UPSC-CMS 2025 - Internal Medicine Practice Questions

Q: 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?

Stage 4 (severe). ***Stage 4 (severe)*** - **Stage 4 Chronic Kidney Disease (CKD)** is defined by a **Glomerular Filtration Rate (GFR)** in the range of **15-29 mL/min/1.73 m²** [1]. - At this stage, significant kidney damage is present, indicating **severe reduction in kidney function** with increased risk of complications. *Stage 3A (mild to moderate)* - **Stage 3A CKD** is characterized by a **GFR** between **45-59 mL/min/1.73 m²**, which is a milder reduction compared to the GFR given in the question [1]. - This stage represents a **mild to moderate decrease** in kidney function, falling above the severe range. *Stage 2 (mild)* - **Stage 2 CKD** involves a **GFR** between **60-89 mL/min/1.73 m²**, which is a mild reduction in GFR but typically with persistent kidney damage. - This GFR range is significantly higher than the 15-29 mL/min/1.73 m² specified in the question, representing **earlier kidney dysfunction**. *Stage 5 (kidney failure)* - **Stage 5 CKD** is defined by a **GFR** of **less than 15 mL/min/1.73 m²**, indicating **kidney failure** requiring dialysis or kidney transplant [1]. - The given GFR range of 15-29 mL/min/1.73 m² is higher than that of Stage 5, although it is still considered a **very advanced stage of CKD**.

Q: Which one of the following hereditary tubulo-interstitial kidney diseases has an autosomal recessive mode of inheritance?

Nephronophthisis. ***Nephronophthisis*** - This is a group of **autosomal recessive** disorders characterized by tubulointerstitial nephritis, renal cysts, and progression to **end-stage renal disease (ESRD)**, often in childhood or adolescence [1]. - It is the most common genetic cause of ESRD in children, with classic features including **polydipsia, polyuria**, and anemia [1]. *Juvenile hyperuricaemic nephropathy* - This condition is typically inherited in an **autosomal dominant** pattern. - It is characterized by early-onset hyperuricemia, gout, and progressive renal insufficiency due to changes in **urate transport**. *Medullary cystic kidney disease type 1* - Previously known as **medullary cystic kidney disease**, this is now often referred to as **Autosomal Dominant Tubulointerstitial Kidney Disease (ADTKD)**. - It is caused by mutations in the **UMOD gene** (encoding uromodulin) and is inherited in an **autosomal dominant** fashion [1]. *Medullary cystic kidney disease type 2* - Also categorized under **ADTKD**, this form is caused by mutations in the **REN gene** (encoding renin). - Like type 1, it follows an **autosomal dominant** inheritance pattern leading to progressive chronic kidney disease.

Q: Which of the following findings in a patient are suggestive of acute nephritis? I. Hematuria II. Oliguria III. Reduced size of both kidneys IV. Edema Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - **Hematuria**, **oliguria**, and **edema** are classic signs of acute nephritis, indicating inflammation and impaired kidney function [1]. - Oliguria results from reduced **glomerular filtration**, while edema is due to fluid retention secondary to kidney dysfunction. *I and II only* - This option is incomplete as **edema** is also a significant finding in acute nephritis due to fluid overload from impaired renal excretion. - While hematuria and oliguria are key, omitting edema overlooks a critical systemic manifestation. *I and III* - **Reduced size of both kidneys** (III) is typically associated with **chronic kidney disease** [1], not the acute inflammation seen in acute nephritis. - Acute nephritis usually presents with **normal or enlarged kidneys** due to inflammation and swelling. *III and IV* - This option incorrectly includes **reduced kidney size**, which is characteristic of chronic, not acute, kidney disease. - While edema (IV) is present in acute nephritis, the presence of hematuria and oliguria is also crucial for diagnosis.

Q: A 35 year old male presents with increased urine output. On evaluation, his urinary output was around 4L/day; urinary osmolality was 200 mosmol/L. Which of the following are various differential diagnosis? I. Psychogenic polydipsia II. Solute diuresis III. Central diabetes insipidus IV. Nephrogenic diabetes insipidus Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - **Polyuria** with a **low urine osmolality** (200 mosmol/L, which is less than plasma osmolality) indicates the excretion of a large volume of dilute urine [1]. - This pattern is characteristic of conditions involving water diuresis, specifically **psychogenic polydipsia**, **central diabetes insipidus**, and **nephrogenic diabetes insipidus**, where the body fails to concentrate urine appropriately [2]. *I and IV only* - While **psychogenic polydipsia** and **nephrogenic diabetes insipidus** can cause polyuria with dilute urine, this option incorrectly excludes **central diabetes insipidus**, which presents with very similar urinary findings [2]. - **Central diabetes insipidus** is a primary disorder of ADH secretion, leading to an inability to concentrate urine [1]. *II and IV* - **Solute diuresis** typically results in urine with a relatively normal or slightly elevated osmolality as it's due to the excretion of osmotically active substances, not pure water. The urine osmolality of 200 mosmol/L points away from significant solute diuresis. - This option also omits **central diabetes insipidus** and **psychogenic polydipsia**, which are strong differentials for dilute polyuria. *I and III only* - This option includes **psychogenic polydipsia** and **central diabetes insipidus** but incorrectly excludes **nephrogenic diabetes insipidus**. - **Nephrogenic diabetes insipidus** also results in the inability to respond to ADH, leading to the excretion of dilute urine and polyuria [2].

Q: Which of the following are clinical features of migraine? I. It is associated with dilatation of extracranial vessels II. Common migraine is seen without Aura III. Aura is most often visual Select the correct answer using the code given below :

II and III only. ***II and III only*** - **Common migraine** (migraine without aura) is the most prevalent form of migraine, characterized by recurrent headaches lacking a preceding aura [1]. - An **aura** preceding a migraine attack is most frequently visual, presenting as flashing lights, zigzag lines, or blind spots due to transient cortical dysfunction [1], [2]. *I, II and III* - **Dilatation of extracranial vessels** is largely a secondary phenomenon, occurring after the initial vasoconstriction associated with migraine and does not fully explain migraine pathophysiology [1]. - While migraine involves vascular changes, the primary mechanism is complex and involves **neural activation** and release of inflammatory neuropeptides, not just simple vessel dilatation [1]. *I and II only* - The claim regarding **dilatation of extracranial vessels** as a primary feature is not universally accepted or sufficient to explain migraine [1]. - This option incorrectly includes an imprecise pathophysiological description and omits the accurate statement about the commonality of **visual aura**. *I and III only* - Similar to the above, the role of **extracranial vessel dilatation** as a core clinical feature is oversimplified and not a primary pathogenic event [1]. - This option correctly identifies visual aura but misrepresents the vascular component and omits the fact that **common migraine** is without aura [1].

Q: A 50 year old man presents with brief episodes of lancinating unilateral facial pain, involving the buccal distribution. Pain is triggered by washing face with cold water. What is the most likely diagnosis?

Trigeminal neuralgia. ***Trigeminal neuralgia*** - This condition presents with **brief, lancinating, unilateral facial pain** affecting one or more branches of the trigeminal nerve. - Pain is often **triggered by tactile stimuli** like washing the face, touching the face, or cold water, consistent with the patient's presentation. *Chronic paroxysmal hemicrania* - This type of headache is characterized by **frequent, short-lived attacks of severe, unilateral head pain**, often accompanied by autonomic symptoms (e.g., lacrimation, rhinorrhea). - It is crucial to note that these headaches are **responsive to indomethacin**, and while unilateral, they typically involve periorbital or temporal regions and not specifically the trigeminal distribution or tactile triggers in the same way. *Migraine* - Migraines are typically characterized by **pulsating, moderate to severe head pain**, often unilateral, lasting from hours to days [1]. - They are usually associated with **nausea, vomiting**, and sensitivity to light (photophobia) and sound (phonophobia), which are absent in this patient's presentation [2]. *Medication overuse headache* - This headache is a **chronic daily or near-daily headache** that develops or worsens due to the overuse of acute headache medications [2]. - It does not present with **brief, lancinating pains** or specific triggers like washing the face with cold water.

Q: Consider the following pleural fluid analysis : pH-7.6 Pleural fluid protein -0.5 g / dL Serum total protein -6.5 g / dL Pleural fluid LDH - 100 U / L Serum LDH - 300 U / L What is the most likely diagnosis?

Myxedema. ***Myxedema*** - The pleural fluid analysis shows a **transudative effusion** (pleural fluid protein/serum protein ratio < 0.5 and pleural fluid LDH/serum LDH ratio < 0.6), a characteristic of myxedema (hypothyroidism) [1]. - While other causes of transudates exist, a **high pH** in a transudate, as seen here (pH 7.6), is suggestive of myxedema or a parapneumonic effusion that is not infected, but the latter would likely be an exudate [1]. *Sarcoidosis* - Sarcoidosis typically causes an **exudative pleural effusion**, characterized by higher protein and LDH levels in the pleural fluid. - The pleural fluid pH in sarcoidosis is usually normal to slightly low, but not as high as 7.6 in an exudative process. *Rheumatoid arthritis* - Pleural effusions due to rheumatoid arthritis are typically **exudative**, with low glucose and very low pH (often <7.0 to 7.1) [1]. - The given pleural fluid composition does not match the typical findings of a rheumatoid effusion. *Pancreatitis* - Pancreatitis can cause an **exudative pleural effusion**, particularly on the left side, with very high amylase levels. - The protein and LDH ratios in this case are consistent with a transudate, not an exudate as seen in pancreatitis.

Q: Which one of the following conditions is a complication of bacterial pharyngitis involving extension of infection into the internal jugular veins leading to thrombosis and metastatic dispersal of the organism?

Lemierre syndrome. ***Lemierre syndrome*** - This syndrome is characterized by **bacterial pharyngitis** that extends to the **internal jugular vein**, leading to **thrombosis** and subsequent septic emboli [3]. - The most common causative organism is ***Fusobacterium necrophorum***, and it can result in metastatic infections in organs like the lungs. *Wegener's granulomatosis* - This is an **autoimmune vasculitis** affecting small to medium-sized vessels, primarily in the respiratory tract and kidneys [2]. - It is distinct from infection-related venous thrombosis and is characterized by **granulomatous inflammation** and **ANCA positivity**. *Chronic Pulmonary Aspergillosis* - This is a fungal infection of the lungs, typically occurring in individuals with pre-existing lung conditions or immunosuppression [1]. - It does not involve the initial presentation of bacterial pharyngitis followed by internal jugular vein thrombosis. *Cystic Fibrosis* - This is an **autosomal recessive genetic disorder** affecting exocrine glands, leading to thick, sticky mucus, primarily impacting the lungs and digestive system. - While it causes chronic respiratory infections, it is not initiated by bacterial pharyngitis leading to septic thrombophlebitis of the jugular vein.

Q: Which one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?

Transabdominal ultrasound. ***Transabdominal ultrasound*** - It is an **accurate, non-invasive, and cost-effective** imaging modality for detecting gallstones [1]. - Ultrasound can visualize the stones, their size, number, and any associated complications like **gallbladder wall thickening** or **pericholecystic fluid**. *Capsule endoscopy* - This procedure is primarily used to visualize the **small intestine** and is not suitable for evaluating the gallbladder. - It works by capturing images as it passes through the digestive tract, an area where the gallbladder is not directly accessible. *Computed Tomography* - While CT can sometimes detect gallstones, especially those that are calcified, it is **less sensitive than ultrasound** for non-calcified stones [1]. - CT also exposes the patient to **ionizing radiation**, making it less favorable as a primary diagnostic tool for gallstones compared to ultrasound. *Erect X ray of abdomen* - An erect X-ray of the abdomen is **poor at detecting gallstones** as only about 10-20% of gallstones are radiopaque (calcified) and visible on X-ray. - This imaging technique is more useful for detecting conditions like **bowel obstruction** or **perforations**, rather than gallbladder pathology.

Question 1

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)

Question 2

Which one of the following hereditary tubulo-interstitial kidney diseases has an autosomal recessive mode of inheritance?

Accepted Answer

Nephronophthisis

Answer

Juvenile hyperuricaemic nephropathy

Answer

Medullary cystic kidney disease type 1

Answer

Medullary cystic kidney disease type 2

Question 3

Which of the following findings in a patient are suggestive of acute nephritis?
I. Hematuria
II. Oliguria
III. Reduced size of both kidneys
IV. Edema

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I and II only

Answer

I and III

Answer

III and IV

Question 4

A 35 year old male presents with increased urine output. On evaluation, his urinary output was around 4L/day; urinary osmolality was 200 mosmol/L. Which of the following are various differential diagnosis?
I. Psychogenic polydipsia
II. Solute diuresis
III. Central diabetes insipidus
IV. Nephrogenic diabetes insipidus

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

I and IV only

Answer

II and IV

Answer

I and III only

Question 5

Which of the following are clinical features of migraine?
I. It is associated with dilatation of extracranial vessels
II. Common migraine is seen without Aura
III. Aura is most often visual

Select the correct answer using the code given below :

Accepted Answer

II and III only

Answer

I, II and III

Answer

I and II only

Answer

I and III only

Question 6

A 50 year old man presents with brief episodes of lancinating unilateral facial pain, involving the buccal distribution. Pain is triggered by washing face with cold water. What is the most likely diagnosis?

Accepted Answer

Trigeminal neuralgia

Answer

Chronic paroxysmal hemicrania

Answer

Migraine

Answer

Medication overuse headache

Question 7

Consider the following pleural fluid analysis :
pH-7.6
Pleural fluid protein -0.5 g / dL
Serum total protein -6.5 g / dL
Pleural fluid LDH - 100 U / L
Serum LDH - 300 U / L

What is the most likely diagnosis?

Accepted Answer

Myxedema

Answer

Sarcoidosis

Answer

Rheumatoid arthritis

Answer

Pancreatitis

Question 8

Which one of the following statements is correct in respect of pulmonary involvement in rheumatoid disease?

Accepted Answer

Rheumatoid pulmonary nodules are usually asymptomatic and detected incidentally on imaging

Answer

Pleural effusion in these patients is transudative and usually bilateral

Answer

Rheumatoid pulmonary nodules are often solitary and located near hilum

Answer

Combination of pleural effusion and pneumoconiosis in these patients is known as Caplan syndrome

Question 9

Which one of the following conditions is a complication of bacterial pharyngitis involving extension of infection into the internal jugular veins leading to thrombosis and metastatic dispersal of the organism?

Accepted Answer

Lemierre syndrome

Answer

Wegener's granulomatosis

Answer

Chronic Pulmonary Aspergillosis

Answer

Cystic Fibrosis

Question 10

Which one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?

Accepted Answer

Transabdominal ultrasound

Answer

Capsule endoscopy

Answer

Computed Tomography

Answer

Erect X ray of abdomen

UPSC-CMS 2025 — Internal Medicine