UPSC-CMS 2022 - Internal Medicine Practice Questions

Q: Which of the following are correct about Felty's syndrome? 1. It is associated with rheumatoid arthritis. 2. It may present with leukopenia. 3. It may have splenomegaly. 4. Splenectomy always improves the blood picture.

1, 2 and 3. ***1, 2 and 3*** - Felty's syndrome is a severe variant of **rheumatoid arthritis** characterized by the triad of **rheumatoid arthritis**, **splenomegaly**, and **neutropenia** (a type of leukopenia) [1]. - While splenectomy can be considered for persistent severe neutropenia, it does not **always improve the blood picture** and is reserved for cases unresponsive to other treatments. *1, 2 and 4* - This option correctly identifies the association with **rheumatoid arthritis** and **leukopenia** but incorrectly states that splenectomy **always improves the blood picture**. - Splenectomy is not a guarantee of improvement and is considered a last resort. *1, 3 and 4* - This option correctly identifies the association with **rheumatoid arthritis** and **splenomegaly** but incorrectly concludes that splenectomy **always improves the blood picture**, and misses the characteristic **leukopenia**. - Leukopenia, specifically neutropenia, is a defining feature of Felty's syndrome [1]. *2, 3 and 4* - This option incorrectly states that Felty's syndrome is always associated with leukopenia and splenomegaly, but the crucial missing element is its clear association with **rheumatoid arthritis**. - The primary underlying condition for Felty's syndrome is **long-standing, severe rheumatoid arthritis** [1].

Q: Heavy menstrual bleeding is a common presentation in which of the following? 1. Clotting factor deficiency 2. Fibroid uterus 3. Adenomyosis 4. Prolactinoma.

1, 2 and 3. ***1, 2 and 3*** - **Clotting factor deficiencies** (e.g., von Willebrand disease, factor XI deficiency) impair normal hemostasis, leading to prolonged and heavy menstrual bleeding. - **Fibroid uterus** causes heavy menstrual bleeding due to increased endometrial surface area, impaired uterine contractility, and dilated underlying vessels. - **Adenomyosis**, characterized by endometrial tissue within the myometrium, leads to an enlarged, boggy uterus and causes heavy and painful menstruation. *2, 3 and 4* - This option correctly identifies fibroid uterus and adenomyosis, which are common causes of heavy menstrual bleeding. - However, **prolactinoma** typically causes **amenorrhea** or oligomenorrhea, not heavy menstrual bleeding, due to its inhibitory effect on gonadotropin-releasing hormone (GnRH). *1, 2 and 4* - While clotting factor deficiency and fibroid uterus are valid causes of heavy menstrual bleeding, **prolactinoma** is an incorrect inclusion. - Prolactinoma often leads to **hypogonadism** and anovulation, resulting in irregular or absent menstrual periods. *1, 3 and 4* - This option includes clotting factor deficiency and adenomyosis, which are causes of heavy menstrual bleeding. - However, **prolactinoma** is not associated with heavy menstrual bleeding; instead, it is known to cause **menstrual irregularities** including amenorrhea.

Q: Which of the following are the clinical features of hyperprolactinemia? 1. Hypergonadotropic hypogonadism 2. Hypogonadotropic hypergonadism 3. Oligomenorrhea 4. Heavy menstruation

3. Oligomenorrhea. ***Oligomenorrhea*** - **Oligomenorrhea** (infrequent or light menstruation) is a common symptom of **hyperprolactinemia** due to prolactin's inhibitory effect on **GnRH** and, consequently, **gonadotropin** release [1], [2]. - The resulting **estrogen deficiency** can lead to menstrual irregularities, including anovulation and delayed periods [3]. *Hypogonadotropic hypergonadism* - This condition involves **low gonadotropins** (LH, FSH) despite **high sex hormones**, which is not characteristic of **hyperprolactinemia**. - **Hyperprolactinemia** typically causes **hypogonadotropic hypogonadism** by suppressing pituitary gonadotropin release [2]. *Hypergonadotropic hypogonadism* - This is characterized by **high gonadotropins** (LH, FSH) and **low sex hormones**, indicating primary gonadal failure. - **Hyperprolactinemia** causes **low gonadotropins** by inhibiting **GnRH** pulsatility, leading to secondary gonadal dysfunction [1]. *Heavy menstruation* - **Heavy menstruation (menorrhagia)** is generally not associated with **hyperprolactinemia**; rather, **oligomenorrhea** or **amenorrhea** are typical due to **estrogen deficiency** [3]. - **Estrogen deficiency** results in an underdeveloped uterine lining, which is less likely to cause heavy bleeding.

Q: Which of the following is NOT a complication of malaria in pregnancy?

Metabolic alkalosis. ***Metabolic alkalosis*** - **Metabolic alkalosis** is not typically associated with malaria in pregnancy. - Malaria complications usually lead to conditions like **metabolic acidosis** due to lactate production or kidney dysfunction. *Disseminated intravascular coagulation* - **Disseminated intravascular coagulation (DIC)** is a severe complication of malaria, particularly **severe P. falciparum infection**, leading to widespread clot formation and bleeding. - It occurs due to systemic inflammation and endothelial damage caused by malarial parasites. *Hypoglycemia* - **Hypoglycemia** is a common and serious complication of malaria in pregnancy, especially with **P. falciparum infection**. - It results from increased glucose consumption by parasites, impaired gluconeogenesis, and quinine treatment. *Thrombocytopenia* - **Thrombocytopenia** (low platelet count) is a very common complication in both pregnant and non-pregnant patients with malaria. - It is caused by platelet destruction, splenic sequestration, and bone marrow suppression.

Q: Which of the following statements are correct in respect of haemophilia? 1. It is hereditary bleeding disorder. 2. It has a higher incidence among Asians. 3. It affects females occasionally and mildly.

1 and 3 only. ***1 and 3 only*** - Haemophilia is a well-known **hereditary bleeding disorder**, primarily affecting males, caused by a deficiency in certain clotting factors [1]. - While haemophilia mainly affects males, females can be carriers and, in rare instances, experience mild to moderate symptoms, especially due to **extreme X-inactivation**. *2 and 3 only* - The statement that it has a higher incidence among Asians is **incorrect**; haemophilia incidence is generally consistent across ethnic groups, approximately 1 in 5,000 live male births worldwide [2]. - While females can be affected, their involvement is typically mild and occasional, making statement 3 correct. *1 and 2 only* - Haemophilia is indeed a **hereditary bleeding disorder** (statement 1 is correct) [1]. - However, the claim of higher incidence among Asians is **unsupported** by epidemiological data, rendering statement 2 incorrect. *1, 2 and 3* - While haemophilia is a **hereditary bleeding disorder** and can affect females, the assertion of a higher incidence among Asians is **false** [2]. - Its global incidence rates do not show a significant racial or ethnic predilection.

Q: Which one of the following is the commonest extra-salivary gland manifestation of mumps in adults?

Orchitis. **Orchitis** - **Orchitis**, the inflammation of the testes, is the most common extra-salivary gland manifestation of mumps in **post-pubertal males** and can lead to **testicular atrophy** and infertility. - The incidence of orchitis in adult males with mumps can be as high as 30–50%. *Pancreatitis* - While mumps can cause **pancreatitis**, it is less common than orchitis, occurring in only about 2-5% of cases [1]. - Mumps-induced pancreatitis is usually mild and self-limiting [1]. *Polyarthritis* - **Polyarthritis** is a rare complication of mumps, typically resolving without long-term sequelae. - It is much less frequently observed compared to orchitis, especially in adults. *Hydrocephalus* - **Hydrocephalus** is an extremely rare and severe complication of mumps, often associated with mumps **meningoencephalitis**. - This complication involves an abnormal accumulation of cerebrospinal fluid, which is highly uncommon following mumps infection.

Question 1

Which of the following are correct about Felty's syndrome?

1. It is associated with rheumatoid arthritis.
2. It may present with leukopenia.
3. It may have splenomegaly.
4. Splenectomy always improves the blood picture.

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 2

Heavy menstrual bleeding is a common presentation in which of the following?

1. Clotting factor deficiency
2. Fibroid uterus
3. Adenomyosis
4. Prolactinoma.

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 3

Which of the following are the clinical features of hyperprolactinemia?

1. Hypergonadotropic hypogonadism
2. Hypogonadotropic hypergonadism
3. Oligomenorrhea
4. Heavy menstruation

Accepted Answer

3. Oligomenorrhea

Answer

2. Hypogonadotropic hypergonadism

Answer

1. Hypergonadotropic hypogonadism

Answer

4. Heavy menstruation

Question 4

Which of the following is NOT a complication of malaria in pregnancy?

Accepted Answer

Metabolic alkalosis

Answer

Disseminated intravascular coagulation

Answer

Hypoglycemia

Answer

Thrombocytopenia

Question 5

Which of the following statements are correct in respect of haemophilia?

1. It is hereditary bleeding disorder.
2. It has a higher incidence among Asians.
3. It affects females occasionally and mildly.

Accepted Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 2 and 3

Question 6

Which one of the following is the commonest extra-salivary gland manifestation of mumps in adults?

Accepted Answer

Orchitis

Answer

Pancreatitis

Answer

Polyarthritis

Answer

Hydrocephalus

UPSC-CMS 2022 — Internal Medicine