UPSC-CMS 2024 - Internal Medicine PYQs Practice Questions

Q: Which of the following statements are correct regarding Barrett's oesophagus? 1. It is a metaplastic change. 2. It is a risk factor for development of adenocarcinoma. 3. Ingestion of NSAIDs is the aetiological factor for its development. 4. Endoscopic mucosal resection is an effective treatment. Select the answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** - **Barrett's esophagus** is characterized by the replacement of the normal **stratified squamous epithelium** of the distal esophagus with **specialized intestinal columnar epithelium**, which is a classic example of **metaplasia**. [1] - This metaplastic change is a significant **risk factor** for developing **esophageal adenocarcinoma**, making regular surveillance and treatment crucial. [1] **Endoscopic mucosal resection (EMR)** is an effective treatment option for early-stage adenocarcinoma or high-grade dysplasia in Barrett's esophagus, capable of removing superficial neoplastic tissue. *2, 3 and 4* - This option incorrectly includes ingestion of NSAIDs as an etiological factor for Barrett's esophagus. **NSAIDs** are not directly associated with the development of Barrett's esophagus. - While statements 2 and 4 are correct, the inclusion of statement 3 makes this option incorrect. *1, 3 and 4* - This option wrongly implicates **NSAIDs** in the etiology of Barrett's esophagus. The primary cause is **chronic gastroesophageal reflux disease (GERD)**, not NSAID use. [1] - Statement 2, which identifies Barrett's as a risk factor for adenocarcinoma, is critically important but is omitted here. *1, 2 and 3* - This option incorrectly states that NSAID ingestion is an etiological factor for Barrett's esophagus. The main cause is **chronic acid reflux**. [1] - While statements 1 and 2 are correct, statement 3 is incorrect, rendering this entire option invalid. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following are risk factors for the development of pancreatic cancer? 1. Cigarette smoking 2. Diabetes mellitus 3. Obesity 4. Caucasian ethnicity Select the correct answer using the code given below.

1, 2 and 3. ***1, 2 and 3*** - **Cigarette smoking** is a well-established and significant modifiable risk factor for pancreatic cancer, increasing the risk two to three-fold [1]. - **Long-standing diabetes mellitus**, particularly type 2, is both an independent risk factor and can be an early symptom of pancreatic cancer. **Obesity** is also clearly linked to an increased risk of pancreatic cancer, likely due to chronic inflammation and metabolic changes. *2, 3 and 4* - While diabetes mellitus and obesity are risk factors, **Caucasian ethnicity** is not considered a primary isolated risk factor for pancreatic cancer; rather, the incidence is slightly higher in certain other ethnic groups like African Americans. - This option incorrectly includes ethnicity as a primary risk factor while excluding **cigarette smoking**, which is a major contributor [1]. *1, 3 and 4* - This option correctly identifies **cigarette smoking** and **obesity** as risk factors. However, it incorrectly includes **Caucasian ethnicity** as a specific risk factor while omitting **diabetes mellitus**, which is a strong and well-documented risk factor. - **Diabetes mellitus** is a more significant risk factor than ethnicity. *1, 2 and 4* - This option correctly identifies **cigarette smoking** and **diabetes mellitus** as risk factors. However, it incorrectly includes **Caucasian ethnicity** and omits **obesity**, which is a well-established and significant risk factor. - **Obesity** has a stronger and more direct link to pancreatic cancer risk than ethnicity. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following are features of autosomal dominant polycystic kidney disease? 1. Cyst may also occur in liver, pancreas and arachnoid membrane. 2. Most commonly manifests between 20-30 years of age. 3. Clinical manifestations are renal and extrarenal. 4. Men tend to progress to renal failure more rapidly than women. Select the correct answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - **Autosomal dominant polycystic kidney disease (ADPKD)** is characterized by the growth of numerous cysts in the kidneys [1], but can also lead to **extrarenal cysts** in organs such as the **liver, pancreas, and arachnoid membrane**. - **ADPKD** causes both renal and extrarenal manifestations, and **men typically progress to renal failure more rapidly than women**. *1, 2 and 4* - This option correctly identifies the presence of cysts in other organs and the rapid progression to renal failure in men, but it incorrectly states that the disease most commonly manifests between **20-30 years of age**. - While symptoms can appear at any age, **ADPKD** often manifests with symptoms such as pain due to cysts or hypertension later in life [1], and **renal function decline** is typically observed in middle age. *1, 2 and 3* - This option incorrectly includes the statement that the disease most commonly manifests between **20-30 years of age**. - Although the genetic defect is present from birth, significant clinical symptoms leading to diagnosis or renal failure often develop later, typically in the **4th to 6th decades of life**. *2, 3 and 4* - This option incorrectly states that the disease most commonly manifests between **20-30 years of age**. - It also omits the key feature that cysts can occur in other organs like the **liver, pancreas, and arachnoid membrane**, which is a crucial aspect of ADPKD. [Practice more Internal Medicine PYQs on OnCourse]

Q: Consider the following clinical features : 1. Raised ICP 2. Seizures 3. Focal deficit 4. Headache Which of the above clinical features are related to most brain tumours?

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All four clinical features—**raised ICP**, **seizures**, **focal neurological deficits**, and **headache**—are commonly associated with brain tumors [1]. - Brain tumors can cause **increased intracranial pressure** through mass effect, edema, or CSF flow obstruction, leading to headaches and, less commonly, seizures [1]. **Focal deficits** result from direct tissue destruction or compression depending on the tumor's location [2]. *2, 3 and 4 only* - This option incorrectly omits **raised ICP**, which is a frequent and significant symptom of brain tumors, contributing to headaches, nausea, vomiting, and altered mental status [1]. - While seizures, focal deficits, and headaches are common, **raised ICP** often underlies many of these symptoms. *1 and 2 only* - This option excludes **focal deficits** and **headache**, both of which are very common presentations of brain tumors. - The specific location of a tumor often dictates **focal deficits** [2], and **headache** is one of the most prevalent symptoms. *1, 2 and 3 only* - This option incorrectly omits **headache**, which is a classic and highly prevalent symptom in patients with brain tumors, often severe and resistant to common analgesics. - Headaches can result from **mass effect**, **increased ICP** [1], or irritation of pain-sensitive structures within the brain. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 40-year-old lady complains of progressive deformities of her hands and fingers associated with stiffness which is present in both the hands and improves as the day progresses. On examination, there is symmetrical involvement of hands and fingers of both the upper limbs with flexion and ulnar deviation at the metacarpophalangeal joints. What is the most likely diagnosis in this lady?

Rheumatoid arthritis. ***Rheumatoid arthritis*** - The combination of **symmetrical polyarthritis** affecting the hands and fingers, **morning stiffness** that improves with activity ("improves as the day progresses" not as severe as morning stiffness) [1][4], and characteristic **flexion and ulnar deviation at the metacarpophalangeal joints** (Swan-neck, Boutonniere's, and Z-thumb deformities) are classic features of rheumatoid arthritis (RA) [3]. - RA is an **autoimmune disease** causing chronic inflammation of the synovial lining of joints, leading to progressive joint damage and characteristic deformities [3]. *Ankylosing spondylitis* - This condition primarily affects the **axial skeleton** (spine and sacroiliac joints), causing **back pain and stiffness**, not typically significant small joint deformities of the hands. - While it can involve peripheral joints, it is often **asymmetrical** and doesn't present with the specific hand deformities described. *Osteoarthritis* - **Osteoarthritis** is a degenerative joint disease characterized by **cartilage breakdown**, leading to pain that **worsens with activity** and improves with rest [2]. - Joint involvement is often **asymmetrical** and typically affects weight-bearing joints or causes **Heberden's** and **Bouchard's nodes** in the fingers, not the symmetrical MCP involvement and specific deformities seen here [2]. *Tenosynovitis* - **Tenosynovitis** is an inflammation of the **synovial sheath surrounding a tendon**, causing localized pain, swelling, and difficulty moving the affected digit or limb. - It does not explain the widespread, symmetrical joint involvement, progressive deformities of multiple joints, or systemic nature of the symptoms described. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Which of the following statements are correct regarding Barrett's oesophagus?

1. It is a metaplastic change.
2. It is a risk factor for development of adenocarcinoma.
3. Ingestion of NSAIDs is the aetiological factor for its development.
4. Endoscopic mucosal resection is an effective treatment. Select the answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Question 2

Which of the following are risk factors for the development of pancreatic cancer?

1. Cigarette smoking
2. Diabetes mellitus
3. Obesity
4. Caucasian ethnicity

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 3

Which of the following are features of autosomal dominant polycystic kidney disease?

1. Cyst may also occur in liver, pancreas and arachnoid membrane.
2. Most commonly manifests between 20-30 years of age.
3. Clinical manifestations are renal and extrarenal.
4. Men tend to progress to renal failure more rapidly than women.

Select the correct answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 4

Consider the following clinical features :

1. Raised ICP
2. Seizures
3. Focal deficit
4. Headache Which of the above clinical features are related to most brain tumours?

Accepted Answer

1, 2, 3 and 4

Answer

2, 3 and 4 only

Answer

1 and 2 only

Answer

1, 2 and 3 only

Question 5

A 40-year-old lady complains of progressive deformities of her hands and fingers associated with stiffness which is present in both the hands and improves as the day progresses. On examination, there is symmetrical involvement of hands and fingers of both the upper limbs with flexion and ulnar deviation at the metacarpophalangeal joints. What is the most likely diagnosis in this lady?

Accepted Answer

Rheumatoid arthritis

Answer

Ankylosing spondylitis

Answer

Osteoarthritis

Answer

Tenosynovitis

Question 6

Upper motor neuron lesions are characterized by which of the following?

1. Increased tone (spasticity)
2. Hyperreflexia
3. Absent plantar response
4. Motor weakness

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 7

Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)?

1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria.
2. It is same as bacteraemia.
3. It results in Multiple Organ Dysfunction Syndrome (MODS).
4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 8

Which of the following statements are correct regarding iron deficiency?

1. More common in older age group
2. More common in females of reproductive age
3. Associated with heavy menstrual bleeding
4. Commonly caused by chronic blood loss

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 9

Consider the following statements: Statement I: Waist circumference and waist to hip ratio are more powerful predictors of subsequent risk of type 2 diabetes than Body Mass Index (BMI). Statement II: Central obesity is an important determinant of insulin resistance, the underlying abnormality in most cases of type 2 diabetes. Which one of the following is correct in respect of the above statements?

Accepted Answer

Both Statement I and Statement II are correct and Statement II is the correct explanation of Statement I

Answer

Statement I is incorrect but Statement II is correct

Answer

Statement I is correct but Statement II is incorrect

Answer

Both Statement I and Statement II are correct but Statement II is not the correct explanation of Statement I

Question 10

An industrial worker was brought to a medical facility due to health problems. On his workup including laboratory tests, a finding of basophilic stippling of Red Blood Cells (RBC) was observed. Which among the following is he/she likely to be having?

Accepted Answer

Lead poisoning

Answer

Brucellosis

Answer

Asbestosis

Answer

Farmer's lung

UPSC-CMS 2024 — Internal Medicine