UPSC-CMS 2016 - Internal Medicine Practice Questions

Q: Which one of the following is the investigation of choice in a patient with haematemesis?

Flexible upper gastrointestinal endoscopy. ***Flexible upper gastrointestinal endoscopy*** - This is the **investigation of choice** for haematemesis as it allows for direct visualization of the upper gastrointestinal tract to identify the source of bleeding [1]. - It also enables **therapeutic intervention**, such as injection sclerotherapy, banding, or clip application, to stop the bleeding [1]. *Contrast enhanced CT scan* - A CT scan is generally **not the primary investigation** for acute haematemesis because it offers less diagnostic accuracy for mucosal lesions and cannot provide therapeutic intervention [1]. - While it can identify large bleeds or structural abnormalities, it is **less sensitive for smaller bleeds** or subtle mucosal abnormalities compared to endoscopy. *Barium meal for stomach and duodenum* - A barium meal is **contraindicated in acute gastrointestinal bleeding** as the barium can obscure endoscopic views and interfere with subsequent attempts at endoscopy or angiography [1]. - It provides **limited diagnostic information** about the active bleeding site and offers no therapeutic capabilities. *Selective left gastric angiography* - Angiography is typically reserved for cases of **severe, persistent bleeding** where endoscopy has failed to locate or control the bleed. - It is an **invasive procedure** with potential complications and is not indicated as the initial diagnostic investigation.

Q: Smoking is associated with all the following diseases except:

Sarcoidosis. ***Sarcoidosis*** - **Smoking** has been found to have a protective or null effect on the development of **sarcoidosis**, and it is generally *not* considered a risk factor. - The etiology of sarcoidosis is unknown, but it is thought to involve a combination of genetic predisposition and environmental triggers, none of which strongly implicate smoking. *Emphysema* - **Smoking** is the leading cause of **emphysema**, a type of **COPD**, by causing chronic inflammation and destruction of alveolar walls. - Toxins and irritants in smoke activate inflammatory cells and enzymes, leading to the breakdown of elastic fibers in the lungs. *Cardiovascular disease* - **Smoking** is a major risk factor for various **cardiovascular diseases**, including **atherosclerosis**, **coronary artery disease**, and stroke. - It damages blood vessel walls, increases **blood pressure**, and promotes clot formation, significantly increasing the risk of cardiovascular events. *Lung cancer* - **Smoking** is the primary cause of the vast majority of **lung cancer** cases, with dose-dependent effects on risk [1]. - Carcinogens in tobacco smoke directly damage DNA in lung cells, leading to uncontrolled cell growth and tumor formation [1].

Q: Umbilical cord blood stem cells are used to treat all the following diseases except :

Parkinsonism. ***Parkinsonism*** - While stem cell research for Parkinson's disease is ongoing, current treatments using **umbilical cord blood stem cells** have not shown efficacy or routine use for this neurodegenerative disorder. - Parkinson's disease primarily affects **dopaminergic neurons** in the substantia nigra, which are not effectively replaced or regenerated by umbilical cord blood stem cells in a therapeutic context. *Leukemia* - **Umbilical cord blood stem cells** are a well-established source of **hematopoietic stem cells** used in transplantation to treat various forms of leukemia. - These stem cells can engraft in the bone marrow and differentiate into healthy blood cells, replacing cancerous cells after chemotherapy or radiation. *Osteoporosis* - Research is exploring the use of **mesenchymal stem cells** from umbilical cord blood for bone regeneration and treatment of osteoporosis. - These stem cells have the potential to differentiate into **osteoblasts**, which are essential for bone formation and repair. *Diabetes* - Experimental treatments and clinical trials are investigating the use of **umbilical cord blood stem cells** to treat Type 1 Diabetes by modulating the immune system and potentially regenerating insulin-producing beta cells. - The immunomodulatory properties of these stem cells may help in preventing the autoimmune destruction of **pancreatic beta cells**.

Q: For a 40 year old hypertensive woman, which one of the following is not recommended for contraception?

NuvaRing. ***NuvaRing*** - **NuvaRing** is a **combined hormonal contraceptive** that releases both estrogen and progestin. - **Estrogen-containing contraception** is generally **contraindicated** or used with caution in women with uncontrolled hypertension due to an increased risk of **cardiovascular events** such as stroke and myocardial infarction. *IUCD* - **Intrauterine contraceptive devices (IUCDs)**, both copper and levonorgestrel-releasing, are considered **safe** and highly effective for women with hypertension. - They do not contain systemic hormones or contain only progestin, which has a minimal impact on blood pressure. *Minipill* - The **minipill** is a **progestin-only oral contraceptive**. - **Progestin-only contraceptives** are safe for women with hypertension as they do not carry the same cardiovascular risks associated with estrogen. *LNG IUD (LNg IUD)* - The **levonorgestrel-releasing intrauterine device (LNG IUD)** is a **progestin-only contraceptive**. - It is **safe** for women with hypertension because the progestin is primarily local, and it does not contain estrogen, thereby avoiding cardiovascular risks.

Question 1

Which one of the following is the investigation of choice in a patient with haematemesis?

Accepted Answer

Flexible upper gastrointestinal endoscopy

Answer

Contrast enhanced CT scan

Answer

Barium meal for stomach and duodenum

Answer

Selective left gastric angiography

Question 2

Smoking is associated with all the following diseases except:

Accepted Answer

Sarcoidosis

Answer

Emphysema

Answer

Cardiovascular disease

Answer

Lung cancer

Question 3

Umbilical cord blood stem cells are used to treat all the following diseases except :

Accepted Answer

Parkinsonism

Answer

Leukemia

Answer

Osteoporosis

Answer

Diabetes

Question 4

For a 40 year old hypertensive woman, which one of the following is not recommended for contraception?

Accepted Answer

NuvaRing

Answer

IUCD

Answer

Minipill

Answer

LNG IUD (LNg IUD)

UPSC-CMS 2016 — Internal Medicine