UPSC-CMS 2025 Practice Questions

Q: The glymphatic system is the lymphatic-like structure of which system?

Central Nervous System. ***Central Nervous System*** - The **glymphatic system** is a specialized waste clearance pathway unique to the **central nervous system (CNS)**. - It facilitates the removal of metabolic waste products, including **amyloid-beta**, from the brain, playing a crucial role in CNS health. *Gastro-intestinal* - The gastrointestinal system has its own extensive lymphatic network, including **Peyer's patches** and **mesenteric lymph nodes**, for immune surveillance and lipid absorption. - These structures differ significantly in function and anatomy from the brain's glymphatic system. *Respiratory* - The respiratory system is equipped with **bronchial lymphatics** and **pulmonary lymph nodes** that drain fluid and immune cells from the lungs. - This system is involved in immune responses and fluid balance in the lungs, not directly related to brain waste clearance. *Renal* - The renal system has lymphatic drainage associated with the kidneys, which helps in the return of interstitial fluid and immune cells [1]. - This system is distinct from the glymphatic system and primarily involved in kidney function and fluid balance [1].

Q: Which one of the following is the myelinating cell of Central Nervous System?

Oligodendrocyte. ***Oligodendrocyte*** - **Oligodendrocytes** are the primary cells responsible for producing and maintaining the **myelin sheath** around axons in the **Central Nervous System (CNS)** [2], [3]. - Each oligodendrocyte can myelinate multiple axons or multiple segments of the same axon [3]. *Astrocyte* - **Astrocytes** are star-shaped glial cells that provide structural and metabolic support to neurons in the CNS [1]. - They are involved in forming the **blood-brain barrier** and regulating the chemical environment around neurons, but they do not produce myelin. *Microglia* - **Microglia** are the resident **immune cells** of the CNS, functioning as macrophages [1]. - They are primarily involved in immune surveillance, phagocytosis of cellular debris and pathogens, and inflammatory responses, not myelination [1]. *Schwann cell* - **Schwann cells** are the myelinating cells of the **Peripheral Nervous System (PNS)** [2], [3]. - Unlike oligodendrocytes, each Schwann cell typically myelinates only a single axon segment [3].

Q: Which one of the following is the correct description of Mee's lines, seen in chronic arsenic poisoning?

Transverse white lines on nails of fingers and toes. ***Transverse white lines on nails of fingers and toes*** - **Mee's lines** are characteristic **white transverse bands** seen specifically on the **nails** of the fingers and toes. - They are typically associated with **arsenic poisoning** but can also be seen in other systemic illnesses. *Transverse white lines on the skin of palms and soles* - While chronic arsenic poisoning can cause **skin pigmentation changes** (melanosis) and **hyperkeratosis** on the palms and soles, it does not typically manifest as distinct white transverse lines on the skin. - Mee's lines are exclusively a **nail finding**. *Transverse red lines on the nails of fingers and toes* - **Red lines on nails** are not characteristic of Mee's lines; Mee's lines are described as **white**. - Red nail changes, such as splinter hemorrhages, are often associated with other conditions, like **endocarditis**. *Transverse red lines on the skin of palms and soles* - This description does not correspond to Mee's lines, which are **white nail changes**, nor is it a typical manifestation of chronic arsenic poisoning on the skin in this specific pattern. - Skin manifestations of arsenic poisoning on palms and soles are usually **hyperpigmentation** and **hyperkeratosis**.

Q: Which of the following are features of Alzheimer's disease? I. It is a disorder of cerebral cortical function II. Only short term memory is affected III. Patients deny that there is anything wrong IV. Depression is commonly present Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - Alzheimer's disease is indeed a **disorder of cerebral cortical function** [1], primarily affecting areas responsible for memory, language, and executive functions. - Patients often exhibit **anosognosia** (denial of illness), failing to recognize their cognitive deficits, and **depression** is a common comorbidity [2] that can complicate diagnosis and management. *II, III and IV* - This option incorrectly states that **only short-term memory is affected** in Alzheimer's disease; both short-term and long-term memory are progressively impaired [2]. - While denial of illness and depression are common, the underlying memory impairment is more global than just short-term memory [2]. *I, II and III* - This option incorrectly includes the statement that **only short-term memory is affected**, which is not characteristic of Alzheimer's disease. - Alzheimer's patients experience a decline in various cognitive domains, including **long-term memory** [2], language, and executive functions. *I, II and IV* - This option incorrectly includes the statement that **only short-term memory is affected**; Alzheimer's disease impacts both short-term and long-term memory [2]. - While cerebral cortical dysfunction and depression are relevant features, the denial of illness (anosognosia) is also a significant clinical presentation not included here.

Q: Which of the following are causes of reversible dementia? I. Hypothyroidism II. Vitamin B12 deficiency III. Dementia with lewy body IV. Thiamine deficiency Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - **Hypothyroidism** can cause cognitive impairment, including memory loss and slowed thinking, which are often reversible with **thyroid hormone replacement**. - **Vitamin B12 deficiency** can lead to neurological symptoms such as memory problems and cognitive decline, which can improve significantly with **B12 supplementation** [1]. - **Thiamine deficiency**, particularly in the context of Wernicke-Korsakoff syndrome, can cause severe amnesia and cognitive deficits that may be partially or fully reversible with **thiamine repletion** [1], [2]. *II, III and IV* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is a progressive and irreversible neurodegenerative disease. - While II and IV are correct, the inclusion of III makes this option incorrect. *I, III and IV* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is a progressive neurodegenerative dementia. - Although I and IV are correct, the presence of III makes this an invalid choice. *I, II and III* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is an **irreversible neurodegenerative disorder**. - While I and II are correct, the miscategorization of III leads to this option being incorrect.

Q: Which of the following combinations of lab test results is indicative of heavy alcohol consumption, with more than 60 % sensitivity and specificity?

GGT >35 U / L and CDT >20 U / L. ***GGT >35 U / L and CDT >20 U / L*** - Elevated **gamma-glutamyl transferase (GGT)** is a **sensitive marker for liver damage** and enzyme induction from alcohol use [1]. - **Carbohydrate-deficient transferrin (CDT)** is a specific and sensitive biomarker for **chronic heavy alcohol consumption**, with levels above 20 U/L indicating heavy intake. *Gamma glutamyl transferase (GGT) >35 U / L and alkaline phosphatase >45 U / L* - While elevated **GGT** can indicate alcohol use, **alkaline phosphatase (ALP)** primarily reflects **cholestasis** or bone disease and is not a specific marker for alcohol consumption [1]. - The combination of only these two markers lacks the high sensitivity and specificity for heavy alcohol consumption compared to the inclusion of CDT. *High normal MCV >91 fL and CDT 20 U / L and serum uric acid 20 U/L** is a strong indicator of heavy alcohol use, **serum uric acid** levels are commonly *elevated* in chronic alcohol consumption, not decreased. - Alcohol metabolism can lead to hyperuricemia (elevated uric acid), making a lower level of uric acid inconsistent with heavy drinking.

Q: Which of the following joints are commonly affected in osteoarthritis? I. First metatarsophalangeal joint II. Proximal interphalangeal joint III. Ankle joint IV. 5th and 6th cervical vertebrae joint Select the correct answer using the code given below :

I, II and IV only. ***I, II and IV only*** - **Osteoarthritis** commonly affects joints that bear significant weight or are subject to repetitive stress, such as the **first metatarsophalangeal joint**, **proximal interphalangeal joints**, and the **cervical spine**. - Degenerative changes in these joints, including cartilage loss and **osteophyte formation**, are characteristic findings in osteoarthritis. *I, II, III and IV* - While the first metatarsophalangeal joint, proximal interphalangeal joints, and cervical vertebrae are commonly affected, the **ankle joint** is typically spared in primary osteoarthritis. - Ankle involvement in osteoarthritis is usually secondary to **trauma** or inflammatory arthritis rather than primary degenerative change. *III and IV only* - This option misses the common involvement of the **first metatarsophalangeal joint** and **proximal interphalangeal joints**, which are frequently affected in osteoarthritis. - The ankle joint is less commonly involved in primary osteoarthritis compared to other load-bearing joints like the **knee** and **hip**. *I and II only* - This option incorrectly omits the **cervical vertebrae**, which are a very common site for osteoarthritis, often leading to neck pain and **radiculopathy**. - While the metatarsophalangeal and proximal interphalangeal joints are correct, the exclusion of the cervical spine makes this option incomplete.

Q: Fomepizole is an antidote used to treat poisoning from which of the following substances? I. Methanol II. Digoxin III. Cocaine IV. Ethylene glycol Select the correct answer using the code given below :

I and IV. ***I and IV*** - **Fomepizole** is a competitive inhibitor of **alcohol dehydrogenase**, the enzyme that metabolizes both methanol and ethylene glycol into toxic metabolites [1]. - For **methanol** poisoning: Prevents conversion to **formic acid**, which causes metabolic acidosis and optic nerve damage [2]. - For **ethylene glycol** poisoning: Prevents conversion to **glycolic acid and oxalic acid**, which cause metabolic acidosis, renal failure, and calcium oxalate crystal deposition [1]. - Fomepizole is the preferred antidote over ethanol due to its safer profile and ease of administration. *III and IV* - While ethylene glycol (IV) is correctly identified, **cocaine** (III) poisoning is not treated with fomepizole. - Cocaine toxicity management involves supportive care, benzodiazepines for agitation and seizures, and management of cardiovascular complications (hypertension, arrhythmias). - Fomepizole has no role in cocaine overdose as the toxic mechanism does not involve alcohol dehydrogenase. *I and II* - While methanol (I) is correctly identified, **digoxin** (II) poisoning is not treated with fomepizole. - Digoxin toxicity is managed with **digoxin-specific antibody fragments (Digoxin Fab)**, which bind and neutralize digoxin. - Fomepizole's mechanism of alcohol dehydrogenase inhibition is irrelevant to digoxin toxicity. *II and III* - Neither **digoxin** (II) nor **cocaine** (III) poisoning is treated with fomepizole. - Both substances have different toxic mechanisms unrelated to alcohol dehydrogenase. - Digoxin requires Fab fragments; cocaine requires supportive care and symptomatic management.

Q: Which of the following are clinical features of Fronto-Temporal dementia ? I. Personality change II. Language disturbance III. Memory may be preserved in early stages IV. Anti-cholinesterases are the drug of choice for treatment Select the correct answer using the code given below :

I, II and III. ***Correct Answer: I, II and III*** - **Fronto-temporal dementia (FTD)** is characterized by prominent **personality and behavioral changes** (disinhibition, apathy, loss of empathy) and **language disturbances** (progressive non-fluent aphasia or semantic variant aphasia). - Unlike Alzheimer's disease, **memory is often relatively preserved in the early stages** of FTD, with executive function, behavior, and social cognition being more affected initially. - **Statement IV is incorrect**: Anti-cholinesterases (donepezil, rivastigmine, galantamine) are the treatment for Alzheimer's disease and are **generally ineffective or may even worsen behavioral symptoms in FTD**. There is no FDA-approved pharmacological treatment specifically for FTD; management focuses on behavioral interventions and symptomatic treatment. *Incorrect: II, III and IV* - This option incorrectly includes **Statement IV (anti-cholinesterases)** as a clinical feature or appropriate treatment. - Anti-cholinesterases are not the drug of choice for FTD and may exacerbate behavioral symptoms. *Incorrect: I, III and IV* - This option incorrectly includes **Statement IV (anti-cholinesterases)** while missing the important language disturbance feature. - Language disturbances are a core feature of FTD, particularly in the language-variant subtypes. *Incorrect: I, II and IV* - This option incorrectly includes **Statement IV (anti-cholinesterases)** while missing the fact that memory preservation in early stages is characteristic. - The preservation of memory early on is a key distinguishing feature between FTD and Alzheimer's disease.

Q: The 4AT is a screening tool for detection of delirium. Which THREE of the following parameters listed below are included in the 4AT tool? I. Alertness II. Apnoea III. Abbreviated Mental Test (AMT4) IV. Attention Select the correct answer using the code given below:

I, III and IV. ***I, III and IV*** - The 4AT screening tool specifically includes **Alertness**, **AMT4 (Abbreviated Mental Test)**, and **Attention** as key parameters for detecting delirium. - The **AMT4** component assesses **cognitive function**, while **Alertness** and **Attention** evaluate the patient's state of consciousness and focus. *I, II and IV* - This option incorrectly includes **Apnoea**. While apnoea is a significant medical condition, it is not a direct parameter in the **4AT delirium screening tool**. - The 4AT focuses on cognitive and neurological signs of delirium, not respiratory patterns. *I, II and III* - This option also incorrectly includes **Apnoea** as one of the parameters in the 4AT tool. - The 4AT is designed to assess **delirium**, which primarily manifests through altered mental status, rather than respiratory issues. *II, III and IV* - This option is incorrect as it includes **Apnoea** and omits **Alertness**, which is a fundamental component of the **4AT delirium screening tool**. - **Alertness** is crucial for evaluating the patient's level of consciousness, a primary sign of delirium.

Question 1

The glymphatic system is the lymphatic-like structure of which system?

Accepted Answer

Central Nervous System

Answer

Gastrointestinal

Answer

Respiratory

Answer

Renal

Question 2

Which one of the following is the myelinating cell of Central Nervous System?

Accepted Answer

Oligodendrocyte

Answer

Astrocyte

Answer

Microglia

Answer

Schwann cell

Question 3

Which one of the following is the correct description of Mee's lines, seen in chronic arsenic poisoning?

Accepted Answer

Transverse white lines on nails of fingers and toes

Answer

Transverse white lines on the skin of palms and soles

Answer

Transverse red lines on the nails of fingers and toes

Answer

Transverse red lines on the skin of palms and soles

Question 4

Which of the following are features of Alzheimer's disease?
I. It is a disorder of cerebral cortical function
II. Only short term memory is affected
III. Patients deny that there is anything wrong
IV. Depression is commonly present

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and III

Answer

I, II and IV

Question 5

Which of the following are causes of reversible dementia?
I. Hypothyroidism
II. Vitamin B12 deficiency
III. Dementia with lewy body
IV. Thiamine deficiency

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 6

Which of the following combinations of lab test results is indicative of heavy alcohol consumption, with more than 60 % sensitivity and specificity?

Accepted Answer

GGT >35 U / L and CDT >20 U / L

Answer

Gamma glutamyl transferase (GGT) >35 U / L and alkaline phosphatase >45 U / L

Answer

High normal MCV >91 fL and CDT <20 U / L

Answer

Carbohydrate-deficient transferrin (CDT) >20 U / L and serum uric acid <7 mg / dL

Question 7

Which of the following joints are commonly affected in osteoarthritis?
I. First metatarsophalangeal joint
II. Proximal interphalangeal joint
III. Ankle joint
IV. 5th and 6th cervical vertebrae joint

Select the correct answer using the code given below :

Accepted Answer

I, II and IV only

Answer

I, II, III and IV

Answer

I and II only

Answer

III and IV only

Question 8

Fomepizole is an antidote used to treat poisoning from which of the following substances?
I. Methanol
II. Digoxin
III. Cocaine
IV. Ethylene glycol

Select the correct answer using the code given below :

Accepted Answer

I and IV

Answer

III and IV

Answer

I and II

Answer

II and III

Question 9

Which of the following are clinical features of Fronto-Temporal dementia ?
I. Personality change
II. Language disturbance
III. Memory may be preserved in early stages
IV. Anti-cholinesterases are the drug of choice for treatment
Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and IV

Question 10

The 4AT is a screening tool for detection of delirium. Which THREE of the following parameters listed below are included in the 4AT tool?
I. Alertness
II. Apnoea
III. Abbreviated Mental Test (AMT4)
IV. Attention

Select the correct answer using the code given below:

Accepted Answer

I, III and IV

Answer

I, II and IV

Answer

I, II and III

Answer

II, III and IV

UPSC-CMS 2025

Anatomy

Dermatology

Internal Medicine

Orthopaedics

Pharmacology

Psychiatry