UPSC-CMS 2025 — Internal Medicine

67 Questions — Page 7 of 7

Q61

Vibration white finger refers to :

Q62

A 45 -year-old lady presents with complaints of fatigue, muscle weakness along with bilateral multiple renal calculi which were picked up on a routine ultrasound. Further workup revealed serum calcium levels of 11.4 mg %. What is the next best investigation required to arrive at a diagnosis?

Q63

Which of the following statements are correct regarding a brain abscess? I. Abscesses arise when the brain is exposed directly as a result of fracture or infection of air sinus. II. Presenting features include low grade fever, confusion, seizures and focal deficits. III. MRI with contrast is the initial imaging modality of choice. IV. The aetological agents include bacteria, fungi, protozoa and viruses. Select the answer using the code given below :

Q64

A 60 -year-old female presents with pain in her back of recent onset, which has become severe of late. During the course of investigations, she was found to have lytic lesions in the vertebrae and ribs. Which of the following organs should be carefully screened now for detecting the primary cause of these lesions?

Q65

Which of the following statements are correct regarding Cauda equine syndrome? I. Its presenting symptoms are perineal numbness, painless urinary retention and fecal incontinence. II. Urgent investigation with MRI is required. III. It is present most commonly in the 45-60 year age group. IV. Confirmed cases require early surgical decompression. Select the answer using the code given below :

Q66

Which of the following treatments are recommended for a pregnant woman suffering from sickle cell disease ? I. Folic acid 1 mg daily II. Azathioprine III. Penicillin prophylaxis IV. Thromboprophylaxis with low molecular weight heparin Select the correct answer using the code given below :

Q67

Consider the following statements regarding Wernicke's encephalopathy : I. It is caused by niacin deficiency. II. It is often seen in alcoholics. III. Ophthalmoplegia, polyneuritis and ataxia are some of its characteristic features. IV. It occurs occasionally in people who fast. Which of the statements given above are correct?

UPSC-CMS 2025 - Internal Medicine UPSC-CMS Practice Questions and MCQs

Question 61: Vibration white finger refers to :

A. Acrocyanosis
B. Raynaud's syndrome (Correct Answer)
C. Buerger's disease
D. Takayasu disease

Explanation: ***Raynaud's syndrome*** - **Vibration White Finger** is a form of secondary Raynaud's phenomenon, specifically caused by occupational exposure to high levels of **vibration**. [2] - It is characterized by **vasoconstriction** of the digital arteries, leading to episodic **finger blanching**, numbness, and tingling, often triggered by cold or stress. [2] *Acrocyanosis* - This condition involves persistent, painless **cyanosis** of the hands and feet, particularly in cold weather. - Unlike Raynaud's, acrocyanosis does not typically involve a triphasic color change (white, blue, red) and is generally **benign**. *Buerger's disease* - Also known as **thromboangiitis obliterans**, this is an inflammatory disease of small and medium-sized arteries and veins, mainly affecting the **limbs**. - It is strongly associated with **tobacco use** and can lead to gangrene and amputation, but its primary presentation is not vibration-induced. *Takayasu disease* - This is a form of **large-vessel vasculitis** primarily affecting the aorta and its major branches. [1] - It can lead to absent pulses, discrepancies in blood pressure between limbs, and systemic symptoms, but it is not directly related to vibration-induced digital vasoconstriction.

Question 62: A 45 -year-old lady presents with complaints of fatigue, muscle weakness along with bilateral multiple renal calculi which were picked up on a routine ultrasound. Further workup revealed serum calcium levels of 11.4 mg %. What is the next best investigation required to arrive at a diagnosis?

A. MRI neck
B. CECT head and neck
C. NCCT head and neck
D. Sestamibi scan (Correct Answer)

Explanation: ***Sestamibi scan*** - A **Sestamibi scan** is the preferred imaging modality for localizing a parathyroid adenoma [1], which is the most common cause of **primary hyperparathyroidism**. - **Primary hyperparathyroidism** often presents with **hypercalcemia** (serum calcium 11.4 mg%), **renal calculi** [1], fatigue, and muscle weakness, as described in the patient. *MRI neck* - While an MRI can visualize neck structures, it is **less specific** for identifying small parathyroid adenomas compared to a Sestamibi scan. - It might be used in cases where other imaging modalities are inconclusive but is not the initial best investigation. *CECT head and neck* - **CECT (Contrast-Enhanced Computed Tomography)** is not the primary choiceto locate parathyroid adenomas as it involves radiation and intravenous contrast, which may not be necessary. - Parathyroid adenomas can be small and difficult to differentiate from thyroid tissue or lymph nodes on CECT alone. *NCCT head and neck* - **NCCT (Non-Contrast Computed Tomography)** is even less effective than CECT for localizing parathyroid adenomas as it lacks the discriminatory power of contrast enhancement. - It would mainly show bony structures and calcifications, which are not helpful for identifying a glandular adenoma.

Question 63: Which of the following statements are correct regarding a brain abscess? I. Abscesses arise when the brain is exposed directly as a result of fracture or infection of air sinus. II. Presenting features include low grade fever, confusion, seizures and focal deficits. III. MRI with contrast is the initial imaging modality of choice. IV. The aetological agents include bacteria, fungi, protozoa and viruses. Select the answer using the code given below :

A. I, III and IV
B. I, II and III (Correct Answer)
C. I, II and IV
D. II, III and IV

Explanation: I, II and III - This option correctly identifies that brain abscesses can result from direct exposure due to fractures or sinus infections [1], present with symptoms like fever, confusion, seizures, and focal deficits, and are best initially imaged with MRI with contrast. - While bacteria, fungi, and protozoa are common causes of brain abscesses, viruses are generally not a primary cause of brain abscess formation [1], making statement IV incorrect in its broad inclusion of viruses. I, III and IV - This option incorrectly includes statement IV, which claims viruses are etiological agents for brain abscesses. While viruses cause CNS infections, they typically lead to meningitis or encephalitis [1], not abscesses. - It also omits statement II, which accurately describes the common clinical presentation of brain abscesses, including symptoms like confusion and focal deficits. I, II and IV - This option incorrectly includes statement IV, which states that viruses are common etiologic agents for brain abscesses. Brain abscesses are primarily caused by bacteria, fungi, and parasites [1]. - It omits statement III, which correctly identifies MRI with contrast as the initial imaging modality of choice, crucial for diagnosis due to its superior soft tissue resolution. II, III and IV - This option incorrectly includes statement IV, which suggests viruses are among the etiologic agents. Viral infections of the brain typically manifest as encephalitis or meningitis [1], not abscesses. - It omits statement I, which correctly describes common routes of infection, including direct extension from adjacent structures like infected sinuses or trauma [1].

Question 64: A 60 -year-old female presents with pain in her back of recent onset, which has become severe of late. During the course of investigations, she was found to have lytic lesions in the vertebrae and ribs. Which of the following organs should be carefully screened now for detecting the primary cause of these lesions?

A. Large intestine
B. Breast (Correct Answer)
C. Adrenal
D. Small intestine

Explanation: **Breast** - **Breast cancer** is a common primary malignancy in women that frequently metastasizes to bone, causing **lytic lesions** in the vertebrae and ribs [4]. - The patient's age (60-year-old female) and the presence of severe, recent-onset back pain with multiple lytic lesions strongly suggest metastatic disease [2], with **breast cancer** being a top differential [4]. *Large intestine* - While **colorectal cancer** can metastasize to bone, it typically causes mixed lytic and blastic lesions or predominantly blastic lesions, rather than purely lytic lesions. - Furthermore, the frequency of bone metastases from colorectal cancer is generally lower compared to breast or lung primary tumors [1]. *Adrenal* - Primary **adrenal tumors** (e.g., adrenal cortical carcinoma, pheochromocytoma) rarely metastasize to bone and are not a common cause of diffuse lytic bone lesions. - Bone metastases from adrenal cancers are much less frequent and typically associated with advanced, aggressive disease [3]. *Small intestine* - **Small bowel malignancies** (e.g., adenocarcinomas, neuroendocrine tumors) rarely metastasize to bone. - When they do, the pattern of bone involvement is variable but less commonly presents as widespread lytic lesions in the spine and ribs without other systemic symptoms.

Question 65: Which of the following statements are correct regarding Cauda equine syndrome? I. Its presenting symptoms are perineal numbness, painless urinary retention and fecal incontinence. II. Urgent investigation with MRI is required. III. It is present most commonly in the 45-60 year age group. IV. Confirmed cases require early surgical decompression. Select the answer using the code given below :

A. I, II and III
B. I, III and IV
C. I, II and IV (Correct Answer)
D. II, III and IV

Explanation: ***I, II and IV*** - Perineal numbness leading to **saddle anesthesia**, painless urinary retention, and fecal incontinence are classic red-flag symptoms of **cauda equina syndrome (CES)** indicating compression of the nerve roots [1]. - Early diagnosis via **urgent MRI** and prompt surgical decompression are critical to prevent permanent neurological deficits due to irreversible nerve damage [2]. *I, II and III* - While statements I and II are correct, statement III is inaccurate as CES can affect adults of any age due to various causes like **herniated discs** [1] or trauma [2]. - **Urgent intervention** is prioritized over age group considerations in managing this condition [2]. *I, III and IV* - Although statements I and IV are correct, statement III incorrectly restricts CES to a specific age group, as it can occur across a **broad age spectrum**. - The primary focus in CES is on symptom recognition and **rapid surgical intervention** [2]. *II, III and IV* - While statements II and IV are correct, statement III is factually incorrect regarding the typical age of presentation for Cauda Equina Syndrome. - **Accurate identification of symptoms** (statement I) is crucial for triggering the necessary urgent investigations and treatment [1].

Question 66: Which of the following treatments are recommended for a pregnant woman suffering from sickle cell disease ? I. Folic acid 1 mg daily II. Azathioprine III. Penicillin prophylaxis IV. Thromboprophylaxis with low molecular weight heparin Select the correct answer using the code given below :

A. I, II and IV
B. I, III and IV (Correct Answer)
C. I, II and III
D. II, III and IV

Explanation: ***I, III and IV*** - **Folic acid 5 mg daily** (not 1mg) is essential in pregnancy, especially for women with **sickle cell disease**, to prevent **megaloblastic anemia** due to increased red cell turnover [1]. - **Penicillin prophylaxis** is crucial to prevent **Bacterial infections** as patients with sickle cell disease are at increased risk of infection, especially from encapsulated organisms, due to **functional asplenia** [1]. - **Thromboprophylaxis with low molecular weight heparin** is recommended because pregnancy in sickle cell disease significantly increases the risk of **venous thromboembolism** [1]. *I, II and IV* - **Azathioprine** is an immunosuppressant typically used for autoimmune conditions or organ transplantation, and it is **not a standard treatment** for managing sickle cell disease itself during pregnancy. - While folic acid and thromboprophylaxis are indicated, the inclusion of azathioprine makes this option incorrect. *I, II and III* - This option incorrectly includes **azathioprine**, an immunosuppressant not indicated for routine sickle cell management in pregnancy. - It also omits crucial **thromboprophylaxis**, which is vital given the increased risk of blood clots. *II, III and IV* - This option correctly includes **penicillin prophylaxis** and **thromboprophylaxis** but **incorrectly omits folic acid**, which is a cornerstone of daily management for all pregnant women with sickle cell disease. - It also incorrectly includes **azathioprine**, which is not a standard treatment.

Question 67: Consider the following statements regarding Wernicke's encephalopathy : I. It is caused by niacin deficiency. II. It is often seen in alcoholics. III. Ophthalmoplegia, polyneuritis and ataxia are some of its characteristic features. IV. It occurs occasionally in people who fast. Which of the statements given above are correct?

A. II, III and IV (Correct Answer)
B. I, III and IV
C. I, II and III
D. I, II and IV

Explanation: ***II, III and IV*** - Wernicke's encephalopathy is primarily caused by **thiamine (vitamin B1) deficiency**, not niacin [1]. It is indeed often seen in **alcoholics** due to poor nutrition and impaired thiamine absorption [1], [3]. - The classic triad of Wernicke's encephalopathy includes **ophthalmoplegia** (often nystagmus or gaze palsies), **ataxia**, and **confusion** (or global confusion), and polyneuritis is also associated with chronic thiamine deficiency [2]. It can occur in people who fast or have other conditions leading to severe malnutrition. *I, III and IV* - This option incorrectly states that Wernicke's encephalopathy is caused by **niacin deficiency**. Niacin deficiency causes **pellagra**. - The remaining statements regarding its occurrence in alcoholics, characteristic features (including polyneuritis), and occurrence in people who fast are correct. *I, II and III* - This option incorrectly attributes the cause of Wernicke's encephalopathy to **niacin deficiency**. - While statements II and III are correct regarding its association with alcoholism and its characteristic features [1], [2], the error in statement I makes this option incorrect. *I, II and IV* - This option is incorrect because it states that Wernicke's encephalopathy is caused by **niacin deficiency**. - While the statements regarding its occurrence in alcoholics and in people who fast are accurate, statement I is fundamentally false.