UPSC-CMS 2017 - Internal Medicine PYQs Practice Questions

Q: A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from:

Carcinoma head of pancreas. A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from: ***Carcinoma head of pancreas*** - The classic triad of **painless progressive jaundice**, **weight loss**, and a **palpable, non-tender gallbladder** (Courvoisier's sign) strongly indicates carcinoma of the head of the pancreas due to obstruction of the common bile duct [1]. - The high serum bilirubin value further supports a severe obstructive process, typical of a pancreatic head mass compressing the bile duct [1]. *Carcinoma stomach* - Carcinoma of the stomach typically presents with upper abdominal pain, dyspepsia, early satiety, and weight loss, but **jaundice is rare** unless there is extensive metastasis to the liver or porta hepatis. - It usually does not directly lead to **obstructive jaundice** with a palpable gallbladder, as the tumor's location is remote from the common bile duct. *Choledocholithiasis* - While choledocholithiasis can cause obstructive jaundice, it is often associated with **pain** (biliary colic) and fluctuating jaundice rather than the painless, progressive pattern described. - A gallbladder obstructed by a stone would typically be **tender** if inflamed, or decompressed if the obstruction is intermittent, rather than smooth and non-tender due to chronic distal obstruction. *Klatskin tumour* - A Klatskin tumor (hilar cholangiocarcinoma) causes obstructive jaundice, but it typically obstructs the bile ducts above the cystic duct insertion, meaning the **gallbladder would usually be decompressed and non-palpable** [2]. - These tumors often present with **jaundice and itching**, but the presence of a palpable gallbladder makes a pancreatic head mass more likely [2]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is NOT true regarding ‘Renal Carbuncle’?

It is a type of renal tuberculosis. A **renal carbuncle** is essentially a **renal abscess** caused by bacterial infection, typically *Staphylococcus aureus* or *Escherichia coli*, not *Mycobacterium tuberculosis*. Renal tuberculosis manifests differently, often with **sterile pyuria** and granulomatous inflammation, and is not synonymous with a carbuncle. Patients with **diabetes mellitus** are at an increased risk of developing bacterial infections, including **renal carbuncles**, due to impaired immune function and glucose-rich urine. Poorly controlled diabetes is a significant **predisposing factor** for severe renal infections. **Intravenous drug users** are at higher risk of bloodstream infections, including **septic emboli** that can disseminate to the kidneys and form renal carbuncles. **Skin contaminants** and unsterile injection practices can introduce bacteria into the bloodstream that eventually localize in renal tissue. A **renal carbuncle** is defined as a focal collection of **pus** and necrotic tissue within the renal parenchyma, essentially a **renal abscess**. It results from the **hematogenous spread** of bacteria or, less commonly, from an ascending urinary tract infection [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: In endoscopic retrograde cholangiopancreatography endoscope used is:

Side viewing. ***Side viewing*** - **Side-viewing endoscopes** are specifically designed for ERCP, allowing the endoscopist to visualize the **ampulla of Vater** en face for precise cannulation [1]. - The side-viewing optic facilitates the passage of accessories like **catheters, guidewires**, and **sphincterotomes** into the bile and pancreatic ducts [1]. *End viewing* - **End-viewing endoscopes** (like standard gastroscopes or colonoscopes) have the camera directly at the tip, providing a straight-ahead view. - This design makes cannulation of the **ampulla of Vater** challenging, as it would be viewed tangentially, not directly. *Front viewing* - This term is synonymous with **end-viewing** and describes the typical orientation of standard gastrointestinal endoscopes. - While suitable for examining the lumen of organs, it lacks the specialized optics needed for the complex angulation and cannulation required in **ERCP**. *Rigid* - **Rigid endoscopes** are generally used for procedures where flexibility is not required, such as laparoscopy or cystoscopy [2]. - They are unsuitable for **ERCP**, which requires a highly flexible instrument to navigate the esophagus, stomach, duodenum, and access the **ampulla of Vater**. [Practice more Internal Medicine PYQs on OnCourse]

Q: Oliguria is defined as:

Less than 400 ml of urine excreted in a day. ***Less than 400 ml of urine excreted in a day*** - **Oliguria** is medically defined as a daily urine output that is **less than 400 ml** in adults. [1] - This level of urine production is often insufficient to effectively excrete metabolic waste products. [1] *600 ml to 700 ml of urine excreted in a day* - This range of urine output is generally considered within the **normal limits**, not oliguric. - Normal daily urine production for an adult typically ranges from **800 to 2000 ml**. *More than 900 ml of urine excreted in a day* - An output of **more than 900 ml** per day for an adult indicates normal urine production, well above the threshold for oliguria. - This level suggests adequate kidney function in terms of fluid excretion. *Absence of urine production* - The complete absence of urine production is known as **anuria**, which is a more severe condition than oliguria. [1] - Anuria is typically defined as **less than 50 ml of urine** per day. [1] [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is NOT a feature of Systemic Inflammatory Response Syndrome?

Bradycardia. ***Bradycardia*** - **Bradycardia** (a slow heart rate) is **not** a typical diagnostic criterion for **Systemic Inflammatory Response Syndrome (SIRS)**. - SIRS is usually associated with **tachycardia** (heart rate >90 beats/min) due to the body's increased metabolic demand and stress response [2]. *Hypothermia (less than 36°C)* - **Hypothermia** ( 38°C) is a common and primary diagnostic criterion for **SIRS**, reflecting the body's inflammatory response to infection or injury [2], [3]. - This elevated core temperature is part of the systemic response to pathogens or tissue damage. *Leucocytosis* - **Leucocytosis** (white blood cell count >12,000 cells/mm³) is a key diagnostic criterion for **SIRS**, indicating a robust innate immune response [1], [2]. - A WBC count 10% immature neutrophils ("bands") also fulfills this criterion. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from:

Accepted Answer

Carcinoma head of pancreas

Answer

Carcinoma stomach

Answer

Choledocholithiasis

Answer

Klatskin tumour

Question 2

Which of the following is NOT true regarding ‘Renal Carbuncle’?

Accepted Answer

It is a type of renal tuberculosis

Answer

It occurs in diabetic patient

Answer

It occurs in intravenous drug abusers

Answer

It is an abscess in renal parenchyma

Question 3

In endoscopic retrograde cholangiopancreatography endoscope used is:

Accepted Answer

Side viewing

Answer

End viewing

Answer

Front viewing

Answer

Rigid

Question 4

Oliguria is defined as:

Accepted Answer

Less than 400 ml of urine excreted in a day

Answer

600 ml to 700 ml of urine excreted in a day

Answer

More than 900 ml of urine excreted in a day

Answer

Absence of urine production

Question 5

Which of the following is NOT a feature of Systemic Inflammatory Response Syndrome?

Accepted Answer

Bradycardia

Answer

Hypothermia (less than 36°C)

Answer

Hyperthermia (more than 38°C)

Answer

Leucocytosis

Question 6

A 35 year old woman presented with a lump in her upper abdomen for two months which was slightly increasing. She also complained of early satiety. She gave a history of acute severe pain in upper abdomen for which she was admitted in hospital for 10 days, about three months ago. On examination, the mass was firm, smooth surfaced and not moving with respiration. She was most likely suffering from:

Accepted Answer

Pseudocyst pancreas

Answer

Cancer colon

Answer

Splenic cyst

Answer

Cancer stomach

Question 7

Which of the following is NOT a symptom of atherosclerotic occlusive disease at the bifurcation of aorta (Leriche syndrome)?

Accepted Answer

Claudication of the calf

Answer

Sexual impotence

Answer

Claudication of the buttock and thigh

Answer

Gangrene localised to the feet

Question 8

Fitz‐Hugh‐Curtis syndrome involving perihepatitis is present in the following:

Accepted Answer

Gonorrhoea

Answer

Syphilis

Answer

Tuberculosis

Answer

Moniliasis

UPSC-CMS 2017 — Internal Medicine