UPSC-CMS 2016 - Internal Medicine PYQs Practice Questions

Q: A patient has recurrent abdominal pain and jaundice. The blood investigations reveal reticulocytosis and hyperbilirubinemia. What is the clinical diagnosis?

Hereditary spherocytosis. ***Hereditary spherocytosis*** - The combination of **recurrent abdominal pain**, **jaundice**, **reticulocytosis**, and **hyperbilirubinemia** is highly suggestive of hereditary spherocytosis, which causes chronic hemolytic anemia [1, 3]. - **Jaundice** and **abdominal pain** can result from pigment gallstones (due to chronic hemolysis) and splenic enlargement, both common in this condition [2, 3]. *Mirizzi's syndrome* - Characterized by **extrinsic compression of the common hepatic duct** by a stone impacted in the cystic duct or gallbladder neck. - While it causes jaundice and abdominal pain, it does not typically present with **reticulocytosis** or **hemolysis** [1]. *Sclerosing cholangitis* - A chronic cholestatic liver disease characterized by **inflammation and fibrosis** of the bile ducts. - While it causes jaundice and abdominal pain, it is not associated with **reticulocytosis** or signs of **hemolysis** [1]. *Choledochal cyst* - A **congenital dilation of the bile ducts**, leading to recurrent abdominal pain, jaundice, and a palpable mass. - It does not involve **hemolysis** or **reticulocytosis**, making it less likely in this context. [Practice more Internal Medicine PYQs on OnCourse]

Q: The most common route of spread in a case of pyogenic liver abscess is:

Haematogenous through portal vein. Haematogenous through portal vein - Pyogenic liver abscesses commonly result from bacterial translocation from the gut, reaching the liver via the portal venous system. - This route accounts for a significant proportion of cases, especially when associated with conditions like diverticulitis or appendicitis. *Hepatic artery* - While possible, spread via the hepatic artery is less common and usually seen in cases of septicemia or endocarditis. - It would imply a more generalized systemic infection rather than a localized abdominal source. *Ascending infection through biliary duct* - This mechanism is characteristic of cholangitis and often leads to multiple small abscesses or a subcapsular collection, not typically a solitary pyogenic liver abscess. - It occurs due to obstruction to biliary flow from stones or strictures. *Local spread* - Local spread can occur from adjacent infected organs like a subphrenic abscess or an infected gallbladder, but it is not the most common route for the initial development of a pyogenic liver abscess. - This typically results in direct extension into the liver parenchyma. [Practice more Internal Medicine PYQs on OnCourse]

Q: At present, treatment is recommended for H. pylori in association with the following except:

Functional dyspepsia without alarm features. ***Functional dyspepsia without alarm features*** - While *H. pylori* eradication can be considered for some patients with **functional dyspepsia**, it is not universally recommended as a primary treatment given the **variable and often limited symptomatic improvement**. - The decision to treat in this specific scenario often depends on individual patient factors and local epidemiology, and it's not a standard indication compared to other *H. pylori*-associated conditions. *MALT lymphoma* - **Eradication of *H. pylori*** is a cornerstone of treatment for **gastric MALT lymphoma**, often leading to remission [1]. - This is a well-established indication for *H. pylori* therapy due to the direct pathogenic link [1]. *Duodenal ulcer* - All patients with **duodenal ulcers** who test positive for *H. pylori* should receive eradication therapy [2]. - *H. pylori* infection is a major cause of **duodenal ulcers**, and eradication significantly reduces recurrence [2]. *Peptic ulcer disease* - **Eradication of *H. pylori*** is strongly recommended for all patients with **peptic ulcer disease** (gastric or duodenal) found to be *H. pylori* positive [2]. - This intervention is crucial for **healing ulcers** and preventing future recurrences and complications [2]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is not a clinical feature of tetanus?

Loss of consciousness. ***Loss of consciousness*** - Tetanus is characterized by **spasms** and increased muscle tone, but patients typically remain **fully conscious** throughout the disease course. - The disease primarily affects the **motor neurons**, not the brain structures responsible for consciousness. *Risus sardonicus* - This is a characteristic feature of tetanus, referring to a **sustained, grotesque grin** caused by spasms of the facial muscles. - It is a classic clinical sign resulting from the **excitatory effects** of tetanospasmin on motor neurons [1]. *Respiratory failure* - This is a common and serious complication of tetanus, often leading to death, caused by **spasms of the respiratory muscles** [1]. - **Laryngeal spasms** and rigidity of the chest wall muscles impair breathing, necessitating mechanical ventilation. *Opisthotonus* - This refers to a severe, sustained **arching of the back** due to muscle spasms, causing the head and heels to bend backward. - It is a hallmark sign of generalized tetanus, reflecting profound **muscle rigidity** and uncontrolled muscle contractions [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Consider the following statements: Poor prognostic indicators in advanced germ cell tumours show 1. primary sites in mediastinum 2. non-pulmonary metastasis 3. lactate dehydrogenase more than 10 times of normal value Which of the statements given above are correct?

1, 2 and 3. ***1, 2 and 3*** - **All three statements** represent poor prognostic indicators in advanced germ cell tumors, as defined by the **International Germ Cell Cancer Collaborative Group (IGCCCG)** classification. - A primary site in the **mediastinum**, the presence of **non-pulmonary visceral metastases**, and **LDH levels >10 times the upper limit of normal** are all independent factors associated with a worse prognosis. *1 and 2 only* - This option is incorrect because it excludes a critically important poor prognostic indicator: **markedly elevated lactate dehydrogenase (LDH)**. - While mediastinal primary and non-pulmonary metastases are poor prognostic factors, high LDH further defines the **poor risk group**. [1] *2 and 3 only* - This option is incorrect as it omits the significance of a **mediastinal primary site** as a poor prognostic factor in advanced germ cell tumors. - **Mediastinal germ cell tumors** are known to have a worse prognosis compared to testicular primaries, even in the absence of other poor risk factors. *1 and 3 only* - This option is incorrect because it fails to include **non-pulmonary metastases** as a distinct poor prognostic factor for advanced germ cell tumors. - The presence of metastases to sites like the **liver, brain, or bone** significantly worsens the prognosis compared to lung-only metastases. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

A patient has recurrent abdominal pain and jaundice. The blood investigations reveal reticulocytosis and hyperbilirubinemia. What is the clinical diagnosis?

Accepted Answer

Hereditary spherocytosis

Answer

Mirizzi's syndrome

Answer

Sclerosing cholangitis

Answer

Choledochal cyst

Question 2

The most common route of spread in a case of pyogenic liver abscess is:

Accepted Answer

Haematogenous through portal vein

Answer

Hepatic artery

Answer

Ascending infection through biliary duct

Answer

Local spread

Question 3

At present, treatment is recommended for H. pylori in association with the following except:

Accepted Answer

Functional dyspepsia without alarm features

Answer

MALT lymphoma

Answer

Duodenal ulcer

Answer

Peptic ulcer disease

Question 4

Which of the following is not a clinical feature of tetanus?

Accepted Answer

Loss of consciousness

Answer

Risus sardonicus

Answer

Respiratory failure

Answer

Opisthotonus

Question 5

Consider the following statements: Poor prognostic indicators in advanced germ cell tumours show

1. primary sites in mediastinum 
2. non-pulmonary metastasis 
3. lactate dehydrogenase more than 10 times of normal value Which of the statements given above are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 and 3 only

Question 6

Smoking is associated with all the following diseases except:

Accepted Answer

Sarcoidosis

Answer

Emphysema

Answer

Cardiovascular disease

Answer

Lung cancer

Question 7

Umbilical cord blood stem cells are used to treat all the following diseases except :

Accepted Answer

Parkinsonism

Answer

Leukemia

Answer

Osteoporosis

Answer

Diabetes

UPSC-CMS 2016 — Internal Medicine