UPSC-CMS 2012 - Internal Medicine PYQs Practice Questions

Q: The commonest cause of primary hyper-parathyroidism is

Parathyroid adenoma. ***Parathyroid adenoma*** - **Parathyroid adenomas** account for approximately **85% of all cases** of primary hyperparathyroidism. [1] - This condition involves a **benign tumor** of one or more parathyroid glands that secretes excessive parathyroid hormone (PTH), leading to hypercalcemia. [1] *Idiopathic parathyroid hyperplasia* - **Idiopathic parathyroid hyperplasia** is responsible for about **10-15% of cases** of primary hyperparathyroidism, making it less common than adenomas. - In hyperplasia, **all four parathyroid glands** are typically enlarged and overactive, unlike the localized growth in an adenoma. *Familial hyperparathyroidism* - **Familial hyperparathyroidism** is a rare cause, accounting for **less than 1% of cases**, and is often associated with genetic syndromes like **MEN1** or **MEN2A**. - It involves inherited genetic mutations that predispose individuals to parathyroid gland overactivity, which distinguishes it from sporadic causes. *Primary parathyroid carcinoma* - **Primary parathyroid carcinoma** is an **extremely rare malignancy**, accounting for **less than 1%** of all primary hyperparathyroidism cases. - While it causes severe hypercalcemia, its rarity means it is not the commonest cause. [Practice more Internal Medicine PYQs on OnCourse]

Q: In a 30-year-old male smoker, the commonest cause of dry gangrene of foot will be

Buerger's disease. Buerger's disease - **Buerger's disease** (**thromboangiitis obliterans**) is strongly associated with **heavy smoking** and typically affects young to middle-aged adult males, leading to dry gangrene in the extremities. - It involves **inflammation and thrombosis** of small and medium-sized arteries and veins, predominantly in the limbs, often manifesting as **ischemic pain**, ulcerations, and gangrene. *Diabetes mellitus* - While **diabetes** can cause dry gangrene due to **peripheral artery disease** and small vessel disease, it is more commonly associated with **wet gangrene** due to increased infection risk, and the age and smoking history point away from it being the *commonest* cause in this specific demographic for dry gangrene [1]. - Diabetic neuropathy can also mask symptoms, leading to delayed presentation and worsening tissue damage [1]. *Embolism* - An **embolic event** would typically present with **sudden onset** severe pain, pallor, pulselessness, paresthesia, and paralysis (the "6 Ps"), leading to acute limb ischemia rather than the progressive dry gangrene described implied in the question. - While it can cause tissue necrosis, it's usually an acute event rather than a chronic process leading to gradual gangrene. *Atherosclerosis* - While **atherosclerosis** is a significant cause of peripheral artery disease and gangrene, especially in smokers, it typically affects an **older population** than the 30-year-old male described [2]. - In younger smokers with gangrene, **Buerger's disease** is a more specific and common diagnosis, as atherosclerosis tends to manifest later in life unless other significant risk factors are present [2]. [Practice more Internal Medicine PYQs on OnCourse]

Q: The Ranson prognostic criteria used at the time of admission in acute pancreatitis include all of the following except

Serum calcium 200 mg/100 mL** is one of the five Ranson criteria assessed at the time of admission. - High glucose indicates significant physiological stress and typically a more severe illness. *WBC count more than 16,000/mm3* - An elevated **white blood cell count > 16,000/mm3** is one of the Ranson criteria assessed at admission. - This indicates a significant inflammatory response, suggesting severe pancreatitis. *Age more than 55 years* - **Age > 55 years** is one of the Ranson criteria assessed at the time of admission [1]. - Older age is a recognized risk factor for more severe outcomes in acute pancreatitis [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: The most common opportunistic infection observed in patients with AIDS is

Pneumocystis carinii. ***Pneumocystis carinii*** - **Pneumocystis pneumonia (PCP)**, caused by *Pneumocystis jirovecii* (formerly *P. carinii*), is the **most common opportunistic infection** and a leading cause of death in AIDS patients [1]. - It typically presents with **fever, cough, and dyspnea** in patients with a CD4 count below 200 cells/µL [1]. *Pseudomonas aeruginosa* - While *Pseudomonas aeruginosa* can cause serious infections in immunocompromised individuals, it is not the **most common opportunistic infection** seen in patients with AIDS. - Infections usually involve the **lungs (pneumonia)**, skin, urinary tract, or bacteremia, often in patients with **neutropenia** or hospitalized for other reasons. *Atypical mycobacteria* - **Mycobacterium avium complex (MAC)** is an important opportunistic pathogen in AIDS patients (CD4 < 50 cells/µL), causing disseminated disease, but it is not the **most common** overall [2]. - Symptoms include **fever, weight loss, night sweats, and diarrhea**, and diagnosis requires blood cultures or tissue biopsy [2]. *Haemophilus influenzae* - *Haemophilus influenzae* can cause **respiratory tract infections** (e.g., sinusitis, bronchitis, pneumonia) and invasive disease, particularly in children and individuals with underlying lung disease. - While patients with HIV may be more susceptible to bacterial infections, *H. influenzae* is **not classified as a classic opportunistic infection** in the same way as *Pneumocystis* or MAC in AIDS patients. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following conditions may produce "wrist drop" ?

Lead poisoning. ***Lead poisoning*** - **Lead neuropathy** predominantly affects motor nerves, often leading to **wrist drop** and **foot drop** due to involvement of the radial and peroneal nerves, respectively [1]. - The toxic effects of lead interfere with heme synthesis and neuronal function, leading to **demyelination** and axonal degeneration [1]. *Alcoholics* - **Alcoholic neuropathy** typically affects peripheral nerves, causing sensory and motor deficits, often as a **stocking-glove distribution** [3]. - While it can manifest as weakness, classic "wrist drop" is not a hallmark feature; rather, it often involves generalized weakness and sensory loss. *Beriberi* - **Beriberi** is caused by **thiamine (vitamin B1) deficiency** and presents in two main forms: wet (cardiovascular) and dry (neurological). - Dry beriberi causes **peripheral neuropathy** with symmetrical motor and sensory impairment, but **wrist drop** is not a characteristic isolated sign. *Diabetes mellitus* - **Diabetic neuropathy** commonly leads to a **stocking-glove sensory loss** and - Can cause motor weakness, but isolated **wrist drop** [2] is not a typical presentation; rather, it's often polyneuropathy or mononeuropathy multiplex [3]. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

The commonest cause of primary hyper-parathyroidism is

Accepted Answer

Parathyroid adenoma

Answer

Idiopathic parathyroid hyperplasia

Answer

Familial hyperparathyroidism

Answer

Primary parathyroid carcinoma

Question 2

In a 30-year-old male smoker, the commonest cause of dry gangrene of foot will be

Accepted Answer

Buerger's disease

Answer

Diabetes mellitus

Answer

Embolism

Answer

Atherosclerosis

Question 3

The Ranson prognostic criteria used at the time of admission in acute pancreatitis include all of the following except

Accepted Answer

Serum calcium < 2.0 mmol/L

Answer

Blood glucose more than 200 mg/100 mL

Answer

WBC count more than 16,000/mm3

Answer

Age more than 55 years

Question 4

The most common opportunistic infection observed in patients with AIDS is

Accepted Answer

Pneumocystis carinii

Answer

Pseudomonas aeruginosa

Answer

Atypical mycobacteria

Answer

Haemophilus influenzae

Question 5

Which of the following conditions may produce "wrist drop" ?

Accepted Answer

Lead poisoning

Answer

Alcoholics

Answer

Beriberi

Answer

Diabetes mellitus

Question 6

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

Accepted Answer

A→3  B→1  C→2  D→4

Answer

A→3  B→2  C→1  D→4

Answer

A→1  B→4  C→2  D→3

Answer

A→4  B→2  C→1  D→3

Question 7

Which of the following is a non-modifiable risk factor for coronary heart disease ?

Accepted Answer

Age

Answer

Elevated serum cholesterol

Answer

Alcoholism

Answer

Cigarette smoking

UPSC-CMS 2012 — Internal Medicine