UPSC-CMS 2021 - Internal Medicine PYQs Practice Questions

Q: A 50 year old female presents to the emergency with pain, swelling and redness over the left foot following a trivial trauma 3 days back. On examination, the swelling over the left foot is poorly localised; local tenderness and erythema are present and crepitus is absent; distal pulsations are palpable. The most likely clinical diagnosis is

Cellulitis. **Cellulitis** - The clinical presentation of **pain, swelling, redness, poorly localized swelling**, and local tenderness following a minor trauma strongly suggests **cellulitis** [1]. - The absence of crepitus and presence of palpable distal pulses argue against severe infections like necrotizing fasciitis or compartment syndrome. *Abscess* - An abscess typically presents as a **localized, fluctuant** collection of pus, distinct from the poorly localized swelling described. - While an abscess can cause pain, swelling, and redness, its **well-demarcated nature** would differentiate it from the diffuse presentation of cellulitis [1]. *Fasciitis* - **Necrotizing fasciitis** is characterized by severe pain out of proportion to examination findings, rapid progression, systemic toxicity, and often **crepitus** due to gas production by bacteria. - The description lacks signs of overwhelming infection and crepitus, making fasciitis less likely. *Compartment syndrome* - Compartment syndrome involves severe pain, **pallor, paresthesia, pulselessness**, and paralysis (the 5 Ps), caused by increased pressure within a fascial compartment. - The presence of **palpable distal pulsations** makes compartment syndrome highly unlikely, as it typically impairs blood flow. [Practice more Internal Medicine PYQs on OnCourse]

Q: Serum thyroglobulin level is an important tumor marker for

Papillary carcinoma thyroid. ***Papillary carcinoma thyroid*** - **Serum thyroglobulin** is produced by follicular cells of the thyroid and serves as an excellent tumor marker for **differentiated thyroid cancers**, including papillary carcinoma, particularly after thyroidectomy [1]. - Elevated thyroglobulin levels in a patient with a history of papillary thyroid cancer, especially after removal of the thyroid gland, suggest **recurrence or persistent disease**. *Thyroid lymphoma* - **Thyroid lymphoma** is a lymphoid malignancy, and its primary tumor marker is typically associated with lymphocytic origin, such as **beta-2 microglobulin** or **LDH**, not thyroglobulin. - Thyroglobulin is a product of thyroid follicular cells, which are not the cell of origin for lymphoma. *Medullary carcinoma thyroid* - **Medullary thyroid carcinoma** originates from the parafollicular C cells, which produce **calcitonin**. - **Calcitonin** is the primary tumor marker for medullary thyroid carcinoma, not thyroglobulin. *Anaplastic carcinoma thyroid* - **Anaplastic thyroid carcinoma** is an undifferentiated tumor with very aggressive behavior and often does not produce significant amounts of thyroglobulin. - While some anaplastic carcinomas may have elevated thyroglobulin, it's not a reliable or specific marker due to the **dedifferentiated nature** of the cells. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following statements regarding Ogilvie’s syndrome are correct? 1. It presents as acute large bowel mechanical obstruction 2. Marked caecal dilatation is a common feature on X-ray abdomen 3. Caecal perforation is a well recognized complication of this condition 4. Intravenous Neostigmine is used for the treatment of this condition

2, 3 and 4. **2, 3 and 4** - **Marked caecal dilatation** is a hallmark of Ogilvie's syndrome on X-ray, indicating the pseudo-obstruction. - **Caecal perforation** is a serious and well-recognized complication, especially if the caecal diameter exceeds 12-14 cm. - **Intravenous Neostigmine** is a parasympathomimetic drug used to stimulate colonic motility and is an effective treatment for Ogilvie's syndrome. *1, 3 and 4* - Ogilvie's syndrome is characterized by **acute large bowel pseudo-obstruction**, meaning it mimics a mechanical obstruction without an actual physical blockage. - Therefore, statement 1, which claims it presents as acute large bowel *mechanical* obstruction, is incorrect. *1, 2 and 3* - As noted, Ogilvie's syndrome is a **pseudo-obstruction**, not a mechanical one, making statement 1 incorrect. - The other statements regarding caecal dilatation and perforation are correct. *1, 2 and 4* - Again, the key differentiating factor is that Ogilvie's syndrome is a **pseudo-obstruction**, not a mechanical obstruction, rendering statement 1 inaccurate. - Statements 2 and 4 are accurate descriptions of the condition and its treatment. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = 106/min, BP = 100/70 mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size 13 x 8 cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is

Gastrointestinal stromal tumor. ***Gastrointestinal stromal tumor*** - The rapid onset of symptoms like **upper abdominal pain**, **nausea**, **vomiting**, and **hematemesis**, along with signs of **hypovolemia** (tachycardia, hypotension, pallor), suggests acute gastrointestinal bleeding from a tumor [1]. - A **large exophytic tumor** in the stomach fundus with **intact overlying mucosa** on endoscopy points to a **submucosal lesion**, and **positive CD117 (c-Kit)** staining is a hallmark diagnostic feature of GISTs. *Carcinoid tumor* - While carcinoid tumors can occur in the gastrointestinal tract, they are typically **neuroendocrine tumors** and less commonly present as large, exophytic masses causing acute massive bleeding with the same frequency as GISTs. - Carcinoid tumors typically stain positive for **chromogranin A** and **synaptophysin**, not CD117. *Gastric lymphoma* - Gastric lymphoma commonly presents with **ulcerations** or infiltrative lesions of the gastric wall, which would typically cause mucosal disruption on endoscopy [2]. - Lymphomas are characterized by lymphoid markers like **CD20** or **CD3**, and not CD117 [2]. *Carcinoma stomach* - **Gastric carcinoma** often presents with **mucosal irregularities**, **ulcerations**, or **masses** that arise directly from the gastric epithelium, which would be visible on endoscopy as an invasive lesion [3]. - Gastric carcinomas are typically epithelial in origin and would not stain positive for **CD117**. [Practice more Internal Medicine PYQs on OnCourse]

Q: Among the extra intestinal manifestations of Crohn’s disease which one of the following is related to the disease activity ?

Eye complications (Iritis/Uveitis). ***Eye complications (Iritis/Uveitis)*** - **Uveitis and iritis** in Crohn's disease often correlate with disease activity, meaning flares in the bowel disease can trigger or worsen these ocular manifestations [1]. - Successful treatment of the underlying intestinal inflammation frequently leads to improvement or resolution of these **eye complications** [1]. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic liver disease associated with inflammatory bowel disease, particularly ulcerative colitis, but its course is largely **independent of IBD activity**. - It progresses irrespective of intestinal disease flares and often requires its **own specific management**. *Renal calculi* - **Renal calculi (kidney stones)** can be a complication of Crohn's disease, linked to fluid loss and changes in oxalate absorption, but their occurrence is generally **not directly correlated with the inflammatory activity** of the bowel disease. - Instead, factors like **dehydration** and calcium/oxalate metabolism are more significant drivers. *Chronic active hepatitis* - While various hepatic manifestations can occur in Crohn's disease, **chronic active hepatitis** is not one of the well-established extraintestinal manifestations directly linked to disease activity. - Other liver conditions like **fatty liver disease** or **drug-induced liver injury** are more commonly seen, but their presence doesn't typically parallel intestinal inflammation. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

A 50 year old female presents to the emergency with pain, swelling and redness over the left foot following a trivial trauma 3 days back. On examination, the swelling over the left foot is poorly localised; local tenderness and erythema are present and crepitus is absent; distal pulsations are palpable. The most likely clinical diagnosis is

Accepted Answer

Cellulitis

Answer

Abscess

Answer

Fasciitis

Answer

Compartment syndrome

Question 2

Serum thyroglobulin level is an important tumor marker for

Accepted Answer

Papillary carcinoma thyroid

Answer

Thyroid lymphoma

Answer

Medullary carcinoma thyroid

Answer

Anaplastic carcinoma thyroid

Question 3

Which of the following statements regarding Ogilvie’s syndrome are correct?

1. It presents as acute large bowel mechanical obstruction

2. Marked caecal dilatation is a common feature on X-ray abdomen

3. Caecal perforation is a well recognized complication of this condition

4. Intravenous Neostigmine is used for the treatment of this condition

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 4

A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = 106/min, BP = 100/70 mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size 13 x 8 cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is

Accepted Answer

Gastrointestinal stromal tumor

Answer

Carcinoid tumor

Answer

Gastric lymphoma

Answer

Carcinoma stomach

Question 5

Among the extra intestinal manifestations of Crohn’s disease which one of the following is related to the disease activity ?

Accepted Answer

Eye complications (Iritis/Uveitis)

Answer

Primary sclerosing cholangitis

Answer

Renal calculi

Answer

Chronic active hepatitis

Question 6

The Model for End Stage Liver Disease (MELD) score includes which of the following variables?

1. Serum bilirubin
2. Serum albumin
3. Serum creatinine
4. International Normalised Ratio (INR)

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 7

Insulin Resistance Syndrome (Syndrome X) is associated with which of the following?

1. Type 2 Diabetes Mellitus
2. Hyperinsulinaemia
3. Dyslipidaemia
4. Hypercalcaemia

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 8

The "DASH diet" is a lifestyle modification for management of which of these conditions ?

Accepted Answer

Hypertension

Answer

Diabetes

Answer

Cancer

Answer

Anemia

UPSC-CMS 2021 — Internal Medicine