UPSC-CMS 2023 Practice Questions

Q: Basophilic stippling of the RBCs is a sensitive index of

Lead poisoning. ***Correct: Lead poisoning*** - **Basophilic stippling** is a classic and sensitive hematologic finding in lead poisoning [1] - Results from inhibition of **pyrimidine 5'-nucleotidase**, which impairs RNA degradation in red blood cells - The presence of these **ribonucleoprotein granules** indicates defective heme synthesis and red cell maturation due to lead toxicity [1] - Other findings in lead poisoning include microcytic anemia and increased zinc protoporphyrin [1] *Incorrect: Silicosis* - A **lung disease** caused by inhaling **silica dust**, leading to pulmonary fibrosis and nodular lesions [2] - Does not primarily affect red blood cell morphology or cause basophilic stippling - Findings are limited to the respiratory system *Incorrect: Asbestosis* - A chronic **lung disease** caused by inhaling **asbestos fibers**, resulting in pulmonary fibrosis [2] - Does not directly cause changes in red blood cell morphology such as basophilic stippling - Associated with pleural plaques and increased risk of mesothelioma [2] *Incorrect: Arsenic poisoning* - Can cause various hematologic abnormalities including **anemia** and **pancytopenia** - **Not typically associated** with prominent basophilic stippling as a key diagnostic feature - Neurological symptoms (peripheral neuropathy), gastrointestinal symptoms, and dermatological findings (Mees' lines, hyperpigmentation) are more characteristic **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 418-420. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 695-699.

Q: Which of the following will qualify as a Class III exposure to Rabies?

Bites by wild animals. ***Bites by wild animals*** - All bites and scratches by **wild carnivores (dogs, jackals, wolves, foxes)** or **bats** are **ALWAYS considered Category III exposures** regardless of the wound severity or location. - This is because wild animals cannot be observed for 10 days, and the risk of rabies is extremely high. - This classification mandates immediate post-exposure prophylaxis (PEP) with both **rabies immunoglobulin (RIG)** and **vaccine**. - This is the **most definitive** Category III exposure among the options. *Bites on legs by a dog* - According to WHO guidelines, **any transdermal bite or scratch** (breaking the skin) is technically a **Category III exposure**. - However, the classification can be modified if the biting dog is a **healthy domestic dog** that can be kept under **observation for 10 days**. - If the dog remains healthy during observation, PEP can be discontinued. - The question stem asks which "will qualify" - implying certainty. Wild animal bites are **always** Category III, while domestic dog bites may have conditional management based on observation. *Drinking unboiled milk of a suspect animal* - Rabies virus is transmitted through **saliva** via bites, scratches, or mucous membrane contamination. - The virus is **inactivated by gastric acid** and cannot be transmitted through the gastrointestinal route. - Ingesting milk from a suspect animal poses **no risk** of rabies transmission. - This is **not a rabies exposure** and does not require PEP. *Licks on intact skin by a dog* - Licks on **intact skin** are classified as **Category I exposure**. - Rabies virus **cannot penetrate healthy, unbroken skin**. - Category I exposures do **not warrant** any rabies post-exposure prophylaxis.

Q: Consider the following : 1. Magnesium Sulphate 2. Calcium bicarbonate 3. Calcium Sulphate 4. Magnesium bicarbonate Hardness of water relates to the presence of which of the above?

1, 2, 3 and 4. **Correct Answer: 1, 2, 3 and 4** **Hardness of water** is caused by the presence of dissolved multivalent metallic cations, primarily **calcium (Ca²⁺)** and **magnesium (Mg²⁺)** ions. These ions combine with various anions to form compounds that cause water hardness: - **Magnesium sulfate (MgSO₄)** - Causes **permanent hardness** (cannot be removed by boiling) - **Calcium bicarbonate (Ca(HCO₃)₂)** - Causes **temporary hardness** (can be removed by boiling) - **Calcium sulfate (CaSO₄)** - Causes **permanent hardness** - **Magnesium bicarbonate (Mg(HCO₃)₂)** - Causes **temporary hardness** **Therefore, all four compounds (1, 2, 3, and 4) contribute to water hardness.** *Why other options are incorrect:* *1, 2 and 3 only* - Incorrectly excludes **magnesium bicarbonate**, which is a significant contributor to temporary hardness *2, 3 and 4 only* - Incorrectly excludes **magnesium sulfate**, which contributes to permanent hardness *1 and 4 only* - Incorrectly omits **calcium bicarbonate** and **calcium sulfate**, which are major contributors to both temporary and permanent hardness

Q: Which of the following is a third generation intrauterine device?

TCu-380A. **TCu-380A** - The **TCu-380A** is a copper-containing intrauterine device designed with a T-shape and has a surface area of 380 mm² of copper. - It is classified as a **third-generation IUD** due to its enhanced design and higher copper content, providing greater contraceptive efficacy and a longer duration of action compared to older models. *Cu-7* - The **Cu-7** is a first-generation copper IUD, characterized by its "7-shaped" design and lower copper content. - It had a shorter lifespan and lower efficacy compared to later generations of copper IUDs. *TCu-200* - The **TCu-200** is a second-generation copper IUD, a T-shaped device with 200 mm² of copper surface area. - While improved over first-generation devices, it offered less longevity and efficacy than the current third-generation models. *Progestasert* - **Progestasert** was one of the first hormone-releasing IUDs, releasing progesterone. - It is significantly different from copper IUDs and is not classified among the copper-containing generations; it had a shorter lifespan and less common use today compared to modern levonorgestrel-releasing IUDs.

Q: In which of the following diseases is post-exposure immunisation prescribed?

Rabies. ***Rabies*** - **Rabies post-exposure prophylaxis (PEP)** is critical with documented or suspected exposure, given its near 100% fatality rate once symptoms appear. - PEP consists of both **rabies vaccine** and **rabies immunoglobulin** administered as soon as possible after exposure. *Poliomyelitis* - Poliovirus vaccination is a **pre-exposure intervention** aimed at preventing infection in the first place through herd immunity. - There is no specific post-exposure immunization strategy for polio once exposure has occurred. *Yellow fever* - The yellow fever vaccine is a highly effective **pre-exposure preventive measure** for individuals traveling to or living in endemic areas. - While it provides long-lasting immunity, it is not used as a post-exposure treatment. *Cholera* - Cholera vaccines are primarily used for **pre-exposure prevention**, especially for travelers or populations in endemic areas. - Post-exposure management of cholera focuses on **rehydration therapy** and antibiotics, not immunization.

Q: Which of the following is not associated with Acute Food Poisoning?

Tenesmus. ***Tenesmus*** - **Tenesmus** is a symptom of **inflammatory bowel disease** or other **colonic inflammation**, characterized by the sensation of incomplete defecation [1]. - While it can be associated with some forms of infectious colitis, it is **not a typical or direct symptom of acute food poisoning**, which primarily manifests with acute onset of nausea, vomiting, diarrhea, and abdominal cramps [2], [3]. *High skin surface temperature* - **High skin surface temperature** (fever) is a common symptom of acute food poisoning, as the body fights off pathogens or toxins. - It is an indication of the **systemic inflammatory response** to the ingested contaminants. *Onset with vomiting* - **Vomiting** is one of the most prominent and often initial symptoms of acute food poisoning, especially with preformed toxins [2], [3]. - It is the body's rapid mechanism to **expel harmful substances** from the gastrointestinal tract. *Leucocytosis* - **Leucocytosis** (an increase in white blood cells) is a common finding in many infections, including bacterial food poisoning. - It indicates an **active immune response** to combat the invading pathogens or toxins.

Q: Which one of the following is the correct sequence of appearance for the Hepatitis B virus serological markers?

HBsAg, HBeAg, Anti-HBc, Anti-HBe. ***HBsAg, HBeAg, Anti-HBc, Anti-HBe*** - **HBsAg** (Hepatitis B surface antigen) is the first marker to appear in acute infection, indicating active viral replication. - **HBeAg** (Hepatitis B e-antigen) appears shortly after HBsAg, correlating with high viral replication and infectivity. **Anti-HBc** (antibody to hepatitis B core antigen) is the next to appear, often during the window period. **Anti-HBe** (antibody to hepatitis B e-antigen) signals reduced viral replication and decreased infectivity, typically following the disappearance of HBeAg. *Anti-HBe, HBsAg, Anti-HBc* - This sequence is incorrect because **Anti-HBe** appears much later in the infection, typically after clearance of HBeAg, indicating reduced viral replication. - **HBsAg** is the earliest indicator of active infection, not appearing after Anti-HBe. *HBeAg, Anti-HBe, Anti-HBc, HBsAg* - This sequence is incorrect as **HBeAg** and **Anti-HBe** do not typically appear before **HBsAg**, which is the initial marker of viral presence. - The appearance of **Anti-HBe** before **HBsAg** is also not consistent with the natural history of Hepatitis B infection. *Anti-HBc, HBsAg, Anti-HBe* - This sequence is incorrect because **Anti-HBc** usually appears earlier than Anti-HBe, and while it can be detected relatively early, **HBsAg** is the first antigen to be detectable. - The appearance of **Anti-HBe** is a sign of decreasing viral activity and generally appears later than both HBsAg and Anti-HBc.

Q: Which one of the following statements about Human Immunoglobulins is not correct?

IgG and IgM can both cross the placenta. ***IgG and IgM can both cross the placenta*** - This statement is incorrect because only **IgG** can actively cross the placenta, providing **passive immunity** to the fetus. - **IgM** is too large to cross the placental barrier, so its presence in a newborn suggests **congenital infection**. *The half life of IgM is about 10 days* - The approximate **half-life of IgM** is indeed around **5-10 days**, making this statement largely correct in general contexts. - This relatively short half-life means that IgM levels can change quickly in response to acute infections. *IgG comprises about 75-80% of the total serum immunoglobulins* - **IgG** is the most abundant immunoglobulin in serum, typically accounting for **75-80%** of the total immunoglobulins. - Its high concentration and long half-life contribute to its critical role in **secondary immune responses** and **long-term immunity**. *IgA comprises 15% of the total serum immunoglobulins and is mainly found in the body secretions* - **IgA** accounts for about **10-15%** of the total serum immunoglobulins, with a significant proportion found in secretions. - It plays a crucial role in **mucosal immunity**, protecting surfaces like the gastrointestinal, respiratory, and genitourinary tracts.

Q: The contraindications for Progestasert include the following except

Previous history of abortion. ***Previous history of abortion*** - A prior history of abortion is generally **not a contraindication** for the insertion of a progestogen-releasing intrauterine device (Progestaert or similar IUDs). - The risk of complications like infection or perforation is not significantly increased in women with a history of abortion, especially if it was a safe procedure. *Previous history of ectopic pregnancy* - A history of **ectopic pregnancy** is a **relative contraindication** for progestogen-only IUDs, as these devices primarily prevent intrauterine pregnancy but can marginally increase the risk of ectopic pregnancy if conception occurs. - While IUDs are highly effective at preventing pregnancy overall, if a pregnancy does occur with an IUD in place, there is a higher chance it will be ectopic. *Pelvic Inflammatory Disease* - **Active or recent Pelvic Inflammatory Disease (PID)** is a **strong contraindication** for IUD insertion due to the increased risk of ascending infection and exacerbation of the condition. - IUD insertion can potentially introduce bacteria into the uterus, worsening an existing infection or causing a new one if the patient is at high risk. *Uterine fibroids* - **Large or distorting uterine fibroids** can be a **contraindication** for IUD insertion, especially if they alter the uterine cavity significantly. - Fibroids can make IUD insertion difficult, increase the risk of perforation, and compromise the effectiveness of the device by preventing proper placement or causing expulsion.

Q: The ratio for Type-I to Type-III collagen during maturation of collagen in remodelling phase is :

2 : 1. **2 : 1** - During the maturation of **collagen in the remodeling phase**, Type-I collagen replaces Type-III collagen to provide greater tensile strength. - The mature scar tissue predominantly consists of **Type-I collagen**, with a typical Type-I to Type-III ratio around 2:1. *1 : 1* - A 1:1 ratio of Type-I to Type-III collagen is more characteristic of **early granulation tissue formation** rather than the mature remodeling phase. - In the initial stages of wound healing, there is a relatively high proportion of **Type-III collagen** for rapid closure and scaffolding. *4 : 1* - While the ratio does shift towards Type-I collagen, a 4:1 ratio of Type-I to Type-III collagen would imply an **even greater dominance of Type-I**, which is higher than the commonly accepted ratio for mature scar tissue. - This ratio is not typically observed in the normal remodeling process and might indicate a **hypertrophic scar** or keloid, if Type 1 is greatly increased as comparison to Type 3 *3 : 1* - A 3:1 ratio of Type-I to Type-III collagen represents a significant increase in Type-I collagen, but it is **not the most accurately recognized ratio** for mature collagen remodeling. - While the ratio moves in this direction, 3:1 is a less precise representation compared to the more commonly cited 2:1 for mature scar tissue.

Question 1

Basophilic stippling of the RBCs is a sensitive index of

Accepted Answer

Lead poisoning

Answer

Silicosis

Answer

Asbestosis

Answer

Arsenic poisoning

Question 2

Which of the following will qualify as a Class III exposure to Rabies?

Accepted Answer

Bites by wild animals

Answer

Bites on legs by a dog

Answer

Drinking unboiled milk of a suspect animal

Answer

Licks on intact skin by a dog

Question 3

Consider the following :

1. Magnesium Sulphate
2. Calcium bicarbonate
3. Calcium Sulphate
4. Magnesium bicarbonate

Hardness of water relates to the presence of which of the above?

Accepted Answer

1, 2, 3 and 4

Answer

1, 2 and 3 only

Answer

2, 3 and 4 only

Answer

1 and 4 only

Question 4

Which of the following is a third generation intrauterine device?

Accepted Answer

TCu-380A

Answer

Cu-7

Answer

TCu-200

Answer

Progestasert

Question 5

In which of the following diseases is post-exposure immunisation prescribed?

Accepted Answer

Rabies

Answer

Poliomyelitis

Answer

Yellow fever

Answer

Cholera

Question 6

Which of the following is not associated with Acute Food Poisoning?

Accepted Answer

Tenesmus

Answer

High skin surface temperature

Answer

Onset with vomiting

Answer

Leucocytosis

Question 7

Which one of the following is the correct sequence of appearance for the Hepatitis B virus serological markers?

Accepted Answer

HBsAg, HBeAg, Anti-HBc, Anti-HBe

Answer

Anti-HBe, HBsAg, Anti-HBc

Answer

HBeAg, Anti-HBe, Anti-HBc, HBsAg

Answer

Anti-HBc, HBsAg, Anti-HBe

Question 8

Which one of the following statements about Human Immunoglobulins is not correct?

Accepted Answer

IgG and IgM can both cross the placenta

Answer

The half life of IgM is about 10 days

Answer

IgG comprises about 75-80% of the total serum immunoglobulins

Answer

IgA comprises 15% of the total serum immunoglobulins and is mainly found in the body secretions

Question 9

The contraindications for Progestasert include the following except

Accepted Answer

Previous history of abortion

Answer

Previous history of ectopic pregnancy

Answer

Pelvic Inflammatory Disease

Answer

Uterine fibroids

Question 10

The ratio for Type-I to Type-III collagen during maturation of collagen in remodelling phase is :

Accepted Answer

2 : 1

Answer

1 : 1

Answer

4 : 1

Answer

3 : 1

UPSC-CMS 2023

Community Medicine

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pathology