UPSC CMS Solution

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CMS Examination Question Paper-I

1. Which of the following is NOT correct?
(a) Hepatitis A does not lead to massive hepatic necrosis
(b) Hepatitis B vaccination is part of universal childhood vaccination
(c) Hepatitis C is commonest cause of transfusion transmitted hepatitis
(d) Hepatitis E carries very high mortality in pregnant women
2. Which of the following antihypertensive drugs is contraindicated in pregnancy?
(a) Hydralazine
(b) Amlodipine
(c) Labetalol
(d) Ramipril
3. Which of the following least predisposes to infective endocarditis?
(a) Ventricular septal defect
(b) Atrial septal defect
(c) Patent ductus arteriosus
(d) Tetralogy of Fallot4. A 60 year old male with Marfan’s syndrome comes to emergency department with
severe generalised tearing pain localised to chest anteriorly and inter scapular region,
sweating and weakness. On examination, his BP is 200/140 mm Hg. X ray chest
shows widening of superior mediastinum. ECG shows sinus tachycardia. What is the
most likely diagnosis?
(a) Acute pulmonary embolism
(b) Dissection of aorta
(c) Acute myocardial infraction
(d) Acute pericarditis
5. A patient who is allergic to penicillin can be prescribed which of the following drugs
for prophylaxis of acute rheumatic fever?
(a) Ciprofloxacin
(b) Erythromycin
(c) Cotrimoxazole
(d) Tetracycline
6. QT interval is prolonged in:
(a) Hypocalcaemia
(b) Hyperkalaemia
(c) Hypermagnesaemia
(d) Digoxin therapy
7. Differential cyanosis is seen in:
(a) Atrial septal defect with pulmonary arterial hypertension
(b) Ventricular septal defect with pulmonary arterial hypertension
(c) Patent ductus arteriosuswith pulmonary arterial hypertension
(d) Fallot tetralogy

8. Wilson’s disease is characterised by all EXCEPT:
(a) Increased urinary copper
(b) Increased hepatic copper
(c) Deposition of copper in Descemet’s membrane
(d) Increased serum ceruloplasmin
9. Following drugs are used for H.Pylori eradication EXCEPT:
(a) Amoxycillin
(b) Bismuth subsalicylate
(c) Tetracycline
(d) Cephalexin
10. A 45 year old female comes to you with dysphagia. She is found to have anaemia and
koilonychia. Most likely diagnosis is:
(a) Plummer Vinson syndrome
(b) Boerhaave syndrome
(c) Carcinoma oesophagus
(d) Reflux oesophagitis
11. Chest tube insertion should be considered in a patient with parapneumonic effusion
include the following EXCEPT:
(a) Loculated pleural effusion
(b) Positive Gram stain/culture of pleural fluid
(c) Pleural effusion is less than 10 mm thickness on decubitus
(d) Pleural fluid pH less than 7.20
12. A patient underwent hip replacement surgery. On fourth post-operative day, he had
dyspnoea, pleuritic pain and haemoptysis. Most likely diagnosis is:
(a) Pulmonary embolism
(b) Pneumonia
(c) Pulmonary oedema
(d) Pericarditis
13. A 55 year old male with a history of chronic obstructive pulmonary disease was
rushed to emergency department with increasing shortness of breath, fever and a
productive cough with yellow green sputum. He has difficulty in communicating
because of his inability to complete a sentence. Measurement of arterial blood gas
shows pH 7.3, PaCO2 68 mmHg, HCO3 28 mmol/L, and PaO2 60 mmHg. How would
you interpret this?
(a) Respiratory acidosis, uncompensated
(b) Respiratory alkalosis, uncompensated
(c) Respiratory acidosis, partially compensated
(d) Respiratory alkalosis, partially compensated
14. A 40 years old woman presents with hematuria, ecchymoses and menorrhagia of six
months duration. What is the most likely diagnosis?
(a) Haemophilia A
(b) Haemophilia B
(c) Idiopathic thrombocytopaenic purpura
(d) Henoch Schonlein purpura

15. Which of the following heavy metal poisoning strictly affects motor nerve ?
(a) Cadmium
(b) Mercury
(c) Lead
(d) Thallium
16. A patient develops skin necrosis 3 days after being started on warfarin for deep vein
thrombosis. What is the most likely cause?
(a) Antiphospholipid antibody syndrome
(b) Protein C deficiency
(c) Disseminated intravascular coagulation
(d) Thrombotic thrombocytopaenic purpura
17. A 15 year old boy is brought to emergency with two days history of headache,
vomiting and altered sensorium. His BP is 70 mmHg systolic and he has ecchymoses
on his skin. Most likely organism causing his condition is:
(a) Haemophilus influenzae
(b) Listeria monocytogenes
(c) Neisseria meningitidis
(d) Streptococcus pneumoniae
18. A child presents with episode of hematuria soon after respiratory tract infection. What
is the most likely diagnosis?
(a) IgA nephropathy
(b) Wegener granulomatosis
(c) Post streptococcal glomerulonephritis
(d) Churg Strauss syndrome
19. In microalbuminuria, 24 hours urinary albumin is:
(a) 8-10 mg
(b) 30-300 mg
(c) 300-3000 mg
(d) > 3000 mg
20. Following are complications of acute renal failure EXCEPT:
(a) Intravascular volume overload
(b) Hyponatraemia
(c) Hyperkalaemia
(d) Metabolic alkalosis
21. Deficiency of which vitamin causes subacute combined degeneration of spinal cord?
(a) Vitamin B1
(b) Vitamin B6
(c) Vitamin B2
(d) Vitamin B12

22. Obstructive lung function tests are seen in which of the following conditions?
(a) Obesity
(b) Kyphoscoliosis
(c) Pleural effusion
(d) Asthma
23. In which of the following conditions is there an increase in lung diffusion capacity?
(a) Emphysema
(b) Idiopathic pulmonary fibrosis
(c) Alveolar haemorrhage
(d) Pulmonary oedema
24. Which one of the following statements is correct?
(a) Omalizumab is an antileukotriene
(b) Omalizumab is a blocking antibody that neutralises circulating IgE
(c) Omalizumab is a newer long acting anticholinergic agent
(d) Omalizumab is once a day long acting beta-2 agonistic
25. Widespread concave ST segment elevation and PR depression in most leads except
aVR lead favours the diagnosis of:
(a) Acute myocardial infarction
(b) Pericarditis
(c) Digoxin toxicity
(d) Hypertrophic obstructive cardiomyopathy
26. A known case of lepromatous leprosy was initiated on treatment. She developed
painful erythmatous papules with fever and lymphadenopathy. What is the likely
reactional state?
(a) Type 1 lepra reaction
(b) Type 2 lepra reaction
(c) Lucio’s phenomenon
(d) Lupus pernio
27. Which of the following is not true regarding congestive cardiac failure in the elderly?
(a) Incidence rises with age
(b) Common causes include coronary artery disease and hypertension
(c) Diastolic dysfunction is often present
(d) Loop diuretics are usually well tolerated
28. Multidrug resistant tuberculosis is defined as:
(a) At least resistance to three or more antitubercular drugs
(b) At least resistance to Isoniazid, Streptomycin and Ethambutol
(c) At least resistance to Isoniazid and Rifampicin
(d) At least resistance to Streptomycin and Rifampicin

29. Aortic stenosis is associated with:
(a) Pulsus paradoxus
(b) Pulsus parvus et tardus
(c) Pulsus alternates bisferens
(d) Pulsus bigeminus
30. Which of the following is associated with hypercoagulable state?
1. Protein C deficiency
2. Antiphospholipid syndrome
3. Homocysteinemia
Select the correct answer using the code given below:
(a) 1 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
31. A 20 year old male walked into outpatient department with high grade fever, cough
and chest pain for one day. Chest X-ray showed consolidation of left upper zone. His
respiratory rate is 22/minute, pulse rate 96/minute, BP systolic 120 mmHg and blood
urea 18 mg/dl. What is his CURB score?
(a) 0
(b) 1
(c) 2
(d) 3
32. Which of the following conditions is an autosomal dominant disorder?
(a) G-6PD deficiency
(b) Sickel cell disease
(c) Fanconi anaemia
(d) Marfan syndrome
33. Consider the following statements regarding the treatment of bronchial asthma:
1. Tablets of β2 adrenoceptor agonist are better than aerosol therapy
2. Inhaled corticosteroids are contraindicated in acute severe asthma
3. Oral steroids may be necessary for severe acute asthma
4. Anticholinergic bronchodilators are muscarinic antagonists
5. Salmeterol and formoterol are highly selective and potent long acting β2
adrenoceptor agonists
Which of the statements given above are true?
(a) 1, 4 and 5 only
(b) 3, 4 and 5 only
(c) 1, 2 and 5 only
(d) 1, 2 and 3 only
34. Acute massive pulmonary embolism is manifested by the following EXCEPT:
(a) Reduced PaO2 and reduced PaCO2
(b) Pulmonary opacities in chest X ray
(c) SIQIIITIII with RBBB in ECG
(d) Reduced cardiac output and acute right heart failure

35. The side effects of isoniazid include the following EXCEPT:
(a) Hepatitis
(b) Rash
(c) Peripheral neuropathy
(d) Hyperuricaemia
36. A patient of COPD develops a large pneumothorax during a violent bout of coughing.
The most appropriate management would be:
1. Simple aspiration
2. Tube thoracostomy
3. Pleurodesis
Which of the above is/are correct?
(a) 1 and 2
(b) 2 and 3
(c) 1 and 3
(d) 2 only
37. Carbon dioxide tension (PaCO2) in arterial blood at sea level is:
(a) Less than 25 mm of Hg
(b) 25-35 mm of Hg
(c) 35-45 mm of Hg
(d) 45-55 mm of Hg
38. The volume of fresh air entering the alveoli each minute is called as:
(a) Dead space
(b) Diffusing capacity
(c) Alveolar ventilation
(d) Ventilation perfusion
39. Exacerbations of bronchial asthma that occur with little or no warning are called:
(a) Brittle asthma
(b) Acute severe asthma
(c) Poorly controlled asthma
(d) Nocturnal asthma
40. Which of the following constituents of antacid can cause constipation?
(a) Magnesium hydroxide
(b) Aluminium hydroxide
(c) Calcium carbonate
(d) Sodium bicarbonate
41. “TIPS” procedure in the treatment of cirrhosis liver stands for:
(a) Transvenous intrahepatic portal shunt
(b) Transvenous intraabdominal portal shunt
(c) Transjugular intrahepatic portosystemic shunt
(d) Transjugular intrahepatic peritoneal shunt

42. The drug of choice in the treatment of oesophageal candidiasis is:
(a) Fluconazole
(b) Nystatin oral suspension
(c) IV amphotericin
(d) Griseofulvin
43. Which of the following statements is NOT true regarding neuroleptic malignant
syndrome?
(a) Caused by haloperidol
(b) Characterized by muscle rigidity and hyperthermia
(c) There is stimulation of central dopamine receptors in hypothalamus
(d) Treated by IV dantrolene
44. Type IV renal tubular acidosis may be caused by all of the following EXCEPT:
(a) Low molecular weight heparin
(b) NSAIDS
(c) Penicillin
(d) Trimethoprim
45. Treatment options available for management of renal artery stenosis is/are:
(a) Medical treatment for hypertension by antihypertensive drugs
(b) Angioplasty, with or without stenting
(c) Renal artery bypass surgery
(d) All of these
46. A reversible cause of dementia is:
(a) Alzheimer disease
(b) Huntington chorea
(c) Parkinson disease
(d) Subdural haematoma
47. In Wallenberg syndrome, where is the site of lesion?
(a) Lateral medulla
(b) Medial medulla
(c) Pontomedullary junction
(d) Dorsal midbrain
48. The following are features of polycythaemia vera EXCEPT:
(a) Elevated red cell mass
(b) Normal arterial oxygen saturation
(c) Splenomegaly
(d) Elevated plasma erythropoietin levels
49. Which of the following conditions is associated with cigarette smoking?
(a) Non-specific interstitial pneumonia
(b) Acute interstitial pneumonia
(c) Cryptogenic organizing pneumonia
(d) Desquamative interstitial pneumonia

50. Which of the following is NOT true of Wilson disease?
(a) There is hepatolenticular degeneration
(b) Autosomal recessive transmission
(c) Serum ceruloplasmin is increased
(d) Urinary copper is increased