UPSC-CMS 2025 Practice Questions

Q: Contralateral Homonymous upper quadrantanopia is the type of visual loss seen when the lesion is located at which one of the following anatomical locations?

Temporal lobe. ***Temporal lobe*** - Lesions in the **temporal lobe** disrupt the **Meyer's loop**, which carries contralateral inferior retinal (superior visual field) fibers. - This specific disruption leads to a **contralateral homonymous upper quadrantanopia**, affecting the upper visual field on the side opposite the lesion [1]. *Parietal lobe* - Lesions in the **parietal lobe** typically cause a **contralateral homonymous inferior quadrantanopia**. - This is because the parietal optic radiations carry fibers from the contralateral superior retina (inferior visual field) [1]. *Frontal lobe* - The **frontal lobe** is primarily involved in **eye movements** and **saccades**, not direct processing of visual fields. - Lesions here might cause gaze preferences or motor deficits, but generally not specific quadrantanopias. *Occipital lobe* - Lesions in the **occipital lobe**, especially the visual cortex, result in **contralateral homonymous hemianopia** with **macular sparing** [1]. - A quadrantanopia from an occipital lesion would typically be inferior, and a complete hemianopia is more common.

Q: Which of the following are clinical features of migraine? I. It is associated with dilatation of extracranial vessels II. Common migraine is seen without Aura III. Aura is most often visual Select the correct answer using the code given below :

II and III only. ***II and III only*** - **Common migraine** (migraine without aura) is the most prevalent form of migraine, characterized by recurrent headaches lacking a preceding aura [1]. - An **aura** preceding a migraine attack is most frequently visual, presenting as flashing lights, zigzag lines, or blind spots due to transient cortical dysfunction [1], [2]. *I, II and III* - **Dilatation of extracranial vessels** is largely a secondary phenomenon, occurring after the initial vasoconstriction associated with migraine and does not fully explain migraine pathophysiology [1]. - While migraine involves vascular changes, the primary mechanism is complex and involves **neural activation** and release of inflammatory neuropeptides, not just simple vessel dilatation [1]. *I and II only* - The claim regarding **dilatation of extracranial vessels** as a primary feature is not universally accepted or sufficient to explain migraine [1]. - This option incorrectly includes an imprecise pathophysiological description and omits the accurate statement about the commonality of **visual aura**. *I and III only* - Similar to the above, the role of **extracranial vessel dilatation** as a core clinical feature is oversimplified and not a primary pathogenic event [1]. - This option correctly identifies visual aura but misrepresents the vascular component and omits the fact that **common migraine** is without aura [1].

Q: A 50 year old man presents with brief episodes of lancinating unilateral facial pain, involving the buccal distribution. Pain is triggered by washing face with cold water. What is the most likely diagnosis?

Trigeminal neuralgia. ***Trigeminal neuralgia*** - This condition presents with **brief, lancinating, unilateral facial pain** affecting one or more branches of the trigeminal nerve. - Pain is often **triggered by tactile stimuli** like washing the face, touching the face, or cold water, consistent with the patient's presentation. *Chronic paroxysmal hemicrania* - This type of headache is characterized by **frequent, short-lived attacks of severe, unilateral head pain**, often accompanied by autonomic symptoms (e.g., lacrimation, rhinorrhea). - It is crucial to note that these headaches are **responsive to indomethacin**, and while unilateral, they typically involve periorbital or temporal regions and not specifically the trigeminal distribution or tactile triggers in the same way. *Migraine* - Migraines are typically characterized by **pulsating, moderate to severe head pain**, often unilateral, lasting from hours to days [1]. - They are usually associated with **nausea, vomiting**, and sensitivity to light (photophobia) and sound (phonophobia), which are absent in this patient's presentation [2]. *Medication overuse headache* - This headache is a **chronic daily or near-daily headache** that develops or worsens due to the overuse of acute headache medications [2]. - It does not present with **brief, lancinating pains** or specific triggers like washing the face with cold water.

Q: Consider the following pleural fluid analysis : pH-7.6 Pleural fluid protein -0.5 g / dL Serum total protein -6.5 g / dL Pleural fluid LDH - 100 U / L Serum LDH - 300 U / L What is the most likely diagnosis?

Myxedema. ***Myxedema*** - The pleural fluid analysis shows a **transudative effusion** (pleural fluid protein/serum protein ratio < 0.5 and pleural fluid LDH/serum LDH ratio < 0.6), a characteristic of myxedema (hypothyroidism) [1]. - While other causes of transudates exist, a **high pH** in a transudate, as seen here (pH 7.6), is suggestive of myxedema or a parapneumonic effusion that is not infected, but the latter would likely be an exudate [1]. *Sarcoidosis* - Sarcoidosis typically causes an **exudative pleural effusion**, characterized by higher protein and LDH levels in the pleural fluid. - The pleural fluid pH in sarcoidosis is usually normal to slightly low, but not as high as 7.6 in an exudative process. *Rheumatoid arthritis* - Pleural effusions due to rheumatoid arthritis are typically **exudative**, with low glucose and very low pH (often <7.0 to 7.1) [1]. - The given pleural fluid composition does not match the typical findings of a rheumatoid effusion. *Pancreatitis* - Pancreatitis can cause an **exudative pleural effusion**, particularly on the left side, with very high amylase levels. - The protein and LDH ratios in this case are consistent with a transudate, not an exudate as seen in pancreatitis.

Q: Which one of the following conditions is a complication of bacterial pharyngitis involving extension of infection into the internal jugular veins leading to thrombosis and metastatic dispersal of the organism?

Lemierre syndrome. ***Lemierre syndrome*** - This syndrome is characterized by **bacterial pharyngitis** that extends to the **internal jugular vein**, leading to **thrombosis** and subsequent septic emboli [3]. - The most common causative organism is ***Fusobacterium necrophorum***, and it can result in metastatic infections in organs like the lungs. *Wegener's granulomatosis* - This is an **autoimmune vasculitis** affecting small to medium-sized vessels, primarily in the respiratory tract and kidneys [2]. - It is distinct from infection-related venous thrombosis and is characterized by **granulomatous inflammation** and **ANCA positivity**. *Chronic Pulmonary Aspergillosis* - This is a fungal infection of the lungs, typically occurring in individuals with pre-existing lung conditions or immunosuppression [1]. - It does not involve the initial presentation of bacterial pharyngitis followed by internal jugular vein thrombosis. *Cystic Fibrosis* - This is an **autosomal recessive genetic disorder** affecting exocrine glands, leading to thick, sticky mucus, primarily impacting the lungs and digestive system. - While it causes chronic respiratory infections, it is not initiated by bacterial pharyngitis leading to septic thrombophlebitis of the jugular vein.

Q: 'Masson Bodies' formed due to proliferation of immature collagen are a characteristic histopathological finding seen in which of the following conditions?

Cryptogenic Organizing Pneumonia. ***Cryptogenic Organizing Pneumonia*** - **Masson bodies**, which are intraluminal plugs of organizing connective tissue composed of fibroblasts, myofibroblasts, and immature collagen, are the **hallmark histopathological feature** of cryptogenic organizing pneumonia (COP) [1]. - These plugs are found predominantly in the **alveolar ducts** and **bronchioles**, leading to a characteristic pattern of organizing pneumonia [1]. *Lymphocytic Interstitial Pneumonia* - Characterized by a **dense interstitial infiltrate** dominated by **lymphocytes**, plasma cells, and histiocytes, often forming germinal centers. - It is frequently associated with **immunodeficiency states** such as HIV infection or autoimmune diseases like Sjögren's syndrome. *Desquamative Interstitial Pneumonia* - Marked by the accumulation of a large number of **macrophages** within the alveolar spaces, with minimal interstitial inflammation or fibrosis. - Primarily seen in **smokers** and is thought to be a reaction to inhaled particulate matter. *Respiratory Bronchiolitis* - Characterized by **peribronchiolar inflammation** and fibrosis, with pigment-laden macrophages accumulating within the respiratory bronchioles. - This condition is also strongly associated with **cigarette smoking** and is considered a milder variant of interstitial lung disease. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 330-331.

Q: A 42-year old man with history of alcohol dependency presents with progressive abdominal distension. Abdominal examination reveals a shifting dullness. Which one of the following is the most appropriate drug to relieve this abdominal distension?

Spironolactone. **Spironolactone** - **Spironolactone** is an **aldosterone antagonist**, which is the **first-line diuretic** used in the management of **ascites** due to **cirrhosis**, often developing secondary to alcohol dependency. - It works by blocking aldosterone receptors in the **renal collecting duct**, leading to increased sodium and water excretion while conserving potassium, effectively reducing fluid accumulation. *Lactulose* - **Lactulose** is a non-absorbable disaccharide primarily used to treat and prevent **hepatic encephalopathy** by reducing ammonia levels. - It does not directly relieve abdominal distension caused by ascites, and its use is unrelated to fluid overload. *Propranolol* - **Propranolol** is a **non-selective beta-blocker** used to reduce **portal pressure** and prevent **variceal bleeding** in patients with cirrhosis. - While it addresses a complication of chronic liver disease, it does not directly manage or relieve ascites. *Octreotide* - **Octreotide** is a **somatostatin analog** used to treat complications like **acute variceal bleeding** or **hepatic encephalopathy** by reducing splanchnic blood inflow. - It is not indicated for the management of ascites or relief of abdominal distension caused by fluid accumulation.

Q: Consider the following statements regarding respiratory function in old age: I. There is increasing ventilation-perfusion mismatch II. There is increased ventilatory response to hypoxia and hypercapnia III. There is a decline in maximum oxygen uptake leading to reduction in cardiorespiratory reserve IV. There is decline in the Forced Expiratory Volume to Forced Vital Capacity ratio (FEV1/FVC) by around 0.2% per year after the forties Which of the statements given above are correct?

I, III and IV. ***I, III and IV*** - With aging, there is a **loss of elastic recoil** in the lungs and a structural decrease in **alveolar surface area**, leading to increased **ventilation-perfusion (V/Q) mismatch** as gravity-dependent areas collapse. - The **maximum oxygen uptake (VO2 max)** declines with age due to reduced cardiac output and skeletal muscle mass, thus decreasing **cardiorespiratory reserve**. The **FEV1/FVC ratio** also decreases by approximately **0.2% per year** after age 40 because of reduced elastic recoil and increased airway collapsibility. *I, II and IV* - While statement I and IV are correct, statement II is incorrect because the **ventilatory response to hypoxia and hypercapnia** actually **decreases** with age. - Older adults have a blunted response to changes in oxygen and carbon dioxide levels, making them more susceptible to respiratory compromise. *II, III and IV* - Statement II is incorrect as the **ventilatory response to hypoxia and hypercapnia decreases** with age, not increases. - Statements III and IV accurately describe the decline in **maximum oxygen uptake** and the **FEV1/FVC ratio** with aging. *I, II and III* - Statement II is incorrect; the **ventilatory response to hypoxia and hypercapnia is diminished** in older adults. - Statements I and III correctly identify increased **ventilation-perfusion mismatch** and decreased **maximum oxygen uptake** as age-related changes in respiratory function.

Q: Which of the following are trigger factors for seizures? I. Sleep deprivation II. Missed doses of antiepileptic drugs III. Recreational drug misuse IV. Physical exhaustion Select the correct answer using the code given below:

I, II, III and IV. ***I, II, III and IV*** - **Sleep deprivation** significantly lowers the **seizure threshold** by altering brain excitability and neurochemical balance. - **Missed doses of antiepileptic drugs** lead to subtherapeutic drug levels, increasing the likelihood of breakthrough seizures in individuals undergoing treatment. - **Recreational drug misuse** (e.g., cocaine, amphetamines, alcohol withdrawal) can directly cause seizures by neurotoxic effects or by unmasking an underlying seizure disorder. - **Physical exhaustion** can act as a stressor, disrupting brain homeostasis and making individuals more susceptible to seizures, similar to sleep deprivation. *II and III only* - This option is incomplete as **sleep deprivation** and **physical exhaustion** are also well-established seizure triggers. *I and IV only* - This option is incomplete because **missed doses of antiepileptic drugs** and **recreational drug misuse** are critical and common triggers for seizures. *I, II and III only* - This option overlooks **physical exhaustion**, which can, similar to sleep deprivation, significantly reduce the seizure threshold.

Question 1

Contralateral Homonymous upper quadrantanopia is the type of visual loss seen when the lesion is located at which one of the following anatomical locations?

Accepted Answer

Temporal lobe

Answer

Parietal lobe

Answer

Frontal lobe

Answer

Occipital lobe

Question 2

Which of the following are clinical features of migraine?
I. It is associated with dilatation of extracranial vessels
II. Common migraine is seen without Aura
III. Aura is most often visual

Select the correct answer using the code given below :

Accepted Answer

II and III only

Answer

I, II and III

Answer

I and II only

Answer

I and III only

Question 3

A 50 year old man presents with brief episodes of lancinating unilateral facial pain, involving the buccal distribution. Pain is triggered by washing face with cold water. What is the most likely diagnosis?

Accepted Answer

Trigeminal neuralgia

Answer

Chronic paroxysmal hemicrania

Answer

Migraine

Answer

Medication overuse headache

Question 4

Consider the following pleural fluid analysis :
pH-7.6
Pleural fluid protein -0.5 g / dL
Serum total protein -6.5 g / dL
Pleural fluid LDH - 100 U / L
Serum LDH - 300 U / L

What is the most likely diagnosis?

Accepted Answer

Myxedema

Answer

Sarcoidosis

Answer

Rheumatoid arthritis

Answer

Pancreatitis

Question 5

Which one of the following statements is correct in respect of pulmonary involvement in rheumatoid disease?

Accepted Answer

Rheumatoid pulmonary nodules are usually asymptomatic and detected incidentally on imaging

Answer

Pleural effusion in these patients is transudative and usually bilateral

Answer

Rheumatoid pulmonary nodules are often solitary and located near hilum

Answer

Combination of pleural effusion and pneumoconiosis in these patients is known as Caplan syndrome

Question 6

Which one of the following conditions is a complication of bacterial pharyngitis involving extension of infection into the internal jugular veins leading to thrombosis and metastatic dispersal of the organism?

Accepted Answer

Lemierre syndrome

Answer

Wegener's granulomatosis

Answer

Chronic Pulmonary Aspergillosis

Answer

Cystic Fibrosis

Question 7

'Masson Bodies' formed due to proliferation of immature collagen are a characteristic histopathological finding seen in which of the following conditions?

Accepted Answer

Cryptogenic Organizing Pneumonia

Answer

Lymphocytic Interstitial Pneumonia

Answer

Desquamative Interstitial Pneumonia

Answer

Respiratory Bronchiolitis

Question 8

A 42-year old man with history of alcohol dependency presents with progressive abdominal distension. Abdominal examination reveals a shifting dullness. Which one of the following is the most appropriate drug to relieve this abdominal distension?

Accepted Answer

Spironolactone

Answer

Lactulose

Answer

Propranolol

Answer

Octreotide

Question 9

Consider the following statements regarding respiratory function in old age:
I. There is increasing ventilation-perfusion mismatch
II. There is increased ventilatory response to hypoxia and hypercapnia
III. There is a decline in maximum oxygen uptake leading to reduction in cardiorespiratory reserve
IV. There is decline in the Forced Expiratory Volume to Forced Vital Capacity ratio (FEV1/FVC) by around 0.2% per year after the forties
Which of the statements given above are correct?

Accepted Answer

I, III and IV

Answer

I, II and IV

Answer

II, III and IV

Answer

I, II and III

Question 10

Which of the following are trigger factors for seizures?
I. Sleep deprivation
II. Missed doses of antiepileptic drugs
III. Recreational drug misuse
IV. Physical exhaustion

Select the correct answer using the code given below:

Accepted Answer

I, II, III and IV

Answer

II and III only

Answer

I and IV only

Answer

I, II and III only

UPSC-CMS 2025

Anatomy

Internal Medicine

Pathology

Pharmacology

Physiology

Psychiatry