UPSC-CMS 2023 - Internal Medicine Practice Questions

Q: Which of the following is not associated with Acute Food Poisoning?

Tenesmus. ***Tenesmus*** - **Tenesmus** is a symptom of **inflammatory bowel disease** or other **colonic inflammation**, characterized by the sensation of incomplete defecation [1]. - While it can be associated with some forms of infectious colitis, it is **not a typical or direct symptom of acute food poisoning**, which primarily manifests with acute onset of nausea, vomiting, diarrhea, and abdominal cramps [2], [3]. *High skin surface temperature* - **High skin surface temperature** (fever) is a common symptom of acute food poisoning, as the body fights off pathogens or toxins. - It is an indication of the **systemic inflammatory response** to the ingested contaminants. *Onset with vomiting* - **Vomiting** is one of the most prominent and often initial symptoms of acute food poisoning, especially with preformed toxins [2], [3]. - It is the body's rapid mechanism to **expel harmful substances** from the gastrointestinal tract. *Leucocytosis* - **Leucocytosis** (an increase in white blood cells) is a common finding in many infections, including bacterial food poisoning. - It indicates an **active immune response** to combat the invading pathogens or toxins.

Q: A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is :

Speckled leucoplakia. ***Speckled leucoplakia*** - This patient, a **tobacco chewer** and **bidi smoker**, has risk factors and presents with a "white buccal mucosa with a bright red velvety plaque" (known as **speckled leukoplakia**), which is a highly suspicious lesion for **oral squamous cell carcinoma (OSCC)**, especially with symptoms like diminished mouth opening and occasional spitting of blood. - **Speckled leukoplakia** combines features of both leukoplakia (white areas) and erythroplakia (red velvety areas), and is considered the **highest risk precancerous lesion** for malignant transformation. *Erythroplakia* - Characterized by a **bright red velvety patch** that is flat or slightly depressed. - While highly suspicious for malignancy (with a 90% chance of being dysplastic or malignant), the description also includes a "white buccal mucosa," indicating a mixed white and red lesion. *Oral candidiasis* - Presents as **white, curdy patches** that can be scraped off, often revealing an erythematous base, and is typically associated with immunosuppression or antibiotic use. - It does not usually present with a persistent **red velvety component** or symptoms of diminished mouth opening indicative of malignancy. *Leukoplakia* - Defined as a **white plaque** that cannot be rubbed off and cannot be characterized as any other diagnosable disease. - Only describes the white component, while the patient's lesion also has a significant **red, velvety component**, classifying it more accurately as speckled leukoplakia.

Q: Which of the following are correct regarding Trichobezoar ? 1. It is a hair ball in the stomach. 2. It is common in psychiatric patients. 3. Common complications are bleeding, perforation or obstruction. 4. Treated with long course of proton pump inhibitors. Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - A **trichobezoar** is indeed a mass of undigested hair found in the gastrointestinal tract, most commonly in the **stomach**. [1] - It is frequently associated with **psychiatric conditions** such as trichotillomania (compulsive hair pulling) and trichophagia (compulsive hair eating), leading to its occurrence predominantly in psychiatric patients. Common complications include **gastrointestinal bleeding**, **perforation**, and **obstruction** due to the size and abrasive nature of the hairball. [1] *2, 3 and 4* - While trichobezoars are common in psychiatric patients and can lead to bleeding, perforation, or obstruction, the treatment is typically **surgical removal** or **endoscopic fragmentation**, not long-term proton pump inhibitors (PPIs). - PPIs are used to reduce gastric acid, which is not the primary treatment for a physical obstruction like a trichobezoar. *1, 3 and 4* - Although a trichobezoar is a hairball in the stomach and can cause bleeding, perforation, or obstruction, the statement about treatment with a long course of **proton pump inhibitors (PPIs)** is incorrect. - PPIs would not resolve a physical mass like a trichobezoar, which usually requires removal. *1, 2 and 4* - While trichobezoars are stomach hairballs and are more prevalent in psychiatric patients, and long-term **proton pump inhibitors (PPIs)** are not a primary treatment for trichobezoars. - The correct management involves physical removal rather than acid suppression.

Q: Zollinger Ellison syndrome is characterized by which of the following ?

Non-beta islet cell tumour of pancreas. ***Non-beta islet cell tumour of pancreas*** - **Zollinger-Ellison syndrome (ZES)** is caused by a **gastrin-secreting tumor** (gastrinoma), which is a type of **non-beta islet cell tumor** of the pancreas or duodenum. - This gastrinoma leads to excessive gastric acid secretion [1]. *Recurrent ulceration despite treatment* - While **recurrent ulceration** is a prominent symptom of ZES due to hypersecretion of gastric acid, it is a *consequence* of the underlying disease rather than its defining characteristic or cause. - The persistence of ulcers despite standard anti-secretory therapy is a strong clinical indicator that points towards ZES [1]. *Recurrent episodes of dysentery* - **Dysentery** is characterized by bloody diarrhea, often caused by bacterial infections, and is not a typical or primary feature of Zollinger-Ellison syndrome. - While severe diarrhea can occur in ZES due to inactivation of pancreatic enzymes and damage to intestinal mucosa from excessive acid, it is not described as dysentery. *Fulminating gastric ulcers* - Gastric ulcers in ZES can be severe and numerous, but the term "fulminating" typically implies a rapid onset, severe, and aggressive course, often seen in conditions like *H. pylori*-associated ulcers with complications. - While ulcers in ZES are often refractory and severe, the defining characteristic of the syndrome is the gastrinoma itself, not merely the severity of ulcers.

Q: Which one of the following statements regarding Inflammatory Bowel Disease is correct ?

Perianal disease is common in Crohn's disease.. ***Perianal disease is common in Crohn's disease.*** [1] - **Crohn's disease** is characterized by **transmural inflammation** that involves all layers of the bowel wall, leading to complications like **fistulas, strictures, and perianal disease** [2]. - **Perianal disease** manifestations include **fissures, fistulas, abscesses**, and skin tags, and it is a defining characteristic of Crohn's [2]. *Stricture formation is common in Ulcerative Colitis.* - **Stricture formation** is generally **uncommon in uncomplicated ulcerative colitis** but can occur in severe, long-standing disease. - **Strictures** are more characteristic of **Crohn's disease** due to its transmural inflammation and fibrotic changes [3]. *Fistula formation is common in Ulcerative Colitis.* - **Fistula formation** is a hallmark of **Crohn's disease**, resulting from the deep, transmural inflammation that penetrates the bowel wall [2]. - **Ulcerative colitis** inflammation is typically **mucosal and superficial**, making fistula formation rare in this condition [1]. *Rectum is always involved in Crohn's disease.* - While **Crohn's disease** can affect any part of the gastrointestinal tract from mouth to anus, skip lesions are common, and the **rectum is often spared** [1]. - In contrast, **ulcerative colitis always involves the rectum**, extending proximally in a continuous fashion [1].

Q: Which one of the following is a cause of exudative ascites ?

Peritoneal malignancy. ***Peritoneal malignancy*** - **Malignant cells** can directly or indirectly increase capillary permeability and fluid production within the peritoneal cavity. - This leads to a **high protein content** in the ascitic fluid, characteristic of exudate [1]. *Nephrotic syndrome* - Causes **transudative ascites** due to severe **hypoalbuminemia**, leading to decreased plasma oncotic pressure [1]. - The liver is healthy, and there is no direct inflammation or increased capillary permeability in the peritoneum. *Portal vein thrombosis* - Results in **increased hydrostatic pressure** within the portal circulation, leading to the transudation of fluid into the peritoneal cavity. - The ascitic fluid typically has a **low protein content** as it's a transudate, not an exudate [1]. *Congestive cardiac failure* - Leads to **increased systemic venous pressure** and consequently elevated hepatic sinusoidal and splanchnic capillary pressures [1]. - This causes **transudative ascites** with low protein content due to passive fluid leakage rather than inflammation or direct vascular damage [1].

Q: Which of the following are seen in Normal pressure hydrocephalus ? 1. Hearing loss 2. Gait disturbance 3. Incontinence 4. Cognitive decline Select the correct answer using the code given below :

2, 3 and 4. ***2, 3 and 4*** - This option correctly identifies the **Hakim-Adams triad** of Normal pressure hydrocephalus: **gait disturbance**, **urinary incontinence**, and **cognitive decline**. - The classic mnemonic "**wet, wobbly, and wacky**" describes these three cardinal features - incontinence (wet), gait instability (wobbly), and cognitive impairment (wacky). *3 and 4 only* - This option only includes **incontinence** and **cognitive decline**, missing the crucial **gait disturbance** component of the triad. - **Gait apraxia** is often the earliest and most prominent feature of NPH, making this option incomplete. *1, 2 and 3* - **Hearing loss** is not a feature of Normal pressure hydrocephalus and is incorrectly included in this option. - While it correctly includes **gait disturbance** and **incontinence**, the presence of hearing loss makes this choice inaccurate. *1, 2 and 4* - **Hearing loss** is not associated with NPH and represents a major error in this option. - Though **gait disturbance** and **cognitive decline** are correct features, including hearing loss eliminates this as a valid choice.

Q: Which of the following are included in the classical clinical presentation of pericardial tamponade ?

Muffled heart sounds. ***Muffled heart sounds*** - Pericardial tamponade involves an accumulation of fluid in the **pericardial sac**, which dampens sound transmission and results in **muffled heart sounds** [1]. - This is a key component of **Beck's triad**, indicating compromised cardiac filling. *Collapsed neck veins* - In pericardial tamponade, there is a significant increase in **intrapericardial pressure**, which impedes venous return to the heart [1]. - This typically leads to **distended neck veins** (elevated jugular venous pressure), not collapsed ones. *Tachycardia* - While **tachycardia** can be present as a compensatory mechanism due to reduced cardiac output in tamponade, it is a non-specific finding. - It is not considered part of the **classical Beck's triad**, which specifically focuses on the triad of muffled heart sounds, hypotension, and elevated jugular venous pressure. ***Decreased arterial pressure*** - The increased intrapericardial pressure in tamponade severely restricts **ventricular filling**, leading to a reduction in stroke volume and subsequently **decreased cardiac output** [1], [2]. - This reduction in cardiac output manifests as systemic **hypotension** (decreased arterial pressure), which is a critical finding in tamponade.

Q: Which of the following are blood values of Iron Deficiency Anaemia ? 1. Serum iron is less than 30 mg/100 mL 2. Total iron binding capacity is less than 400 µg/mL 3. Percentage saturation is 10% or less 4. Serum ferritin is below 30 µg/mL Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - In **iron deficiency anemia**, **serum iron** levels are typically **less than 30 µg/dL** [1] (or 30 mg/100 mL), indicating a reduced iron supply. - The **percentage saturation** of transferrin with iron falls to **10% or less** [1] because there is insufficient iron to bind to the available transferrin. - **Serum ferritin**, which reflects iron stores, is significantly **reduced, usually below 30 ng/mL** (or 30 µg/mL) [1]. *1, 2 and 4* - While options 1 and 4 are correct, option 2 stating **total iron binding capacity (TIBC) less than 400 µg/mL** is incorrect. - In iron deficiency, the body attempts to increase iron absorption by producing more transferrin, leading to an **elevated TIBC** [1] (often >400 µg/dL). *1, 2 and 3* - Although options 1 and 3 are correct for iron deficiency anemia, option 2, which states **TIBC is less than 400 µg/mL**, is false. - **TIBC is elevated** in iron deficiency, reflecting an increased capacity for iron binding due to increased transferrin. *2, 3 and 4* - While options 3 and 4 are correct, option 2, suggesting **TIBC is less than 400 µg/mL**, is inaccurate. - **TIBC** is typically **increased** in iron deficiency anemia as the body tries to maximize any available iron.

Q: Which of the following statements are correct regarding Mantoux test for tuberculosis? 1. It entails injecting 1 TU (Tuberculin Unit) of PPD (Purified Protein Derivative) in 0.1 mL intradermally. 2. The injection should be given with the needle bevel facing downward. 3. When placed correctly, the injection should produce a pale wheal of the skin, 1 - 2 mm in diameter. 4. The injection should be given with a tuberculin syringe. Select the correct answer using the code given below:

1 and 4. **1 and 4** - Statement 1 is correct: The Mantoux test involves injecting **1 TU (Tuberculin Unit) of PPD (Purified Protein Derivative)** in **0.1 mL intradermally** into the forearm, which is the standard dose and administration route. - Statement 4 is correct: A **tuberculin syringe** is specifically designed for small, precise volume injections like the Mantoux test, ensuring accurate dosing and placement. *1 and 2* - Statement 1 is correct, but statement 2 is incorrect regarding the **Mantoux test procedure**. - The needle bevel should face **upward** during intradermal injection to ensure proper placement of the PPD and formation of the wheal. *2 and 3* - Statement 2 is incorrect because the needle bevel should face **upward** for intradermal injection. - Statement 3 is incorrect because a correctly placed Mantoux injection should produce a wheal of **6-10 mm in diameter**, not 1-2 mm, indicating the PPD is in the dermis. *2 and 4* - Statement 2 is incorrect as the needle bevel should be positioned **facing upward**. - While statement 4 correctly identifies the use of a tuberculin syringe, the incorrectness of statement 2 makes this option unsuitable.

Question 1

Which of the following is not associated with Acute Food Poisoning?

Accepted Answer

Tenesmus

Answer

High skin surface temperature

Answer

Onset with vomiting

Answer

Leucocytosis

Question 2

A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is :

Accepted Answer

Speckled leucoplakia

Answer

Erythroplakia

Answer

Oral candidiasis

Answer

Leukoplakia

Question 3

Which of the following are correct regarding Trichobezoar ?

1. It is a hair ball in the stomach.

2. It is common in psychiatric patients.

3. Common complications are bleeding, perforation or obstruction.

4. Treated with long course of proton pump inhibitors.

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Question 4

Zollinger Ellison syndrome is characterized by which of the following ?

Accepted Answer

Non-beta islet cell tumour of pancreas

Answer

Recurrent ulceration despite treatment

Answer

Recurrent episodes of dysentery

Answer

Fulminating gastric ulcers

Question 5

Which one of the following statements regarding Inflammatory Bowel Disease is correct ?

Accepted Answer

Perianal disease is common in Crohn's disease.

Answer

Stricture formation is common in Ulcerative Colitis.

Answer

Fistula formation is common in Ulcerative Colitis.

Answer

Rectum is always involved in Crohn's disease.

Question 6

Which one of the following is a cause of exudative ascites ?

Accepted Answer

Peritoneal malignancy

Answer

Nephrotic syndrome

Answer

Portal vein thrombosis

Answer

Congestive cardiac failure

Question 7

Which of the following are seen in Normal pressure hydrocephalus ?

1. Hearing loss
2. Gait disturbance
3. Incontinence
4. Cognitive decline

Select the correct answer using the code given below :

Accepted Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

3 and 4 only

Question 8

Which of the following are included in the classical clinical presentation of pericardial tamponade ?

Accepted Answer

Muffled heart sounds

Answer

Collapsed neck veins

Answer

Tachycardia

Question 9

Which of the following are blood values of Iron Deficiency Anaemia ?

1. Serum iron is less than 30 mg/100 mL
2. Total iron binding capacity is less than 400 µg/mL
3. Percentage saturation is 10% or less
4. Serum ferritin is below 30 µg/mL

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 10

Which of the following statements are correct regarding Mantoux test for tuberculosis?

1. It entails injecting 1 TU (Tuberculin Unit) of PPD (Purified Protein Derivative) in 0.1 mL intradermally.
2. The injection should be given with the needle bevel facing downward.
3. When placed correctly, the injection should produce a pale wheal of the skin, 1 - 2 mm in diameter.
4. The injection should be given with a tuberculin syringe.

Select the correct answer using the code given below:

Accepted Answer

1 and 4

Answer

1 and 2

Answer

2 and 3

Answer

2 and 4

UPSC-CMS 2023 — Internal Medicine