UPSC-CMS 2022 - Internal Medicine Practice Questions

Q: Which of the following is the LEAST invasive initial treatment option for achalasia? 1. Botulinum toxin 2. Beta blockers 3. Pneumatic dilation 4. Heller's myotomy

2. Beta blockers. ***Beta blockers*** - This is incorrect as **beta blockers** are not a recognized treatment for achalasia. - Achalasia management focuses on reducing **lower esophageal sphincter (LES)** pressure, which beta blockers do not achieve [1]. *Pneumatic dilation* - While less invasive than surgery, **pneumatic dilation** involves stretching the LES using a balloon, which carries risks such as perforation [2]. - It is generally considered a more invasive intervention than endoscopic injection therapies, and not initial treatment [2]. *Heller's myotomy* - This is a **surgical procedure** to cut the muscle fibers of the LES, making it the most invasive option among those listed [2]. - It is typically reserved for cases where less invasive treatments have failed or for patients who prefer a more definitive, long-term solution. *Botulinum toxin* - **Botulinum toxin** injection into the LES is a less invasive endoscopic procedure [2]. - It temporarily relaxes the LES by inhibiting acetylcholine release, though its effects are not permanent and repeated injections may be necessary [2].

Q: Which of the following statements regarding peptic ulcers are correct? 1. Duodenal ulcers are more common as compared to gastric ulcers. 2. Helicobacter pylori and NSAIDs are most common causative agents. 3. Bleeding is the most common complication associated with posterior duodenal ulcer.

1 and 2 only. ***1 and 2 only*** - **Duodenal ulcers** are significantly more common than gastric ulcers, with a ratio of about 4:1 [1]. - The two primary causes of peptic ulcers are infection with **_Helicobacter pylori_** and the use of **non-steroidal anti-inflammatory drugs (NSAIDs)** [1]. *2 and 3 only* - While _**H. pylori**_ and **NSAIDs** are indeed the most common causes, the statement incorrectly assumes that bleeding is the most common complication associated with **posterior duodenal ulcers**, when the most common complication of all peptic ulcers is **hemorrhage** but it is more specifically associated with posterior duodenal ulcers due to proximity to the **gastroduodenal artery**. - Hence, the second and third statements are individually correct, but the first statement which says duodenal ulcers are more common then gastric ulcers is also correct. *1, 2 and 3* - While statements 1 and 2 are correct individually, statement 3, which attributes bleeding as the most common complication specifically to posterior duodenal ulcers, is correct because posterior duodenal ulcers are particularly prone to bleeding due to the proximity of the **gastroduodenal artery** [1]. - Thus, all three statements are individually correct, but the combination chosen is redundant. *1 and 3 only* - This option is flawed because it omits statement 2, which correctly identifies **_H. pylori_** and **NSAIDs** as the primary causes of peptic ulcers [1]. - Although posterior duodenal ulcers are associated with bleeding, statement 3 is not complete enough without the inclusion of statement 2.

Q: Which of the following statements are correct with regard to Budd-Chiari syndrome? 1. Venous drainage of liver is occluded by hepatic vein thrombosis. 2. It most commonly affects the young males. 3. It is associated with protein C, protein S and antithrombin III deficiency. 4. Abdominal discomfort and ascites are the most common features associated with acute thrombosis.

1, 3 and 4. ***1, 3 and 4*** - **Budd-Chiari syndrome** is characterized by the **occlusion of hepatic venous outflow**, typically due to **thrombosis** in the hepatic veins or inferior vena cava [1]. - It is frequently associated with **hypercoagulable states**, including deficiencies of **protein C, protein S, and antithrombin III**, and commonly presents acutely with **abdominal discomfort, ascites**, and hepatomegaly due to acute thrombosis [1], [2]. *1, 2 and 3* - This option is incorrect because Budd-Chiari syndrome does not most commonly affect young males; it has a variable incidence and can affect both sexes, often in their early adulthood or middle age. - While venous drainage occlusion and association with hypercoagulable states are correct, the demographic statement renders this option partially incorrect. *1, 2 and 4* - This option is incorrect because the statement that Budd-Chiari syndrome most commonly affects young males is not accurate; it has a broader demographic distribution. - The other points regarding venous occlusion and clinical features are correct, but the demographic inaccuracy makes this option incorrect. *2, 3 and 4* - This option is incorrect because statement 2, claiming that Budd-Chiari syndrome most commonly affects young males, is not consistently true. - While deficiencies like protein C, protein S, and antithrombin III, as well as symptoms like abdominal discomfort and ascites, are indeed associated, the demographic claim invalidates this choice.

Q: Which of the following is included in Ranson scoring system to predict the severity of acute pancreatitis at the time of admission? A. WBC count > 15 x 10^3/L B. Blood glucose > 200 mg/dL C. LDH > 350 units/L D. AST > 250 units/L

WBC count > 15,000/mm³. ***WBC count > 15,000/mm³*** - A **high white blood cell count** upon admission is one of the initial criteria in the Ranson scoring system indicating more severe inflammation [1]. - This parameter helps to assess the systemic inflammatory response in acute pancreatitis. *LDH > 350 units/L* - The Ranson criteria specify an **LDH level greater than 350 units/L** as a predictor of severity for acute pancreatitis, but it is assessed **at 48 hours after admission**, not at admission. - This value reflects ongoing tissue damage and enzyme release. *Blood glucose > 200 mg/dL* - A blood glucose level > 200 mg/dL is a criterion for the Ranson score, but it is assessed **at 48 hours after admission**, not at the time of admission. - This can indicate significant pancreatic damage impacting insulin production. *AST > 250 units/L* - While an elevated AST level can be present in acute pancreatitis, the specific Ranson criterion for AST is **> 250 units/L**, and it is assessed **at 48 hours after admission**, not upon admission. - This elevation can suggest hepatobiliary involvement or severe pancreatic necrosis.

Q: Which organ is PRIMARILY involved in cystic fibrosis?

Lungs. Lungs - The lungs are **primarily affected** in cystic fibrosis due to the dysfunction of the **CFTR protein**, leading to the production of thick, sticky mucus [1]. - This thick mucus obstructs the airways, causing **recurrent infections**, inflammation, and progressive lung damage, which is the leading cause of morbidity and mortality [1], [2]. *Pancreas* - The pancreas is also significantly affected in cystic fibrosis, leading to **exocrine pancreatic insufficiency** and malabsorption. - However, while pancreatic issues are prominent, the **pulmonary complications** are typically the primary cause of severe illness and death [2]. *Kidney* - The kidneys are generally **not directly affected** by the primary pathology of cystic fibrosis. - Renal complications are usually secondary to treatments or long-term systemic effects of the disease. *Liver* - The liver can be affected in cystic fibrosis, leading to **focal biliary cirrhosis** and other hepatobiliary issues. - However, severe liver disease is less common than pulmonary or pancreatic manifestations and usually does not represent the primary organ involved in the acute or chronic progression of the disease.

Q: Which of the following are correct with regard to lung cancer? 1. Surgical resection has a limited role in curative treatment of lung cancer. 2. Pattern of disease and prognosis of oat cell carcinoma are different to other varieties in the lungs. 3. Small cell lung cancer is a type of Neuroendocrine Tumour (NET). 4. Squamous cancer appears as a cavitating tumour in the lungs.

2, 3 and 4. ***2, 3 and 4*** - **Oat cell carcinoma** (small cell lung cancer) is known for its **aggressive behavior**, rapid growth, early metastasis, and distinct response to chemotherapy and radiation rather than surgery, making its pattern and prognosis different from **non-small cell lung cancer (NSCLC)** types [1]. - **Small cell lung cancer (SCLC)** originates from **neuroendocrine cells** in the lung, classifying it as a type of **Neuroendocrine Tumour (NET)**, which explains its unique biological and clinical characteristics [1]. - **Squamous cell carcinoma** is often centrally located and can undergo central necrosis, leading to **cavitation** which appears as a cavitating tumor on imaging [1]. *1, 3 and 4* - This option is incorrect because statement 1, which suggests surgical resection has a limited role in curative treatment, is generally **false for non-small cell lung cancer (NSCLC)**, where surgery is the primary curative modality in early stages [1]. - While statements 3 and 4 are correct, the inclusion of incorrect statement 1 makes this option invalid. *1, 2 and 3* - This option is incorrect as statement 1 claiming a limited role for surgical resection in curative treatment is generally **false for NSCLC**, where localized tumors are ideally treated with surgery [1]. - Statements 2 and 3 are correct, but the inaccuracy of statement 1 renders this option incorrect. *1, 2 and 4* - This option is incorrect because statement 1, which states that surgical resection has a limited role in curative treatment, is generally **incorrect for early-stage NSCLC** [1]. - Although statements 2 and 4 are accurate, the error in statement 1 makes this combination incorrect.

Q: Which of the following are correct about Felty's syndrome? 1. It is associated with rheumatoid arthritis. 2. It may present with leukopenia. 3. It may have splenomegaly. 4. Splenectomy always improves the blood picture.

1, 2 and 3. ***1, 2 and 3*** - Felty's syndrome is a severe variant of **rheumatoid arthritis** characterized by the triad of **rheumatoid arthritis**, **splenomegaly**, and **neutropenia** (a type of leukopenia) [1]. - While splenectomy can be considered for persistent severe neutropenia, it does not **always improve the blood picture** and is reserved for cases unresponsive to other treatments. *1, 2 and 4* - This option correctly identifies the association with **rheumatoid arthritis** and **leukopenia** but incorrectly states that splenectomy **always improves the blood picture**. - Splenectomy is not a guarantee of improvement and is considered a last resort. *1, 3 and 4* - This option correctly identifies the association with **rheumatoid arthritis** and **splenomegaly** but incorrectly concludes that splenectomy **always improves the blood picture**, and misses the characteristic **leukopenia**. - Leukopenia, specifically neutropenia, is a defining feature of Felty's syndrome [1]. *2, 3 and 4* - This option incorrectly states that Felty's syndrome is always associated with leukopenia and splenomegaly, but the crucial missing element is its clear association with **rheumatoid arthritis**. - The primary underlying condition for Felty's syndrome is **long-standing, severe rheumatoid arthritis** [1].

Q: Heavy menstrual bleeding is a common presentation in which of the following? 1. Clotting factor deficiency 2. Fibroid uterus 3. Adenomyosis 4. Prolactinoma.

1, 2 and 3. ***1, 2 and 3*** - **Clotting factor deficiencies** (e.g., von Willebrand disease, factor XI deficiency) impair normal hemostasis, leading to prolonged and heavy menstrual bleeding. - **Fibroid uterus** causes heavy menstrual bleeding due to increased endometrial surface area, impaired uterine contractility, and dilated underlying vessels. - **Adenomyosis**, characterized by endometrial tissue within the myometrium, leads to an enlarged, boggy uterus and causes heavy and painful menstruation. *2, 3 and 4* - This option correctly identifies fibroid uterus and adenomyosis, which are common causes of heavy menstrual bleeding. - However, **prolactinoma** typically causes **amenorrhea** or oligomenorrhea, not heavy menstrual bleeding, due to its inhibitory effect on gonadotropin-releasing hormone (GnRH). *1, 2 and 4* - While clotting factor deficiency and fibroid uterus are valid causes of heavy menstrual bleeding, **prolactinoma** is an incorrect inclusion. - Prolactinoma often leads to **hypogonadism** and anovulation, resulting in irregular or absent menstrual periods. *1, 3 and 4* - This option includes clotting factor deficiency and adenomyosis, which are causes of heavy menstrual bleeding. - However, **prolactinoma** is not associated with heavy menstrual bleeding; instead, it is known to cause **menstrual irregularities** including amenorrhea.

Q: Which of the following are the clinical features of hyperprolactinemia? 1. Hypergonadotropic hypogonadism 2. Hypogonadotropic hypergonadism 3. Oligomenorrhea 4. Heavy menstruation

3. Oligomenorrhea. ***Oligomenorrhea*** - **Oligomenorrhea** (infrequent or light menstruation) is a common symptom of **hyperprolactinemia** due to prolactin's inhibitory effect on **GnRH** and, consequently, **gonadotropin** release [1], [2]. - The resulting **estrogen deficiency** can lead to menstrual irregularities, including anovulation and delayed periods [3]. *Hypogonadotropic hypergonadism* - This condition involves **low gonadotropins** (LH, FSH) despite **high sex hormones**, which is not characteristic of **hyperprolactinemia**. - **Hyperprolactinemia** typically causes **hypogonadotropic hypogonadism** by suppressing pituitary gonadotropin release [2]. *Hypergonadotropic hypogonadism* - This is characterized by **high gonadotropins** (LH, FSH) and **low sex hormones**, indicating primary gonadal failure. - **Hyperprolactinemia** causes **low gonadotropins** by inhibiting **GnRH** pulsatility, leading to secondary gonadal dysfunction [1]. *Heavy menstruation* - **Heavy menstruation (menorrhagia)** is generally not associated with **hyperprolactinemia**; rather, **oligomenorrhea** or **amenorrhea** are typical due to **estrogen deficiency** [3]. - **Estrogen deficiency** results in an underdeveloped uterine lining, which is less likely to cause heavy bleeding.

Q: Which of the following statements are correct in respect of haemophilia? 1. It is hereditary bleeding disorder. 2. It has a higher incidence among Asians. 3. It affects females occasionally and mildly.

1 and 3 only. ***1 and 3 only*** - Haemophilia is a well-known **hereditary bleeding disorder**, primarily affecting males, caused by a deficiency in certain clotting factors [1]. - While haemophilia mainly affects males, females can be carriers and, in rare instances, experience mild to moderate symptoms, especially due to **extreme X-inactivation**. *2 and 3 only* - The statement that it has a higher incidence among Asians is **incorrect**; haemophilia incidence is generally consistent across ethnic groups, approximately 1 in 5,000 live male births worldwide [2]. - While females can be affected, their involvement is typically mild and occasional, making statement 3 correct. *1 and 2 only* - Haemophilia is indeed a **hereditary bleeding disorder** (statement 1 is correct) [1]. - However, the claim of higher incidence among Asians is **unsupported** by epidemiological data, rendering statement 2 incorrect. *1, 2 and 3* - While haemophilia is a **hereditary bleeding disorder** and can affect females, the assertion of a higher incidence among Asians is **false** [2]. - Its global incidence rates do not show a significant racial or ethnic predilection.

Question 1

Which of the following is the LEAST invasive initial treatment option for achalasia?

1. Botulinum toxin
2. Beta blockers
3. Pneumatic dilation
4. Heller's myotomy

Accepted Answer

2. Beta blockers

Answer

3. Pneumatic dilation

Answer

4. Heller's myotomy

Answer

1. Botulinum toxin

Question 2

Which of the following statements regarding peptic ulcers are correct?

1. Duodenal ulcers are more common as compared to gastric ulcers.
2. Helicobacter pylori and NSAIDs are most common causative agents.
3. Bleeding is the most common complication associated with posterior duodenal ulcer.

Accepted Answer

1 and 2 only

Answer

2 and 3 only

Answer

1, 2 and 3

Answer

1 and 3 only

Question 3

Which of the following statements are correct with regard to Budd-Chiari syndrome?

1. Venous drainage of liver is occluded by hepatic vein thrombosis.
2. It most commonly affects the young males.
3. It is associated with protein C, protein S and antithrombin III deficiency.
4. Abdominal discomfort and ascites are the most common features associated with acute thrombosis.

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 4

Which of the following is included in Ranson scoring system to predict the severity of acute pancreatitis at the time of admission?

A. WBC count > 15 x 10^3/L
B. Blood glucose > 200 mg/dL
C. LDH > 350 units/L
D. AST > 250 units/L

Accepted Answer

WBC count > 15,000/mm³

Answer

LDH > 350 units/L

Answer

Blood glucose > 200 mg/dL

Answer

AST > 250 units/L

Question 5

Which organ is PRIMARILY involved in cystic fibrosis?

Accepted Answer

Lungs

Answer

Pancreas

Answer

Kidney

Answer

Liver

Question 6

Which of the following are correct with regard to lung cancer?

1. Surgical resection has a limited role in curative treatment of lung cancer.
2. Pattern of disease and prognosis of oat cell carcinoma are different to other varieties in the lungs.
3. Small cell lung cancer is a type of Neuroendocrine Tumour (NET).
4. Squamous cancer appears as a cavitating tumour in the lungs.

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 7

Which of the following are correct about Felty's syndrome?

1. It is associated with rheumatoid arthritis.
2. It may present with leukopenia.
3. It may have splenomegaly.
4. Splenectomy always improves the blood picture.

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 8

Heavy menstrual bleeding is a common presentation in which of the following?

1. Clotting factor deficiency
2. Fibroid uterus
3. Adenomyosis
4. Prolactinoma.

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 9

Which of the following are the clinical features of hyperprolactinemia?

1. Hypergonadotropic hypogonadism
2. Hypogonadotropic hypergonadism
3. Oligomenorrhea
4. Heavy menstruation

Accepted Answer

3. Oligomenorrhea

Answer

2. Hypogonadotropic hypergonadism

Answer

1. Hypergonadotropic hypogonadism

Answer

4. Heavy menstruation

Question 10

Which of the following statements are correct in respect of haemophilia?

1. It is hereditary bleeding disorder.
2. It has a higher incidence among Asians.
3. It affects females occasionally and mildly.

Accepted Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 2 and 3

UPSC-CMS 2022 — Internal Medicine