UPSC-CMS 2022 - Internal Medicine PYQs Practice Questions

Q: Mycetoma, a chronic, specific, granulomatous, destructive disease involving the skin and subcutaneous tissue:

may be caused by fungi or bacteria. ***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. [Practice more Internal Medicine PYQs on OnCourse]

Q: 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.

1, 2 and 3. ***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. [Practice more Internal Medicine PYQs on OnCourse]

Q: The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is

24-hour pH recording. ***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. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following scoring systems are PRIMARILY designed for assessing the severity of acute pancreatitis?

1. Ranson and Glasgow score. ***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. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Mycetoma, a chronic, specific, granulomatous, destructive disease involving the skin and subcutaneous tissue:

Accepted Answer

may be caused by fungi or bacteria

Answer

involves the superficial structure only

Answer

frequently causes trophic changes

Answer

is a blood-borne infection

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.

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 3

The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is

Accepted Answer

24-hour pH recording

Answer

upper GI endoscopy

Answer

CT scan

Answer

barium meal follow through

Question 4

Which of the following statements about peptic ulcers is correct?

Accepted Answer

Anteriorly located duodenal ulcers are 'more prone for perforation'.

Answer

It is more commonly seen in females.

Answer

The most common location is the third part of duodenum.

Answer

There is no risk of malignancy in gastric ulcers.

Question 5

Which of the following scoring systems are PRIMARILY designed for assessing the severity of acute pancreatitis?

Accepted Answer

1. Ranson and Glasgow score

Answer

2. APACHE score

Answer

3. MELD score

Answer

4. Modified Marshall score

Question 6

Which of the following are the causes of retroperitoneal fibrosis?

Accepted Answer

Drugs

Answer

Lymphoma

Answer

Carcinoid tumours

Answer

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Question 7

The most common brain tumour in an adult is

Accepted Answer

cerebral metastasis

Answer

glioma

Answer

pituitary tumour

Answer

vestibular schwannoma

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

Accepted Answer

1. Raised ICP

Answer

3. Anopia

Answer

4. Focal deficit

Answer

2. Seizures

Question 9

Among the following sites, which is the most common location for development of pressure sores in debilitated patients?

Accepted Answer

heel

Answer

greater trochanter

Answer

ischium

Answer

occiput

Question 10

Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?

Accepted Answer

Arthropathy

Answer

Primary sclerosing cholangitis

Answer

Pyoderma gangrenosum

Answer

Amyloidosis

UPSC-CMS 2022 — Internal Medicine