UPSC-CMS 2019 - Internal Medicine PYQs Practice Questions

Q: Systemic Inflammatory Response Syndrome (SIRS) is characterized by all of the following EXCEPT:

Platelet count ( 38˚C)* - **Fever** is a classic sign of inflammation and infection, and a temperature greater than 38°C is one of the key diagnostic criteria for SIRS. [2] - This indicates the body's systemic inflammatory response to a perceived insult. [3] *Tachypnoea (>20/min)* - An increased **respiratory rate**, or **tachypnea**, is another important criterion for SIRS, reflecting increased metabolic demand or respiratory compensation. - This criterion helps identify patients with a significant physiological response to inflammation. *Hypothermia (<36˚C)* - While less common than fever, **hypothermia** (temperature less than 36°C) can also be a sign of a severe systemic inflammatory response, particularly in immunocompromised or severely ill patients. - It signifies a dysregulated thermoregulatory response in SIRS. [Practice more Internal Medicine PYQs on OnCourse]

Q: A few days following viral fever, a 50 year old female presented with pain in neck, fever, malaise and firm enlargement of both the lobes of thyroid. On investigation thyroid antibodies were normal & serum T4 was high normal. Probable diagnosis is:

Granulomatous thyroiditis. ***Granulomatous thyroiditis*** - The presentation of **neck pain**, **fever**, **malaise**, and **firm, enlarged thyroid lobes** following a viral fever, along with normal thyroid antibodies and high-normal T4, is highly characteristic of **subacute granulomatous thyroiditis (de Quervain's thyroiditis)** [1]. - This condition is typically **post-viral**, causes inflammation leading to temporary hyperthyroidism due to hormone release, and is often painful [1]. *Lymphoma of thyroid* - Thyroid lymphoma usually presents as a **rapidly growing neck mass** in older individuals and is not typically preceded by a viral illness. - It is less commonly associated with pain and fever in this manner, and thyroid function can be variable. *Riedel's thyroiditis* - **Riedel's thyroiditis** is a rare, invasive fibrosis of the thyroid and surrounding structures, leading to a **rock-hard, painless goiter**. - It does not typically follow a viral infection with acute pain and fever or present with high-normal T4. *Autoimmune thyroiditis* - **Autoimmune thyroiditis (Hashimoto's thyroiditis)** is characterized by elevated thyroid antibodies and typically presents with **hypothyroidism**, often with a **painless goiter**. - It does not usually follow a viral illness with acute pain and fever or cause temporary thyrotoxicosis with normal antibodies [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: A gentleman of 36 years presented with a long history of upper abdominal pain which was periodic and often occurred early morning. For last 3 months, he is having projectile vomiting, which is non bilious, unpleasant in nature with undigested food materials. On examination he appears unwell, dehydrated and seemed to have lost weight. Probably he is suffering from:

Gastric outlet obstruction. ***Gastric outlet obstruction*** - The combination of a long history of **periodic upper abdominal pain** followed by **projectile, non-bilious vomiting** containing undigested food is highly characteristic of gastric outlet obstruction. [1] - **Weight loss** and **dehydration** are common due to inadequate nutrient absorption and persistent vomiting. [1] *Superior mesenteric artery syndrome* - This syndrome is characterized by compression of the **duodenum** between the superior mesenteric artery and the aorta. - While it can cause vomiting and weight loss, the presenting symptoms are typically more acute or chronic pain related to postural changes, and not usually preceded by a long history of periodic upper abdominal pain suggesting prior peptic ulcer disease. *Carcinoma stomach* - While carcinoma of the stomach can cause weight loss and vomiting due to obstruction, the long history of **relieving periodic pain** prior to the onset of projectile vomiting is less typical. - Vomiting in carcinoma stomach might be bilious if the tumor is distal to the ampulla of Vater. *Gastro-oesophageal reflux with oesophagitis* - This condition primarily causes **heartburn**, regurgitation, and sometimes difficulty swallowing or chest pain. - It does not typically lead to repeated **projectile vomiting** of undigested food or significant weight loss in the absence of severe complications like stricture formation, which would present differently. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 40 year old female patient presents with colicky abdominal pain associated with episodes of mild diarrhoea for last 6 months accompanied with intermittent fever and weight loss. There are multiple discharging sinuses on perineal examination. The most likely clinical diagnosis in this patient is:

Crohn disease. ### Crohn disease - **Colicky abdominal pain**, **diarrhea**, **fever**, and **weight loss** are classic symptoms of Crohn disease, indicating chronic inflammation of the gastrointestinal tract [1]. - The presence of **discharging perineal sinuses** is highly characteristic of Crohn disease, as it commonly manifests with **perianal disease** including fistulas and abscesses [1]. ### Ileocaecal Tuberculosis - While ileocaecal tuberculosis can present with abdominal pain, diarrhea, fever, and weight loss, **perianal sinuses** are a less common feature compared to Crohn disease. - Diagnosis typically requires **histopathological evidence** of granulomas with caseous necrosis and acid-fast bacilli, which is not suggested by the initial presentation. ### Ulcerative colitis - **Ulcerative colitis** primarily affects the colon and rectum, leading to bloody diarrhea, abdominal pain, and tenesmus, but rarely causes **perianal fistulas** or sinuses [1]. - The disease typically presents with **continuous inflammation** extending proximally from the rectum, unlike the skip lesions seen in Crohn disease. ### Amoebic colitis - **Amoebic colitis** is an infectious cause of diarrhea, often bloody, with abdominal pain, but typically presents with a more **acute course** and is less commonly associated with chronic weight loss or perianal disease. - Diagnosis is confirmed by identifying **_Entamoeba histolytica_ trophozoites** or cysts in stool or tissue, and the presence of chronic discharging sinuses is not typical. [Practice more Internal Medicine PYQs on OnCourse]

Q: A gentleman of 48 years was being worked up for hepatocellular function. He had no history or signs of encephalopathy. His serum bilirubin was 5 mg%, serum albumin was 3.9 gm%, International normalized ratio was 1.6. On ultrasound no free fluid was detected inside abdomen. As per Child-Turcotte-Pugh (CTP) classification, he was in:

CTP–B. CTP–B - This patient scores 2 points for bilirubin (3.5-5 mg%), 1 point for albumin (>3.5 gm%), 2 points for INR (1.7-2.3), 1 point for no encephalopathy, and 1 point for no ascites. This sums to **7 points**, which falls into the **CTP Class B** range (7-9 points). - The CTP classification is used to assess the prognosis of **chronic liver disease**, primarily **cirrhosis**, based on five clinical and laboratory criteria [1]. CTP–D - The CTP classification only includes A, B, and C; there is no CTP–D class. - This option is incorrect as it represents a classification that does not exist within the CTP scoring system. CTP–A - CTP Class A requires a total score of 5-6 points, indicating **mild liver dysfunction**. - This patient's calculated score of 7 points places him beyond the Class A category. CTP–C - CTP Class C requires a total score of 10-15 points, indicating **severe liver dysfunction**. - This patient's score of 7 points is considerably lower than the range for Class C. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Systemic Inflammatory Response Syndrome (SIRS) is characterized by all of the following EXCEPT:

Accepted Answer

Platelet count (<1,00,000/mm3)

Answer

Hyperthermia (>38˚C)

Answer

Tachypnoea (>20/min)

Answer

Hypothermia (<36˚C)

Question 2

A few days following viral fever, a 50 year old female presented with pain in neck, fever, malaise and firm enlargement of both the lobes of thyroid. On investigation thyroid antibodies were normal & serum T4 was high normal. Probable diagnosis is:

Accepted Answer

Granulomatous thyroiditis

Answer

Lymphoma of thyroid

Answer

Riedel's thyroiditis

Answer

Autoimmune thyroiditis

Question 3

A gentleman of 36 years presented with a long history of upper abdominal pain which was periodic and often occurred early morning. For last 3 months, he is having projectile vomiting, which is non bilious, unpleasant in nature with undigested food materials. On examination he appears unwell, dehydrated and seemed to have lost weight. Probably he is suffering from:

Accepted Answer

Gastric outlet obstruction

Answer

Superior mesenteric artery syndrome

Answer

Carcinoma stomach

Answer

Gastro-oesophageal reflux with oesophagitis

Question 4

A 40 year old female patient presents with colicky abdominal pain associated with episodes of mild diarrhoea for last 6 months accompanied with intermittent fever and weight loss. There are multiple discharging sinuses on perineal examination. The most likely clinical diagnosis in this patient is:

Accepted Answer

Crohn disease

Answer

Ileocaecal Tuberculosis

Answer

Ulcerative colitis

Answer

Amoebic colitis

Question 5

A gentleman of 48 years was being worked up for hepatocellular function. He had no history or signs of encephalopathy. His serum bilirubin was 5 mg%, serum albumin was 3.9 gm%, International normalized ratio was 1.6. On ultrasound no free fluid was detected inside abdomen. As per Child-Turcotte-Pugh (CTP) classification, he was in:

Accepted Answer

CTP–B

Answer

CTP–D

Answer

CTP–A

Answer

CTP–C

Question 6

A 50 year old male presented with pain along the left arm and ptosis. His chest X-ray showed soft tissue opacity at the apex of the left lung along with the erosion of the adjacent rib. The probable diagnosis is:

Accepted Answer

Pancoast lung

Answer

Bronchial carcinoma

Answer

Lung abscess

Answer

Adenocarcinoma of lung

UPSC-CMS 2019 — Internal Medicine