A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100-150 metres. The pain is relieved on taking rest for about 2-3 minutes and the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of
Q2
Which of the following statements are correct regarding Barrett's oesophagus?
1. It is a metaplastic change.
2. It is a risk factor for development of adenocarcinoma.
3. Ingestion of NSAIDs is the aetiological factor for its development.
4. Endoscopic mucosal resection is an effective treatment. Select the answer using the code given below.
Q3
Which of the following are local complications of acute pancreatitis?
1. Pseudocyst
2. Pleural effusion
3. Ileus
4. Acute fluid collection
Select the correct answer using the code given below.
Q4
Which of the following are risk factors for the development of pancreatic cancer?
1. Cigarette smoking
2. Diabetes mellitus
3. Obesity
4. Caucasian ethnicity
Select the correct answer using the code given below.
Q5
Which of the following statements are correct regarding renal cell carcinoma?
1. It arises from the epithelium of the proximal convoluted tubule.
2. It has a female preponderance.
3. Major subtypes are clear cell, papillary and chromophobe.
4. Surgery is the mainstay of treatment for organ-confined disease. Select the answer using the code given below.
Q6
Which of the following are features of autosomal dominant polycystic kidney disease?
1. Cyst may also occur in liver, pancreas and arachnoid membrane.
2. Most commonly manifests between 20-30 years of age.
3. Clinical manifestations are renal and extrarenal.
4. Men tend to progress to renal failure more rapidly than women.
Select the correct answer using the code given below.
Q7
Consider the following clinical features :
1. Raised ICP
2. Seizures
3. Focal deficit
4. Headache Which of the above clinical features are related to most brain tumours?
Q8
A 40-year-old lady complains of progressive deformities of her hands and fingers associated with stiffness which is present in both the hands and improves as the day progresses. On examination, there is symmetrical involvement of hands and fingers of both the upper limbs with flexion and ulnar deviation at the metacarpophalangeal joints. What is the most likely diagnosis in this lady?
Q9
Upper motor neuron lesions are characterized by which of the following?
1. Increased tone (spasticity)
2. Hyperreflexia
3. Absent plantar response
4. Motor weakness
Select the correct answer using the code given below.
Q10
Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)?
1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria.
2. It is same as bacteraemia.
3. It results in Multiple Organ Dysfunction Syndrome (MODS).
4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.
UPSC-CMS 2024 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 1: A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100-150 metres. The pain is relieved on taking rest for about 2-3 minutes and the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of
A. osteoarthritis of the knee
B. muscular fatigue
C. intermittent claudication (Correct Answer)
D. neurogenic claudication
Explanation: ***intermittent claudication***
- The classic presentation of **cramping pain in the calves** that occurs with exertion, particularly walking a specific distance, and is **relieved by rest** within a few minutes, is highly characteristic of **intermittent claudication** [1].
- This condition is a hallmark symptom of **peripheral artery disease (PAD)**, where narrowed arteries reduce blood flow to the limbs, and is exacerbated by risk factors such as **smoking** [1].
*osteoarthritis of the knee*
- While osteoarthritis causes pain with activity, it typically describes a **mechanical joint pain worsened by movement** and often associated with stiffness, crepitus, and swelling [2].
- The pain from osteoarthritis is usually **localized to the joint** and less likely to be described as cramping in the calves or to have such a clear, immediate resolution with rest as seen in claudication [2].
*muscular fatigue*
- Muscular fatigue can cause pain and discomfort with exertion, but it typically does not present with the **consistent, reproducible pattern** of pain onset at a specific distance and rapid relief with a short rest as described.
- Fatigue-related pain is generally more diffuse and gradually improves with prolonged rest, rather than the quick resolution characteristic of claudication.
*neurogenic claudication*
- Neurogenic claudication also causes **leg pain with walking** but is typically associated with **spinal stenosis** and is often described as numbness, tingling, or weakness, rather than pure cramping.
- Crucially, neurogenic claudication is often relieved by **bending forward or sitting**, rather than just standing still, and is less directly tied to the specific walking distance that defines intermittent claudication.
Question 2: Which of the following statements are correct regarding Barrett's oesophagus?
1. It is a metaplastic change.
2. It is a risk factor for development of adenocarcinoma.
3. Ingestion of NSAIDs is the aetiological factor for its development.
4. Endoscopic mucosal resection is an effective treatment. Select the answer using the code given below.
A. 2, 3 and 4
B. 1, 3 and 4
C. 1, 2 and 3
D. 1, 2 and 4 (Correct Answer)
Explanation: ***1, 2 and 4***
- **Barrett's esophagus** is characterized by the replacement of the normal **stratified squamous epithelium** of the distal esophagus with **specialized intestinal columnar epithelium**, which is a classic example of **metaplasia**. [1]
- This metaplastic change is a significant **risk factor** for developing **esophageal adenocarcinoma**, making regular surveillance and treatment crucial. [1] **Endoscopic mucosal resection (EMR)** is an effective treatment option for early-stage adenocarcinoma or high-grade dysplasia in Barrett's esophagus, capable of removing superficial neoplastic tissue.
*2, 3 and 4*
- This option incorrectly includes ingestion of NSAIDs as an etiological factor for Barrett's esophagus. **NSAIDs** are not directly associated with the development of Barrett's esophagus.
- While statements 2 and 4 are correct, the inclusion of statement 3 makes this option incorrect.
*1, 3 and 4*
- This option wrongly implicates **NSAIDs** in the etiology of Barrett's esophagus. The primary cause is **chronic gastroesophageal reflux disease (GERD)**, not NSAID use. [1]
- Statement 2, which identifies Barrett's as a risk factor for adenocarcinoma, is critically important but is omitted here.
*1, 2 and 3*
- This option incorrectly states that NSAID ingestion is an etiological factor for Barrett's esophagus. The main cause is **chronic acid reflux**. [1]
- While statements 1 and 2 are correct, statement 3 is incorrect, rendering this entire option invalid.
Question 3: Which of the following are local complications of acute pancreatitis?
1. Pseudocyst
2. Pleural effusion
3. Ileus
4. Acute fluid collection
Select the correct answer using the code given below.
A. 2, 3 and 4
B. 1, 3 and 4
C. 1, 2 and 4 (Correct Answer)
D. 1, 2 and 3
Explanation: ***1, 2 and 4***
- **Pseudocyst**, **acute fluid collections**, and **pleural effusions** are all recognized **local complications** of acute pancreatitis due to their direct anatomical proximity or fluid spread from the pancreas [1].
- **Ileus** is a common **systemic complication** rather than a local one, and it arises from inflammation and irritation of the bowel.
*2, 3 and 4*
- This option correctly identifies **pleural effusion** and **acute fluid collection** as local complications, but **ileus** is typically classified as a **systemic complication** of acute pancreatitis.
- While it includes two correct local complications, the inclusion of ileus makes it incorrect as a complete list of local complications.
*1, 3 and 4*
- This option correctly identifies **pseudocyst** and **acute fluid collection** as local complications, but incorrectly lists **ileus** as a local complication when it is a **systemic complication** [1].
- It also fails to include **pleural effusion**, which is a significant local complication.
*1, 2 and 3*
- This option correctly identifies **pseudocyst** and **pleural effusion** as local complications but incorrectly includes **ileus**, which is a **systemic complication**.
- It also omits **acute fluid collection**, an important local complication of acute pancreatitis.
Question 4: Which of the following are risk factors for the development of pancreatic cancer?
1. Cigarette smoking
2. Diabetes mellitus
3. Obesity
4. Caucasian ethnicity
Select the correct answer using the code given below.
A. 1, 2 and 3 (Correct Answer)
B. 2, 3 and 4
C. 1, 3 and 4
D. 1, 2 and 4
Explanation: ***1, 2 and 3***
- **Cigarette smoking** is a well-established and significant modifiable risk factor for pancreatic cancer, increasing the risk two to three-fold [1].
- **Long-standing diabetes mellitus**, particularly type 2, is both an independent risk factor and can be an early symptom of pancreatic cancer. **Obesity** is also clearly linked to an increased risk of pancreatic cancer, likely due to chronic inflammation and metabolic changes.
*2, 3 and 4*
- While diabetes mellitus and obesity are risk factors, **Caucasian ethnicity** is not considered a primary isolated risk factor for pancreatic cancer; rather, the incidence is slightly higher in certain other ethnic groups like African Americans.
- This option incorrectly includes ethnicity as a primary risk factor while excluding **cigarette smoking**, which is a major contributor [1].
*1, 3 and 4*
- This option correctly identifies **cigarette smoking** and **obesity** as risk factors. However, it incorrectly includes **Caucasian ethnicity** as a specific risk factor while omitting **diabetes mellitus**, which is a strong and well-documented risk factor.
- **Diabetes mellitus** is a more significant risk factor than ethnicity.
*1, 2 and 4*
- This option correctly identifies **cigarette smoking** and **diabetes mellitus** as risk factors. However, it incorrectly includes **Caucasian ethnicity** and omits **obesity**, which is a well-established and significant risk factor.
- **Obesity** has a stronger and more direct link to pancreatic cancer risk than ethnicity.
Question 5: Which of the following statements are correct regarding renal cell carcinoma?
1. It arises from the epithelium of the proximal convoluted tubule.
2. It has a female preponderance.
3. Major subtypes are clear cell, papillary and chromophobe.
4. Surgery is the mainstay of treatment for organ-confined disease. Select the answer using the code given below.
A. 1, 2 and 3
B. 1, 3 and 4 (Correct Answer)
C. 1, 2 and 4
D. 2, 3 and 4
Explanation: ***1, 3 and 4***
- **Renal cell carcinoma (RCC)** most commonly arises from the **epithelium of the proximal convoluted tubule**, particularly the clear cell subtype [1]. This makes statement 1 correct.
- The major subtypes of RCC are indeed **clear cell, papillary, and chromophobe carcinomas**, accounting for the vast majority of cases [1]. This validates statement 3.
- For **organ-confined renal cell carcinoma**, **surgical resection (nephrectomy)** remains the primary and most effective treatment modality, making statement 4 correct. [1]
*1, 2 and 3*
- This option incorrectly includes statement 2, which claims a female preponderance for RCC. **Renal cell carcinoma is more common in males** than females, not the reverse [1].
- While statements 1 and 3 are correct regarding the origin and major subtypes of RCC, the inclusion of an incorrect epidemiological fact makes this option wrong.
*1, 2 and 4*
- This option falls short by incorrectly including statement 2, which asserts a female predominance for RCC. **RCC has a male predominance**, with a male-to-female ratio of about 2:1 [1].
- This option also omits statement 3, which correctly identifies the major subtypes (clear cell, papillary, and chromophobe), even though statements 1 and 4 are correct.
*2, 3 and 4*
- This option incorrectly includes statement 2, which states a female preponderance for RCC; **renal cell carcinoma is actually more prevalent in males** [1].
- While statements 3 and 4 are correct regarding the major subtypes and the role of surgery in organ-confined disease, the factual error in statement 2 invalidates this option.
Question 6: Which of the following are features of autosomal dominant polycystic kidney disease?
1. Cyst may also occur in liver, pancreas and arachnoid membrane.
2. Most commonly manifests between 20-30 years of age.
3. Clinical manifestations are renal and extrarenal.
4. Men tend to progress to renal failure more rapidly than women.
Select the correct answer using the code given below.
A. 1, 2 and 4
B. 1, 3 and 4 (Correct Answer)
C. 1, 2 and 3
D. 2, 3 and 4
Explanation: ***1, 3 and 4***
- **Autosomal dominant polycystic kidney disease (ADPKD)** is characterized by the growth of numerous cysts in the kidneys [1], but can also lead to **extrarenal cysts** in organs such as the **liver, pancreas, and arachnoid membrane**.
- **ADPKD** causes both renal and extrarenal manifestations, and **men typically progress to renal failure more rapidly than women**.
*1, 2 and 4*
- This option correctly identifies the presence of cysts in other organs and the rapid progression to renal failure in men, but it incorrectly states that the disease most commonly manifests between **20-30 years of age**.
- While symptoms can appear at any age, **ADPKD** often manifests with symptoms such as pain due to cysts or hypertension later in life [1], and **renal function decline** is typically observed in middle age.
*1, 2 and 3*
- This option incorrectly includes the statement that the disease most commonly manifests between **20-30 years of age**.
- Although the genetic defect is present from birth, significant clinical symptoms leading to diagnosis or renal failure often develop later, typically in the **4th to 6th decades of life**.
*2, 3 and 4*
- This option incorrectly states that the disease most commonly manifests between **20-30 years of age**.
- It also omits the key feature that cysts can occur in other organs like the **liver, pancreas, and arachnoid membrane**, which is a crucial aspect of ADPKD.
Question 7: Consider the following clinical features :
1. Raised ICP
2. Seizures
3. Focal deficit
4. Headache Which of the above clinical features are related to most brain tumours?
A. 2, 3 and 4 only
B. 1 and 2 only
C. 1, 2, 3 and 4 (Correct Answer)
D. 1, 2 and 3 only
Explanation: ***1, 2, 3 and 4***
- All four clinical features—**raised ICP**, **seizures**, **focal neurological deficits**, and **headache**—are commonly associated with brain tumors [1].
- Brain tumors can cause **increased intracranial pressure** through mass effect, edema, or CSF flow obstruction, leading to headaches and, less commonly, seizures [1]. **Focal deficits** result from direct tissue destruction or compression depending on the tumor's location [2].
*2, 3 and 4 only*
- This option incorrectly omits **raised ICP**, which is a frequent and significant symptom of brain tumors, contributing to headaches, nausea, vomiting, and altered mental status [1].
- While seizures, focal deficits, and headaches are common, **raised ICP** often underlies many of these symptoms.
*1 and 2 only*
- This option excludes **focal deficits** and **headache**, both of which are very common presentations of brain tumors.
- The specific location of a tumor often dictates **focal deficits** [2], and **headache** is one of the most prevalent symptoms.
*1, 2 and 3 only*
- This option incorrectly omits **headache**, which is a classic and highly prevalent symptom in patients with brain tumors, often severe and resistant to common analgesics.
- Headaches can result from **mass effect**, **increased ICP** [1], or irritation of pain-sensitive structures within the brain.
Question 8: A 40-year-old lady complains of progressive deformities of her hands and fingers associated with stiffness which is present in both the hands and improves as the day progresses. On examination, there is symmetrical involvement of hands and fingers of both the upper limbs with flexion and ulnar deviation at the metacarpophalangeal joints. What is the most likely diagnosis in this lady?
A. Ankylosing spondylitis
B. Rheumatoid arthritis (Correct Answer)
C. Osteoarthritis
D. Tenosynovitis
Explanation: ***Rheumatoid arthritis***
- The combination of **symmetrical polyarthritis** affecting the hands and fingers, **morning stiffness** that improves with activity ("improves as the day progresses" not as severe as morning stiffness) [1][4], and characteristic **flexion and ulnar deviation at the metacarpophalangeal joints** (Swan-neck, Boutonniere's, and Z-thumb deformities) are classic features of rheumatoid arthritis (RA) [3].
- RA is an **autoimmune disease** causing chronic inflammation of the synovial lining of joints, leading to progressive joint damage and characteristic deformities [3].
*Ankylosing spondylitis*
- This condition primarily affects the **axial skeleton** (spine and sacroiliac joints), causing **back pain and stiffness**, not typically significant small joint deformities of the hands.
- While it can involve peripheral joints, it is often **asymmetrical** and doesn't present with the specific hand deformities described.
*Osteoarthritis*
- **Osteoarthritis** is a degenerative joint disease characterized by **cartilage breakdown**, leading to pain that **worsens with activity** and improves with rest [2].
- Joint involvement is often **asymmetrical** and typically affects weight-bearing joints or causes **Heberden's** and **Bouchard's nodes** in the fingers, not the symmetrical MCP involvement and specific deformities seen here [2].
*Tenosynovitis*
- **Tenosynovitis** is an inflammation of the **synovial sheath surrounding a tendon**, causing localized pain, swelling, and difficulty moving the affected digit or limb.
- It does not explain the widespread, symmetrical joint involvement, progressive deformities of multiple joints, or systemic nature of the symptoms described.
Question 9: Upper motor neuron lesions are characterized by which of the following?
1. Increased tone (spasticity)
2. Hyperreflexia
3. Absent plantar response
4. Motor weakness
Select the correct answer using the code given below.
A. 1, 3 and 4
B. 1, 2 and 4 (Correct Answer)
C. 2, 3 and 4
D. 1, 2 and 3
Explanation: ***1, 2 and 4***
- **Upper motor neuron (UMN) lesions** typically present with **increased muscle tone (spasticity)** due to the loss of inhibitory input from higher cortical centers [1].
- They also lead to **hyperreflexia** (exaggerated deep tendon reflexes) and **motor weakness** as the descending pathways controlling voluntary movement are damaged [1].
*1, 3 and 4*
- This option incorrectly includes an **absent plantar response**, whereas UMN lesions are associated with an **extensor plantar response (Babinski sign)** [1].
- While **spasticity** and **motor weakness** are correct, the inclusion of an absent plantar response makes this option incorrect.
*2, 3 and 4*
- This option incorrectly includes an **absent plantar response**, as **hyperreflexia** and **motor weakness** are characteristic of UMN lesions [1].
- The absence of **increased tone (spasticity)**, a key feature of UMN lesions, also makes this option incorrect.
*1, 2 and 3*
- This option incorrectly includes an **absent plantar response**, which is not typical for UMN lesions.
- While **increased tone (spasticity)** and **hyperreflexia** are correct, the lack of **motor weakness**, another hallmark of UMN lesions, renders this option incomplete.
Question 10: Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)?
1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria.
2. It is same as bacteraemia.
3. It results in Multiple Organ Dysfunction Syndrome (MODS).
4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.
A. 2, 3 and 4
B. 1, 2 and 3
C. 1, 3 and 4 (Correct Answer)
D. 1, 2 and 4
Explanation: ***1, 3 and 4***
- **SIRS** can be caused by the release of **lipopolysaccharide endotoxin** from the cell wall of dying **Gram-negative bacteria** like *E. coli*, triggering a systemic inflammatory response [1].
- One of the major complications of **SIRS** is the progression to **Multiple Organ Dysfunction Syndrome (MODS)**, where organs begin to fail due to uncontrolled inflammation [1].
- A component of the **SIRS criteria** is a white blood cell count greater than 12 x 10^9/L or less than 4 x 10^9/L, or the presence of more than 10% immature band forms [1].
*2, 3 and 4*
- **Bacteremia** refers specifically to the presence of **viable bacteria** in the bloodstream, while **SIRS** is a broader inflammatory response that can be triggered by various causes (infectious or non-infectious).
- While bacteremia can lead to SIRS, SIRS can also occur without bacteremia (e.g., pancreatitis, trauma).
*1, 2 and 3*
- **Bacteremia** is not the same as SIRS; bacteremia is a potential cause of SIRS, but SIRS can arise from non-infectious conditions as well.
- The presence of bacteria in the blood (bacteremia) is a specific finding, whereas SIRS describes a *syndrome* of systemic inflammation.
*1, 2 and 4*
- This option incorrectly states that **SIRS is the same as bacteremia**, which it is not.
- Also, while bacteremia can lead to SIRS, **MODS** is a crucial and often fatal consequence of advanced SIRS, which is omitted in this option.