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: 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]

Q: 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?

II, III and IV. ***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. [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

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 4

First line therapy in chronic phase of chronic myeloid leukemia is

Accepted Answer

Imatinib

Answer

Thalidomide

Answer

Rituximab

Answer

Chlorambucil

Question 5

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 6

Which of the following can be used for the management of severe hyperkalaemia?
I. Intravenous calcitonin
II. Intravenous sodium bicarbonate
III. Oral sodium polystyrene sulphate
IV. Intravenous calcium gluconate

Accepted Answer

II, III and IV

Answer

I and II only

Answer

I and IV only

Answer

I, II and IV

Question 7

Which one of the following conditions can cause euvolaemic hyponatraemia?

Accepted Answer

Hypothyroidism

Answer

Adrenocortical failure

Answer

Nephrotic syndrome

Answer

Burns

Question 8

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 9

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

Question 10

Kidney damage and Glomerular Filtration Rate (GFR) value between 15-29 mL / min / 1.73 m^2 are found in which stage of Chronic Kidney Disease?

Accepted Answer

Stage 4 (severe)

Answer

Stage 3A (mild to moderate)

Answer

Stage 2 (mild)

Answer

Stage 5 (kidney failure)

UPSC-CMS 2025 — Internal Medicine