UPSC-CMS 2022 - Internal Medicine PYQs Practice Questions

Q: The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is

24-hour pH recording. ***24-hour pH recording*** - This method directly measures the **frequency** and **duration of acid exposure** in the esophagus, providing objective evidence of reflux. - It is considered the gold standard because it can **quantify reflux episodes** and correlate them with patient symptoms. *upper GI endoscopy* - While useful for visualizing **mucosal damage** [1] (esophagitis, strictures, Barrett's esophagus) caused by reflux, it does not directly measure or confirm reflux itself. - Many patients with GORD symptoms have **normal endoscopic findings**, making it unsuitable as the gold standard for diagnosis. *CT scan* - A CT scan is not typically used for diagnosing GORD. - It is more useful for identifying **structural abnormalities** or **complications** of reflux, such as tumors or hiatal hernias. *barium meal follow through* - This imaging technique can identify **structural abnormalities** like hiatal hernia or severe reflux events, but it is not sensitive enough to detect intermittent or mild reflux. - It provides a **snapshot** of reflux and cannot quantify the total acid exposure over a prolonged period. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following are the causes of retroperitoneal fibrosis?

Drugs. ***Drugs*** - Various medications can induce retroperitoneal fibrosis, including **methysergide**, **beta-blockers**, and some **antibiotics**. - Drug-induced retroperitoneal fibrosis often resolves with **discontinuation of the offending agent**. *Lymphoma* - While lymphoma can cause retroperitoneal masses, it typically presents with distinct features such as **lymphadenopathy** and **B symptoms** (fever, night sweats, weight loss) rather than generalized fibrosis [1]. - Lymphoma involves neoplastic proliferation of lymphocytes, leading to **mass effect** and infiltration, which is distinct from the fibrotic process [1]. *Carcinoid tumours* - Carcinoid tumors can cause fibrosis, but typically in the **pericardium** or **pleura** (carcinoid heart disease) or **mesenterium**, not the retroperitoneum directly as a primary cause in this context. - The fibrosis associated with carcinoid syndrome is due to the release of **serotonin** and other vasoactive substances. *Continuous Ambulatory Peritoneal Dialysis (CAPD)* - CAPD can lead to **peritoneal fibrosis** (sclerosing encapsulating peritonitis), which affects the peritoneum lining the abdominal cavity, not the retroperitoneum. - This complication is distinct from retroperitoneal fibrosis and involves changes to the **peritoneal membrane**, often due to bio-incompatible dialysate. [Practice more Internal Medicine PYQs on OnCourse]

Q: The most common brain tumour in an adult is

cerebral metastasis. ***Cerebral metastasis*** - **Cerebral metastases** are the **most common brain tumours in adults**, originating from primary cancers elsewhere in the body (e.g., lung, breast, melanoma). - They often present as **multiple lesions** and can cause focal neurological deficits, seizures, and increased intracranial pressure. *Glioma* - While **gliomas** (including astrocytomas, glioblastoma multiforme) are the most common primary brain tumours, they are less common than metastatic lesions overall in adults. - They arise from **glial cells** within the brain and can be highly aggressive. *Pituitary tumour* - **Pituitary tumours** are benign adenomas originating from the pituitary gland. - They are common but constitute a smaller proportion of all adult brain tumours compared to metastases or gliomas, and often present with **endocrine disturbances** or **visual field defects**. *Vestibular schwannoma* - **Vestibular schwannomas** (acoustic neuromas) are benign tumours arising from the **vestibulocochlear nerve (cranial nerve VIII)**. - They are relatively rare and typically present with **hearing loss**, **tinnitus**, and **balance issues**. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation? 1. Raised ICP 2. Seizures 3. Hemianopia 4. Focal deficit

1. Raised ICP. ***Raised ICP*** - **Increased Intracranial Pressure (ICP)** is the fundamental underlying cause of the classic triad of brain tumor symptoms [1]. - As a tumor grows, it occupies space within the rigid skull, leading to an increase in pressure that manifests as headache, nausea/vomiting, and papilledema [1]. *Anopia* - **Anopia** (complete blindness in one eye) is a specific visual field defect, not a general underlying pathophysiological mechanism for the classic triad. - While brain tumors can cause visual field defects, these are typically considered focal neurological deficits rather than the primary cause of the general triad [1]. *Focal deficit* - **Focal neurological deficits** (like hemianopia, weakness, or sensory loss) are *symptoms* caused by brain tumors, but they represent localized damage, not the overarching pathophysiology of the classic triad [1]. - The classic triad (headache, nausea/vomiting, papilledema) is a manifestation of diffuse increased pressure, not specific focal damage [1]. *Seizures* - **Seizures** are a common symptom of brain tumors, often due to irritation of cortical tissue [1]. - However, seizures are a *symptom* that can occur due to focal irritation or diffuse pressure and do not represent the primary underlying pathophysiology (raised ICP) that causes the classic triad itself [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?

Arthropathy. **Arthropathy** - **Peripheral arthropathy**, particularly **Type 1 (pauciarticular)**, is directly linked to **Crohn's disease activity**, meaning flares in bowel disease often coincide with flares in joint symptoms. - This form of arthritis typically affects large joints, is transient, and resolves with successful treatment of the underlying intestinal inflammation. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a serious extraintestinal manifestation often associated with Crohn's disease but is **not directly correlated with its activity**. - Its progression is independent of whether the intestinal inflammation is well-controlled. *Pyoderma gangrenosum* - **Pyoderma gangrenosum** is a skin manifestation that can occur in patients with Crohn's disease, but its activity often **does not parallel the severity of the bowel disease**. - While it can be debilitating, effective treatment of Crohn's disease may not always lead to remission of pyoderma gangrenosum. *Amyloidosis* - **Amyloidosis**, specifically **AA amyloidosis**, is a rare but severe complication of chronic inflammatory diseases like Crohn's, resulting from long-term inflammation. - While prolonged, uncontrolled disease activity increases the risk, the **amyloidosis itself does not fluctuate with day-to-day or short-term changes in Crohn's disease activity**. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is

Accepted Answer

24-hour pH recording

Answer

upper GI endoscopy

Answer

CT scan

Answer

barium meal follow through

Question 2

Which of the following are the causes of retroperitoneal fibrosis?

Accepted Answer

Drugs

Answer

Lymphoma

Answer

Carcinoid tumours

Answer

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Question 3

The most common brain tumour in an adult is

Accepted Answer

cerebral metastasis

Answer

glioma

Answer

pituitary tumour

Answer

vestibular schwannoma

Question 4

Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation?

1. Raised ICP
2. Seizures
3. Hemianopia
4. Focal deficit

Accepted Answer

1. Raised ICP

Answer

3. Anopia

Answer

4. Focal deficit

Answer

2. Seizures

Question 5

Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?

Accepted Answer

Arthropathy

Answer

Primary sclerosing cholangitis

Answer

Pyoderma gangrenosum

Answer

Amyloidosis

Question 6

Which of the following is the LEAST invasive initial treatment option for achalasia?

1. Botulinum toxin
2. Beta blockers
3. Pneumatic dilation
4. Heller's myotomy

Accepted Answer

2. Beta blockers

Answer

3. Pneumatic dilation

Answer

4. Heller's myotomy

Answer

1. Botulinum toxin

Question 7

Which of the following statements regarding peptic ulcers are correct?

1. Duodenal ulcers are more common as compared to gastric ulcers.
2. Helicobacter pylori and NSAIDs are most common causative agents.
3. Bleeding is the most common complication associated with posterior duodenal ulcer.

Accepted Answer

1 and 2 only

Answer

2 and 3 only

Answer

1, 2 and 3

Answer

1 and 3 only

Question 8

Which of the following statements are correct with regard to Budd-Chiari syndrome?

1. Venous drainage of liver is occluded by hepatic vein thrombosis.
2. It most commonly affects the young males.
3. It is associated with protein C, protein S and antithrombin III deficiency.
4. Abdominal discomfort and ascites are the most common features associated with acute thrombosis.

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 9

Which organ is PRIMARILY involved in cystic fibrosis?

Accepted Answer

Lungs

Answer

Pancreas

Answer

Kidney

Answer

Liver

Question 10

Which of the following are correct with regard to lung cancer?

1. Surgical resection has a limited role in curative treatment of lung cancer.
2. Pattern of disease and prognosis of oat cell carcinoma are different to other varieties in the lungs.
3. Small cell lung cancer is a type of Neuroendocrine Tumour (NET).
4. Squamous cancer appears as a cavitating tumour in the lungs.

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

UPSC-CMS 2022 — Internal Medicine