UPSC-CMS 2018 - Internal Medicine PYQs Practice Questions

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]

Question 1

Cellulitis is:

Accepted Answer

A suppurative invasive infection of skin and subcutaneous tissues

Answer

Infection caused by Gram negative bacilli

Answer

A nonsuppurative invasive infection of tissues

Answer

Infection caused by anaerobic Streptococci

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:

Accepted Answer

Systemic inflammatory response syndrome

Answer

Sepsis syndrome

Answer

Multisystem organ failure (MSOF)

Answer

Wound infection

Question 3

Patients with phlebographically confirmed deep vein thrombosis of the calf:

Accepted Answer

are at risk for significant pulmonary embolism

Answer

can expect asymptomatic recovery if treated promptly with anticoagulant

Answer

may be effectively treated with low-dose heparin

Answer

may be effectively treated with pneumatic compression stockings

Question 4

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

Accepted Answer

It always presents with haematuria

Answer

It may be associated with Pyrexia of unknown origin

Answer

Renal vein extention may embolize to lungs

Answer

It is also called Grawitz tumour

Question 5

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

Accepted Answer

Neurofibromatosis Type II

Answer

Marfan’s syndrome

Answer

Adult polycystic kidney

Answer

Fibromuscular dysplasia

Question 6

Mondor’s disease is:

Accepted Answer

Thrombophlebitis of superficial veins of the breast and anterior chest wall

Answer

Named after the scientist who first coined the term “Actinomycosis of Breast”

Answer

Other name for tuberculosis of breast

Answer

Rare type of chronic intramammary abscess

Question 7

Which one of the following regarding Pancreatic effusion is correct?

Accepted Answer

Percutaneous drainage under image guidance is indicated for symptomatic effusions

Answer

Pancreatic stenting is to be done

Answer

Free fluid collection in Pleural cavity

Answer

Never associated with abdominal collection

UPSC-CMS 2018 — Internal Medicine