UPSC-CMS 2023 - Internal Medicine PYQs Practice Questions

Q: The following statements regarding small bowel tuberculosis are correct except

The strictures are common in the ulcerative type. ***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. [Practice more Internal Medicine PYQs on OnCourse]

Q: Systemic Inflammatory Response Syndrome (SIRS) diagnostic criteria include the following except

White cell count 12,000/mm³ or 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. [Practice more Internal Medicine PYQs on OnCourse]

Q: When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...

0.3. ***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]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following most strongly suggests the diagnosis of primary hyper-parathyroidism ?

Serum calcium above 11 mg/dL. ***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]. [Practice more Internal Medicine PYQs on OnCourse]

Q: 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

Idiopathic thrombocytopenic purpura. ***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. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

The following statements regarding small bowel tuberculosis are correct except

Accepted Answer

The strictures are common in the ulcerative type

Answer

There are two types : ulcerative and hyperplastic

Answer

In the ulcerative type, the bowel serosa is studded with tubercles

Answer

The ulcerative type occurs when the virulence of the organism is greater than the host defence

Question 2

Systemic Inflammatory Response Syndrome (SIRS) diagnostic criteria include the following except

Accepted Answer

White cell count < 4000/mm³

Answer

Temperature > 38°C or < 36°C

Answer

Tachycardia with a heart rate of more than 90/min.

Answer

Tachypnoea with a respiratory rate of > 20/min.

Question 3

When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...

Accepted Answer

0.3

Answer

0.7

Answer

1.0

Answer

0.9

Question 4

Which of the following most strongly suggests the diagnosis of primary hyper-parathyroidism ?

Accepted Answer

Serum calcium above 11 mg/dL

Answer

Serum acid phosphatase above 120 IU/L

Answer

Urinary calcium below 100 mg/day

Answer

Serum alkaline phosphatase above 120 IU/L

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

Accepted Answer

Idiopathic thrombocytopenic purpura

Answer

Kala-azar

Answer

Portal hypertension

Answer

Malaria

Question 6

The following are the common features of Idiopathic Thrombocytopenic Purpura except

Accepted Answer

Massive splenomegaly

Answer

Cutaneous ecchymoses

Answer

Thrombocytopenia

Answer

Epistaxis

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 :

Accepted Answer

2, 3 and 4

Answer

3 and 4 only

Answer

1, 2 and 3

Answer

1 and 4 only

Question 8

The following constitute the Saint's triad except

Accepted Answer

Jaundice

Answer

Colonic diverticulosis

Answer

Gall stones

Answer

Hiatus hernia

Question 9

The most common site of skeletal metastases in carcinoma of the breast is

Accepted Answer

Thoracic vertebrae

Answer

Skull

Answer

Pelvis

Answer

Lumbar vertebrae

Question 10

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→4  B→1  C→3  D→2

Answer

A→4  B→3  C→1  D→2

Answer

A→4  B→2  C→3  D→1

Answer

A→3  B→4  C→1  D→2

UPSC-CMS 2023 — Internal Medicine