UPSC-CMS 2014 - Internal Medicine PYQs Practice Questions

Q: Consider the following statements: The clinical features of tension pneumothorax include 1. tracheal shift to contralateral side 2. absent breath sounds on the affected side 3. low output circulatory failure 4. peripheral cyanosis Which of the statements given above is/are correct?

1, 2 and 3. ***1, 2 and 3*** - **Tracheal deviation to the contralateral side** is a hallmark sign of tension pneumothorax [1], caused by the increasing pressure in the affected hemithorax pushing mediastinal structures away. - **Absent breath sounds on the affected side** result from the complete collapse of the lung and inability of air to enter the pleural space with inspiration [1]. **Low output circulatory failure** occurs due to increased intrathoracic pressure compressing the heart and great vessels, impairing venous return and cardiac output [2]. *1 and 3 only* - While **tracheal shift to the contralateral side** and **low output circulatory failure** [2] are indeed features, this option incorrectly excludes **absent breath sounds on the affected side**, which is a critical clinical finding in tension pneumothorax. - The absence of breath sounds directly reflects the collapsed lung, a primary mechanical consequence of the condition. *2 and 4* - **Absent breath sounds on the affected side** is correct, but **peripheral cyanosis** is not a *primary* or *early* distinguishing feature of tension pneumothorax. While hypoxemia can lead to cyanosis, it's often a late and less specific sign. - This option misses the crucial finding of **tracheal deviation** and the systemic impact of **circulatory failure** [2], which are more direct indicators of the severity and mechanism of tension pneumothorax. *1 and 4* - **Tracheal shift to the contralateral side** is a correct feature. However, **peripheral cyanosis** is a less specific and often later sign compared to the direct mechanical and circulatory effects. - This option incorrectly omits **absent breath sounds on the affected side** and **low output circulatory failure**, both of which are more consistently present and diagnostically important in tension pneumothorax. [Practice more Internal Medicine PYQs on OnCourse]

Q: Tuberculosis in HIV positive individuals is characterized by which of the following? 1. More frequent negative sputum smears. 2. More false–negative tuberculin test results. 3. More extra–pulmonary tuberculosis. 4. More cavitating lesions in lungs as shown by chest X-ray. Select the correct answer using the code given below:

1, 2 and 3 only. ***1, 2, and 3 only*** - HIV coinfection impairs cell-mediated immunity, leading to **atypical presentations** of TB [1]. All three options (more frequent negative sputum smears, more false-negative tuberculin tests, and more extrapulmonary TB) are characteristic of TB in HIV-positive individuals due to this **immunodeficiency** [2]. - The immunocompromised state often results in a **diminished inflammatory response**, making diagnosis more challenging and dissemination more likely. *1, 2, 3 and 4* - This option incorrectly includes "more cavitating lesions in lungs as shown by chest X-ray" as a characteristic feature. HIV-positive individuals, particularly those with advanced immunodeficiency, tend to have **fewer cavitating lesions** because their immune system is less capable of mounting the robust inflammatory response required for cavitation [1]. - Cavitation is more typical of **immunocompetent** individuals with pulmonary TB [1]. *3 and 4 only* - This option is incorrect because, while **more extrapulmonary tuberculosis** is characteristic, **more cavitating lesions** are generally not observed in HIV-positive individuals; in fact, the opposite is true. - The combination of these two points together makes this option largely inaccurate. *1 and 2 only* - While **more frequent negative sputum smears** and **false-negative tuberculin tests** [2] are indeed characteristic, this option is incomplete as it misses the increased prevalence of **extrapulmonary TB** [3], which is a significant feature in HIV-positive individuals. - HIV-related immunodeficiency often leads to the widespread dissemination of *Mycobacterium tuberculosis* outside the lungs [3]. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Consider the following statements: The clinical features of tension pneumothorax include

1. tracheal shift to contralateral side 
2. absent breath sounds on the affected side 
3. low output circulatory failure 
4. peripheral cyanosis Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 4

Answer

1 and 4

Question 2

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

Accepted Answer

A→1  B→3  C→2  D→4

Answer

A→1  B→2  C→3  D→4

Answer

A→3  B→2  C→4  D→1

Answer

A→4  B→3  C→2  D→1

Question 3

Tuberculosis in HIV positive individuals is characterized by which of the following?

1. More frequent negative sputum smears.
2. More false–negative tuberculin test results.
3. More extra–pulmonary tuberculosis.
4. More cavitating lesions in lungs as shown by chest X-ray.

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3 only

Answer

1, 2, 3 and 4

Answer

1 and 2 only

Answer

3 and 4 only

Question 4

Consider the following features of cholera:

1. Onset with purging.
2. No nausea or retching.
3. No tenesmus.
4. Leukocytosis. Which of the above features of cholera differentiate it from food poisoning?

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2, 3 and 4

Question 5

Which of the following statements is not true regarding HIV infection?

Accepted Answer

All HIV positive mothers transmit infection to their newborn children.

Answer

Infected blood transfusion leads to 100% transmission among recipients.

Answer

Every HIV infected person would require antiretroviral treatment during lifetime.

Answer

HIV does not transmit through fomites.

UPSC-CMS 2014 — Internal Medicine