UPSC-CMS 2025 - General Medicine PYQs Practice Questions

Q: A 46 year old lady on vegan diet for a decade presents with chief complaints of tingling and numbness in lower limbs for two months and a history of swaying while walking through narrow corridors. Which one of the following blood tests is advisable for diagnosis in this patient?

Vitamin B12 levels. ***Vitamin B12 levels*** - A **vegan diet** for an extended period puts patients at high risk for **vitamin B12 deficiency**, as B12 is primarily found in animal products [1]. - Symptoms like **tingling, numbness (paresthesias)**, and **impaired gait (ataxia)** are classic neurological manifestations of severe vitamin B12 deficiency, often due to **subacute combined degeneration** of the spinal cord [1]. *Serum protein electrophoresis* - This test is used to detect and quantify various proteins in the serum, primarily for suspected **monoclonal gammopathies** like multiple myeloma or Waldenström macroglobulinemia. - Her symptoms are primarily neurological and directly attributable to her dietary choices, making ser um protein electrophoresis less relevant as an initial diagnostic step. *Vitamin 25(OH) D level* - While vegans are at risk for **vitamin D deficiency** due to limited dietary sources and insufficient sun exposure, the primary symptoms of vitamin D deficiency are typically **bone pain, muscle weakness**, or fatigue, not the present neurological signs [2]. - Although vitamin D deficiency can cause non-specific neurological symptoms, the specific combination of paresthesia and ataxia in a long-term vegan points more strongly to B12 deficiency. *Anti-gliadin antibodies* - These antibodies are ordered to screen for **celiac disease**, an autoimmune disorder triggered by gluten consumption. - While celiac disease can present with neurological symptoms, there is no information in the patient's history to suggest a malabsorption disorder other than dietary restrictions, and her strict vegan diet directly points to a lack of B12. [Practice more General Medicine PYQs on OnCourse]

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]. [Practice more General Medicine PYQs on OnCourse]

Q: Which of the following combinations of lab test results is indicative of heavy alcohol consumption, with more than 60 % sensitivity and specificity?

GGT >35 U / L and CDT >20 U / L. ***GGT >35 U / L and CDT >20 U / L*** - Elevated **gamma-glutamyl transferase (GGT)** is a **sensitive marker for liver damage** and enzyme induction from alcohol use [1]. - **Carbohydrate-deficient transferrin (CDT)** is a specific and sensitive biomarker for **chronic heavy alcohol consumption**, with levels above 20 U/L indicating heavy intake. *Gamma glutamyl transferase (GGT) >35 U / L and alkaline phosphatase >45 U / L* - While elevated **GGT** can indicate alcohol use, **alkaline phosphatase (ALP)** primarily reflects **cholestasis** or bone disease and is not a specific marker for alcohol consumption [1]. - The combination of only these two markers lacks the high sensitivity and specificity for heavy alcohol consumption compared to the inclusion of CDT. *High normal MCV >91 fL and CDT 20 U / L and serum uric acid 20 U/L** is a strong indicator of heavy alcohol use, **serum uric acid** levels are commonly *elevated* in chronic alcohol consumption, not decreased. - Alcohol metabolism can lead to hyperuricemia (elevated uric acid), making a lower level of uric acid inconsistent with heavy drinking. [Practice more General Medicine PYQs on OnCourse]

Q: Consider the following statements with regard to the treatment of vitamin A deficiency : I. Repeated high doses of retinol can cause liver damage and teratogenicity II. Acute overdose of vitamin A may lead to increased intracranial pressure and skin desquamation III. Regular vitamin A supplementation is also recommended for pregnant women even in countries where vitamin A deficiency is not endemic IV. Excessive intake of carotene may cause harmless orange pigmentation of the skin Which of the statements given above are correct?

I, II and IV. **I, II and IV** - Statement I is correct: Repeated high doses of **retinol** (preformed vitamin A) can accumulate in the liver, leading to **hepatotoxicity** and potential **teratogenic effects** on a developing fetus. - Statement II is correct: **Acute vitamin A overdose** can manifest as symptoms such as **increased intracranial pressure** (pseudotumor cerebri) and **skin desquamation** (peeling skin). - Statement IV is correct: Excessive intake of **carotene** (a vitamin A precursor from plants) can cause **carotenemia**, characterized by a harmless **orange pigmentation** of the skin, but it does not lead to vitamin A toxicity due to regulated conversion. *II, III and IV* - This option incorrectly includes statement III, which is false because regular vitamin A supplementation is generally **not recommended for pregnant women in non-endemic areas** due to the risk of teratogenicity. - The other statements (II and IV) are correct, as acute overdose of vitamin A can cause increased intracranial pressure and skin desquamation, and excessive carotene intake can lead to harmless orange skin pigmentation. *I, II and III* - This option incorrectly includes statement III, which is false as routine vitamin A supplementation is **contraindicated for pregnant women in non-endemic areas** due to the risk of birth defects. - Statements I and II are correct, as high retinol doses can cause liver damage and teratogenicity, and acute vitamin A overdose can lead to increased intracranial pressure and skin desquamation. *I, III and IV* - This option incorrectly includes statement III, which is false because **pregnant women in non-endemic areas should avoid regular vitamin A supplementation** to prevent toxicity and teratogenic effects. - Statements I and IV are correct; high retinol doses can cause liver damage and teratogenicity, and excessive carotene intake can result in harmless orange skin pigmentation. [Practice more General Medicine PYQs on OnCourse]

Question 1

A 46 year old lady on vegan diet for a decade presents with chief complaints of tingling and numbness in lower limbs for two months and a history of swaying while walking through narrow corridors. Which one of the following blood tests is advisable for diagnosis in this patient?

Accepted Answer

Vitamin B12 levels

Answer

Serum protein electrophoresis

Answer

Vitamin 25(OH) D level

Answer

Anti-gliadin antibodies

Question 2

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 3

Which of the following combinations of lab test results is indicative of heavy alcohol consumption, with more than 60 % sensitivity and specificity?

Accepted Answer

GGT >35 U / L and CDT >20 U / L

Answer

Gamma glutamyl transferase (GGT) >35 U / L and alkaline phosphatase >45 U / L

Answer

High normal MCV >91 fL and CDT <20 U / L

Answer

Carbohydrate-deficient transferrin (CDT) >20 U / L and serum uric acid <7 mg / dL

Question 4

Consider the following statements with regard to the treatment of vitamin A deficiency :
I. Repeated high doses of retinol can cause liver damage and teratogenicity
II. Acute overdose of vitamin A may lead to increased intracranial pressure and skin desquamation
III. Regular vitamin A supplementation is also recommended for pregnant women even in countries where vitamin A deficiency is not endemic
IV. Excessive intake of carotene may cause harmless orange pigmentation of the skin

Which of the statements given above are correct?

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, II and III

Answer

I, III and IV

UPSC-CMS 2025 — General Medicine