UPSC-CMS 2014 - Internal Medicine PYQs Practice Questions

Q: Consider the following statements: The clinical features of tension pneumothorax include 1. tracheal shift to contralateral side 2. absent breath sounds on the affected side 3. low output circulatory failure 4. peripheral cyanosis Which of the statements given above is/are correct?

1, 2 and 3. ***1, 2 and 3*** - **Tracheal deviation to the contralateral side** is a hallmark sign of tension pneumothorax [1], caused by the increasing pressure in the affected hemithorax pushing mediastinal structures away. - **Absent breath sounds on the affected side** result from the complete collapse of the lung and inability of air to enter the pleural space with inspiration [1]. **Low output circulatory failure** occurs due to increased intrathoracic pressure compressing the heart and great vessels, impairing venous return and cardiac output [2]. *1 and 3 only* - While **tracheal shift to the contralateral side** and **low output circulatory failure** [2] are indeed features, this option incorrectly excludes **absent breath sounds on the affected side**, which is a critical clinical finding in tension pneumothorax. - The absence of breath sounds directly reflects the collapsed lung, a primary mechanical consequence of the condition. *2 and 4* - **Absent breath sounds on the affected side** is correct, but **peripheral cyanosis** is not a *primary* or *early* distinguishing feature of tension pneumothorax. While hypoxemia can lead to cyanosis, it's often a late and less specific sign. - This option misses the crucial finding of **tracheal deviation** and the systemic impact of **circulatory failure** [2], which are more direct indicators of the severity and mechanism of tension pneumothorax. *1 and 4* - **Tracheal shift to the contralateral side** is a correct feature. However, **peripheral cyanosis** is a less specific and often later sign compared to the direct mechanical and circulatory effects. - This option incorrectly omits **absent breath sounds on the affected side** and **low output circulatory failure**, both of which are more consistently present and diagnostically important in tension pneumothorax. [Practice more Internal Medicine PYQs on OnCourse]

Q: The following are features of hypovolemic shock except:

Bradycardia. ***Bradycardia*** - Hypovolemic shock typically causes **tachycardia** (increased heart rate) as a compensatory mechanism to maintain cardiac output in the face of reduced blood volume [1]. - **Bradycardia** is generally not a feature of hypovolemic shock unless there are confounding factors or severe terminal stages. *Acidosis* - **Lactic acidosis** is a common feature of hypovolemic shock due to tissue hypoperfusion causing anaerobic metabolism [2]. - Reduced blood flow leads to inadequate oxygen delivery, forcing cells to produce lactic acid. *Oliguria* - **Oliguria** (decreased urine output) occurs in hypovolemic shock as the kidneys attempt to conserve fluid due to reduced renal perfusion. - The body prioritizes blood flow to vital organs, leading to decreased kidney function and urine production. *Low Blood Pressure* - **Hypotension** (low blood pressure) is a hallmark of shock, including hypovolemic shock, resulting from a significant reduction in circulating blood volume [1]. - The decrease in blood volume directly reduces venous return, stroke volume, and ultimately, systemic blood pressure. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 45 year old man sustains trauma in a road traffic accident and develops engorgement of neck veins, pallor, rapid pulse rate, and chest pain. What is the most likely diagnosis?

Cardiac tamponade. ***Cardiac tamponade*** - The classic triad of **Beck's triad** (engorged neck veins, muffled heart sounds, and hypotension) along with **tachycardia** and **pallor** in a trauma setting is highly indicative of cardiac tamponade [1]. - **Chest pain** due to pressure on the heart and surrounding structures further supports this diagnosis. *Haemothorax* - While blunt trauma can cause **haemothorax**, it typically presents with **diminished or absent breath sounds** on the affected side and **respiratory distress**, not prominently with engorged neck veins unless it's very large and significantly compromises venous return. - The primary sign would be **hypotension** and **tachycardia** from hypovolemia, but without the JVD. *Pulmonary laceration* - A pulmonary laceration would primarily cause **pneumothorax** or **haemothorax**, leading to signs like **dyspnea**, **chest pain**, and potentially **subcutaneous emphysema**. - **Engorged neck veins** are not a primary feature unless the resulting pneumothorax is tension type, which would also present with tracheal deviation. *Rupture of spleen* - A ruptured spleen causes **internal bleeding** (hypovolemic shock) presenting as **abdominal pain**, **left upper quadrant tenderness**, **tachycardia**, and **hypotension**. - **Engorged neck veins** are not a characteristic symptom of splenic rupture because it is a source of blood loss leading to hypovolemia. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Which is the most commonly used chemotherapy regimen in the adjuvant treatment following modified radical mastectomy in the estrogen receptor negative 35 year old female with breast cancer?

Accepted Answer

Cyclophosphamide + Adriamycin + 5-Fluorouracil

Answer

Adriamycin + 5-Fluorouracil

Answer

Cyclophosphamide + 5-Fluorouracil

Answer

Cyclophosphamide + Methotrexate + 5-Fluorouracil

Question 2

Consider the following statements: The clinical features of tension pneumothorax include

1. tracheal shift to contralateral side 
2. absent breath sounds on the affected side 
3. low output circulatory failure 
4. peripheral cyanosis Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 4

Answer

1 and 4

Question 3

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

Accepted Answer

A→1  B→3  C→2  D→4

Answer

A→1  B→2  C→3  D→4

Answer

A→3  B→2  C→4  D→1

Answer

A→4  B→3  C→2  D→1

Question 4

The following are features of hypovolemic shock except:

Accepted Answer

Bradycardia

Answer

Acidosis

Answer

Oliguria

Answer

Low Blood Pressure

Question 5

A 45 year old man sustains trauma in a road traffic accident and develops engorgement of neck veins, pallor, rapid pulse rate, and chest pain. What is the most likely diagnosis?

Accepted Answer

Cardiac tamponade

Answer

Haemothorax

Answer

Pulmonary laceration

Answer

Rupture of spleen

Question 6

Which one of the following statements is not correct regarding trichobezoar ( hair balls)?

Accepted Answer

It is usually associated with pyloric stenosis.

Answer

It is associated usually with psychiatric illness.

Answer

It is more common in females.

Answer

It is more common in young.

Question 7

Which one of the following is given a score of two in Alvarado score?

Accepted Answer

Leukocytosis

Answer

Anorexia

Answer

Pyrexia

Answer

Rebound tenderness

Question 8

Tuberculosis in HIV positive individuals is characterized by which of the following?

1. More frequent negative sputum smears.
2. More false–negative tuberculin test results.
3. More extra–pulmonary tuberculosis.
4. More cavitating lesions in lungs as shown by chest X-ray.

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3 only

Answer

1, 2, 3 and 4

Answer

1 and 2 only

Answer

3 and 4 only

Question 9

Consider the following features of cholera:

1. Onset with purging.
2. No nausea or retching.
3. No tenesmus.
4. Leukocytosis. Which of the above features of cholera differentiate it from food poisoning?

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2, 3 and 4

Question 10

Which of the following statements is not true regarding HIV infection?

Accepted Answer

All HIV positive mothers transmit infection to their newborn children.

Answer

Infected blood transfusion leads to 100% transmission among recipients.

Answer

Every HIV infected person would require antiretroviral treatment during lifetime.

Answer

HIV does not transmit through fomites.

UPSC-CMS 2014 — Internal Medicine