UPSC-CMS 2023 — Internal Medicine
29 Previous Year Questions with Answers & Explanations
The following statements regarding small bowel tuberculosis are correct except
Systemic Inflammatory Response Syndrome (SIRS) diagnostic criteria include the following except
When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...
Which of the following most strongly suggests the diagnosis of primary hyper-parathyroidism ?
A young patient presented in the emergency with haematemesis and was found to have massive splenomegaly. The following conditions are associated with the above clinical presentation except
The following are the common features of Idiopathic Thrombocytopenic Purpura except
The prognostic indicators in a case of portal hypertension include: 1. Serum globulin 2. Serum albumin 3. Serum bilirubin 4. Ascites Select the correct answer using the code given below :
The following constitute the Saint's triad except
The most common site of skeletal metastases in carcinoma of the breast is
Match List-I with List-II and select the correct answer using the code given below the Lists:
UPSC-CMS 2023 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 1: The following statements regarding small bowel tuberculosis are correct except
- A. There are two types : ulcerative and hyperplastic
- B. In the ulcerative type, the bowel serosa is studded with tubercles
- C. The ulcerative type occurs when the virulence of the organism is greater than the host defence
- D. The strictures are common in the ulcerative type (Correct Answer)
Explanation: ***The strictures are common in the ulcerative type*** - While both ulcerative and hyperplastic types of small bowel tuberculosis can lead to complications, **strictures are more characteristic of the hyperplastic type**. - In the **hyperplastic form**, chronic inflammation, fibrosis, and granuloma formation cause wall thickening and luminal narrowing, resulting in strictures. *There are two types : ulcerative and hyperplastic* - This statement is correct. Small bowel tuberculosis is broadly classified into **ulcerative** and **hyperplastic** forms, with mixed types also occurring. - The type is often determined by the interplay between the virulence of the organism and the host's immune response. *In the ulcerative type, the bowel serosa is studded with tubercles* - This statement is correct. The **ulcerative type** is often associated with the **spread of infection to the serosa**, leading to the formation of visible **tubercles**. - This indicates more extensive disease and possible peritoneal involvement. *The ulcerative type occurs when the virulence of the organism is greater than the host defence* - This statement is correct. The **ulcerative form** is often observed when the **organism's virulence is high** and/or the host's **immune response is weak**, leading to destructive lesions. - This imbalance results in caseating necrosis and ulceration of the bowel wall.
Question 2: Systemic Inflammatory Response Syndrome (SIRS) diagnostic criteria include the following except
- A. Temperature > 38°C or < 36°C
- B. Tachycardia with a heart rate of more than 90/min.
- C. White cell count < 4000/mm³ (Correct Answer)
- D. Tachypnoea with a respiratory rate of > 20/min.
Explanation: ***White cell count < 4000/mm³*** - The correct SIRS criterion regarding white blood cell count is either > 12,000/mm³ or < 4,000/mm³ or the presence of > 10% **immature (band) forms**. [2] - This option correctly states a **WBC count below 4000/mm³**, which is indeed a criterion for SIRS. *Temperature > 38°C or < 36°C* - This is a correct criterion for SIRS, indicating a significant deviation from normal body temperature. [1] - Both **fever (hyperthermia)** and **hypothermia** are signs of systemic inflammation. *Tachycardia with a heart rate of more than 90/min.* - This is a correct criterion for SIRS, reflecting the increased metabolic demand and sympathetic activation during systemic inflammation. [2] - A persistent **heart rate above 90 bpm** is considered indicative of such stress. *Tachypnoea with a respiratory rate of > 20/min.* - This is a correct criterion for SIRS, showing the body's attempt to compensate for metabolic disturbances or increased oxygen demand. [2] - A **respiratory rate greater than 20 breaths per minute** or a PaCO2 less than 32 mmHg are both SIRS criteria.
Question 3: When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...
- A. 0.7
- B. 1.0
- C. 0.9
- D. 0.3 (Correct Answer)
Explanation: ***0.3*** - A value of **less than 0.3** indicates **severe blood flow impairment**, consistent with critical limb ischemia, necessitating urgent intervention [1]. - This extremely low ABPI reflects a profound decrease in perfusion to the lower extremity [1]. *0.7* - An ABPI of **less than 0.7** typically suggests **moderate peripheral artery disease (PAD)**, which could cause claudication but is not usually indicative of critical limb ischemia [1]. - While concerning, it does not represent the severe, limb-threatening ischemia implied by the term "critical." *1.0* - An ABPI of around **1.0 (0.9-1.3)** is considered **normal**, indicating healthy blood flow without significant arterial obstruction. - This value would rule out any significant peripheral artery disease, including critical limb ischemia. *0.9* - An ABPI of **less than 0.9** generally suggests **peripheral artery disease (PAD)**, which can cause symptoms like intermittent claudication [1]. - However, it is not low enough to diagnose critical limb ischemia, which represents a more severe state of arterial insufficiency [1].
Question 4: Which of the following most strongly suggests the diagnosis of primary hyper-parathyroidism ?
- A. Serum calcium above 11 mg/dL (Correct Answer)
- B. Serum acid phosphatase above 120 IU/L
- C. Urinary calcium below 100 mg/day
- D. Serum alkaline phosphatase above 120 IU/L
Explanation: ***Serum calcium above 11 mg/dL*** - **Hypercalcemia** is the hallmark of primary hyperparathyroidism, as excessive parathyroid hormone (PTH) leads to increased calcium reabsorption from bones and kidneys [1, 3]. - A serum calcium level significantly above the normal range (typically 8.5-10.2 mg/dL) strongly suggests a parathyroid-related issue; specifically, levels exceeding 11.4 mg/dL (2.85 mmol/L) often warrant surgical consideration [1]. *Serum acid phosphatase above 120 IU/L* - **Elevated acid phosphatase** is more commonly associated with conditions like **prostatic carcinoma** with bone metastases or certain hematologic malignancies. - It is not a primary diagnostic marker for hyperparathyroidism. *Urinary calcium below 100 mg/day* - **Low urinary calcium** (hypocalciuria) is characteristic of **familial hypocalciuric hypercalcemia (FHH)**, a genetic condition that can mimic primary hyperparathyroidism [1]. - In primary hyperparathyroidism, **urinary calcium excretion is typically normal or high** due to the PTH-mediated increase in filtered calcium load. *Serum alkaline phosphatase above 120 IU/L* - **Elevated alkaline phosphatase** can indicate increased **bone turnover**, which can be seen in severe, prolonged primary hyperparathyroidism as an indicator of bone resorption [1, 2]. - However, it is a non-specific marker and can also be elevated in various liver diseases or other bone disorders; it is not as specific as hypercalcemia for diagnosing primary hyperparathyroidism [2].
Question 5: A young patient presented in the emergency with haematemesis and was found to have massive splenomegaly. The following conditions are associated with the above clinical presentation except
- A. Kala-azar
- B. Portal hypertension
- C. Idiopathic thrombocytopenic purpura (Correct Answer)
- D. Malaria
Explanation: ***Idiopathic thrombocytopenic purpura*** - While ITP can cause **bleeding** (including hematemesis) due to **thrombocytopenia**, it is generally **not associated with massive splenomegaly**. Splenomegaly, if present, is usually mild. - The primary defect in ITP is **immune-mediated platelet destruction**, not a cause of massive splenic enlargement, which typically results from conditions involving portal congestion, infiltrative diseases, or hemolytic processes. *Kala-azar* - **Kala-azar (visceral leishmaniasis)** is notoriously associated with **massive splenomegaly** and can cause **hematemesis** due to complications like **esophageal varices** or coagulopathy. - The parasite (Leishmania donovani) infiltrates the reticuloendothelial system, leading to profound splenomegaly. *Portal hypertension* - **Portal hypertension** is a direct cause of **massive splenomegaly** due to congestion and can lead to **hematemesis** from **ruptured esophageal varices**. - The increased pressure in the portal venous system causes blood to back up into the splenic vein, enlarging the spleen. *Malaria* - **Chronic malaria**, particularly from *Plasmodium falciparum* or *Plasmodium vivax*, can lead to significant, often **massive splenomegaly** (hyperreactive malarial splenomegaly). - While hematemesis is not a primary symptom, severe malaria can cause **coagulopathy** or contribute to **gastrointestinal bleeding** in complicated cases, though massive splenomegaly itself is a prominent feature.
Question 6: The following are the common features of Idiopathic Thrombocytopenic Purpura except
- A. Cutaneous ecchymoses
- B. Massive splenomegaly (Correct Answer)
- C. Thrombocytopenia
- D. Epistaxis
Explanation: ***Massive splenomegaly*** - Idiopathic Thrombocytopenic Purpura (ITP) typically involves only **mild to moderate splenomegaly**, if any, due to increased platelet destruction in the spleen [1]. **Massive splenomegaly** is not a characteristic feature. - **Massive splenomegaly** would suggest other conditions like chronic myeloid leukemia, myelofibrosis, or certain infectious diseases. *Cutaneous ecchymoses* - **Ecchymoses (bruising)** are a common symptom of ITP due to the low platelet count, leading to easier bleeding under the skin [2]. - These present as larger, purplish patches on the skin, indicating extravasated blood. *Thrombocytopenia* - **Thrombocytopenia** (low platelet count) is the hallmark and diagnostic criterion for ITP [1]. - The reduced number of platelets impairs the body's ability to form clots, leading to bleeding manifestations [2]. *Epistaxis* - **Epistaxis (nosebleeds)** is a common mucocutaneous bleeding symptom in ITP, reflecting the impaired primary hemostasis due to low platelet count [2]. - Bleeding from mucosal surfaces is typical in platelet disorders [2].
Question 7: The prognostic indicators in a case of portal hypertension include: 1. Serum globulin 2. Serum albumin 3. Serum bilirubin 4. Ascites Select the correct answer using the code given below :
- A. 2, 3 and 4 (Correct Answer)
- B. 3 and 4 only
- C. 1, 2 and 3
- D. 1 and 4 only
Explanation: ***2, 3 and 4*** - **Serum albumin**, **serum bilirubin**, and the presence of **ascites** are all key components of scoring systems like the **Child-Pugh score**, which is widely used to assess the severity and prognosis of **liver disease** and **portal hypertension** [1]. - **Low albumin** reflects impaired synthetic function, **high bilirubin** indicates impaired excretory function, and **ascites** points to decompensation, all contributing to a worse prognosis [2]. *3 and 4 only* - This option is incomplete as it correctly identifies **serum bilirubin** and **ascites**, but omits **serum albumin**, which is a crucial prognostic indicator reflecting the liver's synthetic capacity. - While bilirubin and ascites are important, excluding albumin underestimates the complexity of prognostic assessment in **portal hypertension**. *1, 2 and 3* - This option incorrectly includes **serum globulin** as a direct prognostic indicator in the context of standard scoring systems like Child-Pugh which focus on liver function and clinical complications. - While **globulins** can be elevated in chronic liver disease due to inflammation, they are not part of the primary prognostic criteria for **portal hypertension**. *1 and 4 only* - This option incorrectly includes **serum globulin** and excludes **serum albumin** and **serum bilirubin**, two critical markers of liver function. - Relying solely on globulin and ascites would provide an incomplete and inaccurate assessment of prognosis in a patient with **portal hypertension**.
Question 8: The following constitute the Saint's triad except
- A. Jaundice (Correct Answer)
- B. Colonic diverticulosis
- C. Gall stones
- D. Hiatus hernia
Explanation: ***Jaundice*** - **Jaundice** is not part of Saint's Triad, which describes a common co-occurrence of three specific conditions. - While **gallstones** can cause jaundice, jaundice itself is a symptom, not one of the conditions in the triad. *Colonic diverticulosis* - **Colonic diverticulosis** is one of the three components of Saint's Triad. - It refers to the presence of **diverticula** (small pouches) in the colon. *Gall stones* - **Gallstones** (cholelithiasis) are another key component of Saint's Triad. - This condition involves the formation of **hardened deposits** in the gallbladder. *Hiatus hernia* - **Hiatus hernia** is the third component of Saint's Triad [1]. - It occurs when part of the **stomach protrudes** through the diaphragm into the chest cavity [1].
Question 9: The most common site of skeletal metastases in carcinoma of the breast is
- A. Thoracic vertebrae (Correct Answer)
- B. Skull
- C. Pelvis
- D. Lumbar vertebrae
Explanation: ***Thoracic vertebrae*** - The **thoracic spine** is the most frequent site for skeletal metastases from breast carcinoma due to its rich vascular supply and proximity to the primary tumor. - Metastases can lead to **vertebral compression fractures**, spinal cord compression, and severe back pain. *Skull* - While the skull can be a site of bone metastases, it is **less common** as the primary site compared to the thoracic vertebrae. - Skull metastases often present as **punched-out lytic lesions** and can involve cranial nerves. *Pelvis* - The **pelvis** is a common site for bone metastases, but it is **not the most frequent** compared to the axial skeleton, particularly the thoracic spine. - Pelvic metastases can cause pain, fractures, and affect mobility. *Lumbar vertebrae* - The **lumbar spine** is a common site for metastases, but it is generally **less frequently involved** than the thoracic spine in breast cancer. - Lumbar metastases also carry a risk of spinal cord compression affecting the lower limbs.
Question 10: Match List-I with List-II and select the correct answer using the code given below the Lists:
- A. A→4 B→3 C→1 D→2
- B. A→4 B→2 C→3 D→1
- C. A→3 B→4 C→1 D→2
- D. A→4 B→1 C→3 D→2 (Correct Answer)
Explanation: **A→4 B→1 C→3 D→2** - This option correctly matches each endocrine gland with its primary hormone: the **pineal gland** produces **melatonin**, the **testis** produces **testosterone**, the **adrenal gland** produces **cortisol**, and the **ovary** produces **estrogen**. - These pairings are fundamental to understanding the basic functions of the endocrine system. *A→4 B→3 C→1 D→2* - This option incorrectly matches the **testis** with **cortisol** (should be testosterone) and the **adrenal gland** with **melatonin** (should be cortisol). - Cortisol is a steroid hormone produced by the adrenal cortex, while melatonin from the pineal gland regulates sleep-wake cycles. *A→4 B→2 C→3 D→1* - This option incorrectly matches the **testis** with **estrogen** (should be testosterone) and the **ovary** with **melatonin** (should be estrogen). - Estrogen is the primary female sex hormone, while testosterone is the primary male sex hormone. *A→3 B→4 C→1 D→2* - This option incorrectly matches the **pineal gland** with **cortisol** (should be melatonin) and the **testis** with **estrogen** (should be testosterone). - The pineal gland is known for its role in circadian rhythms through melatonin production, not stress response hormones like cortisol.