UPSC-CMS 2009
107 Previous Year Questions with Answers & Explanations
Anatomy
1 questionsIn a patient of carcinoma tongue, the infiltration of which muscle causes ankyloglossia ?
UPSC-CMS 2009 - Anatomy UPSC-CMS Practice Questions and MCQs
Question 1: In a patient of carcinoma tongue, the infiltration of which muscle causes ankyloglossia ?
- A. Palatoglossus muscle
- B. Genioglossus muscle (Correct Answer)
- C. Styloglossus muscle
- D. Mylohyoid muscle
Explanation: ***Genioglossus muscle*** - Infiltration of the **genioglossus muscle** by carcinoma of the tongue restricts tongue protrusion and movement, functionally mimicking **ankyloglossia** [1]. - The genioglossus is the **primary protrusor** of the tongue, originating from the mental spine of the mandible and inserting into the entire length of the tongue. - When infiltrated by tumor, it causes **inability to protrude the tongue** beyond the lower incisor teeth and deviation toward the affected side [1]. - Though true ankyloglossia is a congenital condition involving the lingual frenulum, this term is used clinically to describe **acquired restriction of tongue mobility**. *Palatoglossus muscle* - The palatoglossus muscle primarily **elevates the posterior tongue** and assists in closing the oropharyngeal isthmus. - Its infiltration would affect **swallowing and palatine arch function** rather than tongue protrusion. - Not the primary cause of restricted tongue protrusion seen in this clinical scenario. *Styloglossus muscle* - The styloglossus muscle **retracts and elevates the sides of the tongue**. - Its involvement would impair retraction and lateral movements but would **not restrict protrusion**, which is the hallmark of ankyloglossia. *Mylohyoid muscle* - The mylohyoid forms the **muscular floor of the mouth** and elevates the hyoid bone and tongue during swallowing. - It is not an intrinsic tongue muscle; infiltration would cause **floor of mouth issues** and dysphagia rather than specific restriction of tongue protrusion.
Internal Medicine
4 questionsFollowing the immunotherapy, in patients undergoing renal transplantation, the skin cancer most commonly seen is
Which one of the following is not a correct statement regarding Raynaud's disease ?
What is the best and most sensitive investigation for hypothyroidism ?
Which one of the following is not a common feature of bile duct stone ?
UPSC-CMS 2009 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 1: Following the immunotherapy, in patients undergoing renal transplantation, the skin cancer most commonly seen is
- A. Non-melanoma skin cancers (Squamous cell carcinoma and Basal cell carcinoma) (Correct Answer)
- B. Hepatomas
- C. Kaposi's sarcoma
- D. Mycosis fungoides
Explanation: ***Non-melanoma skin cancers (Squamous cell carcinoma and Basal cell carcinoma)*** - **Immunosuppression** following renal transplantation significantly increases the risk of skin cancers, with non-melanoma types like **squamous cell carcinoma (SCC)** and **basal cell carcinoma (BCC)** being the most common [1]. - This increased risk is due to the impaired immune surveillance against oncogenic viruses (e.g., HPV) and DNA damage from UV radiation [2]. *Hepatomas* - While patients with chronic liver disease are at risk for hepatocellular carcinoma (hepatomas), they are **not the most common cancer** specifically associated with immunosuppression after renal transplantation. - The primary risk factors for hepatomas are chronic **hepatitis B** or **C infection**, alcohol abuse, and **cirrhosis**, not directly the immunosuppressive regimen itself. *Kaposi's sarcoma* - **Kaposi's sarcoma (KS)** is associated with **human herpesvirus 8 (HHV-8)** infection and is more prevalent in immunosuppressed individuals, especially those with AIDS or solid organ transplant recipients [2]. - Although its incidence is increased, it is still **less common** than non-melanoma skin cancers in this patient population. *Mycosis fungoides* - **Mycosis fungoides** is a type of **cutaneous T-cell lymphoma**, characterized by malignant T-lymphocytes infiltrating the skin. - It is a **rare cancer** and is not typically considered the most common skin cancer to occur in transplant recipients undergoing immunotherapy.
Question 2: Which one of the following is not a correct statement regarding Raynaud's disease ?
- A. It commonly affects women
- B. Exposure to cold precipitates vasoconstriction
- C. It is idiopathic
- D. The lower extremity involvement is symmetrical (Correct Answer)
Explanation: ***The lower extremity involvement is symmetrical*** - **Raynaud's phenomenon** primarily affects the **fingers and toes**, but it is characterized by **asymmetrical involvement**, affecting different digits or limbs to varying degrees. Symmetrical involvement of the lower extremities is not a typical characteristic. - While it can affect the lower extremities, the hallmark of Raynaud's is its **episodic, asymmetrical, and often acral distribution** in response to triggers. *It commonly affects women* - **Raynaud's phenomenon** is indeed more prevalent in **women** than men, with an estimated prevalence of 5-10% in the general population. - This higher incidence in women is a well-documented epidemiological feature of the condition. *Exposure to cold precipitates vasoconstriction* - **Cold exposure** is the most common and classic trigger for **Raynaud's phenomenon**, leading to an exaggerated **vasoconstrictive response** in the small arteries and arterioles of the extremities. - This extreme vasoconstriction results in the characteristic color changes (pallor, cyanosis, and rubor) due to reduced blood flow. *It is idiopathic* - **Raynaud's disease**, also known as **primary Raynaud's phenomenon**, is indeed considered **idiopathic**, meaning its cause is unknown. - It occurs in the absence of any underlying medical condition, distinguishing it from secondary Raynaud's phenomenon, which is associated with autoimmune diseases or other factors.
Question 3: What is the best and most sensitive investigation for hypothyroidism ?
- A. T3, T4 levels
- B. TRH levels
- C. Radioactive I2 uptake
- D. TSH levels (Correct Answer)
Explanation: TSH levels - **Thyroid-Stimulating Hormone (TSH)** is the most sensitive and specific test for diagnosing **primary hypothyroidism** because even slight decreases in thyroid hormone levels cause significant increases in TSH [1]. - TSH is released from the **pituitary gland** and acts as a direct feedback mechanism to regulate thyroid hormone production [1]. A high TSH level indicates that the thyroid gland is not producing enough hormones. *T3, T4 levels* - While **T3 (triiodothyronine)** and **T4 (thyroxine)** levels are direct measures of thyroid hormones, their values may remain within the normal range in early or subclinical hypothyroidism [1]. - They are less sensitive than TSH for initial screening and often become abnormal only after hypothyroidism is well-established [1]. *TRH levels* - **Thyrotropin-Releasing Hormone (TRH)** is produced by the hypothalamus and stimulates TSH release from the pituitary [1]. - Measuring TRH levels is generally not used as a primary diagnostic test for hypothyroidism due to its complexity and lack of direct clinical utility in routine screening. *Radioactive I2 uptake* - **Radioactive iodine uptake (RAIU)** measures the thyroid gland's ability to take up iodine, which is used to produce thyroid hormones. - It is primarily used to differentiate causes of hyperthyroidism (e.g., Graves' disease vs. thyroiditis), not as a diagnostic test for hypothyroidism [1].
Question 4: Which one of the following is not a common feature of bile duct stone ?
- A. Clay colored stools
- B. Distended gall bladder (Correct Answer)
- C. Itching
- D. Obstructive jaundice
Explanation: ***Distended gall bladder*** - A distended gallbladder is **less common** when the obstruction is caused by a stone in the **common bile duct (CBD)** because the gallbladder can often decompress through the cystic duct if it is patent. [1] - Furthermore, **Mirizzi syndrome**, which can cause gallbladder distension due to an impacted stone in the cystic duct compressing the CBD, is a specific and less frequent scenario than simple choledocholithiasis. [2] *Clay colored stools* - **Clay-colored stools** (acholic stools) are a common feature of bile duct obstruction as it prevents bilirubin from reaching the intestines to be converted into **stercobilin**, which gives stool its normal brown color. - The absence of bilirubin in the gut results in stools appearing pale or gray. *Itching* - **Pruritus (itching)** is a very common symptom of bile duct obstruction due to the systemic accumulation of **bile salts** and other pruritic substances that are normally excreted in bile. [3] - These substances deposit in the skin, irritating nerve endings. *Obstructive jaundice* - **Obstructive jaundice** is a hallmark feature of bile duct stones. The obstruction prevents the flow of conjugated bilirubin into the intestine, leading to its reabsorption into the bloodstream. [1] - This results in elevated **conjugated bilirubin** and **icterus**, causing yellow discoloration of the skin and sclera.
Pathology
1 questionsIn a patient with breast cancer, the following are poor prognostic factors except
UPSC-CMS 2009 - Pathology UPSC-CMS Practice Questions and MCQs
Question 1: In a patient with breast cancer, the following are poor prognostic factors except
- A. Aneuploid status
- B. Age less than 35 years
- C. High grade
- D. Absence of epidermal growth factor receptor (Correct Answer)
Explanation: ***Absence of epidermal growth factor receptor*** - The **absence of epidermal growth factor receptor (EGFR/HER1) overexpression** is associated with a **better prognosis** in breast cancer. - **EGFR overexpression** is more commonly seen in aggressive breast cancers, particularly **triple-negative breast cancers** (ER-negative, PR-negative, HER2-negative), and is associated with poor outcomes [2]. - When EGFR is absent or not overexpressed, the tumor tends to have less aggressive biological behavior. *Aneuploid status* - **Aneuploid status** (abnormal chromosome number) is a well-recognized **poor prognostic factor** in breast cancer, indicating genetic instability and aggressive tumor behavior [2]. - It is associated with **increased risk of recurrence** and poorer response to therapy. *Age less than 35 years* - **Younger age** (less than 35 years) at diagnosis is a **poor prognostic factor** for breast cancer. - This is often due to more aggressive tumor biology, **higher grade tumors**, hormone receptor negativity, and delayed diagnosis in younger women. *High grade* - A **high histological grade** (Grade III) indicates a more aggressive tumor with rapid cell division, marked nuclear pleomorphism, and poor differentiation, signifying a **poor prognosis** [1]. - High-grade tumors are more likely to metastasize and have higher recurrence rates. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 458-459. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066.
Surgery
4 questionsWhich of the following is a scoring system for severity of wound infection, and is particularly useful for surveillance and research ?
Which one of the following statements is correct in case of squamous cell carcinoma of the lip?
Which one of the following is not a correct statement with reference to locally advanced carcinoma breast ?
Consider the following statements regarding splenectomy : 1. It corrects anemia in congenital hereditary spherocytosis. 2. Postponed until the age of 4 years if possible. 3. Polyvalent pneumococcal vaccine to be administered to all before the surgery. Which of the statements given above are correct ?
UPSC-CMS 2009 - Surgery UPSC-CMS Practice Questions and MCQs
Question 1: Which of the following is a scoring system for severity of wound infection, and is particularly useful for surveillance and research ?
- A. Southampton grading system (Correct Answer)
- B. Apgar score
- C. Glasgow scoring system
- D. ASA classification
Explanation: ***Southampton grading system*** - The **Southampton grading system** is specifically designed for the **severity of wound infection**, offering a clear framework for classification based on clinical signs. - Its utility in **surveillance and research** stems from its structured and reproducible assessment, allowing for consistent data collection on wound healing and infection rates. *Apgar score* - The **Apgar score** is a rapid assessment of a **newborn's health** immediately after birth, evaluating heart rate, respiratory effort, muscle tone, reflex irritability, and color. - It is not used for assessing wound infection severity. *Glasgow scoring system* - The **Glasgow Coma Scale (GCS)** is used to assess the **level of consciousness** in a person following a brain injury, comprising eye opening, verbal, and motor responses. - It is not relevant to wound infection assessment. *ASA classification* - The **American Society of Anesthesiologists (ASA) Physical Status Classification System** is used to assess a patient's **overall health before surgery**, providing an indication of anesthetic risk. - It is not used for evaluating wound infection.
Question 2: Which one of the following statements is correct in case of squamous cell carcinoma of the lip?
- A. Lymph node metastases occur early
- B. Radiotherapy is considered inappropriate treatment for these lesions
- C. More than 90 per cent of cases occur on the upper lip
- D. Lesion often arises in the areas of persistent hyperkeratosis (Correct Answer)
Explanation: ***Lesion often arises in the areas of persistent hyperkeratosis*** - **Squamous cell carcinoma (SCC) of the lip** frequently originates from areas of **actinic cheilitis**, which presents as persistent hyperkeratosis due to chronic sun exposure. - This chronic irritation and dysplasia in hyperkeratotic lesions are known **precursor conditions** for SCC. *Lymph node metastases occur early* - While metastasis can occur in SCC of the lip, it typically does not occur **early**; the primary concern is **local invasion** before regional nodal involvement becomes significant. - The rate of **lymph node metastasis** is generally lower for SCC of the lip compared to other intraoral cancers and often occurs later in the disease course. *Radiotherapy is considered inappropriate treatment for these lesions* - **Radiotherapy** is a highly effective treatment for SCC of the lip, particularly for **small lesions** and in patients who are not surgical candidates, or as an adjuvant therapy. - It can achieve high cure rates with good cosmetic outcomes, making it a perfectly **appropriate treatment option**. *More than 90 per cent of cases occur on the upper lip* - The vast majority of **squamous cell carcinomas of the lip** (over 90%) occur on the **lower lip**, which is much more exposed to **solar radiation**. - The **upper lip** is less commonly affected due to its lesser exposure to chronic sun damage.
Question 3: Which one of the following is not a correct statement with reference to locally advanced carcinoma breast ?
- A. Patients are staged as T3 or T4 with any N, without distant metastasis (M0)
- B. It constitutes the bulk of patients of carcinoma breast in India
- C. Neoadjuvant chemotherapy downgrades the disease
- D. Radical Mastectomy is the treatment of choice (Correct Answer)
Explanation: *Patients are staged as T3 or T4 with any N, without distant metastasis (M0)* - **Locally advanced breast cancer (LABC)** is correctly defined as tumors that are **T3 or T4** or involve regional lymph nodes (**any N**) without distant metastasis (**M0**). - This statement is **correct** regarding LABC staging criteria. *It constitutes the bulk of patients of carcinoma breast in India* - This statement is **correct**. In India, approximately **50-60% of breast cancer patients present with locally advanced disease** at the time of diagnosis. - This is in stark contrast to Western countries where LABC represents less than 10% of cases. - The high prevalence is attributed to lack of screening programs, delayed presentation, limited awareness, and socioeconomic factors. *Neoadjuvant chemotherapy downgrades the disease* - This statement is **correct**. **Neoadjuvant chemotherapy (NACT)** is a cornerstone of LABC management. - NACT aims to **downstage** the tumor, making it more amenable to surgical resection and increasing the feasibility of breast-conserving surgery. - It also provides early treatment of micrometastases and serves as an in vivo test of tumor chemosensitivity. ***Radical Mastectomy is the treatment of choice*** - This statement is **INCORRECT** and is the correct answer to this negation question. - **Radical mastectomy (Halsted mastectomy)** involving removal of breast, pectoral muscles, and axillary nodes is **no longer the standard treatment** for LABC. - Modern treatment involves a **multimodal approach**: neoadjuvant chemotherapy followed by **modified radical mastectomy (MRM)** or breast-conserving surgery with radiation therapy. - MRM preserves the pectoral muscles, providing better functional and cosmetic outcomes while maintaining oncological safety.
Question 4: Consider the following statements regarding splenectomy : 1. It corrects anemia in congenital hereditary spherocytosis. 2. Postponed until the age of 4 years if possible. 3. Polyvalent pneumococcal vaccine to be administered to all before the surgery. Which of the statements given above are correct ?
- A. 1, 2 and 3 (Correct Answer)
- B. 1 and 3 only
- C. 2 and 3 only
- D. 1 and 2 only
Explanation: ***1, 2 and 3*** - **Splenectomy** is a definitive treatment for **hereditary spherocytosis**, as it removes the primary site of red blood cell destruction, thereby correcting the **anemia**. - Delaying splenectomy until after **4 years of age** reduces the risk of **overwhelming post-splenectomy infection (OPSI)**, allowing the child's immune system to mature. *Note: This reflects 2009 guidelines when this question was set. Current guidelines recommend postponing splenectomy until 5-6 years or even older (6-9 years) to further minimize OPSI risk.* - **Vaccination** against encapsulated bacteria like **Streptococcus pneumoniae** (using a polyvalent vaccine) is crucial before splenectomy to prevent severe infections, as the spleen plays a vital role in clearing these pathogens. *1 and 3 only* - This option is incorrect because it omits the important recommendation to **postpone splenectomy** until the child is older, which is a key part of managing hereditary spherocytosis in children. *2 and 3 only* - This option is incorrect because it fails to acknowledge that **splenectomy effectively corrects the anemia** in congenital hereditary spherocytosis by eliminating the site of premature red blood cell destruction, which is a primary indication for the procedure. *1 and 2 only* - This option is incorrect because it overlooks the critical need for **vaccination** against encapsulated bacteria **before splenectomy** to protect against life-threatening infections, a standard and essential practice.
About UPSC-CMS 2009 Questions
This page contains 107 questions from the UPSC-CMS 2009 paper, organised across 14 subjects for focused practice. Every question comes with the correct answer and a detailed explanation to help you understand the underlying concept. Subject-wise organisation lets you target specific areas and identify which topics carried the most weight in this particular year.
Practising year-wise papers is essential for understanding how the UPSC-CMS exam evolves — you can spot trending topics, gauge difficulty shifts, and benchmark your readiness against a real paper. To take your preparation further, download the Oncourse app for AI-driven performance insights, spaced repetition of questions you got wrong, and a personalised study plan built around your UPSC-CMS goals.