UPSC-CMS 2018 — Internal Medicine

Q: A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:

Systemic inflammatory response syndrome. ***Systemic inflammatory response syndrome*** - The patient's presentation with **tachycardia** (pulse 106/min), **tachypnea** (respiratory rate 26/min), and **leukocytosis** (TLC 14000/µL) meets at least two criteria for **Systemic Inflammatory Response Syndrome (SIRS)** following a significant surgical stressor. - SIRS is a generalized inflammatory response to various insults, including major surgery, trauma, and infection, occurring in the absence of a confirmed infection. *Sepsis syndrome* - **Sepsis syndrome** is defined as SIRS with a **confirmed or suspected infectious source**. While the patient had a bowel injury, there is no definitive evidence of active infection provided (e.g., positive cultures, purulent discharge). - Although the bowel injury could lead to infection, the current information only confirms a systemic inflammatory response, not necessarily a microbial cause. *Multisystem organ failure (MSOF)* - **Multisystem organ failure (MSOF)** involves the failure of two or more organ systems. While the patient has elevated **BUN** and **creatinine**, indicating **acute kidney injury**, there's no evidence of failure in other systems required to diagnose MSOF. - MSOF is a more severe progression of SIRS or sepsis, characterized by severe organ dysfunction, which is not fully met by the current presentation. *Wound infection* - **Wound infection** is a localized infection and would typically present with signs like **erythema**, **purulent discharge**, **tenderness**, or **warmth** at the surgical site. None of these specific local signs are mentioned. - While a wound infection could be a potential source of SIRS or sepsis, the clinical picture provided describes a systemic response rather than a localized one. [Practice more Internal Medicine PYQs on OnCourse]

Q: Patients with phlebographically confirmed deep vein thrombosis of the calf:

are at risk for significant pulmonary embolism. ***are at risk for significant pulmonary embolism*** - While calf DVT is often considered less severe than proximal DVT, it still carries a definite risk of extending proximally [1] and subsequently leading to **pulmonary embolism (PE)**, especially if untreated. - Approximately **10-20% of calf DVTs extend proximally**, increasing the risk of potentially fatal PE. *can expect asymptomatic recovery if treated promptly with anticoagulant* - Even with prompt anticoagulant treatment, a significant percentage of patients with DVT experience **post-thrombotic syndrome (PTS)**, characterized by pain, swelling, and skin changes. - While anticoagulants [2] prevent clot extension and PE, they do not guarantee an **asymptomatic recovery** or fully prevent long-term sequelae. *may be effectively treated with low-dose heparin* - **Low-dose heparin** is typically used for DVT prophylaxis, not for treating acute DVT. - Treatment of acute DVT, including calf DVT, requires **therapeutic anticoagulation** with unfractionated heparin, low molecular weight heparin, or oral anticoagulants [2] to prevent clot propagation and embolism. *may be effectively treated with pneumatic compression stockings* - **Pneumatic compression stockings** are primarily used for DVT prevention in high-risk patients, especially post-surgery. - They are not a primary treatment for an **established acute DVT**, where anticoagulation is the cornerstone of therapy to prevent complications. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?

It always presents with haematuria. ***It always presents with haematuria*** - This statement is incorrect because **renal cell carcinoma** (adenocarcinoma of the kidney) often remains asymptomatic until a late stage, meaning **hematuria** is not always present, especially in early disease [1]. - While hematuria is a common symptom in later stages, occurring in about 60% of cases, its absence does not rule out the diagnosis, and many tumors are found incidentally [1]. *It may be associated with Pyrexia of unknown origin* - **Renal cell carcinoma** can produce various paraneoplastic syndromes, including **pyrexia of unknown origin (PUO)** [2]. - The tumor may release **pyrogenic cytokines** that lead to unexplained fever, making this a recognized systemic manifestation. *Renal vein extention may embolize to lungs* - **Renal cell carcinoma** has a propensity to invade the **renal vein** and extend into the inferior vena cava. - Tumor thrombi can then break off and travel to the lungs, resulting in **pulmonary embolism** of tumor cells or even macroscopic tumor emboli. *It is also called Grawitz tumour* - **Grawitz tumor** is an older, historical term used to refer to **renal cell carcinoma**, particularly the clear cell subtype. - This name originated from Paul Grawitz, who first described the tumor's histological features. [Practice more Internal Medicine PYQs on OnCourse]

Q: Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

Neurofibromatosis Type II. ***Neurofibrofomatosis Type II*** - This condition is primarily associated with **central nervous system tumors** like **vestibular schwannomas** and **meningiomas**, not Berry aneurysms [2]. - While it affects the nervous system, its vascular manifestations are typically different from those predisposing to aneurysms. *Marfan’s syndrome* - Patients with Marfan's syndrome have **fragile connective tissue** due to a defect in **fibrillin-1**, which can weaken arterial walls. - This weakness increases the risk of **aortic aneurysms** and dissections, and can also predispose to intracranial aneurysms like Berry aneurysms. *Adult polycystic kidney* - This **autosomal dominant** disorder is characterized by the formation of **cysts in the kidneys**, but also has systemic manifestations [1]. - There is a well-established association between **autosomal dominant polycystic kidney disease (ADPKD)** and an increased incidence of **Berry aneurysms**. *Fibromuscular dysplasia* - This condition involves **abnormal cellular development** in the **arterial walls**, leading to areas of narrowing and enlargement. - It commonly affects the **renal arteries** and **carotid arteries**, and is also a known risk factor for the development of **intracranial aneurysms**, including Berry aneurysms. [Practice more Internal Medicine PYQs on OnCourse]

7 Previous Year Questions with Answers & Explanations

Questions

All Subjects Anatomy (5)Biochemistry (1)Community Medicine (31)ENT (2)Forensic Medicine (1)Internal Medicine (7)Obstetrics and Gynecology (33)Orthopaedics (1)Pathology (1)Pediatrics (5)Pharmacology (4)Physiology (3)Radiology (2)Surgery (23)

Cellulitis is:

A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:

Patients with phlebographically confirmed deep vein thrombosis of the calf:

Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?

Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

Mondor’s disease is:

Which one of the following regarding Pancreatic effusion is correct?

UPSC-CMS 2018 - Internal Medicine UPSC-CMS Practice Questions and MCQs

Question 1: Cellulitis is:

A. Infection caused by Gram negative bacilli
B. A nonsuppurative invasive infection of tissues
C. A suppurative invasive infection of skin and subcutaneous tissues (Correct Answer)
D. Infection caused by anaerobic Streptococci

Explanation: ***A suppurative invasive infection of skin and subcutaneous tissues*** - Cellulitis is characterized by **inflammation** and **infection** of the dermis and subcutaneous fat, often leading to pus formation (**suppurative**). - It involves an **invasive** spread of bacteria through these layers of tissue, rather than just superficial involvement [1]. *Infection caused by Gram negative bacilli* - While Gram-negative bacilli can cause soft tissue infections, **cellulitis is most commonly caused by Gram-positive bacteria** like *Staphylococcus aureus* or *Streptococcus pyogenes* [1]. - Attributing cellulitis solely to Gram-negative bacilli is too restrictive and often incorrect for typical presentations. *A nonsuppurative invasive infection of tissues* - Cellulitis is typically a **suppurative infection**, meaning it involves the formation of pus, which contradicts the "nonsuppurative" description [1]. - While it is an **invasive infection**, the lack of pus formation distinguishes it from classic cellulitis. *Infection caused by anaerobic Streptococci* - **Anaerobic Streptococci** are not the primary or most common cause of typical cellulitis; rather, **aerobic *Streptococcus pyogenes*** and *Staphylococcus aureus* are the main culprits. - Infections caused by anaerobic bacteria often present with **foul-smelling discharge** and specific clinical contexts like deep wound infections or abscesses.

Question 2: A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:

A. Sepsis syndrome
B. Systemic inflammatory response syndrome (Correct Answer)
C. Multisystem organ failure (MSOF)
D. Wound infection

Explanation: ***Systemic inflammatory response syndrome*** - The patient's presentation with **tachycardia** (pulse 106/min), **tachypnea** (respiratory rate 26/min), and **leukocytosis** (TLC 14000/µL) meets at least two criteria for **Systemic Inflammatory Response Syndrome (SIRS)** following a significant surgical stressor. - SIRS is a generalized inflammatory response to various insults, including major surgery, trauma, and infection, occurring in the absence of a confirmed infection. *Sepsis syndrome* - **Sepsis syndrome** is defined as SIRS with a **confirmed or suspected infectious source**. While the patient had a bowel injury, there is no definitive evidence of active infection provided (e.g., positive cultures, purulent discharge). - Although the bowel injury could lead to infection, the current information only confirms a systemic inflammatory response, not necessarily a microbial cause. *Multisystem organ failure (MSOF)* - **Multisystem organ failure (MSOF)** involves the failure of two or more organ systems. While the patient has elevated **BUN** and **creatinine**, indicating **acute kidney injury**, there's no evidence of failure in other systems required to diagnose MSOF. - MSOF is a more severe progression of SIRS or sepsis, characterized by severe organ dysfunction, which is not fully met by the current presentation. *Wound infection* - **Wound infection** is a localized infection and would typically present with signs like **erythema**, **purulent discharge**, **tenderness**, or **warmth** at the surgical site. None of these specific local signs are mentioned. - While a wound infection could be a potential source of SIRS or sepsis, the clinical picture provided describes a systemic response rather than a localized one.

Question 3: Patients with phlebographically confirmed deep vein thrombosis of the calf:

A. can expect asymptomatic recovery if treated promptly with anticoagulant
B. are at risk for significant pulmonary embolism (Correct Answer)
C. may be effectively treated with low-dose heparin
D. may be effectively treated with pneumatic compression stockings

Explanation: ***are at risk for significant pulmonary embolism*** - While calf DVT is often considered less severe than proximal DVT, it still carries a definite risk of extending proximally [1] and subsequently leading to **pulmonary embolism (PE)**, especially if untreated. - Approximately **10-20% of calf DVTs extend proximally**, increasing the risk of potentially fatal PE. *can expect asymptomatic recovery if treated promptly with anticoagulant* - Even with prompt anticoagulant treatment, a significant percentage of patients with DVT experience **post-thrombotic syndrome (PTS)**, characterized by pain, swelling, and skin changes. - While anticoagulants [2] prevent clot extension and PE, they do not guarantee an **asymptomatic recovery** or fully prevent long-term sequelae. *may be effectively treated with low-dose heparin* - **Low-dose heparin** is typically used for DVT prophylaxis, not for treating acute DVT. - Treatment of acute DVT, including calf DVT, requires **therapeutic anticoagulation** with unfractionated heparin, low molecular weight heparin, or oral anticoagulants [2] to prevent clot propagation and embolism. *may be effectively treated with pneumatic compression stockings* - **Pneumatic compression stockings** are primarily used for DVT prevention in high-risk patients, especially post-surgery. - They are not a primary treatment for an **established acute DVT**, where anticoagulation is the cornerstone of therapy to prevent complications.

Question 4: Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?

A. It may be associated with Pyrexia of unknown origin
B. It always presents with haematuria (Correct Answer)
C. Renal vein extention may embolize to lungs
D. It is also called Grawitz tumour

Explanation: ***It always presents with haematuria*** - This statement is incorrect because **renal cell carcinoma** (adenocarcinoma of the kidney) often remains asymptomatic until a late stage, meaning **hematuria** is not always present, especially in early disease [1]. - While hematuria is a common symptom in later stages, occurring in about 60% of cases, its absence does not rule out the diagnosis, and many tumors are found incidentally [1]. *It may be associated with Pyrexia of unknown origin* - **Renal cell carcinoma** can produce various paraneoplastic syndromes, including **pyrexia of unknown origin (PUO)** [2]. - The tumor may release **pyrogenic cytokines** that lead to unexplained fever, making this a recognized systemic manifestation. *Renal vein extention may embolize to lungs* - **Renal cell carcinoma** has a propensity to invade the **renal vein** and extend into the inferior vena cava. - Tumor thrombi can then break off and travel to the lungs, resulting in **pulmonary embolism** of tumor cells or even macroscopic tumor emboli. *It is also called Grawitz tumour* - **Grawitz tumor** is an older, historical term used to refer to **renal cell carcinoma**, particularly the clear cell subtype. - This name originated from Paul Grawitz, who first described the tumor's histological features.

Question 5: Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

A. Marfan’s syndrome
B. Adult polycystic kidney
C. Neurofibromatosis Type II (Correct Answer)
D. Fibromuscular dysplasia

Explanation: ***Neurofibrofomatosis Type II*** - This condition is primarily associated with **central nervous system tumors** like **vestibular schwannomas** and **meningiomas**, not Berry aneurysms [2]. - While it affects the nervous system, its vascular manifestations are typically different from those predisposing to aneurysms. *Marfan’s syndrome* - Patients with Marfan's syndrome have **fragile connective tissue** due to a defect in **fibrillin-1**, which can weaken arterial walls. - This weakness increases the risk of **aortic aneurysms** and dissections, and can also predispose to intracranial aneurysms like Berry aneurysms. *Adult polycystic kidney* - This **autosomal dominant** disorder is characterized by the formation of **cysts in the kidneys**, but also has systemic manifestations [1]. - There is a well-established association between **autosomal dominant polycystic kidney disease (ADPKD)** and an increased incidence of **Berry aneurysms**. *Fibromuscular dysplasia* - This condition involves **abnormal cellular development** in the **arterial walls**, leading to areas of narrowing and enlargement. - It commonly affects the **renal arteries** and **carotid arteries**, and is also a known risk factor for the development of **intracranial aneurysms**, including Berry aneurysms.

Question 6: Mondor’s disease is:

A. Named after the scientist who first coined the term “Actinomycosis of Breast”
B. Thrombophlebitis of superficial veins of the breast and anterior chest wall (Correct Answer)
C. Other name for tuberculosis of breast
D. Rare type of chronic intramammary abscess

Explanation: ***Thrombophlebitis of superficial veins of the breast and anterior chest wall*** - **Mondor's disease** is characterized by inflammation and thrombosis of the superficial veins, most commonly affecting the breast and anterior chest wall. - It typically manifests as a sensitive, cord-like structure under the skin, often associated with a recent trauma, surgery, or inflammation. *Named after the scientist who first coined the term “Actinomycosis of Breast”* - Mondor’s disease is named after **Henri Mondor**, who described this clinical condition in 1939. - He did not specifically coin the term "Actinomycosis of Breast," which is a separate bacterial infection. *Other name for tuberculosis of breast* - **Tuberculosis of the breast** is a rare infectious disease caused by *Mycobacterium tuberculosis*, leading to granulomatous inflammation. - Mondor's disease is a non-infectious thrombophlebitis, distinct from infectious conditions like tuberculosis. *Rare type of chronic intramammary abscess* - A **chronic intramammary abscess** is a localized collection of pus within the breast tissue, usually due to bacterial infection. - Mondor's disease involves inflammation of blood vessels and thrombosis, not pus formation or abscess development.

Question 7: Which one of the following regarding Pancreatic effusion is correct?

A. Pancreatic stenting is to be done
B. Free fluid collection in Pleural cavity
C. Percutaneous drainage under image guidance is indicated for symptomatic effusions (Correct Answer)
D. Never associated with abdominal collection

Explanation: ***Percutaneous drainage under image guidance is indicated for symptomatic effusions*** - For **symptomatic pancreatic effusions**, particularly those causing pain, infection, or organ compression, percutaneous drainage offers an effective and less invasive management option. - This procedure is typically performed under **ultrasound or CT guidance** to ensure accurate placement of the drainage catheter, minimizing complications. *Pancreatic stenting is to be done* - **Pancreatic stenting** is primarily indicated for managing pancreatic duct strictures or leaks, often in the context of chronic pancreatitis or postsurgical complications. - It is not a direct treatment for a pancreatic effusion itself, which is a collection of fluid outside the ductal system. *Free fluid collection in Pleural cavity* - Pancreatic effusion refers to the **leakage of pancreatic fluid** into the abdominal cavity, typically surrounding the pancreas or in the peritoneum. - While pancreatic diseases can sometimes lead to **pleural effusions** (fluid in the chest cavity) due to translocation of fluid through the diaphragm, a pancreatic effusion itself is defined as an abdominal collection. *Never associated with abdominal collection* - This statement is incorrect as a **pancreatic effusion is by definition an abdominal collection** of fluid originating from the pancreas. - These collections can arise from disruptions in the pancreatic duct or parenchyma, leading to the accumulation of pancreatic enzymes, fluid, and debris in the peripancreatic region or elsewhere within the abdomen.