UPSC-CMS 2012 - Internal Medicine PYQs Practice Questions

Q: The commonest cause of primary hyper-parathyroidism is

Parathyroid adenoma. ***Parathyroid adenoma*** - **Parathyroid adenomas** account for approximately **85% of all cases** of primary hyperparathyroidism. [1] - This condition involves a **benign tumor** of one or more parathyroid glands that secretes excessive parathyroid hormone (PTH), leading to hypercalcemia. [1] *Idiopathic parathyroid hyperplasia* - **Idiopathic parathyroid hyperplasia** is responsible for about **10-15% of cases** of primary hyperparathyroidism, making it less common than adenomas. - In hyperplasia, **all four parathyroid glands** are typically enlarged and overactive, unlike the localized growth in an adenoma. *Familial hyperparathyroidism* - **Familial hyperparathyroidism** is a rare cause, accounting for **less than 1% of cases**, and is often associated with genetic syndromes like **MEN1** or **MEN2A**. - It involves inherited genetic mutations that predispose individuals to parathyroid gland overactivity, which distinguishes it from sporadic causes. *Primary parathyroid carcinoma* - **Primary parathyroid carcinoma** is an **extremely rare malignancy**, accounting for **less than 1%** of all primary hyperparathyroidism cases. - While it causes severe hypercalcemia, its rarity means it is not the commonest cause. [Practice more Internal Medicine PYQs on OnCourse]

Q: A recently married woman presents with dysuria and increased urinary frequency of two-days duration. On physical examination, her body temperature is 38°C and her vital signs are normal. Her gynaecologic examination does not reveal any vaginal discharge, vaginitis or cervicitis. Her urine analysis reveals 14 WBC per high power field and many gram negative rods. Which of the following is the most appropriate pharmacotherapy ?

Nitrofurantoin. ***Nitrofurantoin*** - **Nitrofurantoin** is a first-line agent for **uncomplicated cystitis** due to its good efficacy, low resistance rates, and minimal systemic side effects. - Its concentration in the urine is high, making it effective against common urinary pathogens like **Gram-negative rods**. - **Note:** The patient has a temperature of 38°C, which is borderline. Current guidelines suggest that **fever may indicate upper tract involvement** (pyelonephritis), where nitrofurantoin would be less appropriate due to poor tissue penetration. However, with **normal vital signs** and localized symptoms, this may represent uncomplicated cystitis with mild pyrexia. *Ciprofloxacin* - **Fluoroquinolones** like ciprofloxacin are highly effective and achieve excellent tissue penetration, making them ideal for **complicated UTIs or pyelonephritis**. - The presence of **fever (38°C)** could justify fluoroquinolone use, as it may indicate upper tract involvement. - However, fluoroquinolones are increasingly reserved for complicated cases due to concerns about promoting **antibiotic resistance** and potential side effects (e.g., tendon rupture, C. difficile). - **Current IDSA guidelines** recommend fluoroquinolones when pyelonephritis is suspected. *Trimethoprim-sulfamethoxazole* - While effective for UTIs, **trimethoprim-sulfamethoxazole** resistance rates have increased significantly, particularly among *E. coli* strains. - It can be used for uncomplicated cystitis when local resistance rates are <20%, but is less preferred than nitrofurantoin in many settings. *Amoxicillin* - **Amoxicillin** is not recommended as first-line treatment for acute cystitis due to high rates of **bacterial resistance**, particularly from common uropathogens like *E. coli*. - Its efficacy against **Gram-negative rods** is limited, especially with prevalent beta-lactamase production. [Practice more Internal Medicine PYQs on OnCourse]

Q: The most common opportunistic infection observed in patients with AIDS is

Pneumocystis carinii. ***Pneumocystis carinii*** - **Pneumocystis pneumonia (PCP)**, caused by *Pneumocystis jirovecii* (formerly *P. carinii*), is the **most common opportunistic infection** and a leading cause of death in AIDS patients [1]. - It typically presents with **fever, cough, and dyspnea** in patients with a CD4 count below 200 cells/µL [1]. *Pseudomonas aeruginosa* - While *Pseudomonas aeruginosa* can cause serious infections in immunocompromised individuals, it is not the **most common opportunistic infection** seen in patients with AIDS. - Infections usually involve the **lungs (pneumonia)**, skin, urinary tract, or bacteremia, often in patients with **neutropenia** or hospitalized for other reasons. *Atypical mycobacteria* - **Mycobacterium avium complex (MAC)** is an important opportunistic pathogen in AIDS patients (CD4 < 50 cells/µL), causing disseminated disease, but it is not the **most common** overall [2]. - Symptoms include **fever, weight loss, night sweats, and diarrhea**, and diagnosis requires blood cultures or tissue biopsy [2]. *Haemophilus influenzae* - *Haemophilus influenzae* can cause **respiratory tract infections** (e.g., sinusitis, bronchitis, pneumonia) and invasive disease, particularly in children and individuals with underlying lung disease. - While patients with HIV may be more susceptible to bacterial infections, *H. influenzae* is **not classified as a classic opportunistic infection** in the same way as *Pneumocystis* or MAC in AIDS patients. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following conditions may produce "wrist drop" ?

Lead poisoning. ***Lead poisoning*** - **Lead neuropathy** predominantly affects motor nerves, often leading to **wrist drop** and **foot drop** due to involvement of the radial and peroneal nerves, respectively [1]. - The toxic effects of lead interfere with heme synthesis and neuronal function, leading to **demyelination** and axonal degeneration [1]. *Alcoholics* - **Alcoholic neuropathy** typically affects peripheral nerves, causing sensory and motor deficits, often as a **stocking-glove distribution** [3]. - While it can manifest as weakness, classic "wrist drop" is not a hallmark feature; rather, it often involves generalized weakness and sensory loss. *Beriberi* - **Beriberi** is caused by **thiamine (vitamin B1) deficiency** and presents in two main forms: wet (cardiovascular) and dry (neurological). - Dry beriberi causes **peripheral neuropathy** with symmetrical motor and sensory impairment, but **wrist drop** is not a characteristic isolated sign. *Diabetes mellitus* - **Diabetic neuropathy** commonly leads to a **stocking-glove sensory loss** and - Can cause motor weakness, but isolated **wrist drop** [2] is not a typical presentation; rather, it's often polyneuropathy or mononeuropathy multiplex [3]. [Practice more Internal Medicine PYQs on OnCourse]

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

A→3 B→1 C→2 D→4. ***A→3 B→1 C→2 D→4*** - This option correctly matches each pneumoconiosis with its associated occupation. - **Anthracosis** is linked to coal mining, **Byssinosis** to the textile industry, **Bagassosis** to the paper industry, and **Silicosis** to building and construction work. *A→3 B→2 C→1 D→4* - This option incorrectly matches **Byssinosis** with building and construction work and **Bagassosis** with the textile industry. - Byssinosis is caused by cotton dust in the textile industry, and Bagassosis is caused by bagasse dust, commonly from the sugar cane or paper industry. *A→1 B→4 C→2 D→3* - This option contains multiple incorrect matches, including linking Anthracosis to the textile industry and Silicosis to coal mining. - Anthracosis is specifically tied to **coal dust exposure**, and Silicosis results from **silica dust inhalation**. *A→4 B→2 C→1 D→3* - This option is incorrect because it mismatches Anthracosis with the paper industry and Bagassosis with the textile industry, among others. - Each pneumoconiosis has a distinct occupational exposure source. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

The commonest cause of primary hyper-parathyroidism is

Accepted Answer

Parathyroid adenoma

Answer

Idiopathic parathyroid hyperplasia

Answer

Familial hyperparathyroidism

Answer

Primary parathyroid carcinoma

Question 2

A recently married woman presents with dysuria and increased urinary frequency of two-days duration. On physical examination, her body temperature is 38°C and her vital signs are normal. Her gynaecologic examination does not reveal any vaginal discharge, vaginitis or cervicitis. Her urine analysis reveals 14 WBC per high power field and many gram negative rods. Which of the following is the most appropriate pharmacotherapy ?

Accepted Answer

Nitrofurantoin

Answer

Trimethoprim-sulfamethoxazole

Answer

Amoxicillin

Answer

Ciprofloxacin

Question 3

The most common opportunistic infection observed in patients with AIDS is

Accepted Answer

Pneumocystis carinii

Answer

Pseudomonas aeruginosa

Answer

Atypical mycobacteria

Answer

Haemophilus influenzae

Question 4

Which of the following conditions may produce "wrist drop" ?

Accepted Answer

Lead poisoning

Answer

Alcoholics

Answer

Beriberi

Answer

Diabetes mellitus

Question 5

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

Accepted Answer

A→3  B→1  C→2  D→4

Answer

A→3  B→2  C→1  D→4

Answer

A→1  B→4  C→2  D→3

Answer

A→4  B→2  C→1  D→3

UPSC-CMS 2012 — Internal Medicine