UPSC-CMS 2009 - Internal Medicine PYQs Practice Questions

Q: Which one of the following is not a correct statement regarding Raynaud's disease ?

The lower extremity involvement is symmetrical. ***The lower extremity involvement is symmetrical*** - **Raynaud's phenomenon** primarily affects the **fingers and toes**, but it is characterized by **asymmetrical involvement**, affecting different digits or limbs to varying degrees. Symmetrical involvement of the lower extremities is not a typical characteristic. - While it can affect the lower extremities, the hallmark of Raynaud's is its **episodic, asymmetrical, and often acral distribution** in response to triggers. *It commonly affects women* - **Raynaud's phenomenon** is indeed more prevalent in **women** than men, with an estimated prevalence of 5-10% in the general population. - This higher incidence in women is a well-documented epidemiological feature of the condition. *Exposure to cold precipitates vasoconstriction* - **Cold exposure** is the most common and classic trigger for **Raynaud's phenomenon**, leading to an exaggerated **vasoconstrictive response** in the small arteries and arterioles of the extremities. - This extreme vasoconstriction results in the characteristic color changes (pallor, cyanosis, and rubor) due to reduced blood flow. *It is idiopathic* - **Raynaud's disease**, also known as **primary Raynaud's phenomenon**, is indeed considered **idiopathic**, meaning its cause is unknown. - It occurs in the absence of any underlying medical condition, distinguishing it from secondary Raynaud's phenomenon, which is associated with autoimmune diseases or other factors. [Practice more Internal Medicine PYQs on OnCourse]

Q: What is the best and most sensitive investigation for hypothyroidism ?

TSH levels. TSH levels - **Thyroid-Stimulating Hormone (TSH)** is the most sensitive and specific test for diagnosing **primary hypothyroidism** because even slight decreases in thyroid hormone levels cause significant increases in TSH [1]. - TSH is released from the **pituitary gland** and acts as a direct feedback mechanism to regulate thyroid hormone production [1]. A high TSH level indicates that the thyroid gland is not producing enough hormones. *T3, T4 levels* - While **T3 (triiodothyronine)** and **T4 (thyroxine)** levels are direct measures of thyroid hormones, their values may remain within the normal range in early or subclinical hypothyroidism [1]. - They are less sensitive than TSH for initial screening and often become abnormal only after hypothyroidism is well-established [1]. *TRH levels* - **Thyrotropin-Releasing Hormone (TRH)** is produced by the hypothalamus and stimulates TSH release from the pituitary [1]. - Measuring TRH levels is generally not used as a primary diagnostic test for hypothyroidism due to its complexity and lack of direct clinical utility in routine screening. *Radioactive I2 uptake* - **Radioactive iodine uptake (RAIU)** measures the thyroid gland's ability to take up iodine, which is used to produce thyroid hormones. - It is primarily used to differentiate causes of hyperthyroidism (e.g., Graves' disease vs. thyroiditis), not as a diagnostic test for hypothyroidism [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: The following are complications of gall stone except

Haemobilia. ***Haemobilia*** - **Haemobilia** refers to bleeding into the biliary tree, often caused by trauma, surgery, or vascular malformations, and is **not a direct complication of gallstones**. [1] - While gallstones can lead to inflammation and erosion, they typically do not cause bleeding into the bile ducts as a primary complication. *Acute pancreatitis* - **Gallstones** are a common cause of **acute pancreatitis** when a stone obstructs the ampulla of Vater, leading to reflux of bile into the pancreatic duct or obstruction of the pancreatic duct itself [1]. - This obstruction causes premature activation of pancreatic enzymes and autodigestion of the pancreas. *Cholangitis* - **Cholangitis** is an inflammation of the bile ducts, usually caused by bacterial infection, which is often precipitated by an obstruction of the biliary tree, most commonly by **gallstones** [1]. - The obstruction leads to stasis of bile, allowing bacteria to ascend from the duodenum and proliferate. *Biliary enteric fistula* - A **biliary enteric fistula** (e.g., cholecystoduodenal fistula) is a pathological connection between the gallbladder or bile duct and the gastrointestinal tract, which can occur due to chronic inflammation and erosion caused by **gallstones** [1]. - This can lead to gallstone ileus if the stone passes into the bowel and obstructs it [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Consider the following prognostic parameters of acute pancreatitis : 1. Rise in blood urea nitrogen over 5 mg/dl 2. Hematocrit decrease over 10% 3. Base deficit more than 4 mmol/L 4. Blood glucose over 10 mmol/L Which of the above parameters are important during initial 48 hours ?

1 and 2 only. ***1 and 2 only*** - A **rise in blood urea nitrogen over 5 mg/dL** and a **hematocrit decrease over 10%** within the initial 48 hours are significant early indicators of fluid sequestration and systemic inflammation, which are critical prognostic factors in acute pancreatitis [1]. - These parameters are part of common prognostic scoring systems, like the **Modified Glasgow Score** or **Ranson's Criteria**, used to assess the severity and predict outcomes [1]. *2 and 3 only* - While a **hematocrit decrease over 10%** is a relevant early prognostic indicator, a **base deficit more than 4 mmol/L** (indicating metabolic acidosis) typically emerges later or reflects more severe, established organ dysfunction. - Early prognostic assessment focuses on parameters measurable within the first 48 hours that reflect initial systemic impact. *1, 2 and 3* - **Rise in blood urea nitrogen over 5 mg/dL** and **hematocrit decrease over 10%** are valid early indicators, but a **base deficit more than 4 mmol/L** is not included in the standard initial 48-hour prognostic criteria for acute pancreatitis severity assessment for the first two days [1]. - This option incorrectly includes base deficit as a primary early prognostic parameter. *1, 3 and 4* - **Rise in blood urea nitrogen over 5 mg/dL** is a correct early prognostic parameter. However, a **base deficit more than 4 mmol/L** and **blood glucose over 10 mmol/L** are less specifically emphasized as *initial 48-hour* critical parameters in all common scoring systems. - While hyperglycemia can be present, its specific prognostic cutoff often varies, and it typically contributes to overall severity rather than being a standalone early change in the first 48 hours. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Following the immunotherapy, in patients undergoing renal transplantation, the skin cancer most commonly seen is

Accepted Answer

Non-melanoma skin cancers (Squamous cell carcinoma and Basal cell carcinoma)

Answer

Hepatomas

Answer

Kaposi's sarcoma

Answer

Mycosis fungoides

Question 2

Which one of the following is not a correct statement regarding Raynaud's disease ?

Accepted Answer

The lower extremity involvement is symmetrical

Answer

It commonly affects women

Answer

Exposure to cold precipitates vasoconstriction

Answer

It is idiopathic

Question 3

What is the best and most sensitive investigation for hypothyroidism ?

Accepted Answer

TSH levels

Answer

T3, T4 levels

Answer

TRH levels

Answer

Radioactive I2 uptake

Question 4

The following are complications of gall stone except

Accepted Answer

Haemobilia

Answer

Acute pancreatitis

Answer

Cholangitis

Answer

Biliary enteric fistula

Question 5

Consider the following prognostic parameters of acute pancreatitis :

1. Rise in blood urea nitrogen over 5 mg/dl
2. Hematocrit decrease over 10%
3. Base deficit more than 4 mmol/L
4. Blood glucose over 10 mmol/L Which of the above parameters are important during initial 48 hours ?

Accepted Answer

1 and 2 only

Answer

2 and 3 only

Answer

1, 2 and 3

Answer

1, 3 and 4

Question 6

Motility disorders of the oesophagus are best diagnosed by

Accepted Answer

Manometry

Answer

Barium meal

Answer

Endoscopy

Answer

Radiography

Question 7

Consider the following statements : Systemic Inflammatory Response Syndrome is characterised by

1. Temperature either above 38°C or below 36°C.

2. Heart rate less than 80/minute.

3. Tachypnoea > 20/min.

4. Leucocyte count > 4 x 109/L. Which of the statements given above are correct ?

Accepted Answer

3, 4 and 1

Answer

1 and 3

Answer

1, 4, 3 and 2

Answer

2, 4 and 3

Question 8

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→1  B→2  C→4  D→3

Answer

A→1  B→4  C→2  D→3

Answer

A→4  B→3  C→2  D→1

Answer

A→1  B→2  C→3  D→4

UPSC-CMS 2009 — Internal Medicine