Anatomy
1 questionsThe most common site of urethral opening in cases of hypospadias is :
UPSC-CMS 2025 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 131: The most common site of urethral opening in cases of hypospadias is :
- A. On the penile shaft
- B. On the perineum
- C. Just proximal to the glans (Correct Answer)
- D. At the junction of penile shaft and scrotum
Explanation: ***Just proximal to the glans*** - The most frequent location for the urethral opening in **hypospadias** is the **subcoronal** or glanular region, which is just proximal to the glans. - This accounts for approximately 50-70% of all hypospadias cases, making it the **mildest and most common form**. *On the penile shaft* - While hypospadias can manifest with an opening on the **penile shaft** (midshaft or proximal shaft), these are less common than glanular or subcoronal types. - Penile shaft hypospadias usually indicates a more severe form compared to distal types and often presents with more significant **chordee**. *On the perineum* - An opening on the **perineum** represents the most severe form of hypospadias, often classified as **perineal hypospadias**. - This severe anomaly is associated with other urogenital defects and often presents with a **bifid scrotum** and ambiguous genitalia, which are rare compared to distal forms. *At the junction of penile shaft and scrotum* - This location, called **penoscrotal hypospadias**, is another severe form but is still less common than glanular or subcoronal types. - **Penoscrotal hypospadias** is characterized by a high degree of **chordee** and usually requires more complex surgical correction.
Internal Medicine
4 questionsWhich of the following are the symptoms commonly experienced by patients with lymphoedema? I. Swelling II. Burning sensation III. Intolerance to cold IV. Cramps Select the correct answer using the code given below :
Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?
Which of the following are considered aetiological factors for Adenocarcinoma oesophagus? I. Barrett's oesophagus II. Gastro-oesophageal reflux III. Obesity IV. Alcohol intake Select the correct answer using the code given below :
Consider the following statements regarding Plummer-Vinson syndrome : I. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia. II. It is a rare disease, mainly affecting middle-aged women. III. There is predisposition to postcricoid, cervical oesophageal cancer. IV. Treatment is usually surgical. Which of the statements given above are correct?
UPSC-CMS 2025 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 131: Which of the following are the symptoms commonly experienced by patients with lymphoedema? I. Swelling II. Burning sensation III. Intolerance to cold IV. Cramps Select the correct answer using the code given below :
- A. I, II and III
- B. II, III and IV
- C. I, III and IV
- D. I, II and IV (Correct Answer)
Explanation: ***I, II and IV*** - **Swelling**, **burning sensation**, and **cramps** are common symptoms reported by patients with lymphedema, reflecting the impaired lymphatic drainage and associated tissue changes. - **Swelling** is the hallmark symptom, often accompanied by discomfort, pain, and sensory disturbances like burning or numbness, and muscle cramps are also frequently reported. *I, II and III* - While **swelling** and a **burning sensation** are typical, **intolerance to cold** is not a characteristic symptom of lymphedema. - **Intolerance to cold** is more commonly associated with conditions like **Raynaud's phenomenon** or **hypothyroidism**, not directly with lymphatic dysfunction. *I, III and IV* - Although **swelling** and **cramps** are common, **intolerance to cold** is not a primary symptom of lymphedema. - The cardinal signs of lymphedema relate to fluid accumulation and tissue changes, not systemic temperature dysregulation. *II, III and IV* - While a **burning sensation** and **cramps** can occur, the most prominent and always present symptom of lymphedema, **swelling**, is missing from this option. - **Intolerance to cold** is not characteristic of lymphedema, making this option less accurate.
Question 132: Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?
- A. High resolution manometry (Correct Answer)
- B. Upper GI endoscopy
- C. Contrast enhanced CT scan (CECT) oesophagus
- D. Barium swallow
Explanation: ***High resolution manometry*** - **High-resolution manometry (HRM)** is considered the **gold standard** for diagnosing oesophageal motility disorders because it provides detailed, real-time pressure topography of the entire oesophagus during swallowing [1]. - It allows for precise identification and classification of conditions such as **achalasia**, diffuse oesophageal spasm, and **scleroderma oesophagus** based on objective metrics [1]. *Upper GI endoscopy* - While essential for evaluating **mucosal abnormalities** and ruling out structural causes (e.g., tumours, strictures), it does not directly assess oesophageal motility [1]. - An **endoscopy** provides visual information but cannot quantify or characterize the contractile function of the oesophageal muscle [1]. *Contrast enhanced CT scan (CECT) oesophagus* - A **CECT scan** is primarily used for evaluating **extramural compression**, mediastinal involvement, or the presence of mass lesions, not for assessing the functional contractions of the oesophagus. - It provides anatomical information but offers very limited insight into the dynamic pressure changes associated with **oesophageal peristalsis**. *Barium swallow* - A **barium swallow** can suggest motility disorders by visualizing the passage of contrast and identifying abnormalities like **tertiary contractions** or delayed emptying, but it is less precise than manometry [1]. - It provides an anatomical overview and may show gross motility disturbances, but it lacks the quantitative and detailed pressure data that **HRM** offers for definitive diagnosis [1].
Question 133: Which of the following are considered aetiological factors for Adenocarcinoma oesophagus? I. Barrett's oesophagus II. Gastro-oesophageal reflux III. Obesity IV. Alcohol intake Select the correct answer using the code given below :
- A. I, II and IV
- B. II, III and IV
- C. I, II and III (Correct Answer)
- D. I, III and IV
Explanation: ***I, II and III*** - **Barrett's oesophagus** is a known precursor to **oesophageal adenocarcinoma** due to **metaplasia** of the squamous epithelium to columnar epithelium with goblet cells, increasing the risk of dysplasia and subsequent cancer [1]. - **Gastro-oesophageal reflux disease (GERD)** is a major risk factor, as chronic reflux of gastric acid can lead to inflammation, oesophagitis, and eventually **Barrett's oesophagus** [1]. - **Obesity** is strongly associated with an increased risk of **oesophageal adenocarcinoma**, primarily through its links to **GERD** and increased intra-abdominal pressure [1]. *I, II and IV* - This option correctly identifies **Barrett's oesophagus** and **gastro-oesophageal reflux** as risk factors. - However, **alcohol intake** is not as strongly linked to **oesophageal adenocarcinoma** as it is to squamous cell carcinoma of the oesophagus [1]. *II, III and IV* - This option correctly identifies **gastro-oesophageal reflux** and **obesity** as risk factors. - However, it incorrectly includes **alcohol intake** as a primary risk factor for **adenocarcinoma**, and incorrectly omits **Barrett's oesophagus**, which is a direct precursor. *I, III and IV* - This option correctly identifies **Barrett's oesophagus** and **obesity** as risk factors. - However, it incorrectly includes **alcohol intake** and omits **gastro-oesophageal reflux**, which is a fundamental link between obesity, Barrett's, and adenocarcinoma.
Question 134: Consider the following statements regarding Plummer-Vinson syndrome : I. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia. II. It is a rare disease, mainly affecting middle-aged women. III. There is predisposition to postcricoid, cervical oesophageal cancer. IV. Treatment is usually surgical. Which of the statements given above are correct?
- A. I, II and III (Correct Answer)
- B. I, II and IV
- C. II, III and IV
- D. I, III and IV
Explanation: **I, II and III** - **Plummer-Vinson syndrome** is characterized by the triad of **dysphagia**, **iron deficiency anemia**, and an **esophageal web**, typically in the **cervical esophagus**. - It predominantly affects **middle-aged women** and is associated with an increased risk of **postcricoid esophageal cancer**. *I, II and IV* - While statements I and II are correct, statement IV is incorrect because the primary treatment for Plummer-Vinson syndrome is usually medical management of **iron deficiency** and endoscopic dilation of the web, not surgery. - Surgical intervention is generally reserved for complications or malignancy. *II, III and IV* - While statements II and III are correct, statement IV is incorrect as surgery is not the usual first-line treatment for Plummer-Vinson syndrome. - Statement I, which describes the characteristic findings of the syndrome, is also correct and is excluded from this option. *I, III and IV* - While statements I and III are correct, statement IV regarding surgical treatment is incorrect. - The syndrome is indeed rare and mainly affects middle-aged women, making statement II correct, which is excluded from this option.
Pathology
1 questionsWhich of the following are the malignancies associated with lymphoedema? I. Kaposi Sarcoma II. Squamous cell carcinoma III. Malignant melanoma IV. Leukaemia Select the correct answer using the code given below :
UPSC-CMS 2025 - Pathology UPSC-CMS Practice Questions and MCQs
Question 131: Which of the following are the malignancies associated with lymphoedema? I. Kaposi Sarcoma II. Squamous cell carcinoma III. Malignant melanoma IV. Leukaemia Select the correct answer using the code given below :
- A. I, II and IV (Correct Answer)
- B. II, III and IV
- C. I, III and IV
- D. I, II and III
Explanation: ***I, II and IV*** - **Kaposi sarcoma** is a well-documented malignancy that can develop in chronically lymphoedematous limbs, particularly in classic and endemic forms. - **Squamous cell carcinoma** can arise as a complication of chronic lymphoedema, developing in areas of long-standing skin changes and inflammation [1]. - **Leukaemia** is included here as it can cause lymphadenopathy and secondary lymphoedema, representing a bidirectional relationship where leukemic infiltration leads to lymphatic obstruction. - **Note:** The most classic malignancy associated with chronic lymphoedema is **angiosarcoma (Stewart-Treves syndrome)**, though it is not listed among the options. *II, III and IV* - While this includes **squamous cell carcinoma** (correct) [1], it incorrectly includes **malignant melanoma**. - **Malignant melanoma** has no established association with lymphoedema as a predisposing condition, though melanoma can cause lymphoedema through nodal metastases [2]. *I, III and IV* - This incorrectly includes **malignant melanoma** and omits **squamous cell carcinoma**. - **Squamous cell carcinoma** is a more clearly established malignancy that can arise in chronic lymphoedema [1]. *I, II and III* - This correctly includes **Kaposi sarcoma** and **squamous cell carcinoma** but incorrectly includes **malignant melanoma**. - **Malignant melanoma** does not have a recognized causal relationship with pre-existing lymphoedema. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 643-644. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 234-235.
Pharmacology
1 questionsThe maximum safe dose for Lignocaine (without adrenaline) as a local anaesthetic drug is :
UPSC-CMS 2025 - Pharmacology UPSC-CMS Practice Questions and MCQs
Question 131: The maximum safe dose for Lignocaine (without adrenaline) as a local anaesthetic drug is :
- A. 7 mg/kg
- B. 5 mg/kg
- C. 9 mg/kg
- D. 3 mg/kg (Correct Answer)
Explanation: ***3 mg/kg*** - The maximum safe dose for **plain lignocaine** (without adrenaline) is **3 mg/kg**. - Exceeding this limit increases the risk of **systemic toxicity**, particularly central nervous system and cardiovascular effects. *7 mg/kg* - This dosage refers to the maximum safe dose of **lignocaine when combined with adrenaline**. - **Adrenaline causes vasoconstriction**, which delays systemic absorption of lignocaine, allowing for a higher total dose. *5 mg/kg* - This is also within the range of the maximum safe dose for **lignocaine with adrenaline**, though it is sometimes quoted as the upper limit for **plain lignocaine** by some references. - However, for plain lignocaine, **3 mg/kg is the more widely accepted and safer standard**. *9 mg/kg* - This dose is **significantly higher** than the recommended maximum for both plain and adrenaline-containing lignocaine. - Administering 9 mg/kg would carry a **very high risk of severe systemic toxicity**, including convulsions and cardiac arrest.
Surgery
3 questionsWhich of the following about Minimal Access Surgery are correct? I. Decreased intraoperative heat loss II. Improved visualization III. Increased chances of herniation IV. Improved mobility Select the answer using the code given below :
Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound? I. Limberg procedure II. Y-V plasty III. Z-plasty IV. Karydakis procedure Select the correct answer using the code given below :
A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3 x 4 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is :
UPSC-CMS 2025 - Surgery UPSC-CMS Practice Questions and MCQs
Question 131: Which of the following about Minimal Access Surgery are correct? I. Decreased intraoperative heat loss II. Improved visualization III. Increased chances of herniation IV. Improved mobility Select the answer using the code given below :
- A. I, III and IV
- B. I, II and III
- C. I, II and IV (Correct Answer)
- D. II, III and IV
Explanation: ***I, II and IV (Correct Answer)*** **Statement I - Decreased intraoperative heat loss:** Correct. MAS involves smaller incisions with reduced exposure of internal organs to the operating room environment, resulting in significantly less heat loss compared to open surgery. **Statement II - Improved visualization:** Correct. Endoscopic cameras provide magnified, high-definition, and well-illuminated views of the surgical field, offering superior visualization compared to the naked eye in open procedures. **Statement IV - Improved mobility:** Correct. Patients experience faster post-operative recovery with less pain and earlier return to normal activities due to minimal tissue trauma from smaller incisions. **Statement III - Increased chances of herniation:** This statement is **INCORRECT** and is the key reason why options containing it are wrong. MAS typically results in *decreased* risk of incisional hernias due to smaller access points. While trocar-site hernias can occur, they are less common than the large incisional hernias seen in open surgery when proper fascial closure techniques are employed. *I, III and IV* - Incorrect because Statement III (increased herniation) is false. MAS reduces, not increases, herniation risk. *I, II and III* - Incorrect because Statement III (increased herniation) is false. Properly performed MAS has lower incisional hernia rates than open surgery. *II, III and IV* - Incorrect because Statement III (increased herniation) is false. Smaller incisions in MAS lead to reduced hernia formation compared to traditional open approaches.
Question 132: Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound? I. Limberg procedure II. Y-V plasty III. Z-plasty IV. Karydakis procedure Select the correct answer using the code given below :
- A. II, III and IV
- B. I, III and IV
- C. I, II and III
- D. I, II and IV (Correct Answer)
Explanation: ***I, II and IV*** - The **Limberg procedure** (rhomboid flap) and **Karydakis flap** are the most widely established plastic surgical techniques used to close the defect after pilonidal sinus excision. - These techniques aim to **flatten the natal cleft** and move the scar away from the midline, reducing tension and recurrence rates. - **Y-V plasty** is less commonly used specifically for pilonidal sinus compared to Limberg and Karydakis procedures, though it can be employed for tissue advancement in selected cases. - This combination excludes Z-plasty, which is not a primary technique for pilonidal sinus closure. *II, III and IV* - While **Karydakis procedure** is indeed a standard technique, this option incorrectly includes **Z-plasty**, which is generally used for **scar revision** or releasing contractures rather than primary closure of large excisional defects. - It also excludes the **Limberg flap**, which is one of the most commonly used techniques worldwide for pilonidal sinus surgery. *I, III and IV* - This option incorrectly includes **Z-plasty** while excluding **Y-V plasty**. - Z-plasty is not a primary technique for closing pilonidal sinus defects as it doesn't provide adequate tissue coverage for large excisions. - The **Limberg and Karydakis procedures** are the mainstay techniques from this list. *I, II and III* - This combination incorrectly includes **Z-plasty** as a primary technique for closing the excisional defect. - It omits the **Karydakis procedure**, which is one of the most widely recognized and effective flaps for pilonidal disease with excellent outcomes. - The Karydakis flap specifically focuses on **modifying the natal cleft contour** and displacing the incision laterally for better healing and lower recurrence rates.
Question 133: A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3 x 4 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is :
- A. cT₃ N₁ Mₓ
- B. cT₂ N₁ Mₓ (Correct Answer)
- C. cT₁ N₁ Mₓ
- D. cT₃ N₂ Mₓ
Explanation: **cT₂ N₁ Mₓ** - The tumor size of **3 x 4 cm** falls within the T2 classification (>2 cm but ≤5 cm). The description of the lump being "not fixed to the skin or the underlying structures" further supports a T2 (or lower) classification, as fixation would suggest a more advanced T stage (T4). - The presence of "firm mobile lymph nodes (level I)" indicates involvement of regional lymph nodes, which is classified as **N1** in breast cancer staging. An "Mx" designation means that distant metastasis cannot be assessed clinically without further investigation. *cT₃ N₁ Mₓ* - A **T3 classification** would apply if the tumor measured **greater than 5 cm** in its largest dimension, which is not the case here, as the lump is 3 x 4 cm. - While the **N1 and Mx** components are consistent with the findings, the T component is incorrect for the given tumor size. *cT₁ N₁ Mₓ* - A **T1 classification** is used for tumors that are **2 cm or less in greatest dimension**. The given tumor size of 3 x 4 cm clearly exceeds this limit. - The **N1 and Mx** components are consistent, but the T component is inappropriate for the described tumor size. *cT₃ N₂ Mₓ* - This option is incorrect on two counts: the **T3 classification** is wrong for a 3 x 4 cm tumor (should be >5 cm), and the **N2 classification** is also incorrect. - **N2** would indicate metastases to **ipsilateral axillary lymph nodes that are fixed or matted**, or in ipsilateral internal mammary lymph nodes in the absence of clinically apparent axillary lymph node metastases. The description states "firm mobile lymph nodes (level I)," which corresponds to N1, not N2.