Which of the following statements are correct regarding hypernatremia in children? I. Diabetes insipidus due to a deficiency of antidiuretic hormone (ADH) may cause hypernatremia II. Addison disease may be associated with hypernatremia III. Use of boiled skimmed milk can lead to hypernatremia IV. Use of lactulose can lead to hypernatremia Select the answer using the code given below :
Which of the following are causes of hypocalcemia in a child? I. Hypomagnesemia II. Hypophosphatemia III. Metabolic acidosis IV. Pseudohypoparathyroidism Select the correct answer using the code given below :
Which of the following are correct regarding late dumping? I. It usually occurs during the second hour after meal. II. It lasts for 30-40 minutes. III. Major symptoms are tremor, faintness, prostration IV. It is relieved by lying down. Select the answer using the code given below :
Which one of the following statements is not correct regarding Gastric outlet obstruction associated with long standing peptic ulcer disease?
Which of the following are the symptoms commonly experienced by patients with lymphoedema? I. Swelling II. Burning sensation III. Intolerance to cold IV. Cramps Select the correct answer using the code given below :
Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?
Which of the following are considered aetiological factors for Adenocarcinoma oesophagus? I. Barrett's oesophagus II. Gastro-oesophageal reflux III. Obesity IV. Alcohol intake Select the correct answer using the code given below :
Consider the following statements regarding Plummer-Vinson syndrome : I. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia. II. It is a rare disease, mainly affecting middle-aged women. III. There is predisposition to postcricoid, cervical oesophageal cancer. IV. Treatment is usually surgical. Which of the statements given above are correct?
The commonest site of pressure sore is :
Which one of following statements is correct regarding Budd-Chiari Syndrome (BCS)?
UPSC-CMS 2025 - Internal Medicine UPSC-CMS Practice Questions and MCQs
Question 51: Which of the following statements are correct regarding hypernatremia in children? I. Diabetes insipidus due to a deficiency of antidiuretic hormone (ADH) may cause hypernatremia II. Addison disease may be associated with hypernatremia III. Use of boiled skimmed milk can lead to hypernatremia IV. Use of lactulose can lead to hypernatremia Select the answer using the code given below :
- A. II, III and IV
- B. I, III and IV (Correct Answer)
- C. I, II and IV
- D. I, II and III
Explanation: ***I, III and IV*** - **Diabetes insipidus**, whether central (deficient ADH) or nephrogenic (renal unresponsiveness to ADH), leads to excessive free water loss, causing **hypernatremia** if fluid intake does not compensate [1]. - **Boiled skimmed milk** for infants can have a high solute load (especially sodium and protein) and inadequate free water, overwhelming immature renal capacity and leading to **dehydration** and **hypernatremia**. - **Lactulose** is an osmotic laxative that draws water into the colon, which can lead to **dehydration** and potentially **hypernatremia** if significant fluid losses occur, especially in vulnerable populations like infants or the elderly. *II, III and IV* - **Addison's disease** (adrenocortical insufficiency) typically causes **hyponatremia** due to mineralocorticoid deficiency leading to renal sodium wasting and potassium retention, not hypernatremia [2]. - **Boiled skimmed milk** for infants can have a high solute load and inadequate free water, overwhelming immature renal capacity and leading to dehydration and hypernatremia. - **Lactulose** is an osmotic laxative that draws water into the colon, which can lead to dehydration and potentially hypernatremia if significant fluid losses occur. *I, II and IV* - **Diabetes insipidus**, due to a deficiency of ADH, causes uncompensated free water loss and thus **hypernatremia**. - **Addison's disease** usually causes **hyponatremia** due to impaired sodium reabsorption in the renal tubules, not hypernatremia [2]. - **Lactulose** can cause significant osmotic diarrhea, leading to free water loss and subsequent **hypernatremia** if not adequately replaced. *I, II and III* - **Diabetes insipidus** involves a lack of ADH, leading to unchecked water excretion and subsequent **hypernatremia** [1]. - **Addison's disease** leads to adrenal insufficiency, causing **hyponatremia** and hyperkalemia due to aldosterone deficiency [2]. - Feeding infants **boiled skimmed milk**, which is high in solute content and low in free water, can lead to increased renal solute load and excessive water loss, resulting in **hypernatremia**.
Question 52: Which of the following are causes of hypocalcemia in a child? I. Hypomagnesemia II. Hypophosphatemia III. Metabolic acidosis IV. Pseudohypoparathyroidism Select the correct answer using the code given below :
- A. II and III
- B. I and II
- C. I and IV (Correct Answer)
- D. III and IV
Explanation: ***I and IV*** - **Hypomagnesemia** impairs parathyroid hormone (PTH) secretion and causes target organ resistance to PTH, leading to hypocalcemia. - **Pseudohypoparathyroidism** is a genetic disorder where target organs are resistant to PTH, resulting in hypocalcemia and hyperphosphatemia despite normal or elevated PTH levels [1]. *II and III* - **Hypophosphatemia** is typically associated with **hypercalcemia** rather than hypocalcemia, as phosphate binds to calcium [3]. - **Metabolic acidosis** often causes an increase in **ionized calcium** (the physiologically active form) due to reduced protein binding, rather than overall hypocalcemia. *I and II* - While **hypomagnesemia** causes hypocalcemia, **hypophosphatemia** is generally associated with hypercalcemia, making this option incorrect [2]. - Hypophosphatemia reduces the formation of calcium-phosphate complexes, thus increasing free calcium levels. *III and IV* - **Pseudohypoparathyroidism** does cause hypocalcemia, but **metabolic acidosis** typically leads to higher ionized calcium levels, not hypocalcemia. - The compensatory mechanisms for acidosis tend to mobilize calcium from bone, further counteracting hypocalcemia.
Question 53: Which of the following are correct regarding late dumping? I. It usually occurs during the second hour after meal. II. It lasts for 30-40 minutes. III. Major symptoms are tremor, faintness, prostration IV. It is relieved by lying down. Select the answer using the code given below :
- A. I, III and IV
- B. II, III and IV
- C. I, II and III (Correct Answer)
- D. I, II and IV
Explanation: ***I, II and III*** - Late dumping syndrome typically manifests **1 to 3 hours after a meal** (usually around the second hour), triggered by rapid carbohydrate absorption leading to hyperinsulinemia and subsequent hypoglycemia. - The symptoms, which include **tremor, faintness, prostration, sweating, and confusion**, are due to hypoglycemia and usually last for **30-60 minutes**. *I, III and IV* - This option is incorrect because lying down generally **does not relieve symptoms** of late dumping syndrome; instead, consuming a small amount of sugar or glucose is recommended to raise blood glucose levels. - While I and III are correct, the inclusion of IV makes this option incorrect. *II, III and IV* - This option is incorrect because statement IV, suggesting relief by lying down, is **false** for late dumping syndrome. - Additionally, statement I "It usually occurs during the second hour after meal" is an accurate description of late dumping, which this option omits. *I, II and IV* - This option is incorrect because statement IV, which claims symptoms are relieved by lying down, is **inaccurate** for late dumping syndrome. - While I and II are correct, the inclusion of IV makes this option incorrect regarding the characteristic management or relief of late dumping.
Question 54: Which one of the following statements is not correct regarding Gastric outlet obstruction associated with long standing peptic ulcer disease?
- A. Medical therapy has no role in the treatment of this condition. (Correct Answer)
- B. Endoscopic biopsy is essential to exclude malignancy.
- C. Hypochloraemic alkalosis is the usual metabolic abnormality in such cases.
- D. Operation is frequently required along with a drainage procedure.
Explanation: ***Medical therapy has no role in the treatment of this condition.*** - This statement is incorrect because **medical management**, including **proton pump inhibitors (PPIs)**, can be effective in reducing inflammation and ulcer healing, which may alleviate symptoms of **gastric outlet obstruction (GOO)**, especially in cases where the obstruction is due to an active ulcer and associated edema. - While surgery is often required for persistent or severe obstruction, initial medical therapy can be attempted to confirm the reversibility of the obstruction or to optimize the patient's condition before surgical intervention. *Endoscopic biopsy is essential to exclude malignancy.* [1] - **Endoscopic biopsy** is crucial because **malignancy** (e.g., gastric adenocarcinoma) can present with symptoms similar to peptic ulcer disease and lead to **gastric outlet obstruction**. - Distinguishing between benign and malignant causes is critical for appropriate management, as the treatment strategies differ significantly. [1] *Hypochloraemic alkalosis is the usual metabolic abnormality in such cases.* [1] - **Hypochloremic alkalosis** occurs due to the repeated **vomiting of gastric contents**, which are rich in hydrochloric acid. [1] - This loss of acid and chloride, along with fluid depletion, leads to increased bicarbonate retention by the kidneys and can cause a metabolic alkalosis with low chloride levels. *Operation is frequently required along with a drainage procedure.* [1] - When medical therapy fails or the obstruction is severe due to **scarring and fibrosis** from chronic peptic ulcer disease, surgical intervention is often necessary. - A drainage procedure, such as **gastrojejunostomy**, is performed to bypass the obstructed pylorus and restore gastric emptying.
Question 55: Which of the following are the symptoms commonly experienced by patients with lymphoedema? I. Swelling II. Burning sensation III. Intolerance to cold IV. Cramps Select the correct answer using the code given below :
- A. I, II and III
- B. II, III and IV
- C. I, III and IV
- D. I, II and IV (Correct Answer)
Explanation: ***I, II and IV*** - **Swelling**, **burning sensation**, and **cramps** are common symptoms reported by patients with lymphedema, reflecting the impaired lymphatic drainage and associated tissue changes. - **Swelling** is the hallmark symptom, often accompanied by discomfort, pain, and sensory disturbances like burning or numbness, and muscle cramps are also frequently reported. *I, II and III* - While **swelling** and a **burning sensation** are typical, **intolerance to cold** is not a characteristic symptom of lymphedema. - **Intolerance to cold** is more commonly associated with conditions like **Raynaud's phenomenon** or **hypothyroidism**, not directly with lymphatic dysfunction. *I, III and IV* - Although **swelling** and **cramps** are common, **intolerance to cold** is not a primary symptom of lymphedema. - The cardinal signs of lymphedema relate to fluid accumulation and tissue changes, not systemic temperature dysregulation. *II, III and IV* - While a **burning sensation** and **cramps** can occur, the most prominent and always present symptom of lymphedema, **swelling**, is missing from this option. - **Intolerance to cold** is not characteristic of lymphedema, making this option less accurate.
Question 56: Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?
- A. High resolution manometry (Correct Answer)
- B. Upper GI endoscopy
- C. Contrast enhanced CT scan (CECT) oesophagus
- D. Barium swallow
Explanation: ***High resolution manometry*** - **High-resolution manometry (HRM)** is considered the **gold standard** for diagnosing oesophageal motility disorders because it provides detailed, real-time pressure topography of the entire oesophagus during swallowing [1]. - It allows for precise identification and classification of conditions such as **achalasia**, diffuse oesophageal spasm, and **scleroderma oesophagus** based on objective metrics [1]. *Upper GI endoscopy* - While essential for evaluating **mucosal abnormalities** and ruling out structural causes (e.g., tumours, strictures), it does not directly assess oesophageal motility [1]. - An **endoscopy** provides visual information but cannot quantify or characterize the contractile function of the oesophageal muscle [1]. *Contrast enhanced CT scan (CECT) oesophagus* - A **CECT scan** is primarily used for evaluating **extramural compression**, mediastinal involvement, or the presence of mass lesions, not for assessing the functional contractions of the oesophagus. - It provides anatomical information but offers very limited insight into the dynamic pressure changes associated with **oesophageal peristalsis**. *Barium swallow* - A **barium swallow** can suggest motility disorders by visualizing the passage of contrast and identifying abnormalities like **tertiary contractions** or delayed emptying, but it is less precise than manometry [1]. - It provides an anatomical overview and may show gross motility disturbances, but it lacks the quantitative and detailed pressure data that **HRM** offers for definitive diagnosis [1].
Question 57: Which of the following are considered aetiological factors for Adenocarcinoma oesophagus? I. Barrett's oesophagus II. Gastro-oesophageal reflux III. Obesity IV. Alcohol intake Select the correct answer using the code given below :
- A. I, II and IV
- B. II, III and IV
- C. I, II and III (Correct Answer)
- D. I, III and IV
Explanation: ***I, II and III*** - **Barrett's oesophagus** is a known precursor to **oesophageal adenocarcinoma** due to **metaplasia** of the squamous epithelium to columnar epithelium with goblet cells, increasing the risk of dysplasia and subsequent cancer [1]. - **Gastro-oesophageal reflux disease (GERD)** is a major risk factor, as chronic reflux of gastric acid can lead to inflammation, oesophagitis, and eventually **Barrett's oesophagus** [1]. - **Obesity** is strongly associated with an increased risk of **oesophageal adenocarcinoma**, primarily through its links to **GERD** and increased intra-abdominal pressure [1]. *I, II and IV* - This option correctly identifies **Barrett's oesophagus** and **gastro-oesophageal reflux** as risk factors. - However, **alcohol intake** is not as strongly linked to **oesophageal adenocarcinoma** as it is to squamous cell carcinoma of the oesophagus [1]. *II, III and IV* - This option correctly identifies **gastro-oesophageal reflux** and **obesity** as risk factors. - However, it incorrectly includes **alcohol intake** as a primary risk factor for **adenocarcinoma**, and incorrectly omits **Barrett's oesophagus**, which is a direct precursor. *I, III and IV* - This option correctly identifies **Barrett's oesophagus** and **obesity** as risk factors. - However, it incorrectly includes **alcohol intake** and omits **gastro-oesophageal reflux**, which is a fundamental link between obesity, Barrett's, and adenocarcinoma.
Question 58: Consider the following statements regarding Plummer-Vinson syndrome : I. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia. II. It is a rare disease, mainly affecting middle-aged women. III. There is predisposition to postcricoid, cervical oesophageal cancer. IV. Treatment is usually surgical. Which of the statements given above are correct?
- A. I, II and III (Correct Answer)
- B. I, II and IV
- C. II, III and IV
- D. I, III and IV
Explanation: **I, II and III** - **Plummer-Vinson syndrome** is characterized by the triad of **dysphagia**, **iron deficiency anemia**, and an **esophageal web**, typically in the **cervical esophagus**. - It predominantly affects **middle-aged women** and is associated with an increased risk of **postcricoid esophageal cancer**. *I, II and IV* - While statements I and II are correct, statement IV is incorrect because the primary treatment for Plummer-Vinson syndrome is usually medical management of **iron deficiency** and endoscopic dilation of the web, not surgery. - Surgical intervention is generally reserved for complications or malignancy. *II, III and IV* - While statements II and III are correct, statement IV is incorrect as surgery is not the usual first-line treatment for Plummer-Vinson syndrome. - Statement I, which describes the characteristic findings of the syndrome, is also correct and is excluded from this option. *I, III and IV* - While statements I and III are correct, statement IV regarding surgical treatment is incorrect. - The syndrome is indeed rare and mainly affects middle-aged women, making statement II correct, which is excluded from this option.
Question 59: The commonest site of pressure sore is :
- A. Sacrum
- B. Heel (Correct Answer)
- C. Ischium
- D. Occiput
Explanation: ***Heel*** - The **heel** is a common site for pressure sore development, especially in bedridden or immobile patients, due to sustained pressure on the bony prominence. - While less common as the *most* common site compared to the sacrum, it is still very frequently affected and can be equally severe. *Sacrum* - The **sacrum** is the *most common site* for pressure ulcers, particularly in individuals who are bed-bound or spend prolonged periods in a supine position. - This area experiences high pressure when lying on the back due to the body's weight pressing down on the bony prominence of the sacrum [1]. *Ischium* - The **ischial tuberosities** are common sites for pressure sores in individuals who are wheelchair-bound or spend extended periods in a seated position. - Pressure on this area is particularly high when sitting, making it vulnerable to tissue damage. *Occiput* - The **occiput** (back of the head) is a common site for pressure sores in infants, critically ill patients, or individuals who are supine for extended periods and unable to reposition their heads. - This is due to sustained pressure on the bony prominence of the skull against the mattress or support surface.
Question 60: Which one of following statements is correct regarding Budd-Chiari Syndrome (BCS)?
- A. Abdominal discomfort and ascites are the main presenting features. (Correct Answer)
- B. Venous drainage of the liver is occluded by IVC thrombus.
- C. It principally affects young males.
- D. Quadrate lobe (Segment 4) undergoes hypertrophy.
Explanation: ***Abdominal discomfort and ascites are the main presenting features.*** - **Budd-Chiari syndrome** is characterized by the obstruction of hepatic venous outflow, leading to increased sinusoidal pressure, liver congestion, and eventually **ascites** and **abdominal discomfort** due to liver enlargement and peritoneal fluid. - The rapid accumulation of **ascites** is a hallmark symptom, often accompanied by hepatomegaly and jaundice. *Venous drainage of the liver is occluded by IVC thrombus.* - While Budd-Chiari syndrome involves obstruction of hepatic venous outflow, the primary site of occlusion is typically the **hepatic veins** themselves, not the **inferior vena cava (IVC)** alone [1]. - Though IVC obstruction can occur, it's not the defining feature of Budd-Chiari syndrome; the key is the involvement of the hepatic veins [1]. *It principally affects young males.* - **Budd-Chiari syndrome** can affect individuals of any age or gender, but it often has a predilection for **young to middle-aged women**, especially those with predisposing conditions like oral contraceptive use or hypercoagulable states. - The clinical presentation is more diverse and not exclusively tied to a specific gender or age group. *Quadrate lobe (Segment 4) undergoes hypertrophy.* - In Budd-Chiari syndrome, typically the **caudate lobe (Segment 1)** is spared from outflow obstruction due to its direct drainage into the IVC, leading to its compensatory hypertrophy. - Other liver segments, including the quadrate lobe (Segment 4), usually experience relative atrophy or normal size compared to the hypertrophied caudate lobe.