UPSC-CMS 2020 - Internal Medicine PYQs Practice Questions

Q: Consider the following statements regarding claudication: 1. It is a marker for silent coronary disease 2. Structured exercise program ( 2 hours per week for 3 months) leads to improvement in symptoms 3. Diabetes mellitus increases the risk and severity of claudication 4. Beta blockers may exacerbate claudication Which of the above statements are correct?

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All four statements are correct regarding **claudication**, a symptom of **peripheral arterial disease (PAD)**, where reduced blood flow to the limbs causes pain during exercise [1]. - **Claudication** is a significant marker for systemic **atherosclerosis** and **coronary artery disease**, increasing the risk of cardiovascular events, and **structured exercise programs** are a cornerstone of treatment [1]. *1, 3 and 4 only* - This option is incorrect because it omits statement 2. **Structured exercise programs** are unequivocally beneficial in improving claudication symptoms and functional capacity. - Omitting the beneficial effect of exercise contradicts current clinical guidelines for managing **PAD**. *1 and 2 only* - This option is incorrect as it fails to include statements 3 and 4. **Diabetes mellitus** is a major risk factor that significantly worsens PAD and claudication, while **beta-blockers** can indeed exacerbate symptoms in some patients due to their vasoconstrictive effects. - Ignoring the impact of **diabetes** and the potential adverse effects of **beta-blockers** provides an incomplete understanding of claudication management. *2, 3 and 4 only* - This option is incorrect because it excludes statement 1. **Claudication** is a strong indicator of widespread **atherosclerosis** and thus a marker for **silent coronary disease**, warranting investigation for broader cardiovascular risk [1]. - Failing to recognize claudication as a marker for **coronary disease** overlooks a critical aspect of its clinical significance and patient management. [Practice more Internal Medicine PYQs on OnCourse]

Q: Medical management of thyrotoxic crisis includes all of the following EXCEPT:

IV antibiotics. ***IV antibiotics*** - **Antibiotics** are not a primary treatment for **thyrotoxic crisis** itself unless there's an underlying infection triggering the crisis, which is not indicated as a universal management step [1]. - The crisis is caused by an acute exacerbation of **hyperthyroidism**, not bacterial infection, so antibiotics would not address the core pathophysiology. *IV propanolol* - **Propranolol** (or other beta-blockers) helps control the adrenergic symptoms of thyrotoxic crisis, such as **tachycardia**, **tremors**, and **anxiety** [1]. - It also inhibits the peripheral conversion of **T4 to T3**, providing an additional therapeutic effect. *IV hydrocortisone* - **Glucocorticoids** like **hydrocortisone** are crucial in thyrotoxic crisis to inhibit the peripheral conversion of **T4 to T3**, stabilize cell membranes, and provide adrenal support. - They also help manage potential adrenal insufficiency, which can be an exacerbating factor or complication. *IV fluids* - **Intravenous fluids** are essential for correcting **dehydration**, which is often present due to increased metabolic rate, fever, sweating, and vomiting in patients with thyrotoxic crisis [1]. - They also help address **electrolyte imbalances** and support cardiovascular stability. [Practice more Internal Medicine PYQs on OnCourse]

Q: First line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:

Anastrazole. ***Anastrazole*** - **Aromatase inhibitors** like anastrozole are the preferred first-line hormone therapy for **post-menopausal women** with **hormone-receptor-positive metastatic breast cancer**. - They work by **blocking the aromatase enzyme**, which is responsible for estrogen production in peripheral tissues in post-menopausal women. *Ovarian suppression by surgery* - Ovarian suppression is primarily used in **pre-menopausal women** to reduce estrogen production by the ovaries. - Since the patient is **post-menopausal**, her ovaries are no longer the primary source of estrogen production. *Antiprogestins* - **Antiprogestins** are not standard first-line hormone therapy for metastatic breast cancer. - While some progestational agents have been used in breast cancer treatment, **antiprogestins** are not established as a primary treatment. *Tamoxifen* - **Tamoxifen** is a **selective estrogen receptor modulator (SERM)** that has been widely used in breast cancer treatment. - While effective, **aromatase inhibitors** are generally preferred over tamoxifen as first-line therapy for **post-menopausal metastatic breast cancer** due to superior efficacy and tolerability profiles in this demographic. [Practice more Internal Medicine PYQs on OnCourse]

Q: The Child-Turcotte-Pugh (CTP) score for quantifying the severity of chronic liver disease includes all variables EXCEPT:

Serum creatinine. ***Body Mass Index (BMI)*** - The Child-Turcotte-Pugh (CTP) score is an established clinical tool for assessing prognosis in **chronic liver disease**, and it does not include **Body Mass Index (BMI)** as one of its parameters. - The CTP score focuses on liver function and complications of portal hypertension, which are reflected by specific laboratory values and clinical signs, not nutritional status as measured by BMI [1]. *International Normalized Ratio (INR)* - **INR** is a crucial component of the Child-Turcotte-Pugh (CTP) score, as it reflects the liver's synthetic function, specifically its ability to produce clotting factors [1]. - An elevated INR indicates **impaired liver synthetic function** and contributes to a higher CTP score, signifying more severe liver disease. *Serum bilirubin* - **Serum bilirubin** is a key laboratory parameter included in the Child-Turcotte-Pugh (CTP) score [1]. - Elevated bilirubin levels indicate **impaired liver excretory function** and hepatocellular damage, directly correlating with the severity of liver disease. *Serum albumin* - **Serum albumin** is a vital component of the Child-Turcotte-Pugh (CTP) score, reflecting the liver's synthetic capacity [1]. - Low serum albumin levels indicate **reduced liver synthesis**, often seen in advanced liver disease, and contribute to a higher CTP score [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which one of the following statements is NOT correct regarding Pyogenic Liver Abscess?

Treatment is with oral antibiotics alone. ***Treatment is with oral antibiotics alone*** - This statement is incorrect because pyogenic liver abscesses typically require **drainage** (percutaneous or surgical) in addition to **intravenous antibiotics** initially. Oral antibiotics alone are generally insufficient for definitive treatment. - The goal is to eradicate the infection, which often involves both source control (drainage) and systemic antimicrobial therapy. *It is more common in elderly, diabetics and immunocompromised patients* - This statement is correct. Factors such as **age**, **diabetes mellitus**, and **immunocompromised states** weaken the immune response, making individuals more susceptible to developing pyogenic liver abscesses [1]. - These conditions can impair the body's ability to clear bacteria effectively, increasing the risk of infection and abscess formation. *Streptococcus milleri and escherichia coli are the most common causative organisms* - This statement is correct. **_Streptococcus milleri_ (now _Streptococcus anginosus_)** is frequently implicated due to its ability to form abscesses, while **_Escherichia coli_** is common because many liver abscesses arise from biliary or enteric sources. - Other common pathogens include other **Gram-negative bacilli** and **anaerobes**, reflecting the varied etiologies. *Anorexia, fever, malaise and right upper quadrant abdominal discomfort are the most common presenting features* - This statement is correct. These are classic symptoms of liver abscess, reflecting the inflammatory process and the location of the infection [1]. - **Fever** and **right upper quadrant pain** are particularly prominent and should raise suspicion for a liver abscess [1]. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Consider the following statements regarding claudication:

1. It is a marker for silent coronary disease
2. Structured exercise program ( 2 hours per week for 3 months) leads to improvement in symptoms
3. Diabetes mellitus increases the risk and severity of claudication
4. Beta blockers may exacerbate claudication

Which of the above statements are correct?

Accepted Answer

1, 2, 3 and 4

Answer

1, 3 and 4 only

Answer

1 and 2 only

Answer

2, 3 and 4 only

Question 2

Medical management of thyrotoxic crisis includes all of the following EXCEPT:

Accepted Answer

IV antibiotics

Answer

IV propanolol

Answer

IV hydrocortisone

Answer

IV fluids

Question 3

First line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:

Accepted Answer

Anastrazole

Answer

Ovarian suppression by surgery

Answer

Antiprogestins

Answer

Tamoxifen

Question 4

The Child-Turcotte-Pugh (CTP) score for quantifying the severity of chronic liver disease includes all variables EXCEPT:

Accepted Answer

Serum creatinine

Answer

INR (International Normalised Ratio)

Answer

Serum bilirubin

Answer

Serum albumin

Question 5

Which one of the following statements is NOT correct regarding Pyogenic Liver Abscess?

Accepted Answer

Treatment is with oral antibiotics alone

Answer

It is more common in elderly, diabetics and immunocompromised patients

Answer

Streptococcus milleri and escherichia coli are the most common causative organisms

Answer

Anorexia, fever, malaise and right upper quadrant abdominal discomfort are the most common presenting features

Question 6

Which of the following are correct regarding splenic artery aneurysm?

1. Main arterial trunk is the common site
2. Palpable thrill can be felt
3. It is symptomless unless it ruptures

Select the correct answer using the code given below:

Accepted Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 2 and 3

Question 7

Spontaneous bacterial peritonitis occurs due to:

Accepted Answer

acute bacterial infection of ascites

Answer

duodenal stump blowout

Answer

infection via fallopian tubes

Answer

peptic ulcer perforation

Question 8

Which one of the following is NOT correct regarding MEN-1 syndrome?

Accepted Answer

It involves pineal gland

Answer

It involves pancreas

Answer

It involves pituitary gland

Answer

It involves parathyroid glands

Question 9

Which one of the following is NOT an electronic information site in surgery?

Accepted Answer

Surgical textbook

Answer

Embase

Answer

Cochrane library

Answer

Pubmed

Question 10

DASH diet plan is advocated in the control of which one of the following diseases?

Accepted Answer

Hypertension

Answer

Rheumatic heart disease

Answer

Cancer

Answer

Chronic Obstructive Pulmonary Disease

UPSC-CMS 2020 — Internal Medicine