UPSC-CMS 2025 Practice Questions

Q: A 40 year old man with a known case of chronic pancreatitis presents to the OPD with complaint of skin pigmentation over the abdomen. The patient gives a history of chronic use of a hot water bottle to relieve the abdominal discomfort. Which one of the following is the most appropriate diagnosis?

Erythema ab igne. ***Erythema ab igne*** - This condition is caused by **chronic exposure to moderate heat**, which aligns with the patient's history of using a hot water bottle for abdominal discomfort. - It presents as **reticulated erythema** and **hyperpigmentation** on the affected skin, precisely matching the description of skin pigmentation over the abdomen. *Erythema infectiosum* - This is also known as **Fifth disease** and is caused by **Parvovirus B19**. - It typically presents with a characteristic **"slapped cheek" rash** on the face and a lacy rash on the trunk and limbs, which is not consistent with the patient's presentation. *Erythema marginatum* - This is a rare, transient rash associated with **acute rheumatic fever**. - It presents as **pink-red macules with clear centers and serpiginous borders** that migrate, which does not fit the described chronic pigmentation. *Erythema nodosum* - This condition is characterized by **tender, red nodules** typically found on the **shins**. - It is a form of **panniculitis** (inflammation of subcutaneous fat) and is not caused by chronic heat exposure, nor does it present as diffuse pigmentation.

Q: Which one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?

Transabdominal ultrasound. ***Transabdominal ultrasound*** - It is an **accurate, non-invasive, and cost-effective** imaging modality for detecting gallstones [1]. - Ultrasound can visualize the stones, their size, number, and any associated complications like **gallbladder wall thickening** or **pericholecystic fluid**. *Capsule endoscopy* - This procedure is primarily used to visualize the **small intestine** and is not suitable for evaluating the gallbladder. - It works by capturing images as it passes through the digestive tract, an area where the gallbladder is not directly accessible. *Computed Tomography* - While CT can sometimes detect gallstones, especially those that are calcified, it is **less sensitive than ultrasound** for non-calcified stones [1]. - CT also exposes the patient to **ionizing radiation**, making it less favorable as a primary diagnostic tool for gallstones compared to ultrasound. *Erect X ray of abdomen* - An erect X-ray of the abdomen is **poor at detecting gallstones** as only about 10-20% of gallstones are radiopaque (calcified) and visible on X-ray. - This imaging technique is more useful for detecting conditions like **bowel obstruction** or **perforations**, rather than gallbladder pathology.

Q: Consider the following with regard to Gilbert Syndrome : I. Autosomal recessive trait of a mutation in gene for UDPglucuronyl transferase enzyme II. Elevation of unconjugated bilirubin III. No stigmata of chronic liver disease other than jaundice IV. Early Liver biopsy recommended in patients with possible Gilbert Syndrome Which of the above are correct?

II and III only. ***II and III only*** - **Gilbert Syndrome** is characterized by an **elevation of unconjugated bilirubin** [1] due to reduced activity of the UGT1A1 enzyme [2]. - Patients typically present with **no stigmata of chronic liver disease** other than mild, fluctuating jaundice, often triggered by stress or fasting [2]. *I and II only* - While it involves **elevation of unconjugated bilirubin (II)** [1], Gilbert syndrome is an **autosomal recessive** condition due to a **polymorphism** in the promoter region of the **UGT1A1 gene**, leading to reduced enzyme activity [2], not a mutation that completely abolishes it. - The reduced enzyme activity is typically mild, resulting in only intermittent, mild hyperbilirubinemia. *III and IV* - **No stigmata of chronic liver disease other than jaundice (III)** is correct [2]. However, **early liver biopsy (IV)** is **not recommended** in patients with suspected Gilbert Syndrome. - Gilbert syndrome is a benign condition [1], and a liver biopsy is generally unnecessary and invasive for diagnosis in the absence of other liver disease signs. *I, II and III* - Although it features **elevation of unconjugated bilirubin (II)** and **no stigmata of chronic liver disease (III)**, the description of **I** is partially incorrect. - Gilbert syndrome is due to a **polymorphism** in the UGT1A1 gene promoter resulting in reduced enzyme activity [1], and it follows an **autosomal recessive inheritance pattern**, but the core issue is the **polymorphism**, not a standard mutation that significantly impairs the enzyme.

Q: The single most important treatment and prognostic factor in alcohol-related liver disease is

Cessation of alcohol consumption. ***Cessation of alcohol consumption*** - **Abstinence from alcohol** is the fundamental and most effective intervention for halting the progression of **alcohol-related liver disease (ARLD)** and significantly improving patient prognosis [1]. - Continued alcohol intake directly fuels liver damage, whereas stopping consumption allows the **liver to regenerate** and reduces inflammation, often leading to clinical improvement [1]. *N-acetyl cysteine* - While **N-acetyl cysteine (NAC)** is used in some liver conditions, particularly paracetamol overdose, its routine use for chronic ARLD is not supported by strong evidence as a primary treatment [3]. - It functions as an antioxidant and glutathione precursor, but **does not address the root cause** of alcohol-induced liver injury. *High dose vitamin E* - **High-dose vitamin E** is an antioxidant that has been investigated for various liver diseases, particularly non-alcoholic fatty liver disease (NAFLD) [2]. - However, there is **insufficient evidence** to support its widespread use as a primary or prognostic treatment in **alcohol-related liver disease** [2]. *Liver transplantation* - While **liver transplantation** can be a definitive treatment for end-stage ARLD, it is a **major surgical procedure** with strict criteria and is only considered after prolonged alcohol abstinence (typically 6 months) [1]. - It is a **salvage therapy** for irreversible damage, not the "single most important treatment and prognostic factor" in managing the disease from its earlier stages [1].

Q: Which of the following heart sounds are best heard with the bell of stethoscope? I. Opening snap II. Systolic click III. Third heart sound IV. Mid diastolic murmur Select the correct answer using the code given below :

III and IV. ***III and IV*** - The **bell of the stethoscope** is designed to auscultate **low-pitched sounds** due to its larger surface area and lighter application to the skin. - The **third heart sound (S3)** and **mid-diastolic murmurs** (e.g., from mitral stenosis) are classic examples of low-pitched sounds best heard with the bell [2]. *II and III only* - While the **third heart sound (S3)** is correctly identified as being heard with the bell, the **systolic click** is a high-pitched sound [1]. - **Systolic clicks**, often associated with mitral valve prolapse, are best heard with the **diaphragm** of the stethoscope [1]. *I, II and III* - This option incorrectly includes both the **opening snap** and **systolic click** as being best heard with the bell. - The **opening snap** (related to mitral stenosis) and **systolic click** (related to mitral valve prolapse) are typically **high-pitched sounds** and are better heard with the **diaphragm** [1], [3]. *I and IV* - This option incorrectly states that the **opening snap** is best heard with the bell. - Although the **mid-diastolic murmur** is correctly identified as a low-pitched sound [2], the **opening snap** is a high-pitched sound [1], [3], making the entire option incorrect.

Q: Consider the following statements for diagnosing ventricular aneurysm in a patient with recent myocardial infarction : I. Paradoxical impulse on chest wall II. Persistent ST elevation on ECG III. Unusual bulge from cardiac silhouette on X-ray IV. Presence of pulsus paradoxsus Which of the above are correct?

I, II and III. ***I, II and III*** - A **paradoxical impulse** on the chest wall (statement I) is a classic physical finding, indicating dyskinetic movement of the aneurysm during systole [1]. - **Persistent ST segment elevation** on ECG weeks to months after a myocardial infarction (statement II) is a hallmark sign, often reflecting the fibrous scar tissue of the aneurysm [1]. - An **unusual bulge** from the cardiac silhouette on X-ray (statement III) can indicate an enlarged left ventricular contour due to the aneurysm [1]. *II, III and IV* - While statements II and III are correct for diagnosing ventricular aneurysm, **pulsus paradoxus** (statement IV) is typically associated with **cardiac tamponade** or severe asthma/COPD, not directly with ventricular aneurysms. *I and II only* - Statements I and II are indeed correct indicators, but statement III, the **cardiac silhouette bulge on X-ray**, is also a valid and often observed finding for ventricular aneurysm [1]. *I and IV* - Statement I is correct, but **pulsus paradoxus** (statement IV) is not a diagnostic feature of ventricular aneurysm; it suggests conditions like **pericardial effusion** with tamponade.

Q: Which one of the following is correct with regard to Carey Coombs murmur?

Soft mid-diastolic murmur due to mitral valvulitis. ***Soft mid-diastolic murmur due to mitral valvulitis*** - The **Carey Coombs murmur** is a soft, mid-diastolic murmur heard in acute rheumatic fever, characterized by inflammation of the mitral valve (mitral valvulitis) [4]. - It is distinct from the Austin Flint murmur and indicates active **rheumatic carditis** [4]. *Harsh early diastolic murmur due to aortic regurgitation* - An early diastolic murmur, especially a harsh one, typically indicates **aortic regurgitation**, which is a different valvular pathology [3]. - The Carey Coombs murmur is described as soft and mid-diastolic, not harsh and early diastolic. *Soft systolic murmur due to mitral regurgitation* - A soft systolic murmur suggests **mitral regurgitation**, which is a backflow of blood during systole [2]. - The Carey Coombs murmur is specifically a diastolic murmur, differentiating it from systolic murmurs [3]. *Blowing late systolic murmur due to aortic stenosis* - A blowing late systolic murmur is characteristic of **aortic stenosis**, where there is narrowing of the aortic valve. - The Carey Coombs murmur is an early to mid-diastolic murmur, related to mitral valve inflammation, not aortic stenosis [1].

Q: Melanosis coli, which occurs due to long term consumption of stimulant laxatives, presents as brown discolouration of colonic mucosa due to deposition of which one of the following pigments?

Lipofuscin. ***Lipofuscin*** - **Melanosis coli** is characterized by the accumulation of **lipofuscin** in macrophages within the lamina propria of the colon. - This accumulation is typically induced by the long-term use of **stimulant laxatives**, particularly those containing anthraquinones (e.g., senna, cascara). *Haemoglobin* - **Haemoglobin** is the protein in red blood cells responsible for oxygen transport and does not deposit in the colonic mucosa to cause brown discoloration in melanosis coli. - Its presence in stool typically indicates **gastrointestinal bleeding**, which is a distinct condition from melanosis coli. *Haemosiderin* - **Haemosiderin** is an iron-storage complex that can accumulate in tissues as a result of **hemorrhage** or increased iron load [1]. - While it can cause brown discoloration, it is not the pigment responsible for the characteristic appearance of melanosis coli. *Melanin* - **Melanin** is the pigment primarily responsible for skin and hair color, produced by melanocytes [1]. - It is not found in significant amounts in the colonic mucosa and is not involved in the pathogenesis of melanosis coli. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 75.

Q: Which one of the following agents used in the treatment of inflammatory Bowel Disease acts by inhibiting the enzyme 'Janus Kinase'?

Tofacitinib. ***Tofacitinib*** - **Tofacitinib** is an oral medication that functions as a small molecule **Janus Kinase (JAK) inhibitor**, primarily targeting JAK1 and JAK3. - By inhibiting JAK enzymes, tofacitinib disrupts the signaling pathways of several **cytokines** involved in inflammation, including those implicated in **inflammatory bowel disease (IBD)**. *Adalimumab* - **Adalimumab** is a monoclonal antibody that targets and neutralizes **tumor necrosis factor-alpha (TNF-α)**, a key inflammatory cytokine. - It is not a JAK inhibitor but rather works by blocking the interaction of TNF-α with its receptors on cell surfaces. *Vedolizumab* - **Vedolizumab** is an anti-integrin monoclonal antibody that selectively blocks the α4β7 integrin on lymphocytes. - This action prevents lymphocytes from migrating into the gastrointestinal tract, thereby reducing inflammation in IBD. *Infliximab* - **Infliximab** is a chimeric monoclonal antibody that, like adalimumab, targets and neutralizes **tumor necrosis factor-alpha (TNF-α)**. - It works by binding to soluble and transmembrane forms of TNF-α, preventing its pro-inflammatory effects.

Question 1

A 40 year old man with a known case of chronic pancreatitis presents to the OPD with complaint of skin pigmentation over the abdomen. The patient gives a history of chronic use of a hot water bottle to relieve the abdominal discomfort. Which one of the following is the most appropriate diagnosis?

Accepted Answer

Erythema ab igne

Answer

Erythema infectiosum

Answer

Erythema marginatum

Answer

Erythema nodosum

Question 2

Which one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?

Accepted Answer

Transabdominal ultrasound

Answer

Capsule endoscopy

Answer

Computed Tomography

Answer

Erect X ray of abdomen

Question 3

Consider the following with regard to Gilbert Syndrome :
I. Autosomal recessive trait of a mutation in gene for UDPglucuronyl transferase enzyme
II. Elevation of unconjugated bilirubin
III. No stigmata of chronic liver disease other than jaundice
IV. Early Liver biopsy recommended in patients with possible Gilbert Syndrome

Which of the above are correct?

Accepted Answer

II and III only

Answer

I and II only

Answer

III and IV

Answer

I, II and III

Question 4

The single most important treatment and prognostic factor in alcohol-related liver disease is

Accepted Answer

Cessation of alcohol consumption

Answer

N -acetyl cysteine

Answer

High dose vitamin E

Answer

Liver transplantation

Question 5

Which of the following heart sounds are best heard with the bell of stethoscope?
I. Opening snap
II. Systolic click
III. Third heart sound
IV. Mid diastolic murmur

Select the correct answer using the code given below :

Accepted Answer

III and IV

Answer

II and III only

Answer

I, II and III

Answer

I and IV

Question 6

Consider the following statements for diagnosing ventricular aneurysm in a patient with recent myocardial infarction :
I. Paradoxical impulse on chest wall
II. Persistent ST elevation on ECG
III. Unusual bulge from cardiac silhouette on X-ray
IV. Presence of pulsus paradoxsus

Which of the above are correct?

Accepted Answer

I, II and III

Answer

II, III and IV

Answer

I and II only

Answer

I and IV

Question 7

Which one of the following statements is correct for subcutaneous nodules in Rheumatic fever?

Accepted Answer

They typically appear more than 3 weeks after onset of other clinical manifestations

Answer

They are present over flexor aspect of forearm

Answer

They are painful tender nodules

Answer

The usual size of these nodules is 3-5 cm

Question 8

Which one of the following is correct with regard to Carey Coombs murmur?

Accepted Answer

Soft mid-diastolic murmur due to mitral valvulitis

Answer

Harsh early diastolic murmur due to aortic regurgitation

Answer

Soft systolic murmur due to mitral regurgitation

Answer

Blowing late systolic murmur due to aortic stenosis

Question 9

Melanosis coli, which occurs due to long term consumption of stimulant laxatives, presents as brown discolouration of colonic mucosa due to deposition of which one of the following pigments?

Accepted Answer

Lipofuscin

Answer

Haemoglobin

Answer

Haemosiderin

Answer

Melanin

Question 10

Which one of the following agents used in the treatment of inflammatory Bowel Disease acts by inhibiting the enzyme 'Janus Kinase'?

Accepted Answer

Tofacitinib

Answer

Adalimumab

Answer

Vedolizumab

Answer

Infliximab

UPSC-CMS 2025

Dermatology

Internal Medicine

Pathology

Pharmacology