UPSC-CMS 2010 - Internal Medicine PYQs Practice Questions

Q: A patient presents with claudication in both buttocks and has impotence. The clinical examination reveals bruit over lower abdomen. What is the clinical diagnosis?

Aortoiliac occlusion. Aortoiliac occlusion - The triad of **buttock claudication**, **impotence**, and **absent or diminished femoral pulses** (often associated with an abdominal bruit) is classic for **Leriche syndrome**, which is caused by aortoiliac occlusion [2], [3]. - This occlusion impairs blood flow to both lower extremities and the internal iliac arteries, affecting erectile function [1]. Bilateral iliofemoral occlusion - While this would cause bilateral lower limb symptoms, it typically would not explain the **impotence** as clearly as an aortoiliac occlusion which affects the internal iliac arteries that supply the penis [2], [3]. - An iliofemoral occlusion is distal to the aorta, and the symptom complex provided points to a more **proximal lesion**. Bilateral iliac artery occlusion - This would cause similar symptoms to aortoiliac occlusion including **buttock claudication** and **impotence** [2]. - However, the presence of a **bruit over the lower abdomen** often indicates a more proximal lesion involving the aorta, making aortoiliac occlusion a more comprehensive diagnosis for these findings. Bilateral femoropopliteal occlusion - This would primarily cause **calf and thigh claudication**, less commonly buttock claudication, as the occlusion is more distal [1]. - **Impotence** is not a typical symptom of isolated femoropopliteal occlusion, as the internal iliac arteries are usually unaffected. [Practice more Internal Medicine PYQs on OnCourse]

Q: The normal ankle brachial pressure index (ABPI) is 1.0. A value of 0.8 suggests

some degree of arterial obstruction. ***some degree of arterial obstruction*** - An **ABPI of 0.8** indicates a reduction in blood flow to the lower extremities compared to the upper limbs [1]. - This value is generally considered to signify **mild to moderate peripheral artery disease (PAD)**, suggesting the presence of arterial narrowing or obstruction [1]. *impending gangrene* - **Impending gangrene** or critical limb ischemia is typically associated with a much lower ABPI, usually **below 0.4** or even 0.3 [1]. - At an ABPI of 0.8, severe tissue damage and gangrene are not imminent, although careful monitoring is still warranted. *presence of collaterals* - While **collateral arteries** can develop in response to chronic arterial obstruction, an ABPI of 0.8 primarily reflects the overall net blood flow, which is still reduced despite collaterals [1]. - The presence of collaterals can actually help to maintain tissue viability and prevent more severe symptoms, but they don't normalize the ABPI in the presence of significant disease [1]. *good flow* - A value of **1.0 to 1.4** is generally considered a normal ABPI, indicating good arterial flow. - An ABPI of **0.8 is significantly below normal** and suggests impaired rather than good blood flow [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Serum calcitonin may be elevated in

medullary carcinoma of thyroid. ***medullary carcinoma of thyroid*** - **Medullary thyroid carcinoma (MTC)** originates from the **parafollicular C cells** of the thyroid gland, which physiologically produce and secrete **calcitonin**. - Therefore, MTC is a classic cause of significantly elevated serum **calcitonin** levels, used both as a diagnostic marker and for monitoring disease recurrence. *choriocarcinoma of ovary* - **Choriocarcinoma** is a germ cell tumor that typically produces **human chorionic gonadotropin (hCG)**, not calcitonin [3]. - Ovarian choriocarcinoma is a rare and highly aggressive tumor, and its primary tumor marker is **hCG** [3]. *islet cell tumour of pancreas* - **Islet cell tumors** of the pancreas (neuroendocrine tumors) typically produce hormones like **insulin, glucagon, somatostatin, or gastrin**, depending on their subtype [1], [2]. - While they are endocrine tumors, they do not originate from calcitonin-producing cells and thus generally do not elevate **calcitonin**. *carcinoid tumour of appendix* - **Carcinoid tumors**, especially those of the appendix, are **neuroendocrine tumors** that typically secrete **serotonin** and other vasoactive substances [1]. - These tumors are associated with **carcinoid syndrome** (flushing, diarrhea, bronchospasm) but do not produce **calcitonin** [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Priapism in a young male could occur because of

leukaemia. ***Leukaemia*** - In leukaemia, especially **myeloid leukaemia**, immature white blood cells can accumulate in the **corpus cavernosa**, leading to stasis and **venous occlusion**. [1] - This cellular congestion prevents venous outflow from the penis, causing a prolonged and **painful erection (priapism)**. *Carcinoid tumour of appendix* - A carcinoid tumour of the appendix is typically associated with **carcinoid syndrome**, which involves symptoms like flushing and diarrhoea. - It does **not directly cause priapism**, as its mediators (e.g., serotonin) do not typically induce this specific local vascular event. *Testicular cancer* - Testicular cancer primarily manifests as a **painless lump in the testis** and can cause symptoms related to metastasis, but **priapism is not a typical direct presenting symptom**. - While some cancers can cause paraneoplastic syndromes, testicular cancer is not associated with priapism. *Penile cancer* - Penile cancer typically presents as a **lesion, ulcer, or mass on the penis**, often associated with pain, bleeding, or discharge. - While it affects the penis, it does **not typically cause prolonged erections (priapism)**, but rather local tissue destruction or obstruction. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

A patient presents with claudication in both buttocks and has impotence. The clinical examination reveals bruit over lower abdomen. What is the clinical diagnosis?

Accepted Answer

Aortoiliac occlusion

Answer

Bilateral iliofemoral occlusion

Answer

Bilateral iliac artery occlusion

Answer

Bilateral femoropopliteal occlusion

Question 2

The normal ankle brachial pressure index (ABPI) is 1.0. A value of 0.8 suggests

Accepted Answer

some degree of arterial obstruction

Answer

impending gangrene

Answer

presence of collaterals

Answer

good flow

Question 3

Serum calcitonin may be elevated in

Accepted Answer

medullary carcinoma of thyroid

Answer

choriocarcinoma of ovary

Answer

islet cell tumour of pancreas

Answer

carcinoid tumour of appendix

Question 4

Priapism in a young male could occur because of

Accepted Answer

leukaemia

Answer

carcinoid tumour of appendix

Answer

testicular cancer

Answer

penile cancer

UPSC-CMS 2010 — Internal Medicine