UPSC-CMS 2010 - Internal Medicine PYQs Practice Questions

Q: A patient presents with claudication in both buttocks and has impotence. The clinical examination reveals bruit over lower abdomen. What is the clinical diagnosis?

Aortoiliac occlusion. Aortoiliac occlusion - The triad of **buttock claudication**, **impotence**, and **absent or diminished femoral pulses** (often associated with an abdominal bruit) is classic for **Leriche syndrome**, which is caused by aortoiliac occlusion [2], [3]. - This occlusion impairs blood flow to both lower extremities and the internal iliac arteries, affecting erectile function [1]. Bilateral iliofemoral occlusion - While this would cause bilateral lower limb symptoms, it typically would not explain the **impotence** as clearly as an aortoiliac occlusion which affects the internal iliac arteries that supply the penis [2], [3]. - An iliofemoral occlusion is distal to the aorta, and the symptom complex provided points to a more **proximal lesion**. Bilateral iliac artery occlusion - This would cause similar symptoms to aortoiliac occlusion including **buttock claudication** and **impotence** [2]. - However, the presence of a **bruit over the lower abdomen** often indicates a more proximal lesion involving the aorta, making aortoiliac occlusion a more comprehensive diagnosis for these findings. Bilateral femoropopliteal occlusion - This would primarily cause **calf and thigh claudication**, less commonly buttock claudication, as the occlusion is more distal [1]. - **Impotence** is not a typical symptom of isolated femoropopliteal occlusion, as the internal iliac arteries are usually unaffected. [Practice more Internal Medicine PYQs on OnCourse]

Q: The normal ankle brachial pressure index (ABPI) is 1.0. A value of 0.8 suggests

some degree of arterial obstruction. ***some degree of arterial obstruction*** - An **ABPI of 0.8** indicates a reduction in blood flow to the lower extremities compared to the upper limbs [1]. - This value is generally considered to signify **mild to moderate peripheral artery disease (PAD)**, suggesting the presence of arterial narrowing or obstruction [1]. *impending gangrene* - **Impending gangrene** or critical limb ischemia is typically associated with a much lower ABPI, usually **below 0.4** or even 0.3 [1]. - At an ABPI of 0.8, severe tissue damage and gangrene are not imminent, although careful monitoring is still warranted. *presence of collaterals* - While **collateral arteries** can develop in response to chronic arterial obstruction, an ABPI of 0.8 primarily reflects the overall net blood flow, which is still reduced despite collaterals [1]. - The presence of collaterals can actually help to maintain tissue viability and prevent more severe symptoms, but they don't normalize the ABPI in the presence of significant disease [1]. *good flow* - A value of **1.0 to 1.4** is generally considered a normal ABPI, indicating good arterial flow. - An ABPI of **0.8 is significantly below normal** and suggests impaired rather than good blood flow [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Serum calcitonin may be elevated in

medullary carcinoma of thyroid. ***medullary carcinoma of thyroid*** - **Medullary thyroid carcinoma (MTC)** originates from the **parafollicular C cells** of the thyroid gland, which physiologically produce and secrete **calcitonin**. - Therefore, MTC is a classic cause of significantly elevated serum **calcitonin** levels, used both as a diagnostic marker and for monitoring disease recurrence. *choriocarcinoma of ovary* - **Choriocarcinoma** is a germ cell tumor that typically produces **human chorionic gonadotropin (hCG)**, not calcitonin [3]. - Ovarian choriocarcinoma is a rare and highly aggressive tumor, and its primary tumor marker is **hCG** [3]. *islet cell tumour of pancreas* - **Islet cell tumors** of the pancreas (neuroendocrine tumors) typically produce hormones like **insulin, glucagon, somatostatin, or gastrin**, depending on their subtype [1], [2]. - While they are endocrine tumors, they do not originate from calcitonin-producing cells and thus generally do not elevate **calcitonin**. *carcinoid tumour of appendix* - **Carcinoid tumors**, especially those of the appendix, are **neuroendocrine tumors** that typically secrete **serotonin** and other vasoactive substances [1]. - These tumors are associated with **carcinoid syndrome** (flushing, diarrhea, bronchospasm) but do not produce **calcitonin** [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which one of the following is not a component of Charcot's triad?

Vomiting. ***Vomiting*** - **Charcot's triad** consists of **right upper quadrant abdominal pain**, **fever**, and **jaundice**, which are classic signs of **acute cholangitis** [1]. - Vomiting is not considered one of the three classic components of Charcot's triad. *Fever* - **Fever** is a cardinal symptom of systemic inflammation and infection, a key component indicating the presence of an infectious process in the biliary tree. - It often accompanies the other two symptoms, pain and jaundice, to complete Charcot's triad in **acute cholangitis** [1]. *Pain* - **Right upper quadrant abdominal pain** is a critical component of Charcot's triad, arising from the inflammation and distension of the biliary tree due to obstruction and infection [1]. - This localized pain helps direct the diagnostic focus to the **liver and biliary system**. *Jaundice* - **Jaundice**, characterized by yellowing of the skin and eyes, results from the obstruction of bile flow leading to the accumulation of bilirubin in the bloodstream. - Its presence signifies **biliary obstruction**, often due to gallstones or strictures, which is a common precursor to cholangitis [1]. [Practice more Internal Medicine PYQs on OnCourse]

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

A→3 B→4 C→1 D→2. ***A→3 B→4 C→1 D→2*** - This option correctly matches each condition with its primary causative agent: **Viral hepatitis** with **Hepatitis A, B, C**; **Amoebic liver abscess** with **Entamoeba histolytica**; **Ascending cholangitis** with **Enteric bacteria**; and **Hydatid liver disease** with **Echinococcus granulosus**. - This mapping accurately reflects established medical knowledge regarding the etiology of these liver and biliary tract conditions. *A→1 B→2 C→3 D→4* - This option incorrectly associates viral hepatitis with enteric bacteria and amoebic liver abscess with Echinococcus granulosus, which are not the primary causes. - The link between ascending cholangitis and hepatitis viruses is also incorrect, as ascending cholangitis is typically bacterial. *A→3 B→1 C→4 D→2* - This option correctly matches viral hepatitis, but incorrectly attributes amoebic liver abscess to enteric bacteria and ascending cholangitis to Entamoeba histolytica. - The causative agent for amoebic liver abscess is *Entamoeba histolytica*, not enteric bacteria, and ascending cholangitis is caused by bacteria, not *Entamoeba histolytica*. *A→2 B→4 C→1 D→3* - This option incorrectly links viral hepatitis to Echinococcus granulosus and hydatid liver disease to hepatitis viruses. - Hydatid liver disease is caused by *Echinococcus granulosus*, and viral hepatitis is caused by hepatitis viruses, so these are mismatched. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

A patient presents with claudication in both buttocks and has impotence. The clinical examination reveals bruit over lower abdomen. What is the clinical diagnosis?

Accepted Answer

Aortoiliac occlusion

Answer

Bilateral iliofemoral occlusion

Answer

Bilateral iliac artery occlusion

Answer

Bilateral femoropopliteal occlusion

Question 2

The normal ankle brachial pressure index (ABPI) is 1.0. A value of 0.8 suggests

Accepted Answer

some degree of arterial obstruction

Answer

impending gangrene

Answer

presence of collaterals

Answer

good flow

Question 3

Serum calcitonin may be elevated in

Accepted Answer

medullary carcinoma of thyroid

Answer

choriocarcinoma of ovary

Answer

islet cell tumour of pancreas

Answer

carcinoid tumour of appendix

Question 4

Which one of the following is not a component of Charcot's triad?

Accepted Answer

Vomiting

Answer

Fever

Answer

Pain

Answer

Jaundice

Question 5

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

Accepted Answer

A→3  B→4  C→1  D→2

Answer

A→1  B→2  C→3  D→4

Answer

A→3  B→1  C→4  D→2

Answer

A→2  B→4  C→1  D→3

Question 6

Priapism in a young male could occur because of

Accepted Answer

leukaemia

Answer

carcinoid tumour of appendix

Answer

testicular cancer

Answer

penile cancer

Question 7

Which one of the following is an autosomal recessive disease?

Accepted Answer

Cystic fibrosis

Answer

Retinitis pigmentosa

Answer

Vitamin D resistant rickets

Answer

Neurofibromatosis

UPSC-CMS 2010 — Internal Medicine