UPSC-CMS 2023 - Internal Medicine Practice Questions

Q: In a head injury victim, which of the following is the most common initial manifestation of an increasing intra-cranial pressure?

Change in the consciousness level. ***Change in the consciousness level*** - As **intracranial pressure (ICP)** rises due to brain swelling or hematoma, cerebral perfusion is compromised, leading to global brain dysfunction. [1] - This typically manifests first as **subtle changes in arousal**, attention, and orientation, rather than focal neurological deficits. [1] *Ipsilateral pupillary dilatation* - This is a later sign of increasing ICP, specifically indicating **uncal herniation** and compression of the **oculomotor nerve (CN III)**. [1], [2] - While concerning, it usually occurs after changes in consciousness have already been noted. *Contralateral pupillary dilatation* - This is an **atypical finding** in the context of increasing ICP and **unilateral mass effect**. - Pupillary changes due to uncal herniation are typically ipsilateral to the lesion. *Hemiparesis* - **Hemiparesis (weakness on one side of the body)** indicates focal brain compression or damage, often of the **corticospinal tract**. [2] - While it can occur with increasing ICP, it is usually preceded by or occurs concurrently with a decline in the level of consciousness, especially when ICP is rising broadly.

Q: The complications of prolonged parenteral hyperalimentation may include the following except

Hyperphosphataemia. ***Hyperphosphataemia*** - **Hypophosphatemia** is a common complication of prolonged parenteral hyperalimentation (TPN), particularly during refeeding syndrome, due to increased cellular uptake of phosphate for ATP synthesis [1]. - **Hyperphosphatemia** is rare in TPN unless there is significant renal impairment or excessive phosphate administration, which is usually avoided. *Hyperosmolar acidosis* - This can occur with total parenteral nutrition (TPN) if the **glucose load is too high** or if the patient has underlying impaired glucose tolerance [1]. - The high glucose acts as an **osmotic diuretic**, leading to dehydration and metabolic acidosis [1]. *Hyperammonaemia* - This is a potential complication, especially with **excessive amino acid administration** in patients with liver dysfunction or immature liver enzymes (e.g., neonates). - The inability to adequately metabolize ammonia can lead to **encephalopathy**. *Cholestatic jaundice* - Prolonged TPN is a recognized cause of **TPN-associated liver disease**, which can manifest as cholestatic jaundice. - The etiology is multifactorial, involving factors such as **lack of enteral stimulation**, hepatotoxic components in TPN solutions, and altered bile flow.

Q: Which of the following is not associated with Acute Food Poisoning?

Tenesmus. ***Tenesmus*** - **Tenesmus** is a symptom of **inflammatory bowel disease** or other **colonic inflammation**, characterized by the sensation of incomplete defecation [1]. - While it can be associated with some forms of infectious colitis, it is **not a typical or direct symptom of acute food poisoning**, which primarily manifests with acute onset of nausea, vomiting, diarrhea, and abdominal cramps [2], [3]. *High skin surface temperature* - **High skin surface temperature** (fever) is a common symptom of acute food poisoning, as the body fights off pathogens or toxins. - It is an indication of the **systemic inflammatory response** to the ingested contaminants. *Onset with vomiting* - **Vomiting** is one of the most prominent and often initial symptoms of acute food poisoning, especially with preformed toxins [2], [3]. - It is the body's rapid mechanism to **expel harmful substances** from the gastrointestinal tract. *Leucocytosis* - **Leucocytosis** (an increase in white blood cells) is a common finding in many infections, including bacterial food poisoning. - It indicates an **active immune response** to combat the invading pathogens or toxins.

Q: Which of the following are components of "Klippel-Trenaunay syndrome" ? 1. Cutaneous Naevus 2. Subcutaneous Lipomas 3. Varicose veins 4. Soft tissue hypertrophy Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - Klippel-Trenaunay syndrome is characterized by a triad of **capillary malformations (cutaneous naevus)**, **venous malformations (varicose veins)**, and **limb overgrowth (soft tissue hypertrophy)**. - These features are typically present at birth and often affect a single limb or a region of the body. *1, 2 and 3* - This option incorrectly includes **subcutaneous lipomas** as a core component of Klippel-Trenaunay syndrome, which are not typically associated with the condition. - While capillary malformations and varicose veins are characteristic, the inclusion of lipomas makes this option incorrect. *2, 3 and 4* - This option incorrectly includes **subcutaneous lipomas** and omits the essential feature of **cutaneous naevus (capillary malformation)**. - The absence of cutaneous naevus, a hallmark of the syndrome, makes this selection inaccurate. *1, 2 and 4* - This option incorrectly includes **subcutaneous lipomas** and omits **varicose veins**, a key component of the syndrome. - The presence of capillary malformations and soft tissue hypertrophy are correct, but the missing varicose veins and incorrect inclusion of lipomas render this option incorrect.

Q: A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is :

Speckled leucoplakia. ***Speckled leucoplakia*** - This patient, a **tobacco chewer** and **bidi smoker**, has risk factors and presents with a "white buccal mucosa with a bright red velvety plaque" (known as **speckled leukoplakia**), which is a highly suspicious lesion for **oral squamous cell carcinoma (OSCC)**, especially with symptoms like diminished mouth opening and occasional spitting of blood. - **Speckled leukoplakia** combines features of both leukoplakia (white areas) and erythroplakia (red velvety areas), and is considered the **highest risk precancerous lesion** for malignant transformation. *Erythroplakia* - Characterized by a **bright red velvety patch** that is flat or slightly depressed. - While highly suspicious for malignancy (with a 90% chance of being dysplastic or malignant), the description also includes a "white buccal mucosa," indicating a mixed white and red lesion. *Oral candidiasis* - Presents as **white, curdy patches** that can be scraped off, often revealing an erythematous base, and is typically associated with immunosuppression or antibiotic use. - It does not usually present with a persistent **red velvety component** or symptoms of diminished mouth opening indicative of malignancy. *Leukoplakia* - Defined as a **white plaque** that cannot be rubbed off and cannot be characterized as any other diagnosable disease. - Only describes the white component, while the patient's lesion also has a significant **red, velvety component**, classifying it more accurately as speckled leukoplakia.

Q: Which of the following are correct regarding Trichobezoar ? 1. It is a hair ball in the stomach. 2. It is common in psychiatric patients. 3. Common complications are bleeding, perforation or obstruction. 4. Treated with long course of proton pump inhibitors. Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - A **trichobezoar** is indeed a mass of undigested hair found in the gastrointestinal tract, most commonly in the **stomach**. [1] - It is frequently associated with **psychiatric conditions** such as trichotillomania (compulsive hair pulling) and trichophagia (compulsive hair eating), leading to its occurrence predominantly in psychiatric patients. Common complications include **gastrointestinal bleeding**, **perforation**, and **obstruction** due to the size and abrasive nature of the hairball. [1] *2, 3 and 4* - While trichobezoars are common in psychiatric patients and can lead to bleeding, perforation, or obstruction, the treatment is typically **surgical removal** or **endoscopic fragmentation**, not long-term proton pump inhibitors (PPIs). - PPIs are used to reduce gastric acid, which is not the primary treatment for a physical obstruction like a trichobezoar. *1, 3 and 4* - Although a trichobezoar is a hairball in the stomach and can cause bleeding, perforation, or obstruction, the statement about treatment with a long course of **proton pump inhibitors (PPIs)** is incorrect. - PPIs would not resolve a physical mass like a trichobezoar, which usually requires removal. *1, 2 and 4* - While trichobezoars are stomach hairballs and are more prevalent in psychiatric patients, and long-term **proton pump inhibitors (PPIs)** are not a primary treatment for trichobezoars. - The correct management involves physical removal rather than acid suppression.

Q: Zollinger Ellison syndrome is characterized by which of the following ?

Non-beta islet cell tumour of pancreas. ***Non-beta islet cell tumour of pancreas*** - **Zollinger-Ellison syndrome (ZES)** is caused by a **gastrin-secreting tumor** (gastrinoma), which is a type of **non-beta islet cell tumor** of the pancreas or duodenum. - This gastrinoma leads to excessive gastric acid secretion [1]. *Recurrent ulceration despite treatment* - While **recurrent ulceration** is a prominent symptom of ZES due to hypersecretion of gastric acid, it is a *consequence* of the underlying disease rather than its defining characteristic or cause. - The persistence of ulcers despite standard anti-secretory therapy is a strong clinical indicator that points towards ZES [1]. *Recurrent episodes of dysentery* - **Dysentery** is characterized by bloody diarrhea, often caused by bacterial infections, and is not a typical or primary feature of Zollinger-Ellison syndrome. - While severe diarrhea can occur in ZES due to inactivation of pancreatic enzymes and damage to intestinal mucosa from excessive acid, it is not described as dysentery. *Fulminating gastric ulcers* - Gastric ulcers in ZES can be severe and numerous, but the term "fulminating" typically implies a rapid onset, severe, and aggressive course, often seen in conditions like *H. pylori*-associated ulcers with complications. - While ulcers in ZES are often refractory and severe, the defining characteristic of the syndrome is the gastrinoma itself, not merely the severity of ulcers.

Q: Which of the following statements with regard to Colorectal Carcinoma are correct ? 1. Left-sided Colorectal Carcinoma presents with bleeding per rectum. 2. Right-sided Colorectal Carcinoma presents with iron deficiency anaemia. 3. Right-sided Colorectal Carcinoma is more common as compared to the left-sided Colorectal Carcinoma. 4. Colonoscopy is the investigation of choice for suspected Colorectal Carcinoma. Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 4*** - **Left-sided colorectal carcinoma** often presents with **bleeding per rectum** due to its proximity to the anus [1]. - **Right-sided colorectal carcinoma** is more likely to cause insidious blood loss, leading to **iron deficiency anemia** [1]. - **Colonoscopy** is considered the **gold standard** for diagnosing colorectal carcinoma due to its ability to visualize the entire colon and allow for biopsy [1]. *2, 3 and 4* - While statements 2 and 4 are correct, statement 3 is incorrect. **Left-sided colorectal carcinoma is more common** than right-sided colorectal carcinoma [1]. - Right-sided lesions more generally cause anemia, and colonoscopy is the appropriate investigation of choice [1]. *1, 2 and 3* - Statements 1 and 2 are correct. However, statement 3 is incorrect; **left-sided colorectal carcinoma has a higher incidence** compared to right-sided colorectal carcinoma [1]. - Bleeding per rectum is characteristic of left-sided lesions while iron deficiency anemia for right-sided lesions [1]. *1, 3 and 4* - While statements 1 and 4 are correct, statement 3 is incorrect. **Left-sided colorectal carcinoma is more prevalent** than right-sided colorectal carcinoma [1]. - Clinical presentation with bleeding per rectum is typical for left-sided cancers, and colonoscopy is the definitive diagnostic tool [1].

Q: Which one of the following statements regarding Inflammatory Bowel Disease is correct ?

Perianal disease is common in Crohn's disease.. ***Perianal disease is common in Crohn's disease.*** [1] - **Crohn's disease** is characterized by **transmural inflammation** that involves all layers of the bowel wall, leading to complications like **fistulas, strictures, and perianal disease** [2]. - **Perianal disease** manifestations include **fissures, fistulas, abscesses**, and skin tags, and it is a defining characteristic of Crohn's [2]. *Stricture formation is common in Ulcerative Colitis.* - **Stricture formation** is generally **uncommon in uncomplicated ulcerative colitis** but can occur in severe, long-standing disease. - **Strictures** are more characteristic of **Crohn's disease** due to its transmural inflammation and fibrotic changes [3]. *Fistula formation is common in Ulcerative Colitis.* - **Fistula formation** is a hallmark of **Crohn's disease**, resulting from the deep, transmural inflammation that penetrates the bowel wall [2]. - **Ulcerative colitis** inflammation is typically **mucosal and superficial**, making fistula formation rare in this condition [1]. *Rectum is always involved in Crohn's disease.* - While **Crohn's disease** can affect any part of the gastrointestinal tract from mouth to anus, skip lesions are common, and the **rectum is often spared** [1]. - In contrast, **ulcerative colitis always involves the rectum**, extending proximally in a continuous fashion [1].

Question 1

In a head injury victim, which of the following is the most common initial manifestation of an increasing intra-cranial pressure?

Accepted Answer

Change in the consciousness level

Answer

Ipsilateral pupillary dilatation

Answer

Contralateral pupillary dilatation

Answer

Hemiparesis

Question 2

The complications of prolonged parenteral hyperalimentation may include the following except

Accepted Answer

Hyperphosphataemia

Answer

Hyperosmolar acidosis

Answer

Hyperammonaemia

Answer

Cholestatic jaundice

Question 3

The "Subclavian steal syndrome" occurs due to

Accepted Answer

Occlusion of the subclavian artery proximal to origin of vertebral artery

Answer

Occlusion/stenosis of the carotid artery

Answer

Occlusion/stenosis of the vertebral artery

Answer

Occlusion of the subclavian artery distal to origin of vertebral artery

Question 4

Which of the following is not associated with Acute Food Poisoning?

Accepted Answer

Tenesmus

Answer

High skin surface temperature

Answer

Onset with vomiting

Answer

Leucocytosis

Question 5

Which of the following are components of "Klippel-Trenaunay syndrome" ?

1. Cutaneous Naevus
2. Subcutaneous Lipomas
3. Varicose veins
4. Soft tissue hypertrophy

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 6

A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is :

Accepted Answer

Speckled leucoplakia

Answer

Erythroplakia

Answer

Oral candidiasis

Answer

Leukoplakia

Question 7

Which of the following are correct regarding Trichobezoar ?

1. It is a hair ball in the stomach.

2. It is common in psychiatric patients.

3. Common complications are bleeding, perforation or obstruction.

4. Treated with long course of proton pump inhibitors.

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Question 8

Zollinger Ellison syndrome is characterized by which of the following ?

Accepted Answer

Non-beta islet cell tumour of pancreas

Answer

Recurrent ulceration despite treatment

Answer

Recurrent episodes of dysentery

Answer

Fulminating gastric ulcers

Question 9

Which of the following statements with regard to Colorectal Carcinoma are correct ?

1. Left-sided Colorectal Carcinoma presents with bleeding per rectum.
2. Right-sided Colorectal Carcinoma presents with iron deficiency anaemia.
3. Right-sided Colorectal Carcinoma is more common as compared to the left-sided Colorectal Carcinoma.
4. Colonoscopy is the investigation of choice for suspected Colorectal Carcinoma.

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 10

Which one of the following statements regarding Inflammatory Bowel Disease is correct ?

Accepted Answer

Perianal disease is common in Crohn's disease.

Answer

Stricture formation is common in Ulcerative Colitis.

Answer

Fistula formation is common in Ulcerative Colitis.

Answer

Rectum is always involved in Crohn's disease.

UPSC-CMS 2023 — Internal Medicine