UPSC-CMS 2022 — Internal Medicine
21 Previous Year Questions with Answers & Explanations
Mycetoma, a chronic, specific, granulomatous, destructive disease involving the skin and subcutaneous tissue:
Which of the following statements are correct regarding Buerger's disease? 1. It involves small to medium arteries. 2. It is common in smokers. 3. It commonly involves lower limb vessels. 4. Cessation of smoking reverses the disease process.
The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is
Which of the following statements about peptic ulcers is correct?
Which of the following scoring systems are PRIMARILY designed for assessing the severity of acute pancreatitis?
Which of the following are the causes of retroperitoneal fibrosis?
The most common brain tumour in an adult is
Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation? 1. Raised ICP 2. Seizures 3. Hemianopia 4. Focal deficit
Among the following sites, which is the most common location for development of pressure sores in debilitated patients?
Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?
UPSC-CMS 2022 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 1: Mycetoma, a chronic, specific, granulomatous, destructive disease involving the skin and subcutaneous tissue:
- A. may be caused by fungi or bacteria (Correct Answer)
- B. involves the superficial structure only
- C. frequently causes trophic changes
- D. is a blood-borne infection
Explanation: ***may be caused by fungi or bacteria*** - Mycetoma can be caused by either **eumycetes (true fungi)**, leading to **eumycetoma**, or by certain **aerobic actinomycetes (bacteria)**, resulting in **actinomycetoma** [1]. - Both forms present with similar clinical features, including **granulomatous inflammation** and the formation of **grains** or granules. *involves the superficial structure only* - Mycetoma is characterized by its **destructive nature**, progressively involving **deep tissues** like fascia, muscle, and even bone, not just superficial structures [1]. - The disease often leads to **deformity** and **loss of function** due to deep tissue invasion. *frequently causes trophic changes* - While mycetoma leads to significant tissue destruction and deformity, **trophic changes** (e.g., changes in skin, hair, and nails due to nerve damage) are not its primary or most characteristic feature. - The main complications are related to **tissue destruction**, **secondary infections**, and **amputation**. *is a blood-borne infection* - Mycetoma is acquired through **traumatic inoculation** of the causative organism into the skin, typically via thorns or splinters. - It is a **localized infection** and does not spread via the bloodstream; systemic dissemination is very rare.
Question 2: Which of the following statements are correct regarding Buerger's disease? 1. It involves small to medium arteries. 2. It is common in smokers. 3. It commonly involves lower limb vessels. 4. Cessation of smoking reverses the disease process.
- A. 1, 2 and 3 (Correct Answer)
- B. 1, 3 and 4
- C. 1, 2 and 4
- D. 2, 3 and 4
Explanation: ***1, 2 and 3*** - Buerger's disease, or **thromboangiitis obliterans**, primarily affects **small to medium-sized arteries and veins** in the upper and lower extremities. - It is **strongly associated with tobacco use** and commonly affects the **distal arteries** of the limbs, leading to ischemia and potential gangrene. *1, 3 and 4* - While Buerger's disease involves small to medium arteries and commonly affects lower limb vessels, **cessation of smoking does not reverse the disease process** but rather stops its progression. - The damage caused to the vessels by inflammation and thrombosis is largely irreversible. *1, 2 and 4* - This option incorrectly states that cessation of smoking reverses the disease process, which is not true. - While smoking cessation is crucial for preventing progression, existing vascular damage is permanent. *2, 3 and 4* - This option misses that Buerger's disease involves **small to medium arteries**, which is a key characteristic of the condition. - Additionally, it incorrectly suggests that smoking cessation reverses the disease.
Question 3: The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is
- A. upper GI endoscopy
- B. 24-hour pH recording (Correct Answer)
- C. CT scan
- D. barium meal follow through
Explanation: ***24-hour pH recording*** - This method directly measures the **frequency** and **duration of acid exposure** in the esophagus, providing objective evidence of reflux. - It is considered the gold standard because it can **quantify reflux episodes** and correlate them with patient symptoms. *upper GI endoscopy* - While useful for visualizing **mucosal damage** [1] (esophagitis, strictures, Barrett's esophagus) caused by reflux, it does not directly measure or confirm reflux itself. - Many patients with GORD symptoms have **normal endoscopic findings**, making it unsuitable as the gold standard for diagnosis. *CT scan* - A CT scan is not typically used for diagnosing GORD. - It is more useful for identifying **structural abnormalities** or **complications** of reflux, such as tumors or hiatal hernias. *barium meal follow through* - This imaging technique can identify **structural abnormalities** like hiatal hernia or severe reflux events, but it is not sensitive enough to detect intermittent or mild reflux. - It provides a **snapshot** of reflux and cannot quantify the total acid exposure over a prolonged period.
Question 4: Which of the following statements about peptic ulcers is correct?
- A. It is more commonly seen in females.
- B. The most common location is the third part of duodenum.
- C. Anteriorly located duodenal ulcers are 'more prone for perforation'. (Correct Answer)
- D. There is no risk of malignancy in gastric ulcers.
Explanation: Anteriorly located duodenal ulcers are 'more prone for perforation' - The duodenal bulb is largely peritonealized, and an **anterior ulcer** perforates into the peritoneal cavity, leading to **peritonitis**. - Posterior ulcers, in contrast, are more likely to erode into vessels like the **gastroduodenal artery**, causing **hemorrhage** rather than perforation. *It is more commonly seen in females* - Peptic ulcers, particularly **duodenal ulcers**, are generally more common in **men** than women, though the incidence in women has increased. - The prevalence largely depends on risk factors like **NSAID use** and **H. pylori infection**, which do not show a strong female predominance [1]. *The most common location is the third part of duodenum* - The most common location for **duodenal ulcers** is the **first part of the duodenum** (duodenal bulb) [1]. - Ulcers in the third part of the duodenum are less common and may suggest underlying conditions like **Zollinger-Ellison syndrome**. *There is no risk of malignancy in gastric ulcers* - While not all gastric ulcers are malignant, there is a definite **risk of malignancy** associated with **gastric ulcers**, especially within the setting of chronic inflammation or H. pylori infection [1]. - All gastric ulcers, once identified, require follow-up and **biopsy to rule out malignancy**; this is less of a concern for duodenal ulcers.
Question 5: Which of the following scoring systems are PRIMARILY designed for assessing the severity of acute pancreatitis?
- A. 2. APACHE score
- B. 3. MELD score
- C. 1. Ranson and Glasgow score (Correct Answer)
- D. 4. Modified Marshall score
Explanation: ***Ranson and Glasgow score*** - The **Ranson criteria** and the **Glasgow Coma Scale** (also known as the Imrie score) are classical scoring systems specifically developed and widely used to assess the **severity of acute pancreatitis** [1]. - Both scores incorporate multiple clinical and laboratory parameters evaluated at admission and within the first 48 hours to predict the likelihood of complications and mortality in acute pancreatitis. *APACHE score* - The **Acute Physiology, Age, Chronic Health Evaluation (APACHE) score** (e.g., APACHE II, APACHE III) is a general severity-of-illness classification system for critically ill patients and is not specific to acute pancreatitis. - While it can be applied to patients with acute pancreatitis in the ICU, it's designed for a **broader range of critical illnesses** rather than primarily for pancreatitis. *MELD score* - The **Model for End-Stage Liver Disease (MELD) score** is used to assess the severity of **chronic liver disease** and predict prognosis, particularly for patients awaiting liver transplantation. - It is **not designed for acute pancreatitis** and is irrelevant in this context. *Modified Marshall score* - The **Modified Marshall scoring system** is primarily used to assess **organ dysfunction** in acute pancreatitis, especially in clinical trials or for defining severe acute pancreatitis. - While relevant to pancreatitis severity, it is more focused on **specific organ systems' failure** rather than providing a global predictive score for overall severity and mortality in the same way Ranson or Glasgow scores do.
Question 6: Which of the following are the causes of retroperitoneal fibrosis?
- A. Lymphoma
- B. Carcinoid tumours
- C. Drugs (Correct Answer)
- D. Continuous Ambulatory Peritoneal Dialysis (CAPD)
Explanation: ***Drugs*** - Various medications can induce retroperitoneal fibrosis, including **methysergide**, **beta-blockers**, and some **antibiotics**. - Drug-induced retroperitoneal fibrosis often resolves with **discontinuation of the offending agent**. *Lymphoma* - While lymphoma can cause retroperitoneal masses, it typically presents with distinct features such as **lymphadenopathy** and **B symptoms** (fever, night sweats, weight loss) rather than generalized fibrosis [1]. - Lymphoma involves neoplastic proliferation of lymphocytes, leading to **mass effect** and infiltration, which is distinct from the fibrotic process [1]. *Carcinoid tumours* - Carcinoid tumors can cause fibrosis, but typically in the **pericardium** or **pleura** (carcinoid heart disease) or **mesenterium**, not the retroperitoneum directly as a primary cause in this context. - The fibrosis associated with carcinoid syndrome is due to the release of **serotonin** and other vasoactive substances. *Continuous Ambulatory Peritoneal Dialysis (CAPD)* - CAPD can lead to **peritoneal fibrosis** (sclerosing encapsulating peritonitis), which affects the peritoneum lining the abdominal cavity, not the retroperitoneum. - This complication is distinct from retroperitoneal fibrosis and involves changes to the **peritoneal membrane**, often due to bio-incompatible dialysate.
Question 7: The most common brain tumour in an adult is
- A. glioma
- B. pituitary tumour
- C. cerebral metastasis (Correct Answer)
- D. vestibular schwannoma
Explanation: ***Cerebral metastasis*** - **Cerebral metastases** are the **most common brain tumours in adults**, originating from primary cancers elsewhere in the body (e.g., lung, breast, melanoma). - They often present as **multiple lesions** and can cause focal neurological deficits, seizures, and increased intracranial pressure. *Glioma* - While **gliomas** (including astrocytomas, glioblastoma multiforme) are the most common primary brain tumours, they are less common than metastatic lesions overall in adults. - They arise from **glial cells** within the brain and can be highly aggressive. *Pituitary tumour* - **Pituitary tumours** are benign adenomas originating from the pituitary gland. - They are common but constitute a smaller proportion of all adult brain tumours compared to metastases or gliomas, and often present with **endocrine disturbances** or **visual field defects**. *Vestibular schwannoma* - **Vestibular schwannomas** (acoustic neuromas) are benign tumours arising from the **vestibulocochlear nerve (cranial nerve VIII)**. - They are relatively rare and typically present with **hearing loss**, **tinnitus**, and **balance issues**.
Question 8: Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation? 1. Raised ICP 2. Seizures 3. Hemianopia 4. Focal deficit
- A. 3. Anopia
- B. 1. Raised ICP (Correct Answer)
- C. 4. Focal deficit
- D. 2. Seizures
Explanation: ***Raised ICP*** - **Increased Intracranial Pressure (ICP)** is the fundamental underlying cause of the classic triad of brain tumor symptoms [1]. - As a tumor grows, it occupies space within the rigid skull, leading to an increase in pressure that manifests as headache, nausea/vomiting, and papilledema [1]. *Anopia* - **Anopia** (complete blindness in one eye) is a specific visual field defect, not a general underlying pathophysiological mechanism for the classic triad. - While brain tumors can cause visual field defects, these are typically considered focal neurological deficits rather than the primary cause of the general triad [1]. *Focal deficit* - **Focal neurological deficits** (like hemianopia, weakness, or sensory loss) are *symptoms* caused by brain tumors, but they represent localized damage, not the overarching pathophysiology of the classic triad [1]. - The classic triad (headache, nausea/vomiting, papilledema) is a manifestation of diffuse increased pressure, not specific focal damage [1]. *Seizures* - **Seizures** are a common symptom of brain tumors, often due to irritation of cortical tissue [1]. - However, seizures are a *symptom* that can occur due to focal irritation or diffuse pressure and do not represent the primary underlying pathophysiology (raised ICP) that causes the classic triad itself [1].
Question 9: Among the following sites, which is the most common location for development of pressure sores in debilitated patients?
- A. heel (Correct Answer)
- B. greater trochanter
- C. ischium
- D. occiput
Explanation: Heel - The heels are a common location due to the localized pressure, especially in supine or chair-bound individuals, and are a high-risk area for developing pressure ulcers because they often bear a significant portion of body weight. [1] - The bone prominence and lack of subcutaneous fat make the skin over the heel particularly vulnerable to ischemia and tissue damage from sustained pressure. [1] Greater trochanter - The greater trochanter is a common site for pressure sore development, especially in individuals positioned in a lateral recumbent position. - However, it typically ranks second or third after the sacrum and heels in overall incidence for most debilitated patients. Ischium - The ischium is a high-risk area for pressure sores, particularly in patients who spend prolonged periods sitting. - While significant in seated patients, it is not the most common site generally across all debilitated patients and various positions. Occiput - The occiput is a risk area for pressure sores, especially in patients who are critically ill, intubated, or lying supine for extended periods. - While it is a significant concern for certain patient populations, it is generally less common than the heels or sacrum for pressure ulcer development in the broad category of debilitated patients.
Question 10: Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?
- A. Primary sclerosing cholangitis
- B. Arthropathy (Correct Answer)
- C. Pyoderma gangrenosum
- D. Amyloidosis
Explanation: **Arthropathy** - **Peripheral arthropathy**, particularly **Type 1 (pauciarticular)**, is directly linked to **Crohn's disease activity**, meaning flares in bowel disease often coincide with flares in joint symptoms. - This form of arthritis typically affects large joints, is transient, and resolves with successful treatment of the underlying intestinal inflammation. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a serious extraintestinal manifestation often associated with Crohn's disease but is **not directly correlated with its activity**. - Its progression is independent of whether the intestinal inflammation is well-controlled. *Pyoderma gangrenosum* - **Pyoderma gangrenosum** is a skin manifestation that can occur in patients with Crohn's disease, but its activity often **does not parallel the severity of the bowel disease**. - While it can be debilitating, effective treatment of Crohn's disease may not always lead to remission of pyoderma gangrenosum. *Amyloidosis* - **Amyloidosis**, specifically **AA amyloidosis**, is a rare but severe complication of chronic inflammatory diseases like Crohn's, resulting from long-term inflammation. - While prolonged, uncontrolled disease activity increases the risk, the **amyloidosis itself does not fluctuate with day-to-day or short-term changes in Crohn's disease activity**.