORD symptoms have **normal endoscopic findings**, making it unsuitable as the gold standard for diagnosis. *CT scan* - A CT scan is not typically used for diagnosing GORD. - It is more useful for identifying **structural abnormalities** or **complications** of reflux, such as tumors or hiatal hernias. *barium meal follow through* - This imaging technique can identify **structural abnormalities** like hiatal hernia or severe reflux events, but it is not sensitive enough to detect intermittent or mild reflux. - It provides a **snapshot** of reflux and cannot quantify the total acid exposure over a prolonged period. [Practice more UPSC-CMS 2022 questions on OnCourse]

Q: Mycetoma, a chronic, specific, granulomatous, destructive disease involving the skin and subcutaneous tissue:

may be caused by fungi or bacteria. ***may be caused by fungi or bacteria*** - Mycetoma can be caused by either **eumycetes (true fungi)**, leading to **eumycetoma**, or by certain **aerobic actinomycetes (bacteria)**, resulting in **actinomycetoma** [1]. - Both forms present with similar clinical features, including **granulomatous inflammation** and the formation of **grains** or granules. *involves the superficial structure only* - Mycetoma is characterized by its **destructive nature**, progressively involving **deep tissues** like fascia, muscle, and even bone, not just superficial structures [1]. - The disease often leads to **deformity** and **loss of function** due to deep tissue invasion. *frequently causes trophic changes* - While mycetoma leads to significant tissue destruction and deformity, **trophic changes** (e.g., changes in skin, hair, and nails due to nerve damage) are not its primary or most characteristic feature. - The main complications are related to **tissue destruction**, **secondary infections**, and **amputation**. *is a blood-borne infection* - Mycetoma is acquired through **traumatic inoculation** of the causative organism into the skin, typically via thorns or splinters. - It is a **localized infection** and does not spread via the bloodstream; systemic dissemination is very rare. [Practice more UPSC-CMS 2022 questions on OnCourse]

Q: Which of the following statements regarding papillary thyroid cancer is correct? 1. It is the most common malignant tumour of thyroid gland. 2. It is more common in young females. 3. It has propensity for haematogenous spread. 4. Distant metastases are uncommon.

1. It is the most common malignant tumour of thyroid gland.. ***1. It is the most common malignant tumour of thyroid gland.*** - **Papillary thyroid cancer (PTC)** accounts for approximately **80-85% of all thyroid cancers**, making it the most prevalent type [1]. - This is the definitive correct statement among the options provided. *2. It is more common in young females.* - While PTC is indeed **more common in females** (3:1 female-to-male ratio), the term "young" is imprecise for exam purposes [3]. - PTC typically occurs in the **3rd to 5th decades** (30-50 years), which is more accurately described as "middle-aged" rather than "young" [1], [2]. - The statement lacks specificity needed for a definitive answer. *3. It has propensity for haematogenous spread.* - This is **incorrect**. PTC primarily spreads via the **lymphatic system** to regional cervical lymph nodes [2]. - **Hematogenous spread** is characteristic of **follicular thyroid carcinoma**, not papillary type [2]. - While distant hematogenous metastases can occur in advanced PTC, it is **not** the characteristic pattern of spread. *4. Distant metastases are uncommon.* - While this statement has merit (distant metastases occur in only 5-10% at presentation), it is less definitively correct than statement 1. - The majority of PTC metastases are **locoregional lymphatic** spread rather than distant. - However, when distant metastases do occur, it affects prognosis significantly (lungs > bones). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1100. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-430. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1095-1096. [Practice more UPSC-CMS 2022 questions on OnCourse]

Q: The most difficult area to visualize using duplex scanning (B-mode ultrasound), especially in an obese patient, is

aortoiliac segment. ***aortoiliac segment*** - The **aortoiliac segment** is often challenging to visualize due to its deep location within the **pelvis** and the presence of overlying **bowel gas**, which scatters ultrasound waves. - In obese patients, increased **adipose tissue** further attenuates the ultrasound signal, making imaging of this specific segment particularly difficult. *abdominal aorta above renal vessels* - While the **abdominal aorta** can be challenging, particularly the segment above the renal vessels due to the diaphragm and lung bases, it is generally more accessible than the deep pelvic structures. - Visualization can be improved by optimizing patient position and using specific transducer angles. *carotid vessels* - **Carotid vessels** are superficial and easily accessible for duplex scanning, making them one of the easiest vascular beds to image. - There is minimal tissue attenuation, and bowel gas is not a factor. *iliofemoral segment* - The **iliofemoral segment** is more superficial than the aortoiliac segment and is generally well visualized, especially the femoral arteries in the groin. - While obesity can increase the scanning depth, it does not pose the same challenges as the deeper and often gas-obscured pelvic vessels. [Practice more UPSC-CMS 2022 questions on OnCourse]

Q: Which of the following statements are correct regarding Buerger's disease? 1. It involves small to medium arteries. 2. It is common in smokers. 3. It commonly involves lower limb vessels. 4. Cessation of smoking reverses the disease process.

1, 2 and 3. ***1, 2 and 3*** - Buerger's disease, or **thromboangiitis obliterans**, primarily affects **small to medium-sized arteries and veins** in the upper and lower extremities. - It is **strongly associated with tobacco use** and commonly affects the **distal arteries** of the limbs, leading to ischemia and potential gangrene. *1, 3 and 4* - While Buerger's disease involves small to medium arteries and commonly affects lower limb vessels, **cessation of smoking does not reverse the disease process** but rather stops its progression. - The damage caused to the vessels by inflammation and thrombosis is largely irreversible. *1, 2 and 4* - This option incorrectly states that cessation of smoking reverses the disease process, which is not true. - While smoking cessation is crucial for preventing progression, existing vascular damage is permanent. *2, 3 and 4* - This option misses that Buerger's disease involves **small to medium arteries**, which is a key characteristic of the condition. - Additionally, it incorrectly suggests that smoking cessation reverses the disease. [Practice more UPSC-CMS 2022 questions on OnCourse]

Question 1

The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is

Accepted Answer

24-hour pH recording

Answer

upper GI endoscopy

Answer

CT scan

Answer

barium meal follow through

Question 2

Mycetoma, a chronic, specific, granulomatous, destructive disease involving the skin and subcutaneous tissue:

Accepted Answer

may be caused by fungi or bacteria

Answer

involves the superficial structure only

Answer

frequently causes trophic changes

Answer

is a blood-borne infection

Question 3

Which of the following statements regarding papillary thyroid cancer is correct?

1. It is the most common malignant tumour of thyroid gland.
2. It is more common in young females.
3. It has propensity for haematogenous spread.
4. Distant metastases are uncommon.

Accepted Answer

1. It is the most common malignant tumour of thyroid gland.

Answer

2. It is more common in young females.

Answer

4. Distant metastases are uncommon.

Answer

3. It has propensity for haematogenous spread.

Question 4

The most difficult area to visualize using duplex scanning (B-mode ultrasound), especially in an obese patient, is

Accepted Answer

aortoiliac segment

Answer

abdominal aorta above renal vessels

Answer

carotid vessels

Answer

iliofemoral segment

Question 5

Which of the following statements are correct regarding Buerger's disease?

1. It involves small to medium arteries.
2. It is common in smokers.
3. It commonly involves lower limb vessels.
4. Cessation of smoking reverses the disease process.

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 6

Which of the following vital structures in the axilla should always be preserved in modified radical mastectomy?

Accepted Answer

Axillary vein

Answer

Intercostobrachial nerves

Answer

Nerve to serratus anterior

Answer

Nerve to latissimus dorsi

Question 7

The most common metabolic abnormality associated with gastric outlet obstruction is

Accepted Answer

hypochloraemic alkalosis

Answer

hyperchloraemic alkalosis

Answer

hypochloraemic acidosis

Answer

hyperchloraemic acidosis

Question 8

Which of the following is the PRIMARY factor that predisposes to the development of incisional hernia?

Accepted Answer

Postoperative wound infection

Answer

Immunocompromised patient

Answer

Malnutrition

Answer

Non-absorbable suture material

Question 9

Which of the following statements about peptic ulcers is correct?

Accepted Answer

Anteriorly located duodenal ulcers are 'more prone for perforation'.

Answer

It is more commonly seen in females.

Answer

The most common location is the third part of duodenum.

Answer

There is no risk of malignancy in gastric ulcers.

Question 10

Which of the following statements regarding annular pancreas is INCORRECT?

1. It results from failure of rotation of ventral pancreatic bud during development.
2. A ring of pancreatic tissue surrounds the second or third part of duodenum.
3. It presents with vomiting due to duodenal obstruction.
4. Duodenoduodenostomy is the preferred treatment of this condition.

Accepted Answer

4. Duodenoduodenostomy is the preferred treatment of this condition.

Answer

3. It presents with vomiting due to duodenal obstruction.

Answer

1. It results from failure of rotation of ventral pancreatic bud during development.

Answer

2. A ring of pancreatic tissue surrounds the second part of duodenum.

UPSC-CMS 2022

Internal Medicine

Microbiology

Pathology

Radiology

Surgery