UPSC-CMS 2025 Practice Questions

Q: Treatment of first choice in acute Gout is

Oral Colchicine. ***Oral Colchicine*** - **Colchicine** is highly effective in treating **acute gout attacks** by reducing inflammation caused by uric acid crystal deposition. - It works best when initiated within **24-36 hours** of symptom onset. - Considered a **first-line option** for acute gout, particularly in patients with contraindications to NSAIDs or corticosteroids. - **Mechanism:** Inhibits microtubule polymerization, thereby reducing neutrophil migration and phagocytosis of urate crystals. *Oral Methotrexate* - **Methotrexate** is an **immunosuppressant** primarily used for chronic inflammatory conditions, such as **rheumatoid arthritis** or **psoriasis**. - It is not a first-line treatment for the rapid relief of acute gout symptoms. *Sulfasalazine* - **Sulfasalazine** is an anti-inflammatory and immunomodulatory drug, commonly used in **inflammatory bowel disease** and **rheumatoid arthritis**. - It has no role in the immediate treatment of an acute gout flare. *Allopurinol* - **Allopurinol** is a **xanthine oxidase inhibitor** used for the **long-term prevention** of gout by lowering uric acid levels. - It is generally *not initiated* during an acute attack, as it can potentially worsen the flare by mobilizing urate crystals. - Used for **prophylaxis** in patients with recurrent gout attacks or chronic tophaceous gout.

Q: Which one of the following is a contraindication to wireless capsule endoscopy?

Small bowel stricture. ***Small bowel stricture*** - A **small bowel stricture** is a major contraindication for wireless capsule endoscopy due to the significant risk of the capsule becoming **retained** at the narrowed segment [1]. - Capsule retention can lead to **obstruction** requiring surgical intervention, thus posing a serious safety concern. *Small bowel Crohn's disease* - While Crohn's disease *can* cause strictures, the existence of Crohn's disease itself is not an absolute contraindication unless a **significant stricture** is already known or highly suspected [1]. - Capsule endoscopy is often used to *diagnose* and *monitor* small bowel Crohn's disease [1]. *Coeliac disease* - **Coeliac disease** is not a contraindication; in fact, capsule endoscopy can be a useful tool in evaluating the small bowel mucosa in refractory cases or for confirming diagnosis [1]. - There is no increased risk of capsule retention or other adverse events directly attributable to coeliac disease itself. *Obscure gastrointestinal bleeding* - **Obscure gastrointestinal bleeding** is considered a primary *indication* for wireless capsule endoscopy, rather than a contraindication [1]. - The capsule can visualize the entire small bowel, often identifying bleeding sources that are not accessible by conventional endoscopy [1].

Q: Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

Sinusoidal - Veno-occlusive disease. ***Sinusoidal - Veno-occlusive disease*** - **Veno-occlusive disease** (also known as sinusoidal obstruction syndrome) specifically affects the blood flow within the **sinusoids** of the liver [1]. - This obstruction at the sinusoidal level directly leads to **sinusoidal portal hypertension** [1]. *Post-hepatic - Schistosomiasis post sinusoidal* - **Schistosomiasis** primarily causes **presinusoidal portal hypertension**, specifically due to periportal fibrosis in the liver. - **Post-hepatic portal hypertension** typically involves obstruction *after* the liver sinusoids, such as in **Budd-Chiari syndrome** or right heart failure [1]. *Pre-hepatic - Portal vein presinusoidal thrombosis* - **Portal vein thrombosis** occurring *before* the liver sinusoids would indeed be classified as **pre-hepatic portal hypertension** [2]. - However, the description **"presinusoidal thrombosis"** describes the *location* of the thrombosis but does not inherently define it as pre-hepatic versus intrahepatic. **Pre-hepatic** explicitly means before the liver substance. *Intrahepatic - Cirrhosis presinusoidal* - **Cirrhosis** is a classic cause of **intrahepatic portal hypertension**, but the obstruction in cirrhosis is predominantly **sinusoidal and post-sinusoidal**, due to fibrosis and regenerating nodules [2]. - While some early fibrotic changes may have presinusoidal components, the dominant site of obstruction in established cirrhosis is at the sinusoidal and perisinusoidal levels, not strictly presinusoidal.

Q: Which one of the following is a secondary cause of headache?

Medication overuse headache. ### Medication overuse headache - This is a form of **secondary headache** caused by the chronic overuse of acute headache medications, which can lead to a *vicious cycle* of increasing headache frequency and medication use [1]. - It arises as a direct consequence of an **external factor** (medication overuse), distinguishing it from primary headache disorders [1]. *Tension-type headache* - This is a **primary headache disorder**, meaning the headache itself is the main problem and not a symptom of another condition [1]. - It is characterized by a **mild to moderate, bilateral, pressing or tightening pain** that is not aggravated by physical activity. *Migraine* - This is a **primary headache disorder** characterized by recurrent headaches affecting one side of the head, and often accompanied by symptoms such as **pulsating pain**, nausea, vomiting, and sensitivity to light and sound [1]. - While it can be debilitating, it is not caused by an **underlying structural or systemic disease**. *Trigeminal autonomic cephalalgia* - These are a group of **primary headache disorders** characterized by severe, strictly unilateral pain with associated **ipsilateral cranial autonomic symptoms** (e.g., conjunctival injection, lacrimation, nasal congestion) [1]. - Examples include cluster headache and paroxysmal hemicrania, and they are not caused by an identifiable **secondary cause**.

Q: A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Kayser-Fleisher rings in the cornea. Detailed clinical features point towards Wilson's disease. ***Kayser-Fleisher rings in the cornea*** - The history of **recurrent jaundice** and **facial grimacing** (likely dystonia/tremors) points towards a **neuropsychiatric disorder** with liver involvement, which is characteristic of **Wilson's disease** [1]. - **Kayser-Fleisher rings** are copper deposits in the Descemet's membrane of the cornea, a pathognomonic sign of Wilson's disease. *Adenoma sebaceum in the mid face* - **Adenoma sebaceum** (facial angiofibromas) is a characteristic skin lesion associated with **tuberous sclerosis complex**, which typically presents with seizures, intellectual disability, and characteristic skin lesions, not recurrent jaundice or facial grimacing indicative of movement disorders. - This condition does not primarily involve recurrent jaundice or movement disorders like facial grimacing. *Erythema nodosum on the skin* - **Erythema nodosum** is an inflammatory condition characterized by painful, red nodules, typically on the shins. - It is often associated with conditions like **sarcoidosis**, inflammatory bowel disease, infections, or drug reactions, and does not commonly present with recurrent jaundice and facial grimacing. *Osler's nodes at the finger tips* - **Osler's nodes** are painful, tender, red or purple lesions found on the fingertips and toes, indicative of **infective endocarditis**. - This symptom is related to immune complex deposition and systemic infection, rather than genetic disorders causing liver disease and neurological dysfunction.

Q: Which one of the following is the causative organism of Erythrasma, a mild, localized and superficial skin infection?

Corynebacterium minutissimum. ***Corynebacterium minutissimum*** - This bacterium is the **primary causative agent** of erythrasma, a superficial skin infection. - It produces **porphyrins**, which fluoresce with a characteristic **coral-red color** under a Wood's lamp, aiding in diagnosis. *Corynebacterium matruchotii* - This species is typically found in the **oral cavity** and is associated with dental plaque and periodontal diseases. - It is **not known** to cause erythrasma or superficial skin infections. *Corynebacterium pseudotuberculosis* - This bacterium is a significant pathogen in **animals**, particularly livestock, causing conditions like caseous lymphadenitis. - While it can *rarely* cause infections in humans (e.g., lymphadenitis), it is **not associated** with erythrasma. *Corynebacterium diphtheriae* - This is the causative agent of **diphtheria**, a severe respiratory illness characterized by a pseudomembrane in the throat. - It causes systemic toxemia and is **not responsible** for localized, superficial skin infections like erythrasma.

Q: Which one of the following is an antidote for Rivaroxaban and Apixaban, when reversal of anticoagulation is needed due to uncontrolled bleeding?

Andexanet Alfa. ***Andexanet Alfa*** - **Andexanet Alfa** is a **modified recombinant factor Xa molecule** that acts as a decoy to bind and sequester direct factor Xa inhibitors like rivaroxaban and apixaban. - It is specifically indicated for the reversal of anticoagulation in patients treated with **rivaroxaban** or **apixaban** experiencing life-threatening or uncontrolled bleeding [1]. *Hydroxocobalamin* - **Hydroxocobalamin** is an antidote for **cyanide poisoning**, not for anticoagulant reversal. - It works by binding to cyanide to form cyanocobalamin, which can be excreted, thereby detoxifying the patient. *Glucarpidase* - **Glucarpidase** is used to rapidly lower **methotrexate concentrations** in patients with delayed methotrexate elimination and associated toxicity. - It is an enzyme that hydrolyzes methotrexate into inactive metabolites, facilitating its clearance. *Idarucizumab* - **Idarucizumab** is a specific reversal agent for **dabigatran**, a direct thrombin inhibitor. - It is a monoclonal antibody fragment that binds to dabigatran with high affinity, neutralizing its anticoagulant effect.

Q: Which one of the following is used to reverse the anticoagulant effects of Dabigatran?

Idarucizumab. ***Idarucizumab*** - **Idarucizumab** is a **monoclonal antibody fragment** specifically designed to bind to dabigatran and its active metabolites. - This binding neutralizes the anticoagulant effect of dabigatran, providing **rapid reversal** in emergency situations. *Desferrioxamine* - **Desferrioxamine** is a **chelating agent** used to treat **iron poisoning**. - It works by binding to iron in the bloodstream, facilitating its excretion from the body, and has no effect on anticoagulant drugs. *Protamine* - **Protamine** is used to reverse the anticoagulant effects of **heparin** by forming a stable salt with it. - It is **not effective** for reversing the effects of direct oral anticoagulants like dabigatran. *Glucarpidase* - **Glucarpidase** is an enzyme used to reduce toxic plasma methotrexate concentrations in patients with impaired renal function. - It catalyzes the hydrolysis of methotrexate into inactive metabolites and has **no role** in anticoagulant reversal.

Q: A 56-year-old male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert an intercostal drain. Which one of the following sites is suitable for such a procedure?

Triangle of safety. ***Triangle of safety*** - The **triangle of safety** is the universally accepted site for safe **intercostal drain (chest tube)** insertion to treat **pneumothorax**. - Its boundaries help avoid injury to vital organs; it is bordered by the **anterior border of the latissimus dorsi**, the **lateral border of the pectoralis major**, and the **fifth intercostal space**. *Petit's triangle* - This anatomical landmark, also known as the **lumbar triangle**, is located in the **lumbar region** of the back. - It defines a weaker area in the abdominal wall and is a common site for **lumbar hernias**, not chest tube insertion for pneumothorax. *Hesselbach's triangle* - This triangle is located in the **groin region** and is an important anatomical landmark for **inguinal hernias**. - It is bordered by the inferior epigastric vessels, the lateral border of the rectus abdominis, and the inguinal ligament, and is entirely unrelated to chest procedures. *Triangle of auscultation* - The **triangle of auscultation** is a small region of the back, bordered by the **latissimus dorsi**, **trapezius**, and **medial border of the scapula**. - It is a thinner area of musculature, making it an ideal location for **listening to breath sounds** with a stethoscope, but it is not used for invasive procedures like chest tube insertion.

Q: Which of the following are included in common causes of mediastinal masses in superior and anterior mediastinum? I. Goitre II. Thymic tumour III. Neurogenic tumour Select the correct answer using the code given below :

I and II only. ***I and II only*** - **Goitre** (retrosternal thyroid extension) is a common cause of superior mediastinal masses. - **Thymic tumors** (thymoma, thymic carcinoma) are characteristically found in the anterior mediastinum. *I, II and III* - While goitre and thymic tumors are common in the superior and anterior mediastinum respectively, **neurogenic tumors** are typically found in the posterior mediastinum. - This option incorrectly includes neurogenic tumors with masses of the superior and anterior mediastinum. *II and III only* - This option correctly identifies **thymic tumors** for the anterior mediastinum but incorrectly includes **neurogenic tumors**, which are found in the posterior mediastinum. - It also omits **goitre**, which is a significant cause of superior mediastinal masses. *I and III only* - This option correctly identifies **goitre** as a superior mediastinal mass but incorrectly includes **neurogenic tumors**, which are typically located in the posterior mediastinum. - It incorrectly omits **thymic tumors**, which are a primary cause of anterior mediastinal masses.

Question 1

Treatment of first choice in acute Gout is

Accepted Answer

Oral Colchicine

Answer

Oral Methotrexate

Answer

Sulfasalazine

Answer

Allopurinol

Question 2

Which one of the following is a contraindication to wireless capsule endoscopy?

Accepted Answer

Small bowel stricture

Answer

Small bowel Crohn's disease

Answer

Coeliac disease

Answer

Obscure gastrointestinal bleeding

Question 3

Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

Accepted Answer

Sinusoidal - Veno-occlusive disease

Answer

Post-hepatic - Schistosomiasis post sinusoidal

Answer

Pre-hepatic - Portal vein presinusoidal thrombosis

Answer

Intrahepatic - Cirrhosis presinusoidal

Question 4

Which one of the following is a secondary cause of headache?

Accepted Answer

Medication overuse headache

Answer

Tension-type headache

Answer

Migraine

Answer

Trigeminal autonomic cephalalgia

Question 5

A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Accepted Answer

Kayser-Fleisher rings in the cornea

Answer

Adenoma sebaceum in the mid face

Answer

Erythema nodosum on the skin

Answer

Osler's nodes at the finger tips

Question 6

Which one of the following is the causative organism of Erythrasma, a mild, localized and superficial skin infection?

Accepted Answer

Corynebacterium minutissimum

Answer

Corynebacterium matruchotii

Answer

Corynebacterium pseudotuberculosis

Answer

Corynebacterium diphtheriae

Question 7

Which one of the following is an antidote for Rivaroxaban and Apixaban, when reversal of anticoagulation is needed due to uncontrolled bleeding?

Accepted Answer

Andexanet Alfa

Answer

Hydroxocobalamin

Answer

Glucarpidase

Answer

Idarucizumab

Question 8

Which one of the following is used to reverse the anticoagulant effects of Dabigatran?

Accepted Answer

Idarucizumab

Answer

Desferrioxamine

Answer

Protamine

Answer

Glucarpidase

Question 9

A 56-year-old male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert an intercostal drain. Which one of the following sites is suitable for such a procedure?

Accepted Answer

Triangle of safety

Answer

Petit's triangle

Answer

Hesselbach's triangle

Answer

Triangle of auscultation

Question 10

Which of the following are included in common causes of mediastinal masses in superior and anterior mediastinum?
I. Goitre
II. Thymic tumour
III. Neurogenic tumour

Select the correct answer using the code given below :

Accepted Answer

I and II only

Answer

I, II and III

Answer

II and III only

Answer

I and III only

UPSC-CMS 2025

Internal Medicine

Microbiology

Pharmacology

Surgery