UPSC-CMS 2025 — Internal Medicine
67 Previous Year Questions with Answers & Explanations
Which of the following are clinical features of Parkinson's disease? I. Reduced eye blinking II. Drooling of saliva III. Soft voice IV. Macrographia Select the correct answer using the code given below :
A 35 year female presents with easy fatigability. Investigations show that Hb is 6 g %; Red cell morphology is normocytic normochromic; and reticulocyte production index is 5.5 . Which one of the following conditions favours this abnormality?
A 46 year old lady on vegan diet for a decade presents with chief complaints of tingling and numbness in lower limbs for two months and a history of swaying while walking through narrow corridors. Which one of the following blood tests is advisable for diagnosis in this patient?
Which one of the following causes low-volume erythrocytosis?
First line therapy in chronic phase of chronic myeloid leukemia is
With regard to management of idiopathic thrombocytopenic purpura, consider the following statements : I. All patients with ITP with platelet count less than 100 x 10^9 / L should receive high dose of glucocorticoids II. For patient with spontaneous bleeding, 40 mg of dexamethasone daily is indicated for 4 days III. Intravenous immunoglobulin can raise the platelet count IV. Life threatening bleeding should be treated with platelet transfusion Which of the statements given above are correct?
Wilson's disease has which of the following inheritance?
Which one of the following conditions can cause euvolaemic hyponatraemia?
Which one of the following conditions is caused by mutations in the gene that encodes the sodium-potassium-2-chloride cotransporter (NKCC2), and presents with sodium wasting, hypokalaemia, hypomagnesaemia and hypercalciuria?
A 52 year old male has uncontrolled diabetes. Which one of the following tests will help in early detection of nephropathy?
UPSC-CMS 2025 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 1: Which of the following are clinical features of Parkinson's disease? I. Reduced eye blinking II. Drooling of saliva III. Soft voice IV. Macrographia Select the correct answer using the code given below :
- A. I, II and IV
- B. I, II and III (Correct Answer)
- C. II, III and IV
- D. I, III and IV
Explanation: ***I, II and III*** - **Reduced eye blinking** (bradykinesia or hypokinesia), **drooling of saliva** (impaired swallowing reflex and reduced clearing) [2], and a **soft voice** (hypophonia) [2] are all classic clinical features of Parkinson's disease. [1] - These symptoms reflect the widespread impact of **dopamine depletion** on motor and autonomic functions. [3] *I, II and IV* - This option correctly identifies **reduced eye blinking** and **drooling of saliva** as features of Parkinson's disease. - However, it incorrectly includes macrographia, as Parkinson's disease is associated with **micrographia**, not macrographia. *II, III and IV* - This option correctly identifies **drooling of saliva** and a **soft voice** as features of Parkinson's disease. - It incorrectly includes macrographia, while missing **reduced eye blinking (hypomimia/bradykinesia)**, which is a prominent feature. *I, III and IV* - This option correctly identifies **reduced eye blinking** and a **soft voice** as features of Parkinson's disease. - It incorrectly includes macrographia and omits **drooling of saliva**, a common non-motor symptom due to dysphagia. [2]
Question 2: A 35 year female presents with easy fatigability. Investigations show that Hb is 6 g %; Red cell morphology is normocytic normochromic; and reticulocyte production index is 5.5 . Which one of the following conditions favours this abnormality?
- A. Folate deficiency
- B. Sideroblastic anemia
- C. Iron deficiency anemia
- D. Intravascular hemolysis (Correct Answer)
Explanation: ***Intravascular hemolysis*** - **Normocytic, normochromic anemia** with a **high reticulocyte production index** (RPI > 2-3) is characteristic of hemolytic anemias, indicating the bone marrow is effectively responding to increased red cell destruction [1]. - **Easy fatigability** is a common symptom of severe anemia, and the low Hb of 6g% confirms significant red blood cell loss, consistent with active hemolysis. *Folate deficiency* - This typically causes **macrocytic anemia** with **megaloblastic red cell morphology**, which contradicts the given normocytic finding [2]. - While it can lead to anemia and fatigue, the **reticulocyte index would be low**, indicating impaired red blood cell production, not increased destruction. *Sideroblastic anemia* - This anemia is usually **microcytic or dimorphic** and can be normocytic, but it is characterized by **ring sideroblasts** in the bone marrow, reflecting impaired heme synthesis. - The **reticulocyte production index is typically low or inappropriately normal**, as the primary issue is ineffective erythropoiesis rather than rapid peripheral destruction. *Iron deficiency anemia* - This is classically a **microcytic, hypochromic anemia**, meaning red blood cells are smaller and paler than normal [3]. - The **reticulocyte production index would be low or normal**, as the bone marrow's ability to produce new red blood cells is limited by the lack of iron.
Question 3: A 46 year old lady on vegan diet for a decade presents with chief complaints of tingling and numbness in lower limbs for two months and a history of swaying while walking through narrow corridors. Which one of the following blood tests is advisable for diagnosis in this patient?
- A. Serum protein electrophoresis
- B. Vitamin 25(OH) D level
- C. Vitamin B12 levels (Correct Answer)
- D. Anti-gliadin antibodies
Explanation: ***Vitamin B12 levels*** - A **vegan diet** for an extended period puts patients at high risk for **vitamin B12 deficiency**, as B12 is primarily found in animal products [1]. - Symptoms like **tingling, numbness (paresthesias)**, and **impaired gait (ataxia)** are classic neurological manifestations of severe vitamin B12 deficiency, often due to **subacute combined degeneration** of the spinal cord [1]. *Serum protein electrophoresis* - This test is used to detect and quantify various proteins in the serum, primarily for suspected **monoclonal gammopathies** like multiple myeloma or Waldenström macroglobulinemia. - Her symptoms are primarily neurological and directly attributable to her dietary choices, making ser um protein electrophoresis less relevant as an initial diagnostic step. *Vitamin 25(OH) D level* - While vegans are at risk for **vitamin D deficiency** due to limited dietary sources and insufficient sun exposure, the primary symptoms of vitamin D deficiency are typically **bone pain, muscle weakness**, or fatigue, not the present neurological signs [2]. - Although vitamin D deficiency can cause non-specific neurological symptoms, the specific combination of paresthesia and ataxia in a long-term vegan points more strongly to B12 deficiency. *Anti-gliadin antibodies* - These antibodies are ordered to screen for **celiac disease**, an autoimmune disorder triggered by gluten consumption. - While celiac disease can present with neurological symptoms, there is no information in the patient's history to suggest a malabsorption disorder other than dietary restrictions, and her strict vegan diet directly points to a lack of B12.
Question 4: Which one of the following causes low-volume erythrocytosis?
- A. High altitude
- B. Polycythemia Rubra Vera
- C. Gaisbock's syndrome (Correct Answer)
- D. Exogenous testosterone therapy
Explanation: ***Gaisbock's syndrome*** - **Gaisbock's syndrome**, also known as **stress erythrocytosis** or **relative polycythemia**, is characterized by a high hematocrit due to reduced plasma volume rather than an absolute increase in red blood cell (RBC) mass. - It is often associated with **hypertension**, **obesity**, and **stress**, predominantly affecting middle-aged men with a normal total erythrocyte mass [1]. *High altitude* - Living at **high altitudes** can cause **secondary erythrocytosis** due to chronic hypoxia, leading to increased erythropoietin production and an absolute increase in red blood cell mass [2]. - This is a **true erythrocytosis**, where both red blood cell count and total blood volume are elevated. *Polycythemia Rubra Vera* - **Polycythemia vera** is a **myeloproliferative neoplasm** causing an absolute increase in the red blood cell mass, resulting from uncontrolled production by the bone marrow. - It is characterized by a **JAK2V617F mutation** and leads to increased total blood volume, not reduced plasma volume [1]. *Exogenous testosterone therapy* - **Exogenous testosterone therapy** can stimulate erythropoiesis, leading to an **increase in red blood cell mass** and hematocrit, which is a form of **secondary erythrocytosis**. - This effect is mediated by increased erythropoietin production and is an absolute increase in RBCs, not a low-volume condition.
Question 5: First line therapy in chronic phase of chronic myeloid leukemia is
- A. Thalidomide
- B. Rituximab
- C. Imatinib (Correct Answer)
- D. Chlorambucil
Explanation: ***Imatinib*** - **Imatinib** is a **tyrosine kinase inhibitor (TKI)** that specifically targets the **BCR-ABL fusion protein**, which is the hallmark of **chronic myeloid leukemia (CML)** [1][2]. - It is highly effective in inducing **hematologic and cytogenetic remissions** in the chronic phase of CML and has significantly improved prognosis [2]. *Thalidomide* - **Thalidomide** is an immunomodulatory drug primarily used in **multiple myeloma** and as a teratogen. - It does not target the **BCR-ABL fusion protein** and is not indicated for CML. *Rituximab* - **Rituximab** is a **monoclonal antibody** that targets the **CD20 antigen** found on B-lymphocytes. - It is used in the treatment of **B-cell non-Hodgkin lymphoma** and **chronic lymphocytic leukemia**, not CML. *Chlorambucil* - **Chlorambucil** is an **alkylating agent**, a type of chemotherapy drug. - While historically used in some hematologic malignancies, it has been largely superseded by targeted therapies like TKIs in CML due to its non-specific action and greater toxicity [2].
Question 6: With regard to management of idiopathic thrombocytopenic purpura, consider the following statements : I. All patients with ITP with platelet count less than 100 x 10^9 / L should receive high dose of glucocorticoids II. For patient with spontaneous bleeding, 40 mg of dexamethasone daily is indicated for 4 days III. Intravenous immunoglobulin can raise the platelet count IV. Life threatening bleeding should be treated with platelet transfusion Which of the statements given above are correct?
- A. I, II and IV
- B. I, II and III
- C. I, III and IV
- D. II, III and IV (Correct Answer)
Explanation: ***II, III and IV*** - Statement II is correct because **40 mg of dexamethasone daily for 4 days** is a common regimen for newly diagnosed ITP with a platelet count <30 x 10^9/L or with bleeding, aiming for rapid platelet increase. - Statement III is correct as **Intravenous Immunoglobulin (IVIG)** works by blocking Fc receptors on macrophages, reducing platelet destruction and rapidly raising platelet counts, especially in cases of active bleeding or before urgent procedures. - Statement IV is correct because in **life-threatening bleeding** associated with ITP, platelet transfusions are indicated to provide immediate hemostasis, often given alongside other therapies like IVIG or high-dose steroids. *I, II and IV* - Statement I is incorrect; not all ITP patients with platelet counts <100 x 10^9/L require high-dose glucocorticoids [1]. Treatment decisions are based on **platelet count, bleeding symptoms**, and patient risk factors, with many asymptomatic patients with counts between 30-100 x 10^9/L being observed. - While statements II and IV are correct, the inclusion of statement I makes this option incorrect. *I, II and III* - Statement I is incorrect for the reasons mentioned above; not all ITP patients with platelet counts <100 x 10^9/L need high-dose glucocorticoids. - Although statements II and III are correct, the presence of the incorrect statement I renders this option invalid. *I, III and IV* - Statement I is incorrect because immediate high-dose glucocorticoid treatment is not indicated for all ITP patients with platelet counts below 100 x 10^9/L; it's reserved for those with **significant bleeding or very low counts** (<30 x 10^9/L) [1]. - Statements III and IV are correct, but the inaccuracy of statement I makes this choice incorrect.
Question 7: Wilson's disease has which of the following inheritance?
- A. It is an acquired disease
- B. Autosomal recessive (Correct Answer)
- C. X-linked recessive
- D. Autosomal dominant
Explanation: ***Autosomal recessive*** - Wilson's disease is caused by mutations in the **ATP7B gene**, which codes for a copper-transporting ATPase. - For an individual to develop the disease, they must inherit **two copies of the mutated gene**, one from each parent. *It is an acquired disease* - Wilson's disease is a **genetic disorder**, meaning it is inherited, not acquired through environmental factors or lifestyle [1]. - While symptoms may manifest later in life, the underlying cause is a **predisposing genetic mutation** [1]. *X-linked recessive* - X-linked recessive disorders primarily affect males as they have only one X chromosome; however, Wilson's disease **affects both sexes equally**. - The gene responsible for Wilson's disease, **ATP7B**, is located on **chromosome 13**, an autosome, not on the X chromosome. *Autosomal dominant* - In autosomal dominant inheritance, only **one copy of the mutated gene** is sufficient to cause the disease, and it is usually seen in every generation. - Wilson's disease requires **two mutated copies** of the gene to manifest, and carriers (heterozygotes) are typically asymptomatic.
Question 8: Which one of the following conditions can cause euvolaemic hyponatraemia?
- A. Adrenocortical failure
- B. Nephrotic syndrome
- C. Burns
- D. Hypothyroidism (Correct Answer)
Explanation: ***Hypothyroidism*** - Severe hypothyroidism can lead to **euvolaemic hyponatraemia** through impaired water excretion [1]. - This occurs due to increased **antidiuretic hormone (ADH)** secretion and decreased renal free water clearance [1]. *Adrenocortical failure* - **Adrenocortical failure** (e.g., Addison's disease) typically causes **hypovolaemic hyponatraemia** due to reduced mineralocorticoid activity, leading to sodium and water loss [1]. - It's also associated with hyperkalemia, which is not characteristic of euvolaemic hyponatremia. *Nephrotic syndrome* - **Nephrotic syndrome** causes **hypervolaemic hyponatraemia** due to significant protein loss, leading to reduced plasma oncotic pressure, fluid shifts to the interstitial space, and secondary hyperaldosteronism [1]. - The primary fluid imbalance is fluid overload with edema [1]. *Burns* - Severe **burns** primarily lead to **hypovolaemic hyponatraemia** or **hypernatraemia** depending on fluid resuscitation and evaporative losses [1]. - The massive fluid shifts and plasma loss usually result in fluid and electrolyte imbalances that are not euvolaemic [1].
Question 9: Which one of the following conditions is caused by mutations in the gene that encodes the sodium-potassium-2-chloride cotransporter (NKCC2), and presents with sodium wasting, hypokalaemia, hypomagnesaemia and hypercalciuria?
- A. Bartter syndrome (Correct Answer)
- B. Fanconi syndrome
- C. Gitelman syndrome
- D. Alport syndrome
Explanation: ***Bartter syndrome*** - This syndrome is characterized by **loss-of-function mutations** in the **NKCC2 cotransporter** in the thick ascending limb of the loop of Henle, leading to impaired sodium and chloride reabsorption. - The resulting electrolyte imbalances include **sodium wasting**, **hypokalemia**, **hypomagnesemia**, and **hypercalciuria**. *Fanconi syndrome* - This syndrome involves a generalized defect in the **proximal renal tubules**, leading to impaired reabsorption of multiple substances including glucose, amino acids, phosphate, and bicarbonate. - It does not specifically involve a mutation in the NKCC2 cotransporter or present with the described electrolyte profile. *Gitelman syndrome* - This condition is caused by a mutation in the **thiazide-sensitive Na-Cl cotransporter (NCC)** in the distal convoluted tubule. - While it shares some features like hypokalemia and hypomagnesemia, it is typically associated with **hypocalciuria**, not hypercalciuria, and a different genetic defect. *Alport syndrome* - This is a genetic disorder affecting type IV collagen, primarily impacting the **glomerular basement membrane**, leading to hematuria, proteinuria, and progressive renal failure. - It is not associated with mutations in electrolyte transporters or the specific electrolyte abnormalities listed in the question.
Question 10: A 52 year old male has uncontrolled diabetes. Which one of the following tests will help in early detection of nephropathy?
- A. Blood urea level
- B. Urine albumin (Correct Answer)
- C. Ultrasonography
- D. Serum creatinine level
Explanation: Urine albumin - **Microalbuminuria**, detected by measuring urine albumin, is often the earliest sign of **diabetic nephropathy**, occurring before changes in GFR or serum creatinine [1], [3]. - **Persistent albuminuria** indicates glomerular damage and is a key marker for monitoring disease progression and treatment effectiveness [3]. *Blood urea level* - **Blood urea nitrogen (BUN)** levels rise significantly only when there's a substantial decline in **renal function**, making it an insensitive marker for early damage [2]. - Factors like dehydration or protein intake can also influence BUN, reducing its specificity for early nephropathy [2]. *Ultrasonography* - **Renal ultrasonography** is useful for assessing kidney size, shape, and identifying structural abnormalities like hydronephrosis or stones. - It is not sensitive enough to detect early-stage changes in **renal function** or microvascular damage characteristic of early diabetic nephropathy. *Serum creatinine level* - **Serum creatinine** levels increase only after a significant portion of kidney function (typically >50%) has been lost [2]. - It is a marker of **reduced glomerular filtration rate (GFR)**, but detecting elevated creatinine means the nephropathy is already more advanced than the microalbuminuria stage [1].