UPSC-CMS 2018 - Internal Medicine PYQs Practice Questions

Q: A pregnant woman in 2nd trimester of pregnancy from North Eastern State has been diagnosed with uncomplicated P. falciparum. She should be treated with:

Artemether and Lumefantrine. ***Artemether and Lumefantrine*** - This combination is a **fixed-dose artemisinin-based combination therapy (ACT)** specifically recommended by WHO for treating uncomplicated *P. falciparum* malaria in the **second and third trimesters of pregnancy**. - ACTs are highly effective against *P. falciparum* and have a favorable safety profile compared to other antimalarials during this period of pregnancy. *Chloroquine and Primaquine* - **Chloroquine** is primarily used for treatment of *P. vivax* and *P. ovale* malaria, as *P. falciparum* has widespread resistance. - **Primaquine** is contraindicated in pregnancy due to the risk of **hemolysis** in the fetus if there is G6PD deficiency and is used for radical cure of *P. vivax* and *P. ovale*. *Artesunate and Sulphadoxine* - While **artesunate** is an artemisinin derivative, **sulphadoxine** is often combined with pyrimethamine (as SP, sulphadoxine-pyrimethamine) for intermittent preventive treatment in pregnancy (IPTp) but is not the first-line for *uncomplicated P. falciparum* treatment in the second trimester, especially with increasing resistance. - This combination lacks the **lumefantrine** component, which provides a longer duration of action and higher efficacy when combined with artemether. *Artesunate, Sulphadoxine and Pyrimethamine* - The combination of **sulphadoxine-pyrimethamine (SP)** alone or with artesunate can be used for intermittent preventive treatment in pregnancy (IPTp), but it is generally *not* the first-line treatment for **uncomplicated P. falciparum malaria** in the 2nd trimester due to resistance concerns and the superior efficacy of Artemether-Lumefantrine. - **Pyrimethamine** is a folate antagonist and generally avoided in significant doses during pregnancy if alternatives are available, although it is part of SP for IPTp. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:

Systemic inflammatory response syndrome. ***Systemic inflammatory response syndrome*** - The patient's presentation with **tachycardia** (pulse 106/min), **tachypnea** (respiratory rate 26/min), and **leukocytosis** (TLC 14000/µL) meets at least two criteria for **Systemic Inflammatory Response Syndrome (SIRS)** following a significant surgical stressor. - SIRS is a generalized inflammatory response to various insults, including major surgery, trauma, and infection, occurring in the absence of a confirmed infection. *Sepsis syndrome* - **Sepsis syndrome** is defined as SIRS with a **confirmed or suspected infectious source**. While the patient had a bowel injury, there is no definitive evidence of active infection provided (e.g., positive cultures, purulent discharge). - Although the bowel injury could lead to infection, the current information only confirms a systemic inflammatory response, not necessarily a microbial cause. *Multisystem organ failure (MSOF)* - **Multisystem organ failure (MSOF)** involves the failure of two or more organ systems. While the patient has elevated **BUN** and **creatinine**, indicating **acute kidney injury**, there's no evidence of failure in other systems required to diagnose MSOF. - MSOF is a more severe progression of SIRS or sepsis, characterized by severe organ dysfunction, which is not fully met by the current presentation. *Wound infection* - **Wound infection** is a localized infection and would typically present with signs like **erythema**, **purulent discharge**, **tenderness**, or **warmth** at the surgical site. None of these specific local signs are mentioned. - While a wound infection could be a potential source of SIRS or sepsis, the clinical picture provided describes a systemic response rather than a localized one. [Practice more Internal Medicine PYQs on OnCourse]

Q: Patients with phlebographically confirmed deep vein thrombosis of the calf:

are at risk for significant pulmonary embolism. ***are at risk for significant pulmonary embolism*** - While calf DVT is often considered less severe than proximal DVT, it still carries a definite risk of extending proximally [1] and subsequently leading to **pulmonary embolism (PE)**, especially if untreated. - Approximately **10-20% of calf DVTs extend proximally**, increasing the risk of potentially fatal PE. *can expect asymptomatic recovery if treated promptly with anticoagulant* - Even with prompt anticoagulant treatment, a significant percentage of patients with DVT experience **post-thrombotic syndrome (PTS)**, characterized by pain, swelling, and skin changes. - While anticoagulants [2] prevent clot extension and PE, they do not guarantee an **asymptomatic recovery** or fully prevent long-term sequelae. *may be effectively treated with low-dose heparin* - **Low-dose heparin** is typically used for DVT prophylaxis, not for treating acute DVT. - Treatment of acute DVT, including calf DVT, requires **therapeutic anticoagulation** with unfractionated heparin, low molecular weight heparin, or oral anticoagulants [2] to prevent clot propagation and embolism. *may be effectively treated with pneumatic compression stockings* - **Pneumatic compression stockings** are primarily used for DVT prevention in high-risk patients, especially post-surgery. - They are not a primary treatment for an **established acute DVT**, where anticoagulation is the cornerstone of therapy to prevent complications. [Practice more Internal Medicine PYQs on OnCourse]

Q: Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

Neurofibromatosis Type II. ***Neurofibrofomatosis Type II*** - This condition is primarily associated with **central nervous system tumors** like **vestibular schwannomas** and **meningiomas**, not Berry aneurysms [2]. - While it affects the nervous system, its vascular manifestations are typically different from those predisposing to aneurysms. *Marfan’s syndrome* - Patients with Marfan's syndrome have **fragile connective tissue** due to a defect in **fibrillin-1**, which can weaken arterial walls. - This weakness increases the risk of **aortic aneurysms** and dissections, and can also predispose to intracranial aneurysms like Berry aneurysms. *Adult polycystic kidney* - This **autosomal dominant** disorder is characterized by the formation of **cysts in the kidneys**, but also has systemic manifestations [1]. - There is a well-established association between **autosomal dominant polycystic kidney disease (ADPKD)** and an increased incidence of **Berry aneurysms**. *Fibromuscular dysplasia* - This condition involves **abnormal cellular development** in the **arterial walls**, leading to areas of narrowing and enlargement. - It commonly affects the **renal arteries** and **carotid arteries**, and is also a known risk factor for the development of **intracranial aneurysms**, including Berry aneurysms. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

A pregnant woman in 2nd trimester of pregnancy from North Eastern State has been diagnosed with uncomplicated P. falciparum. She should be treated with:

Accepted Answer

Artemether and Lumefantrine

Answer

Chloroquine and Primaquine

Answer

Artesunate and Sulphadoxine

Answer

Artesunate, Sulphadoxine and Pyrimethamine

Question 2

Cellulitis is:

Accepted Answer

A suppurative invasive infection of skin and subcutaneous tissues

Answer

Infection caused by Gram negative bacilli

Answer

A nonsuppurative invasive infection of tissues

Answer

Infection caused by anaerobic Streptococci

Question 3

A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:

Accepted Answer

Systemic inflammatory response syndrome

Answer

Sepsis syndrome

Answer

Multisystem organ failure (MSOF)

Answer

Wound infection

Question 4

Patients with phlebographically confirmed deep vein thrombosis of the calf:

Accepted Answer

are at risk for significant pulmonary embolism

Answer

can expect asymptomatic recovery if treated promptly with anticoagulant

Answer

may be effectively treated with low-dose heparin

Answer

may be effectively treated with pneumatic compression stockings

Question 5

Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

Accepted Answer

Neurofibromatosis Type II

Answer

Marfan’s syndrome

Answer

Adult polycystic kidney

Answer

Fibromuscular dysplasia

UPSC-CMS 2018 — Internal Medicine