UPSC Combined Medical Services Solved Papers

A 35-year-old man presented with serial blood pressure recordings of above 140/90 mmHg. Which one of the following signs is not a clue for an underlying cause of hypertension (secondary hypertension)?

A 71-year-old male presents with headache, dizziness, nausea with palpitations. The patient is already on treatment for diabetes and hypertension. The blood pressure reading is 220/140 mmHg. Which of the following statements is/are correct?

1. This is a case of hypertensive emergency which can be managed by intravenous sodium nitroprusside.
2. An immediate normalization of the blood pressure should be the target.
3. Secondary causes of hypertension like renovascular disease are uncommon in patients with hypertensive emergency.

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Match List I with List II and select the correct answer using the code given below the lists:

Consider the following statements regarding Takotsubo cardiomyopathy:

1. There is acute right ventricular dysfunction characterized by dilatation of the right ventricular apex.
2. It can be precipitated by acute emotional stress and is frequently associated with an underlying neuro-psychiatric disorder.
3. Symptoms and ECG findings often mimic acute ST-elevation myocardial infarction.
4. Ventriculography shows normal left ventricle and apical ballooning of the right ventricle.

Which of the statements given above are correct?

With regard to Hypertrophic Cardiomyopathy, match List I with List II and select the correct answer using the code given below the lists:

'Tumour Plop' is a characteristic auscultatory finding seen in which one of the following conditions?

Retinal ischaemia, flame-shaped haemorrhages and cotton-wool exudates are fundoscopy findings in which of the following grades of hypertensive retinopathy?

1. Grade 1
2. Grade 2
3. Grade 3
4. Grade 4

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Aschoff Nodules are a pathognomonic cardiac finding in which one of the following conditions?

Consider the following statements regarding Eisenmenger Syndrome:

1. In patients with severe and prolonged pulmonary hypertension, the right-to-left shunt gets reversed to a left-to-right shunt.
2. There is marked cyanosis, which may be more apparent in the feet and toes than in the upper part of the body.
3. Antihypertensives which cause peripheral vasodilatation can exacerbate the shunting and worsen the symptoms.

Which of the statements given above is/are correct?

Consider the following statements regarding the murmur of Patent Ductus Arteriosus:

1. It is a continuous 'machinery' murmur.
2. There is a late diastolic accentuation.
3. It is maximal in the second left intercostal space below the clavicle.
4. With the development of Eisenmenger Syndrome, the murmur becomes louder and rumbling in character.

Which of the statements given above is/are correct?

A patient presented with pain on the left side of the chest. On examination, there was dullness on percussion on left infra-axillary area. X-ray Chest showed left opaque hemithorax. Which one of the following is an indication for tube thoracentesis in this case?

A patient with a history of smoking presents to the emergency with a complaint of breathlessness for the last two days. On examination, he was found to be cyanosed and had bilateral rhonchi. ABG was done, which shows:

pH : 7.12
PaCO₂ : 80 mmHg
PaO₂ : 46 mmHg
HCO₃⁻ : 29 mEq/L

Based on the history, clinical examination and ABG finding, the most likely diagnosis is:

A patient with a history of chronic smoking presented with breathlessness for the last one year. On examination, there were bilateral rhonchi in the chest. The Chest X-ray was suggestive of hyper-inflated lung field. Which of the following parameters of the pulmonary function test are consistent with the diagnosis of chronic obstructive pulmonary disease in this case?

1. Decreased FEV₁
2. Increased diffusion capacity
3. Increased residual volume
4. Decreased peak expiratory flow rate

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Omalizumab is helpful in which of the following diseases?

1. Asthma
2. Idiopathic pulmonary fibrosis
3. Nasal polyposis

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A 50-year-old male working in a stone industry presents with breathlessness and cough. CT Chest shows calcified mediastinal lymph nodes and pulmonary nodules. He is diagnosed with silicosis. Which of the following statements are correct?

1. Silicosis typically involves lower lobes of the lung.
2. The patient is at a higher risk of developing pulmonary tuberculosis.
3. Pulmonary fibrosis after occupational exposure to silica is dose-dependent.

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A 70-year-old male, with a history of smoking presents with progressive dyspnea and dry cough. Examination reveals clubbing and fine basal crackles. Spirometry shows low forced vital capacity (FVC) and low diffusion capacity (DLCO). CT Chest shows extensive bilateral reticular shadows and subpleural honeycombing. What is the most likely diagnosis?

A 40-year-old obese bank accountant presents with complaints of excessive daytime sleepiness and fatigue. His spouse reports that he has loud snoring and early morning tiredness. Which of the following statements is/are correct?

1. The patient is most likely suffering from obstructive sleep apnea.
2. The diagnosis requires CT/MRI of the neck.
3. Treatment of choice is Zolpidem.

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A 34-year-old medical student has fever, chest pain, severe breathlessness, and dry cough. Chest X-ray shows right homogeneous opacity. Ultrasound lung confirms massive pleural effusion on the right side. Which of the following statements are correct?

1. A therapeutic pleural tap should be done to relieve dyspnoea and sent for analysis.
2. If pleural fluid analysis is inconclusive, a thoracoscopy may be done.
3. Thoracoscopy should be done under general anesthesia.

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A 42-year-old male with chronic kidney disease undergoing chronic dialysis presents with worsening breathlessness. Examination reveals muffled heart sounds. Chest X-ray image is shown below. What is the most likely diagnosis of this patient?

A 22-year-old male presents with left-sided chest pain and breathlessness after a road traffic accident. Examination reveals absent left-sided breath sounds. CT Chest image is shown below. What is the diagnosis of this patient?

Infiltration of the small-intestine mucosa with 'foamy' macrophages, which stain positive with Periodic Acid-Schiff (PAS) reagent, is a characteristic feature of which one of the following conditions?

Which one of the following is not a risk factor for the acquisition of chronic hepatitis C?

Which one of the following is a predictor of liver fibrosis?

A 30-year-old female with irritable bowel syndrome presents with predominant symptom of diarrhea. Which of the following will be helpful in her treatment?

1. Loperamide
2. Lactulose
3. Lubiprostone
4. Sorbitol

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'Melanosis coli' (brownish discoloration of colonic mucosa) can occur due to the long-term consumption of which one of the following?