UPSC-CMS 2023 - Internal Medicine Practice Questions

Q: The best position to palpate the minimal enlargement of spleen is :

Supine with lower limbs extended. ***Supine with lower limbs extended*** - This position allows for optimal relaxation of the abdominal muscles, making it easier to **palpate the spleen** as it descends during inspiration. - In a supine position, the examiner can effectively use techniques like the **hooking method** or palpation from the right side of the patient to detect minimal splenic enlargement. *Bimanual palpation in supine position* - While bimanual palpation is useful for organs like the kidneys, it is generally less effective for detecting minimal splenic enlargement compared to other specialized techniques. - The goal is to feel the spleen as it descends, which is better achieved with precise contact during inspiration rather than a bimanual 'capture'. *Palpation of left subcostal area in right lateral decubitus position* - The **right lateral decubitus position** (Lieper's or Opeczky's position) is indeed used to make a slightly enlarged spleen more prominent by shifting it anteriorly and inferiorly. - However, while helpful for a potentially palpable spleen, the combined supine position with relaxed abdominal muscles can be overall more sensitive for **minimal enlargement** when initially assessing. *Palpation of left subcostal area in knee-elbow position* - The knee-elbow position is primarily used for rectal or vaginal examinations and is not suitable for abdominal palpation, especially for organs like the spleen. - It would make abdominal muscle contraction more likely, hindering effective palpation of the left subcostal area.

Q: Which one of the following is a cause of exudative ascites ?

Peritoneal malignancy. ***Peritoneal malignancy*** - **Malignant cells** can directly or indirectly increase capillary permeability and fluid production within the peritoneal cavity. - This leads to a **high protein content** in the ascitic fluid, characteristic of exudate [1]. *Nephrotic syndrome* - Causes **transudative ascites** due to severe **hypoalbuminemia**, leading to decreased plasma oncotic pressure [1]. - The liver is healthy, and there is no direct inflammation or increased capillary permeability in the peritoneum. *Portal vein thrombosis* - Results in **increased hydrostatic pressure** within the portal circulation, leading to the transudation of fluid into the peritoneal cavity. - The ascitic fluid typically has a **low protein content** as it's a transudate, not an exudate [1]. *Congestive cardiac failure* - Leads to **increased systemic venous pressure** and consequently elevated hepatic sinusoidal and splanchnic capillary pressures [1]. - This causes **transudative ascites** with low protein content due to passive fluid leakage rather than inflammation or direct vascular damage [1].

Q: Which of the following are seen in Normal pressure hydrocephalus ? 1. Hearing loss 2. Gait disturbance 3. Incontinence 4. Cognitive decline Select the correct answer using the code given below :

3 and 4 only. ***3 and 4 only*** - Normal pressure hydrocephalus (NPH) is classically characterized by the triad of **gait disturbance**, **urinary incontinence**, and **cognitive decline** [1]. - This combination is frequently described as "wet, wobbly, and wacky" referring to incontinence, gait instability, and cognitive impairment, respectively [1]. *2, 3 and 4* - This option correctly includes **gait disturbance**, **incontinence**, and **cognitive decline**, which are the hallmark symptoms of NPH [1]. - However, the wording "3 and 4 only" in the question's intended correct answer suggests that among the presented choices, only incontinence and cognitive decline are considered correct in that specific context. *1, 2 and 3* - This option incorrectly includes **hearing loss** as a feature of NPH. Hearing loss is not typically part of the classic triad. - While it includes gait disturbance and incontinence, the presence of hearing loss makes this choice less accurate as a primary characteristic of NPH. *1, 2 and 4* - This option incorrectly includes **hearing loss** as a symptom of NPH. - While gait disturbance and cognitive decline are features, the inclusion of hearing loss makes this an inaccurate representation of the NPH symptom triad.

Q: Which of the following are included in the classical clinical presentation of pericardial tamponade ?

Muffled heart sounds. ***Muffled heart sounds*** - Pericardial tamponade involves an accumulation of fluid in the **pericardial sac**, which dampens sound transmission and results in **muffled heart sounds** [1]. - This is a key component of **Beck's triad**, indicating compromised cardiac filling. *Collapsed neck veins* - In pericardial tamponade, there is a significant increase in **intrapericardial pressure**, which impedes venous return to the heart [1]. - This typically leads to **distended neck veins** (elevated jugular venous pressure), not collapsed ones. *Tachycardia* - While **tachycardia** can be present as a compensatory mechanism due to reduced cardiac output in tamponade, it is a non-specific finding. - It is not considered part of the **classical Beck's triad**, which specifically focuses on the triad of muffled heart sounds, hypotension, and elevated jugular venous pressure. ***Decreased arterial pressure*** - The increased intrapericardial pressure in tamponade severely restricts **ventricular filling**, leading to a reduction in stroke volume and subsequently **decreased cardiac output** [1], [2]. - This reduction in cardiac output manifests as systemic **hypotension** (decreased arterial pressure), which is a critical finding in tamponade.

Q: Consider the following clinical features : 1. Low back pain 2. Saddle anaesthesia 3. Motor weakness in the lower extremities 4. Variable rectal and urinary symptoms Which of the above features may be present in a patient with Cauda Equina syndrome ?

1, 2, 3 and 4. ***1, 2, 3 and 4*** - **Cauda equina syndrome** is a serious neurological condition involving compression of the cauda equina nerve roots, typically manifesting with **low back pain**, **saddle anesthesia**, and **motor weakness** in the lower extremities [1]. - The compression of the nerve roots can also lead to varying degrees of **rectal and urinary dysfunction**, including incontinence or retention, depending on which nerve roots are affected [2]. *1, 2 and 3 only* - While **low back pain**, **saddle anesthesia**, and **motor weakness** are prominent features of cauda equina syndrome, this option incorrectly excludes the crucial symptom of **rectal and urinary dysfunction**. - **Bladder and bowel dysfunction**, along with sexual dysfunction, are hallmark symptoms resulting from the involvement of sacral nerve roots in cauda equina compression [2]. *1 and 2 only* - This option correctly identifies **low back pain** and **saddle anesthesia** as features but omits two critical components of cauda equina syndrome: **motor weakness** and **rectal/urinary symptoms** [1]. - Without considering **motor weakness** and **sphincter dysfunction**, the diagnostic picture of cauda equina syndrome is incomplete, potentially delaying necessary surgical intervention [3]. *3 and 4 only* - This option incorrectly suggests that **motor weakness** and **rectal/urinary symptoms** are the only relevant features, excluding the highly characteristic **low back pain** and **saddle anesthesia**. - **Low back pain** is almost universally present and **saddle anesthesia** is a key indicator of sacral nerve root involvement, crucial for distinguishing cauda equina syndrome from other neurological conditions [1].

Q: A typical case of Iron Deficiency Anaemia (IDA) in pregnancy will show which of the following? 1. Hb less than 10 g/dL 2. PCV less than 30% 3. MCHC more than 30% 4. Microcytic hypochromic picture on peripheral blood smear (PBS). Select the correct answer using the code given below:

1, 2 and 4. ***1, 2 and 4*** - All three options (Hb < 10 g/dL, PCV < 30%, and microcytic hypochromic picture on PBS) are characteristic features of **iron deficiency anemia (IDA)** in pregnancy [1]. - While exact thresholds can vary, these values generally indicate significant anemia and the classic morphological changes associated with IDA [1]. *1, 2 and 3* - This option incorrectly includes "MCHC more than 30%." IDA is characterized by **hypochromia**, meaning **MCHC (mean corpuscular hemoglobin concentration)** is typically *less than* 30%, not more [1]. - The other two points (Hb < 10 g/dL and PCV < 30%) are consistent with IDA [1]. *2, 3 and 4* - This option incorrectly includes "MCHC more than 30%," which is contrary to the **hypochromic** nature of IDA [1]. - While PCV < 30% and microcytic hypochromic picture on PBS are correct, the inclusion of incorrect MCHC value makes this choice invalid. *1 and 4 only* - This option correctly identifies Hb less than 10 g/dL and a microcytic hypochromic picture on PBS as features of IDA [1]. - However, it omits **PCV less than 30%**, which is also a common finding in IDA, making it an incomplete answer compared to the most comprehensive correct option.

Q: Which of the following are blood values of Iron Deficiency Anaemia ? 1. Serum iron is less than 30 mg/100 mL 2. Total iron binding capacity is less than 400 µg/mL 3. Percentage saturation is 10% or less 4. Serum ferritin is below 30 µg/mL Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - In **iron deficiency anemia**, **serum iron** levels are typically **less than 30 µg/dL** [1] (or 30 mg/100 mL), indicating a reduced iron supply. - The **percentage saturation** of transferrin with iron falls to **10% or less** [1] because there is insufficient iron to bind to the available transferrin. - **Serum ferritin**, which reflects iron stores, is significantly **reduced, usually below 30 ng/mL** (or 30 µg/mL) [1]. *1, 2 and 4* - While options 1 and 4 are correct, option 2 stating **total iron binding capacity (TIBC) less than 400 µg/mL** is incorrect. - In iron deficiency, the body attempts to increase iron absorption by producing more transferrin, leading to an **elevated TIBC** [1] (often >400 µg/dL). *1, 2 and 3* - Although options 1 and 3 are correct for iron deficiency anemia, option 2, which states **TIBC is less than 400 µg/mL**, is false. - **TIBC is elevated** in iron deficiency, reflecting an increased capacity for iron binding due to increased transferrin. *2, 3 and 4* - While options 3 and 4 are correct, option 2, suggesting **TIBC is less than 400 µg/mL**, is inaccurate. - **TIBC** is typically **increased** in iron deficiency anemia as the body tries to maximize any available iron.

Q: Which of the following statements are correct regarding Mantoux test for tuberculosis? 1. It entails injecting 1 TU (Tuberculin Unit) of PPD (Purified Protein Derivative) in 0.1 mL intradermally. 2. The injection should be given with the needle bevel facing downward. 3. When placed correctly, the injection should produce a pale wheal of the skin, 1 - 2 mm in diameter. 4. The injection should be given with a tuberculin syringe. Select the correct answer using the code given below:

1 and 4. **1 and 4** - Statement 1 is correct: The Mantoux test involves injecting **1 TU (Tuberculin Unit) of PPD (Purified Protein Derivative)** in **0.1 mL intradermally** into the forearm, which is the standard dose and administration route. - Statement 4 is correct: A **tuberculin syringe** is specifically designed for small, precise volume injections like the Mantoux test, ensuring accurate dosing and placement. *1 and 2* - Statement 1 is correct, but statement 2 is incorrect regarding the **Mantoux test procedure**. - The needle bevel should face **upward** during intradermal injection to ensure proper placement of the PPD and formation of the wheal. *2 and 3* - Statement 2 is incorrect because the needle bevel should face **upward** for intradermal injection. - Statement 3 is incorrect because a correctly placed Mantoux injection should produce a wheal of **6-10 mm in diameter**, not 1-2 mm, indicating the PPD is in the dermis. *2 and 4* - Statement 2 is incorrect as the needle bevel should be positioned **facing upward**. - While statement 4 correctly identifies the use of a tuberculin syringe, the incorrectness of statement 2 makes this option unsuitable.

Q: Which of the following statements are correct regarding Chikungunya fever ? 1. It is usually transmitted by Culex mosquito. 2. A safe and effective vaccine is available for commercial use. 3. Incubation period is 4 - 7 days. 4. One of the prominent symptoms is arthropathy. Select the correct answer using the code given below :

3 and 4 only. ***3 and 4 only*** - The incubation period for Chikungunya fever is typically **3-7 days**, with a range of 2-12 days, making 4-7 days a correct estimate. - **Arthropathy** (severe joint pain and swelling) is a hallmark symptom of Chikungunya fever, often presenting with polyarthralgia that can be debilitating and chronic. *1 and 4 only* - Chikungunya fever is primarily transmitted by **Aedes mosquitoes** (Aedes aegypti and Aedes albopictus), not Culex mosquitoes. - While arthropathy (statement 4) is a correct symptom, the transmission by Culex mosquito (statement 1) is incorrect. *2 and 3 only* - As of now, there is **no commercially available safe and effective vaccine** for Chikungunya fever, although several are in clinical trials. - While the incubation period (statement 3) is correct, the absence of a commercially available vaccine (statement 2) makes this option incorrect. *1 and 2 only* - Chikungunya is transmitted by **Aedes mosquitoes**, not Culex mosquitoes. - There is currently **no licensed vaccine** for Chikungunya available for widespread commercial use.

Question 1

The best position to palpate the minimal enlargement of spleen is :

Accepted Answer

Supine with lower limbs extended

Answer

Bimanual palpation in supine position

Answer

Palpation of left subcostal area in right lateral decubitus position

Answer

Palpation of left subcostal area in knee-elbow position

Question 2

Which one of the following is a cause of exudative ascites ?

Accepted Answer

Peritoneal malignancy

Answer

Nephrotic syndrome

Answer

Portal vein thrombosis

Answer

Congestive cardiac failure

Question 3

Which of the following are seen in Normal pressure hydrocephalus ?

1. Hearing loss
2. Gait disturbance
3. Incontinence
4. Cognitive decline

Select the correct answer using the code given below :

Accepted Answer

3 and 4 only

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 4

Which of the following are included in the classical clinical presentation of pericardial tamponade ?

Accepted Answer

Muffled heart sounds

Answer

Collapsed neck veins

Answer

Tachycardia

Question 5

Consider the following clinical features :

1. Low back pain
2. Saddle anaesthesia
3. Motor weakness in the lower extremities
4. Variable rectal and urinary symptoms Which of the above features may be present in a patient with Cauda Equina syndrome ?

Accepted Answer

1, 2, 3 and 4

Answer

1, 2 and 3 only

Answer

1 and 2 only

Answer

3 and 4 only

Question 6

A typical case of Iron Deficiency Anaemia (IDA) in pregnancy will show which of the following?

1. Hb less than 10 g/dL
2. PCV less than 30%
3. MCHC more than 30%
4. Microcytic hypochromic picture on peripheral blood smear (PBS).

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1 and 4 only

Question 7

Which of the following are blood values of Iron Deficiency Anaemia ?

1. Serum iron is less than 30 mg/100 mL
2. Total iron binding capacity is less than 400 µg/mL
3. Percentage saturation is 10% or less
4. Serum ferritin is below 30 µg/mL

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 8

Which of the following statements are correct regarding Mantoux test for tuberculosis?

1. It entails injecting 1 TU (Tuberculin Unit) of PPD (Purified Protein Derivative) in 0.1 mL intradermally.
2. The injection should be given with the needle bevel facing downward.
3. When placed correctly, the injection should produce a pale wheal of the skin, 1 - 2 mm in diameter.
4. The injection should be given with a tuberculin syringe.

Select the correct answer using the code given below:

Accepted Answer

1 and 4

Answer

1 and 2

Answer

2 and 3

Answer

2 and 4

Question 9

Which of the following statements are correct regarding Chikungunya fever ?

1. It is usually transmitted by Culex mosquito.
2. A safe and effective vaccine is available for commercial use.
3. Incubation period is 4 - 7 days.
4. One of the prominent symptoms is arthropathy.

Select the correct answer using the code given below :

Accepted Answer

3 and 4 only

Answer

1 and 4 only

Answer

2 and 3 only

Answer

1 and 2 only

UPSC-CMS 2023 — Internal Medicine