UPSC-CMS 2025 Practice Questions

Q: Which of the following are criteria for cancer screening? I. Screening test should be sensitive and specific II. Screening test should be acceptable to the screened population III. The disease should be an uncommon one for screening to be effective IV. Disease should be recognisable at an early stage Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - A successful **screening test** should be **sensitive** (correctly identify those with the disease) and **specific** (correctly identify those without the disease) to minimize false negatives and false positives. - For a screening program to be effective, the test must be **acceptable** to the target population to ensure high participation rates. The disease should also be **recognizable at an early stage** to allow for timely and effective intervention. *II, III and IV* - This option is partially correct as it includes acceptability and early recognition, but incorrectly states that the disease should be uncommon. In reality, screening is often more impactful for diseases with a higher prevalence. - The claim that the disease should be uncommon is incorrect; screening programs are often prioritized for relatively common diseases where early detection can significantly alter outcomes. *I, III and IV* - This option correctly identifies the need for a sensitive and specific test, and early disease recognition, but it incorrectly asserts that the disease should be an uncommon one. - Screening is generally most beneficial for diseases with a significant prevalence, allowing for a substantial impact on public health. *I, II and III* - This option accurately points to the necessity of a sensitive and specific test and its acceptability to the screened population, but it mistakenly suggests that the disease should be uncommon. - Effective screening targets diseases where early detection can lead to improved outcomes, which are often diseases with a notable burden in the population.

Q: Vibration white finger refers to :

Raynaud's syndrome. ***Raynaud's syndrome*** - **Vibration White Finger** is a form of secondary Raynaud's phenomenon, specifically caused by occupational exposure to high levels of **vibration**. [2] - It is characterized by **vasoconstriction** of the digital arteries, leading to episodic **finger blanching**, numbness, and tingling, often triggered by cold or stress. [2] *Acrocyanosis* - This condition involves persistent, painless **cyanosis** of the hands and feet, particularly in cold weather. - Unlike Raynaud's, acrocyanosis does not typically involve a triphasic color change (white, blue, red) and is generally **benign**. *Buerger's disease* - Also known as **thromboangiitis obliterans**, this is an inflammatory disease of small and medium-sized arteries and veins, mainly affecting the **limbs**. - It is strongly associated with **tobacco use** and can lead to gangrene and amputation, but its primary presentation is not vibration-induced. *Takayasu disease* - This is a form of **large-vessel vasculitis** primarily affecting the aorta and its major branches. [1] - It can lead to absent pulses, discrepancies in blood pressure between limbs, and systemic symptoms, but it is not directly related to vibration-induced digital vasoconstriction.

Q: A 45 -year-old lady presents with complaints of fatigue, muscle weakness along with bilateral multiple renal calculi which were picked up on a routine ultrasound. Further workup revealed serum calcium levels of 11.4 mg %. What is the next best investigation required to arrive at a diagnosis?

Sestamibi scan. ***Sestamibi scan*** - A **Sestamibi scan** is the preferred imaging modality for localizing a parathyroid adenoma [1], which is the most common cause of **primary hyperparathyroidism**. - **Primary hyperparathyroidism** often presents with **hypercalcemia** (serum calcium 11.4 mg%), **renal calculi** [1], fatigue, and muscle weakness, as described in the patient. *MRI neck* - While an MRI can visualize neck structures, it is **less specific** for identifying small parathyroid adenomas compared to a Sestamibi scan. - It might be used in cases where other imaging modalities are inconclusive but is not the initial best investigation. *CECT head and neck* - **CECT (Contrast-Enhanced Computed Tomography)** is not the primary choiceto locate parathyroid adenomas as it involves radiation and intravenous contrast, which may not be necessary. - Parathyroid adenomas can be small and difficult to differentiate from thyroid tissue or lymph nodes on CECT alone. *NCCT head and neck* - **NCCT (Non-Contrast Computed Tomography)** is even less effective than CECT for localizing parathyroid adenomas as it lacks the discriminatory power of contrast enhancement. - It would mainly show bony structures and calcifications, which are not helpful for identifying a glandular adenoma.

Q: Which of the following statements are correct regarding a brain abscess? I. Abscesses arise when the brain is exposed directly as a result of fracture or infection of air sinus. II. Presenting features include low grade fever, confusion, seizures and focal deficits. III. MRI with contrast is the initial imaging modality of choice. IV. The aetological agents include bacteria, fungi, protozoa and viruses. Select the answer using the code given below :

I, II and III. I, II and III - This option correctly identifies that brain abscesses can result from direct exposure due to fractures or sinus infections [1], present with symptoms like fever, confusion, seizures, and focal deficits, and are best initially imaged with MRI with contrast. - While bacteria, fungi, and protozoa are common causes of brain abscesses, viruses are generally not a primary cause of brain abscess formation [1], making statement IV incorrect in its broad inclusion of viruses. I, III and IV - This option incorrectly includes statement IV, which claims viruses are etiological agents for brain abscesses. While viruses cause CNS infections, they typically lead to meningitis or encephalitis [1], not abscesses. - It also omits statement II, which accurately describes the common clinical presentation of brain abscesses, including symptoms like confusion and focal deficits. I, II and IV - This option incorrectly includes statement IV, which states that viruses are common etiologic agents for brain abscesses. Brain abscesses are primarily caused by bacteria, fungi, and parasites [1]. - It omits statement III, which correctly identifies MRI with contrast as the initial imaging modality of choice, crucial for diagnosis due to its superior soft tissue resolution. II, III and IV - This option incorrectly includes statement IV, which suggests viruses are among the etiologic agents. Viral infections of the brain typically manifest as encephalitis or meningitis [1], not abscesses. - It omits statement I, which correctly describes common routes of infection, including direct extension from adjacent structures like infected sinuses or trauma [1].

Q: A 60 -year-old female presents with pain in her back of recent onset, which has become severe of late. During the course of investigations, she was found to have lytic lesions in the vertebrae and ribs. Which of the following organs should be carefully screened now for detecting the primary cause of these lesions?

Breast. **Breast** - **Breast cancer** is a common primary malignancy in women that frequently metastasizes to bone, causing **lytic lesions** in the vertebrae and ribs [4]. - The patient's age (60-year-old female) and the presence of severe, recent-onset back pain with multiple lytic lesions strongly suggest metastatic disease [2], with **breast cancer** being a top differential [4]. *Large intestine* - While **colorectal cancer** can metastasize to bone, it typically causes mixed lytic and blastic lesions or predominantly blastic lesions, rather than purely lytic lesions. - Furthermore, the frequency of bone metastases from colorectal cancer is generally lower compared to breast or lung primary tumors [1]. *Adrenal* - Primary **adrenal tumors** (e.g., adrenal cortical carcinoma, pheochromocytoma) rarely metastasize to bone and are not a common cause of diffuse lytic bone lesions. - Bone metastases from adrenal cancers are much less frequent and typically associated with advanced, aggressive disease [3]. *Small intestine* - **Small bowel malignancies** (e.g., adenocarcinomas, neuroendocrine tumors) rarely metastasize to bone. - When they do, the pattern of bone involvement is variable but less commonly presents as widespread lytic lesions in the spine and ribs without other systemic symptoms.

Q: Which of the following statements are correct regarding Cauda equine syndrome? I. Its presenting symptoms are perineal numbness, painless urinary retention and fecal incontinence. II. Urgent investigation with MRI is required. III. It is present most commonly in the 45-60 year age group. IV. Confirmed cases require early surgical decompression. Select the answer using the code given below :

I, II and IV. ***I, II and IV*** - Perineal numbness leading to **saddle anesthesia**, painless urinary retention, and fecal incontinence are classic red-flag symptoms of **cauda equina syndrome (CES)** indicating compression of the nerve roots [1]. - Early diagnosis via **urgent MRI** and prompt surgical decompression are critical to prevent permanent neurological deficits due to irreversible nerve damage [2]. *I, II and III* - While statements I and II are correct, statement III is inaccurate as CES can affect adults of any age due to various causes like **herniated discs** [1] or trauma [2]. - **Urgent intervention** is prioritized over age group considerations in managing this condition [2]. *I, III and IV* - Although statements I and IV are correct, statement III incorrectly restricts CES to a specific age group, as it can occur across a **broad age spectrum**. - The primary focus in CES is on symptom recognition and **rapid surgical intervention** [2]. *II, III and IV* - While statements II and IV are correct, statement III is factually incorrect regarding the typical age of presentation for Cauda Equina Syndrome. - **Accurate identification of symptoms** (statement I) is crucial for triggering the necessary urgent investigations and treatment [1].

Q: Which of the following are the aetiological factors associated with a communicating hydrocephalus ? I. Post haemorrhagic II. Lesions within the ventricle III. CSF infection IV. Raised CSF protein Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - **Communicating hydrocephalus** occurs when there is impaired CSF absorption in the **subarachnoid space** despite a patent ventricular system. - **Post-hemorrhagic**, **CSF infection** (meningitis), and **raised CSF protein** (e.g., from tumors or inflammation) can all obstruct the arachnoid villi, preventing proper CSF reabsorption [1]. *I, II and III* - While **post-hemorrhagic** and **CSF infection** are causes of communicating hydrocephalus, **lesions within the ventricle** typically cause **non-communicating (obstructive) hydrocephalus** by blocking CSF flow *within* the ventricular system itself [1]. - This option incorrectly includes an obstructive cause and omits **raised CSF protein**, which is a known cause of impaired CSF absorption. *II, III and IV* - This option incorrectly includes **lesions within the ventricle** as a cause of communicating hydrocephalus, which usually leads to **non-communicating hydrocephalus** [1]. - It correctly identifies **CSF infection** and **raised CSF protein** but omits **post-hemorrhagic** causes, which are a common etiology [1]. *I, II and IV* - This option incorrectly includes **lesions within the ventricle**, which typically cause **non-communicating hydrocephalus** [1]. - While **post-hemorrhagic** and **raised CSF protein** are valid causes, the inclusion of an obstructive cause makes this option incorrect for *communicating* hydrocephalus. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 703-704.

Q: What is the most common type of tumour of Vermiform Appendix?

Carcinoid tumour. ***Carcinoid tumour*** - **Carcinoid tumors** (neuroendocrine tumors) are the **most common primary neoplasms of the appendix**, accounting for approximately 30-50% of all appendiceal tumors. [1] - They typically originate from the **enterochromaffin cells** in the appendiceal mucosa and are often discovered incidentally during appendectomy for suspected appendicitis. - Most appendiceal carcinoids are **small (<2 cm), benign, and located at the tip** of the appendix. [1] *Adenocarcinoma* - **Adenocarcinomas** are the second most common primary tumor of the appendix, representing about 10-20% of cases. - These **epithelial malignancies** include mucinous and non-mucinous subtypes and can present with symptoms mimicking acute appendicitis. - Mucinous adenocarcinomas may lead to **pseudomyxoma peritonei** if they rupture. *Germ cell tumour* - **Germ cell tumors** are exceptionally rare in the appendix and more commonly arise from the gonads (testes, ovaries) or midline structures. - These tumors originate from **pluripotent germ cells** and are not a significant consideration for appendiceal neoplasms. *Papillary cell tumour* - This term describes a **morphological growth pattern** (papillary architecture) rather than a specific primary tumor classification. - While some epithelial tumors may exhibit papillary features, this is **not a recognized primary tumor type** of the appendix. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 375-376.

Q: The earliest specific cystoscopic appearance of Bilharzial cystitis is :

Sandy patches. ***Sandy patches*** - **Sandy patches** are the **earliest and most characteristic** specific cystoscopic finding in Bilharzial cystitis (urinary schistosomiasis). [1] - They appear as fine, yellow-golden granules resembling grains of sand, visible through the bladder mucosa, representing **calcified *Schistosoma haematobium* eggs** deposited in the submucosa. - This pathognomonic finding typically appears in the trigone and posterior bladder wall and is the hallmark early sign during cystoscopy. *Pseudo tubercles* - **Pseudo tubercles (bilharzial tubercles)** represent a **later stage** of the disease, occurring after sandy patches. - They are organized granulomatous reactions (granulomas) that form around egg deposits within the bladder wall, appearing as small, whitish-yellow elevated lesions. [1] - While specific for schistosomiasis, they develop after the initial egg deposition phase marked by sandy patches. *Nodules* - **Nodules** represent more advanced inflammatory changes or can be associated with chronic schistosomiasis and potential neoplastic transformation. - They are non-specific and can occur in various bladder pathologies, not characteristic of early disease. *Ulcers* - **Ulcers** develop in advanced stages of Bilharzial cystitis due to chronic inflammation, tissue necrosis, or secondary bacterial infection. - They indicate significant mucosal damage and are not early manifestations of the disease. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 405-406.

Question 1

Which one of the following best describes craniosynostosis?

Accepted Answer

It is the premature fusion of one or more cranial sutures, preventing growth perpendicular to the suture.

Answer

It is the premature fusion of one or more cranial sutures, facilitating growth perpendicular to the suture.

Answer

It is delayed fusion of one or more cranial sutures facilitating growth perpendicular to the suture.

Answer

It is delayed fusion of one or more cranial sutures preventing growth perpendicular to the suture.

Question 2

Which of the following are criteria for cancer screening?
I. Screening test should be sensitive and specific
II. Screening test should be acceptable to the screened population
III. The disease should be an uncommon one for screening to be effective
IV. Disease should be recognisable at an early stage
Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 3

Vibration white finger refers to :

Accepted Answer

Raynaud's syndrome

Answer

Acrocyanosis

Answer

Buerger's disease

Answer

Takayasu disease

Question 4

A 45 -year-old lady presents with complaints of fatigue, muscle weakness along with bilateral multiple renal calculi which were picked up on a routine ultrasound. Further workup revealed serum calcium levels of 11.4 mg %. What is the next best investigation required to arrive at a diagnosis?

Accepted Answer

Sestamibi scan

Answer

MRI neck

Answer

CECT head and neck

Answer

NCCT head and neck

Question 5

Which of the following statements are correct regarding a brain abscess?
I. Abscesses arise when the brain is exposed directly as a result of fracture or infection of air sinus.
II. Presenting features include low grade fever, confusion, seizures and focal deficits.
III. MRI with contrast is the initial imaging modality of choice.
IV. The aetological agents include bacteria, fungi, protozoa and viruses.

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

I, III and IV

Answer

I, II and IV

Answer

II, III and IV

Question 6

A 60 -year-old female presents with pain in her back of recent onset, which has become severe of late. During the course of investigations, she was found to have lytic lesions in the vertebrae and ribs. Which of the following organs should be carefully screened now for detecting the primary cause of these lesions?

Accepted Answer

Breast

Answer

Large intestine

Answer

Adrenal

Answer

Small intestine

Question 7

Which of the following statements are correct regarding Cauda equine syndrome?
I. Its presenting symptoms are perineal numbness, painless urinary retention and fecal incontinence.
II. Urgent investigation with MRI is required.
III. It is present most commonly in the 45-60 year age group.
IV. Confirmed cases require early surgical decompression.

Select the answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, II and III

Answer

I, III and IV

Answer

II, III and IV

Question 8

Which of the following are the aetiological factors associated with a communicating hydrocephalus ?
I. Post haemorrhagic
II. Lesions within the ventricle
III. CSF infection
IV. Raised CSF protein

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

I, II and III

Answer

II, III and IV

Answer

I, II and IV

Question 9

What is the most common type of tumour of Vermiform Appendix?

Accepted Answer

Carcinoid tumour

Answer

Germ cell tumour

Answer

Adenocarcinoma

Answer

Papillary cell tumour

Question 10

The earliest specific cystoscopic appearance of Bilharzial cystitis is :

Accepted Answer

Sandy patches

Answer

Pseudo tubercles

Answer

Nodules

Answer

Ulcers

UPSC-CMS 2025

Anatomy

Community Medicine

Internal Medicine

Pathology