UPSC-CMS 2023 Practice Questions

Q: Consider the following clinical features : 1. Low back pain 2. Saddle anaesthesia 3. Motor weakness in the lower extremities 4. Variable rectal and urinary symptoms Which of the above features may be present in a patient with Cauda Equina syndrome ?

1, 2, 3 and 4. ***1, 2, 3 and 4*** - **Cauda equina syndrome** is a serious neurological condition involving compression of the cauda equina nerve roots, typically manifesting with **low back pain**, **saddle anesthesia**, and **motor weakness** in the lower extremities [1]. - The compression of the nerve roots can also lead to varying degrees of **rectal and urinary dysfunction**, including incontinence or retention, depending on which nerve roots are affected [2]. *1, 2 and 3 only* - While **low back pain**, **saddle anesthesia**, and **motor weakness** are prominent features of cauda equina syndrome, this option incorrectly excludes the crucial symptom of **rectal and urinary dysfunction**. - **Bladder and bowel dysfunction**, along with sexual dysfunction, are hallmark symptoms resulting from the involvement of sacral nerve roots in cauda equina compression [2]. *1 and 2 only* - This option correctly identifies **low back pain** and **saddle anesthesia** as features but omits two critical components of cauda equina syndrome: **motor weakness** and **rectal/urinary symptoms** [1]. - Without considering **motor weakness** and **sphincter dysfunction**, the diagnostic picture of cauda equina syndrome is incomplete, potentially delaying necessary surgical intervention [3]. *3 and 4 only* - This option incorrectly suggests that **motor weakness** and **rectal/urinary symptoms** are the only relevant features, excluding the highly characteristic **low back pain** and **saddle anesthesia**. - **Low back pain** is almost universally present and **saddle anesthesia** is a key indicator of sacral nerve root involvement, crucial for distinguishing cauda equina syndrome from other neurological conditions [1].

Q: Gas Gangrene resulting in crepitus in tissues and a sweet smelling brown exudate is caused due to infection by :

Clostridium perfringens. ***Clostridium perfringens*** - **Gas gangrene** is caused by obligate anaerobic, gram-positive rods, notably **Clostridium perfringens**. - This bacterium produces **alpha-toxin (lecithinase)**, which destroys tissues and leads to gas formation (crepitus) and a characteristic **sweet-smelling brown exudate**. *Synergistic bacteria* - While synergistic infections can occur and lead to severe tissue damage, they are not the primary or specific cause of **gas gangrene** with its distinct clinical presentation. - The classic features of gas production and a specific exudate are directly tied to the metabolic activity and toxins of **Clostridial species**. *Anaerobic bacteroides spp.* - **Bacteroides** are common anaerobic bacteria, but they are typically associated with **intra-abdominal abscesses** and **wound infections**, not the specific clinical syndrome of gas gangrene. - They do not produce the potent toxins that lead to extensive gas formation and rapid tissue necrosis characteristic of **Clostridium perfringens**. *Gas-forming Klebsiella spp.* - **Klebsiella spp.** are gram-negative, facultative anaerobic bacteria that can produce gas, especially in deep-seated infections like **emphysematous pyelonephritis** or **liver abscesses**. - However, they do not cause **gas gangrene** with its rapid tissue destruction, crepitus, and sweet-smelling brown exudate, which is pathognomonic for **Clostridial infection**.

Q: The daily requirement of iron during second half of pregnancy is :

6 mg per day. ***6 mg per day*** - This represents the **additional absorbed elemental iron** required during the second half of pregnancy (beyond the non-pregnant requirement of ~1-2 mg/day). - The increased demand is due to **fetal growth** (300-400 mg total), **placental development** (50-75 mg), **expansion of maternal red cell mass** (450 mg), and **blood loss at delivery** (150-250 mg). - **Important distinction**: This is the *absorbed* requirement. Since iron absorption from the gut is only 10-20%, the actual **oral supplementation** recommended is much higher: **100-200 mg of elemental iron daily** (as per WHO/ICMR guidelines). - In India, the standard National Iron+ Initiative provides **100 mg elemental iron + 500 mcg folic acid** daily during pregnancy. *2 mg per day* - This represents approximately the **basal iron requirement** for non-pregnant women, which is insufficient for pregnancy. - Would lead to **severe maternal iron-deficiency anemia** and poor fetal outcomes. *20 mg per day* - While higher than baseline, this is still insufficient as absorbed iron requirement. - However, this could represent a fraction of the therapeutic supplementation dose. *10 mg per day* - This exceeds the absorbed requirement but is far below the recommended **oral supplementation dose** of 100-200 mg. - Reflects neither the absorbed requirement nor the standard supplementation protocol. **Clinical Pearl**: When discussing iron in pregnancy, always clarify whether referring to *absorbed* iron (5-6 mg/day additional) or *supplemental* oral iron (100-200 mg/day).

Q: Masaoka staging is used for staging:

Thymoma. ***Thymoma*** - The **Masaoka staging system** is specifically designed for evaluating the extent of **thymomas**, a type of tumor originating from the thymus gland [1]. - This system assesses tumor invasion into surrounding structures, such as the mediastinal fat, pleura, pericardium, and great vessels, which is critical for determining prognosis and treatment [1],[2]. *Germ cell tumours* - **Germ cell tumors** are typically staged using systems specific to their primary site (e.g., testicular, ovarian, mediastinal) that often involve imaging, tumor markers (e.g., AFP, beta-hCG), and histopathological findings. - While germ cell tumors can occur in the mediastinum, the Masaoka system is not their primary staging method. *Neurogenic tumours* - **Neurogenic tumors** encompass a broad range of tumors arising from nervous tissue (e.g., neuroblastoma, schwannoma, ganglioneuroma) and are staged using various systems depending on the specific tumor type and location (e.g., INPC staging for neuroblastoma). - The Masaoka system is not applicable to these tumors. *Lymphoma* - **Lymphomas** are staged using the **Ann Arbor classification system** (or modified Lugano classification), which primarily considers the number and location of involved lymph node regions, as well as extranodal involvement. - This system is distinct from the Masaoka staging system, which is anatomically focused on the thymus and its surrounding structures. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 634-635. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 572-574.

Q: Ischemia-Reperfusion syndrome is characterized by:

Hypoxia and activation of inflammation. **Hypoxia and activation of inflammation** - **Ischemia-reperfusion injury** occurs when blood flow is restored to tissues previously deprived of oxygen, leading to further damage due to the rapid influx of oxygen and inflammatory mediators. - The initial **hypoxia** during ischemia triggers cellular changes, and subsequent reperfusion activates a robust **inflammatory response**, including the recruitment of neutrophils and the release of reactive oxygen species [1]. *Thrombo embolic angiopathy* - While thrombus formation can be a cause of ischemia, **thromboembolic angiopathy** itself is not the primary characteristic of the ischemia-reperfusion syndrome. - The syndrome's defining feature is the injury that occurs *after* the initial ischemic event, upon restoration of blood flow. *Build up of bicarbonate and Na+ ions* - Ischemia typically leads to a buildup of **lactic acid** and a decrease in pH (acidosis), not bicarbonate. - While electrolyte imbalances can occur, a specific buildup of bicarbonate and Na+ ions is not a hallmark characteristic of ischemia-reperfusion injury. *Acute mesenteric thrombosis* - **Acute mesenteric thrombosis** is a *cause* of mesenteric ischemia, not a general characteristic of the ischemia-reperfusion syndrome itself. - The syndrome describes the cellular and tissue injury that results from the initial ischemia and subsequent reperfusion, regardless of the underlying cause of ischemia. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 786-787.

Q: Which one of the following drugs is a long acting local anaesthetic agent ?

Bupivacaine. ***Bupivacaine***- **Bupivacaine** is the **classic and most widely recognized long-acting amide local anesthetic** with a duration of action typically ranging from **2 to 8 hours** depending on the concentration and site of administration. [1]- Its prolonged action is due to its high **lipid solubility** and **protein binding** (95%), allowing it to penetrate nerves effectively and stay bound within tissues for extended periods. [1]- It is the **prototypical long-acting local anesthetic** and has been the gold standard for decades in regional anesthesia and pain management. [1]*Lignocaine*- **Lignocaine** (also known as **lidocaine**) is an **intermediate-acting amide local anesthetic**, with a duration of action of **1-2 hours** (much shorter than bupivacaine). [1]- It is frequently used for **infiltration anesthesia**, **nerve blocks**, and **topical anesthesia** but is **not considered long-acting**. *Prilocaine*- **Prilocaine** is an **intermediate-acting amide local anesthetic**, similar to lignocaine, with a duration of action of approximately **1-2 hours**. [1]- A notable side effect of prilocaine, especially at high doses, is the potential for **methemoglobinemia** due to its metabolite o-toluidine. [1]*Ropivacaine*- **Ropivacaine** is a **newer long-acting amide local anesthetic** (duration 2-6 hours) introduced in the 1990s as an alternative to bupivacaine. [1]- While it has a **similar duration of action**, it is distinguished by its **lower cardiotoxicity** and **greater motor-sensory separation** compared to bupivacaine. [1]- However, **bupivacaine remains the classic textbook example** of a long-acting local anesthetic and is the expected answer in most examination contexts. [1]- Ropivacaine is often preferred in obstetric and pediatric anesthesia due to its better safety profile.

Q: Which of the following are correct regarding Blood substitutes ? 1. They are biomimetic. 2. They are extensively used in war injuries. 3. They are made of perfluorocarbon emulsions. 4. They are haemoglobin-based. Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - **Blood substitutes are biomimetic** - they are artificially engineered to mimic the oxygen-carrying capacity of natural red blood cells. - Blood substitutes fall into **two main categories**: perfluorocarbon (PFC) emulsions and hemoglobin-based oxygen carriers (HBOCs). Statement 3 and 4 correctly identify these two major types. - **PFC emulsions** can dissolve large amounts of oxygen and carbon dioxide, transporting gases to tissues through physical dissolution. - **Hemoglobin-based oxygen carriers** use modified hemoglobin (human, bovine, or recombinant) to bind and transport oxygen similar to natural red blood cells. *1, 2 and 3* - While statements 1 and 3 are correct, **statement 2 is incorrect**. - Blood substitutes are **NOT extensively used in war injuries** - most remain experimental or have very limited clinical approval. - Despite theoretical advantages (extended shelf life, no cross-matching needed), practical deployment has been minimal due to safety concerns and regulatory limitations. *2, 3 and 4* - This option incorrectly includes statement 2 about extensive use in war injuries, which is **factually inaccurate**. - Most blood substitutes have failed to gain widespread approval due to adverse effects including vasoconstriction, hypertension, and increased mortality in some trials. - It also incorrectly excludes statement 1 - the **biomimetic nature** is a fundamental defining characteristic of blood substitutes. *1 and 3 only* - While statements 1 and 3 are correct, this option is **incomplete**. - It fails to recognize that blood substitutes include **both perfluorocarbon-based AND hemoglobin-based** types - the two major categories in development. - Statement 4 about hemoglobin-based carriers is equally important and correct.

Q: Carbohydrate metabolism in normal pregnancy shows :

Fasting hypoglycaemia. ***Fasting hypoglycaemia*** - Due to the **fetus continuously drawing glucose** from the mother's circulation, the mother's glucose levels can fall between meals or during prolonged fasting. - This is exacerbated by the **increased insulin secretion** in early pregnancy and **increased peripheral glucose utilization**. *Decreased plasma glucagon levels* - Plasma **glucagon levels are generally increased** or unchanged in normal pregnancy to counteract the tendency towards hypoglycemia. - Glucagon helps **mobilize glucose from liver stores** to maintain maternal blood glucose levels. *Postprandial hypoglycaemia* - Pregnancy is typically characterized by **postprandial hyperglycemia** due to increased insulin resistance later in pregnancy and a slower insulin response. - The delayed insulin response means that glucose levels can rise higher after a meal before insulin restores them to normal. *Increased sensitivity of insulin receptors in mother* - In normal pregnancy, especially in the **second and third trimesters**, there is a physiologic **decrease in maternal insulin sensitivity**. - This **insulin resistance**, mediated by placental hormones, ensures adequate glucose supply to the fetus.

Q: A patient with head injury with a Glasgow Coma Scale of 10 is classified as :

Moderate injury. ***Moderate injury*** - A Glasgow Coma Scale (GCS) score between **9 and 12** is classified as a **moderate head injury**. - Patients in this range often present with initial loss of consciousness, post-traumatic amnesia, or neurological deficits. *Mild injury* - A **mild head injury** is characterized by a GCS score of **13-15**. - These patients typically have a brief or no loss of consciousness and may experience symptoms like headache or dizziness. *Severe injury* - A **severe head injury** is indicated by a GCS score of **3-8**. - Patients with severe head injuries are often comatose and require urgent medical intervention. *Minor injury* - "Minor injury" is not a standard medical classification for head trauma based on the GCS. - The closest GCS classification would be for **mild head injury**.

Q: Which of the following are the common complications associated with enteral nutrition in postoperative patients ? 1. Tube malposition, displacement 2. Diarrhoea, constipation 3. Predisposition to systemic sepsis 4. Electrolytic imbalance Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - **Tube malposition/displacement** is a common mechanical complication (10-15% incidence), which can lead to ineffective feeding or aspiration into the respiratory tract. - **Diarrhoea and constipation** are frequent gastrointestinal complications (10-20% incidence), occurring due to formula intolerance, rapid infusion rates, or altered gut motility in postoperative patients. - **Predisposition to systemic sepsis**: While enteral nutrition itself has lower infection risk than parenteral nutrition, complications like **aspiration pneumonia** (from tube malposition), **contaminated formula**, and **prolonged ileus** can predispose to severe infections and sepsis in postoperative patients. This is particularly relevant when enteral feeding is improperly managed. *1, 2 and 4* - This combination includes **electrolyte imbalances** (hypokalemia, hypophosphatemia, hypomagnesemia), which are indeed common metabolic complications requiring monitoring. - However, in the context of postoperative patients, the infection risk (sepsis) from aspiration and feeding-related complications is considered a more significant acute complication than electrolyte disturbances, which are generally manageable with proper monitoring and formula adjustment. *1, 3 and 4* - This option incorrectly excludes **diarrhoea and constipation**, which are among the **most common complications** of enteral nutrition, occurring in 10-20% of patients. - GI complications are a primary reason for enteral feeding intolerance and cannot be omitted. *2, 3 and 4* - This option incorrectly omits **tube malposition/displacement**, which is the most important **mechanical complication** directly related to the enteral feeding method. - Without proper tube placement verification, feeding cannot be safely administered, making this a critical complication to recognize.

Question 1

Consider the following clinical features :

1. Low back pain
2. Saddle anaesthesia
3. Motor weakness in the lower extremities
4. Variable rectal and urinary symptoms Which of the above features may be present in a patient with Cauda Equina syndrome ?

Accepted Answer

1, 2, 3 and 4

Answer

1, 2 and 3 only

Answer

1 and 2 only

Answer

3 and 4 only

Question 2

Gas Gangrene resulting in crepitus in tissues and a sweet smelling brown exudate is caused due to infection by :

Accepted Answer

Clostridium perfringens

Answer

Synergistic bacteria

Answer

Anaerobic bacteroides spp.

Answer

Gas-forming Klebsiella spp.

Question 3

The daily requirement of iron during second half of pregnancy is :

Accepted Answer

6 mg per day

Answer

2 mg per day

Answer

20 mg per day

Answer

10 mg per day

Question 4

Masaoka staging is used for staging:

Accepted Answer

Thymoma

Answer

Germ cell tumours

Answer

Neurogenic tumours

Answer

Lymphoma

Question 5

Ischemia-Reperfusion syndrome is characterized by:

Accepted Answer

Hypoxia and activation of inflammation

Answer

Thrombo embolic angiopathy

Answer

Build up of bicarbonate and Na+ ions

Answer

Acute mesenteric thrombosis

Question 6

Which one of the following drugs is a long acting local anaesthetic agent ?

Accepted Answer

Bupivacaine

Answer

Lignocaine

Answer

Prilocaine

Answer

Ropivacaine

Question 7

Which of the following are correct regarding Blood substitutes ?

1. They are biomimetic.
2. They are extensively used in war injuries.
3. They are made of perfluorocarbon emulsions.
4. They are haemoglobin-based.

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1 and 3 only

Answer

1, 2 and 3

Question 8

Carbohydrate metabolism in normal pregnancy shows :

Accepted Answer

Fasting hypoglycaemia

Answer

Decreased plasma glucagon levels

Answer

Postprandial hypoglycaemia

Answer

Increased sensitivity of insulin receptors in mother

Question 9

A patient with head injury with a Glasgow Coma Scale of 10 is classified as :

Accepted Answer

Moderate injury

Answer

Mild injury

Answer

Severe injury

Answer

Minor injury

Question 10

Which of the following are the common complications associated with enteral nutrition in postoperative patients ?

1. Tube malposition, displacement
2. Diarrhoea, constipation
3. Predisposition to systemic sepsis
4. Electrolytic imbalance

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

UPSC-CMS 2023

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pathology

Pharmacology

Physiology

Surgery