UPSC-CMS 2025 - Internal Medicine Practice Questions

Q: In clinical assessment of an elderly patient, 'the get up and go test' is used to evaluate which of the following?

Gait and balance. Gait and balance - The **Timed Up and Go (TUG) test** is a widely used clinical tool designed to assess a person's **mobility**, **balance**, and **fall risk**. [2] - It measures the time taken for an individual to rise from a chair, walk 3 meters, turn, walk back, and sit down again. *Cognition* - While physical and cognitive functions are related, the TUG test does not directly assess **cognitive abilities** like memory, executive function, or language. - Cognitive assessment typically involves tools such as the **Mini-Mental State Examination (MMSE)** or **Montreal Cognitive Assessment (MoCA)**. [1] *Urinary incontinence* - The TUG test does not evaluate **urinary function** or the presence of incontinence. - Assessment of urinary incontinence involves patient history, bladder diaries, and physical examination. *Driving ability* - Although mobility and balance are important for driving, the TUG test alone is not a direct measure of **driving ability**. - Driving assessments are more comprehensive, often involving on-road tests and specialized cognitive and visual evaluations.

Q: Which one of the following is a contraindication to wireless capsule endoscopy?

Small bowel stricture. ***Small bowel stricture*** - A **small bowel stricture** is a major contraindication for wireless capsule endoscopy due to the significant risk of the capsule becoming **retained** at the narrowed segment [1]. - Capsule retention can lead to **obstruction** requiring surgical intervention, thus posing a serious safety concern. *Small bowel Crohn's disease* - While Crohn's disease *can* cause strictures, the existence of Crohn's disease itself is not an absolute contraindication unless a **significant stricture** is already known or highly suspected [1]. - Capsule endoscopy is often used to *diagnose* and *monitor* small bowel Crohn's disease [1]. *Coeliac disease* - **Coeliac disease** is not a contraindication; in fact, capsule endoscopy can be a useful tool in evaluating the small bowel mucosa in refractory cases or for confirming diagnosis [1]. - There is no increased risk of capsule retention or other adverse events directly attributable to coeliac disease itself. *Obscure gastrointestinal bleeding* - **Obscure gastrointestinal bleeding** is considered a primary *indication* for wireless capsule endoscopy, rather than a contraindication [1]. - The capsule can visualize the entire small bowel, often identifying bleeding sources that are not accessible by conventional endoscopy [1].

Q: Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

Sinusoidal - Veno-occlusive disease. ***Sinusoidal - Veno-occlusive disease*** - **Veno-occlusive disease** (also known as sinusoidal obstruction syndrome) specifically affects the blood flow within the **sinusoids** of the liver [1]. - This obstruction at the sinusoidal level directly leads to **sinusoidal portal hypertension** [1]. *Post-hepatic - Schistosomiasis post sinusoidal* - **Schistosomiasis** primarily causes **presinusoidal portal hypertension**, specifically due to periportal fibrosis in the liver. - **Post-hepatic portal hypertension** typically involves obstruction *after* the liver sinusoids, such as in **Budd-Chiari syndrome** or right heart failure [1]. *Pre-hepatic - Portal vein presinusoidal thrombosis* - **Portal vein thrombosis** occurring *before* the liver sinusoids would indeed be classified as **pre-hepatic portal hypertension** [2]. - However, the description **"presinusoidal thrombosis"** describes the *location* of the thrombosis but does not inherently define it as pre-hepatic versus intrahepatic. **Pre-hepatic** explicitly means before the liver substance. *Intrahepatic - Cirrhosis presinusoidal* - **Cirrhosis** is a classic cause of **intrahepatic portal hypertension**, but the obstruction in cirrhosis is predominantly **sinusoidal and post-sinusoidal**, due to fibrosis and regenerating nodules [2]. - While some early fibrotic changes may have presinusoidal components, the dominant site of obstruction in established cirrhosis is at the sinusoidal and perisinusoidal levels, not strictly presinusoidal.

Q: Which one of the following is a secondary cause of headache?

Medication overuse headache. ### Medication overuse headache - This is a form of **secondary headache** caused by the chronic overuse of acute headache medications, which can lead to a *vicious cycle* of increasing headache frequency and medication use [1]. - It arises as a direct consequence of an **external factor** (medication overuse), distinguishing it from primary headache disorders [1]. *Tension-type headache* - This is a **primary headache disorder**, meaning the headache itself is the main problem and not a symptom of another condition [1]. - It is characterized by a **mild to moderate, bilateral, pressing or tightening pain** that is not aggravated by physical activity. *Migraine* - This is a **primary headache disorder** characterized by recurrent headaches affecting one side of the head, and often accompanied by symptoms such as **pulsating pain**, nausea, vomiting, and sensitivity to light and sound [1]. - While it can be debilitating, it is not caused by an **underlying structural or systemic disease**. *Trigeminal autonomic cephalalgia* - These are a group of **primary headache disorders** characterized by severe, strictly unilateral pain with associated **ipsilateral cranial autonomic symptoms** (e.g., conjunctival injection, lacrimation, nasal congestion) [1]. - Examples include cluster headache and paroxysmal hemicrania, and they are not caused by an identifiable **secondary cause**.

Q: A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Kayser-Fleisher rings in the cornea. Detailed clinical features point towards Wilson's disease. ***Kayser-Fleisher rings in the cornea*** - The history of **recurrent jaundice** and **facial grimacing** (likely dystonia/tremors) points towards a **neuropsychiatric disorder** with liver involvement, which is characteristic of **Wilson's disease** [1]. - **Kayser-Fleisher rings** are copper deposits in the Descemet's membrane of the cornea, a pathognomonic sign of Wilson's disease. *Adenoma sebaceum in the mid face* - **Adenoma sebaceum** (facial angiofibromas) is a characteristic skin lesion associated with **tuberous sclerosis complex**, which typically presents with seizures, intellectual disability, and characteristic skin lesions, not recurrent jaundice or facial grimacing indicative of movement disorders. - This condition does not primarily involve recurrent jaundice or movement disorders like facial grimacing. *Erythema nodosum on the skin* - **Erythema nodosum** is an inflammatory condition characterized by painful, red nodules, typically on the shins. - It is often associated with conditions like **sarcoidosis**, inflammatory bowel disease, infections, or drug reactions, and does not commonly present with recurrent jaundice and facial grimacing. *Osler's nodes at the finger tips* - **Osler's nodes** are painful, tender, red or purple lesions found on the fingertips and toes, indicative of **infective endocarditis**. - This symptom is related to immune complex deposition and systemic infection, rather than genetic disorders causing liver disease and neurological dysfunction.

Q: Which of the following statements are typical for classic heat stroke? I. Older patient II. Normokalemia III. Hyponatremia IV. Marked lactic acidosis Select the correct answer using the code given below :

I and III. ***I and III*** - **Older patients** are particularly susceptible to classic heat stroke due to impaired thermoregulation and reduced ability to acclimate to heat [1], [2]. - **Hyponatremia** can occur in classic heat stroke due to excessive fluid intake (often plain water) that dilutes serum sodium, or increased sodium loss through sweat. *II and IV* - **Normokalemia** is not typical in severe heat stroke, as **hyperkalemia** is more common due to **rhabdomyolysis** and **cellular damage**. - While metabolic acidosis is common, **marked lactic acidosis** is more characteristic of **exertional heat stroke** due to intense muscle activity, rather than classic heat stroke [1]. *I and II* - While **older patients** are a key risk factor for classic heat stroke [2], **normokalemia** is less typical, with **hyperkalemia** being a more frequent finding in severe cases. - **Normokalemia** would not adequately explain the electrolyte disturbances seen in severe heat stroke. *III and IV* - **Hyponatremia** is a common finding in classic heat stroke due to dilutional effects or sodium loss. - However, **marked lactic acidosis** is predominantly seen in **exertional heat stroke** rather than classic heat stroke, which is more associated with environmental heat exposure [1].

Q: Which of the following statements are correct regarding Weil's disease? I. It is caused by a virus named leptospira II. Acute kidney injury can lead to oliguria in this disease III. Microscopic agglutination is the investigation of choice IV. Ceftriaxone given parenterally is effective treatment Select the correct answer using the code given below :

II, III and IV. ***II, III and IV*** - **Weil's disease**, a severe form of leptospirosis, frequently causes **acute kidney injury (AKI)**, which can manifest as **oliguria** due to renal tubular damage and interstitial nephritis [2]. - The **microscopic agglutination test (MAT)** is considered the gold standard for diagnosing leptospirosis due to its high specificity and sensitivity in detecting specific antibodies against *Leptospira* serovars [2]. - **Ceftriaxone** is an effective parenteral antibiotic for treating severe leptospirosis, including Weil's disease, particularly when oral antibiotics are insufficient or the patient is critically ill. *I, II and III* - Statement I is incorrect because Weil's disease is caused by a **spirochete bacterium**, *Leptospira interrogans*, not a virus [1]. - While statements II and III are correct regarding **AKI and oliguria** and the utility of **MAT**, the incorrectness of statement I makes this option wrong. *I, III and IV* - Statement I is incorrect as Weil's disease is caused by a **bacterium** (*Leptospira*), not a virus [1]. - While statements III and IV are correct, the presence of an incorrect statement (I) makes this composite option incorrect. *I, II and IV* - Statement I is factually incorrect; Weil's disease is caused by the **bacterium *Leptospira***, not a virus [1]. - Although statements II and IV are correct—**AKI with oliguria** is a feature and **ceftriaxone** is a treatment—the fundamental error in statement I invalidates this option.

Q: Which of the following are components of SOFA scoring system? I. PaO_2 / FiO_2 ratio II. Mean arterial pressure III. Glasgow coma scale IV. Prothrombin Time with INR Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - The **Sequential Organ Failure Assessment (SOFA) score** evaluates organ dysfunction based on six systems: respiration, coagulation, liver, cardiovascular, central nervous system, and renal. - **PaO2/FiO2 ratio** assesses respiratory function, **Glasgow Coma Scale (GCS)** assesses central nervous system function [1], [3], and **Prothrombin Time with INR** assesses coagulation function, all of which are included in the SOFA score calculation. *I, II and IV* - This option incorrectly includes **Mean Arterial Pressure** as a primary component for calculating the cardiovascular SOFA score, though it is indirectly considered when evaluating the use of vasopressors [2]. - The SOFA cardiovascular component primarily relies on **vasopressor dosage** required to maintain blood pressure, rather than absolute mean arterial pressure alone. *II, III and IV* - This option omits the **PaO2/FiO2 ratio**, which is a crucial parameter for assessing respiratory organ dysfunction within the SOFA scoring system. - It incorrectly focuses on **Mean Arterial Pressure** as a direct component instead of the vasopressor requirement. *I, II and III* - This choice omits **Prothrombin Time (PT) with INR**, which is a vital indicator for assessing the **coagulation system** within the SOFA score. - It incorrectly includes **Mean Arterial Pressure** as a direct, standalone component rather than vasopressor support for the cardiovascular system.

Q: What are the components to establish the diagnosis of Brain Death? I. Absent brain stem reflexes II. Apnoea in presence of elevated PCO_2 III. Hypothermia IV. Irreversible and unresponsive coma Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - The diagnosis of **brain death** requires the demonstration of a complete and irreversible cessation of all brain and brainstem functions [2]. This includes **absent brainstem reflexes**, as the brainstem controls vital functions like breathing, pupil constriction, and gag reflex [3], [4]. - The **apnea test**, which involves demonstrating apnea in the presence of elevated PaCO2 (typically >60 mmHg or 20 mmHg above baseline), confirms irreversible loss of respiratory drive, a key brainstem function [4]. An **irreversible and unresponsive coma** signifies the complete loss of consciousness and cortical function [1]. *II and IV only* - This option is incomplete as it omits **absent brainstem reflexes**, which are crucial for the diagnosis of brain death and signify the loss of essential brainstem functions [3]. - While **apnea in the presence of elevated PaCO2** and **irreversible and unresponsive coma** are components, the absence of brainstem reflexes must also be confirmed [4]. *I, II and III* - This option incorrectly includes **hypothermia** as a diagnostic criterion for brain death. Hypothermia (<36°C) can mimic brain death by causing a reversible coma and suppressed brainstem reflexes, and thus must be excluded or corrected before brain death assessment [3]. - The diagnosis of brain death requires excluding conditions that can confound the clinical assessment, such as hypothermia or presence of central nervous system depressant drugs [3], [4]. *I, III and IV* - This option incorrectly includes **hypothermia** as a diagnostic criterion for brain death, which is a confounding factor that must be corrected before assessment [3]. - While **absent brainstem reflexes** and an **irreversible, unresponsive coma** are essential, the critical component of **apnea in the presence of elevated PaCO2** is missing, which is necessary to confirm the irreversible loss of respiratory drive [4].

Q: The most common cause for nontraumatic sub-arachnoid haemorrhage is

Saccular aneurysm rupture. ***Saccular aneurysm rupture*** - **Saccular (berry) aneurysms** are the most common cause of non-traumatic subarachnoid hemorrhage (SAH), accounting for about 85% of cases [1]. - Rupture of these aneurysms, often located at arterial bifurcations in the **Circle of Willis**, leads to sudden bleeding into the subarachnoid space [1]. *A-V malformation* - **Arteriovenous malformations (AVMs)** are a less common cause of non-traumatic SAH compared to saccular aneurysms. - While AVM rupture can cause SAH, it is typically responsible for a smaller percentage of cases. *Extension from primary intracerebral haemorrhage* - While an **intracerebral hemorrhage** can extend into the subarachnoid space, causing secondary SAH, this is not considered the primary or most common cause of non-traumatic SAH itself [2]. - The initial event for most SAH cases directly involves subarachnoid bleeding, not delayed extension from within the brain parenchyma. *Idiopathic* - An **idiopathic** diagnosis means the cause is unknown, which is only assigned after all known causes, such as aneurysm rupture or AVM, have been ruled out. - Given the high prevalence of saccular aneurysm rupture as a cause, true idiopathic SAH is relatively rare.

Question 1

In clinical assessment of an elderly patient, 'the get up and go test' is used to evaluate which of the following?

Accepted Answer

Gait and balance

Answer

Cognition

Answer

Urinary incontinence

Answer

Driving ability

Question 2

Which one of the following is a contraindication to wireless capsule endoscopy?

Accepted Answer

Small bowel stricture

Answer

Small bowel Crohn's disease

Answer

Coeliac disease

Answer

Obscure gastrointestinal bleeding

Question 3

Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

Accepted Answer

Sinusoidal - Veno-occlusive disease

Answer

Post-hepatic - Schistosomiasis post sinusoidal

Answer

Pre-hepatic - Portal vein presinusoidal thrombosis

Answer

Intrahepatic - Cirrhosis presinusoidal

Question 4

Which one of the following is a secondary cause of headache?

Accepted Answer

Medication overuse headache

Answer

Tension-type headache

Answer

Migraine

Answer

Trigeminal autonomic cephalalgia

Question 5

A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Accepted Answer

Kayser-Fleisher rings in the cornea

Answer

Adenoma sebaceum in the mid face

Answer

Erythema nodosum on the skin

Answer

Osler's nodes at the finger tips

Question 6

Which of the following statements are typical for classic heat stroke?
I. Older patient
II. Normokalemia
III. Hyponatremia
IV. Marked lactic acidosis

Select the correct answer using the code given below :

Accepted Answer

I and III

Answer

II and IV

Answer

I and II

Answer

III and IV

Question 7

Which of the following statements are correct regarding Weil's disease?
I. It is caused by a virus named leptospira
II. Acute kidney injury can lead to oliguria in this disease
III. Microscopic agglutination is the investigation of choice
IV. Ceftriaxone given parenterally is effective treatment

Select the correct answer using the code given below :

Accepted Answer

II, III and IV

Answer

I, II and III

Answer

I, III and IV

Answer

I, II and IV

Question 8

Which of the following are components of SOFA scoring system?
I. PaO_2 / FiO_2 ratio
II. Mean arterial pressure
III. Glasgow coma scale
IV. Prothrombin Time with INR

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

I, II and IV

Answer

II, III and IV

Answer

I, II and III

Question 9

What are the components to establish the diagnosis of Brain Death?
I. Absent brain stem reflexes
II. Apnoea in presence of elevated PCO_2
III. Hypothermia
IV. Irreversible and unresponsive coma

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II and IV only

Answer

I, II and III

Answer

I, III and IV

Question 10

The most common cause for nontraumatic sub-arachnoid haemorrhage is

Accepted Answer

Saccular aneurysm rupture

Answer

A-V malformation

Answer

Extension from primary intracerebral haemorrhage

Answer

Idiopathic

UPSC-CMS 2025 — Internal Medicine