UPSC-CMS 2025 - Internal Medicine PYQs Practice Questions

Q: 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 :

I, II and III. ***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] [Practice more Internal Medicine PYQs on OnCourse]

Q: 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?

Intravascular hemolysis. ***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. [Practice more Internal Medicine PYQs on OnCourse]

Q: 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?

Vitamin B12 levels. ***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. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which one of the following causes low-volume erythrocytosis?

Gaisbock's syndrome. ***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. [Practice more Internal Medicine PYQs on OnCourse]

Q: First line therapy in chronic phase of chronic myeloid leukemia is

Imatinib. ***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]. [Practice more Internal Medicine PYQs on OnCourse]

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 :

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

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?

Accepted Answer

Intravascular hemolysis

Answer

Folate deficiency

Answer

Sideroblastic anemia

Answer

Iron deficiency anemia

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?

Accepted Answer

Vitamin B12 levels

Answer

Serum protein electrophoresis

Answer

Vitamin 25(OH) D level

Answer

Anti-gliadin antibodies

Question 4

Which one of the following causes low-volume erythrocytosis?

Accepted Answer

Gaisbock's syndrome

Answer

High altitude

Answer

Polycythemia Rubra Vera

Answer

Exogenous testosterone therapy

Question 5

First line therapy in chronic phase of chronic myeloid leukemia is

Accepted Answer

Imatinib

Answer

Thalidomide

Answer

Rituximab

Answer

Chlorambucil

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?

Accepted Answer

II, III and IV

Answer

I, II and IV

Answer

I, II and III

Answer

I, III and IV

Question 7

Wilson's disease has which of the following inheritance?

Accepted Answer

Autosomal recessive

Answer

It is an acquired disease

Answer

X-linked recessive

Answer

Autosomal dominant

Question 8

Which one of the following conditions can cause euvolaemic hyponatraemia?

Accepted Answer

Hypothyroidism

Answer

Adrenocortical failure

Answer

Nephrotic syndrome

Answer

Burns

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?

Accepted Answer

Bartter syndrome

Answer

Fanconi syndrome

Answer

Gitelman syndrome

Answer

Alport syndrome

Question 10

A 52 year old male has uncontrolled diabetes. Which one of the following tests will help in early detection of nephropathy?

Accepted Answer

Urine albumin

Answer

Blood urea level

Answer

Ultrasonography

Answer

Serum creatinine level

UPSC-CMS 2025 — Internal Medicine