UPSC-CMS 2025 - Internal Medicine Practice Questions

Q: The murmur of mitral regurgitation is best heard at

Cardiac apex. ***Cardiac apex*** - The **mitral valve** is located at the cardiac apex, and the murmur of **mitral regurgitation** is typically loudest at this point [1]. - Mitral regurgitation creates a **holosystolic murmur** that radiates to the axilla [1]. *Tricuspid area* - This area is located at the **lower left sternal border** and is where murmurs originating from the **tricuspid valve** are best heard, such as tricuspid regurgitation [2]. - Murmurs heard here are not characteristic of mitral valve dysfunction. *Aortic area* - The aortic area is at the **right upper sternal border**, primarily for auscultation of the **aortic valve**. - Conditions like **aortic stenosis** or **aortic regurgitation** are best heard here [3]. *Pulmonary area* - This area is located at the **left upper sternal border** and is where murmurs related to the **pulmonic valve** are best heard. - Examples include **pulmonic stenosis** or **pulmonic regurgitation**.

Q: A 28 year female presented to emergency with fever, agitation and delirium. She was on regular medication of Carbimazole 40 mg daily, but missed her doses for the last 2 days. Which of the following scoring systems would you like to do to assess severity of disease?

Burch-Wartofsky score. ***Burch-Wartofsky score*** - The patient's symptoms of **fever, agitation, and delirium** following missed carbimazole doses are highly suggestive of **thyroid storm** [1]. - The **Burch-Wartofsky score** is specifically designed to assess the **likelihood and severity of thyroid storm**, evaluating symptoms related to thermoregulation, central nervous system, gastrointestinal/hepatic dysfunction, cardiovascular dysfunction, and precipitating factors. *Sequential Organ Failure Assessment Score* - The **SOFA score** is used to track the progression of organ dysfunction and predict mortality in critically ill patients, often in the context of **sepsis or general critical illness**. - While thyroid storm can lead to multi-organ dysfunction, the SOFA score does not specifically diagnose or assess the severity of **thyroid storm** itself. *DAS 28 score* - The **DAS28 (Disease Activity Score 28)** is a validated tool for measuring disease activity in patients with **rheumatoid arthritis**. - It assesses joint count, patient global assessment, and inflammatory markers, which are irrelevant to the clinical picture of **fever and delirium**. *Expanded Disability Status Scale* - The **Expanded Disability Status Scale (EDSS)** is a method of quantifying disability in **multiple sclerosis**. - It evaluates neurological function in various systems and is not applicable to an acute presentation of **fever, agitation, and delirium** [2].

Q: Out of the following areas of brain, which area is most commonly affected on brain imaging in Wilson's disease?

Basal ganglia. ***Basal ganglia*** - The **basal ganglia**, particularly the **putamen** and **globus pallidus**, are the most commonly affected brain regions due to their high susceptibility to **copper deposition** in Wilson's disease. - Imaging findings like **hyperintense lesions** on T2-weighted MRI in these areas are characteristic of neurodegeneration and edema caused by copper accumulation. *Thalamus* - While the **thalamus** can be affected in later stages of Wilson's disease, it is not typically the primary or most common site of involvement compared to the basal ganglia. - Thalamic lesions are usually seen in more advanced cases and may contribute to cognitive deficits and motor symptoms. *Sub-cortex* - The term **sub-cortex** refers to a broad region beneath the cerebral cortex, encompassing many structures, including the basal ganglia, thalamus, and white matter. - While structures within the sub-cortex are affected, "basal ganglia" is a more specific and accurate answer for the most commonly affected area. *Cerebellum* - **Cerebellar involvement** is less common than basal ganglia involvement in Wilson's disease, though it can occur in some patients. - When affected, it can lead to **ataxia** and coordination problems, but it is not the most consistently or severely damaged area.

Q: Which of the following are secondary iron overload conditions? I. Transfusion related iron load II. Thalassemia III. Hepatitis C associated liver disease Select the correct answer using the code given below :

I, II and III. ***I, II and III*** - All three listed conditions—**transfusion-related iron load**, **thalassemia**, and **Hepatitis C associated liver disease**—are well-recognized causes of secondary iron overload. - Secondary iron overload occurs due to external factors or underlying diseases that cause increased iron absorption or repeated administration of iron. [1] *I and II only* - This option is incomplete as **Hepatitis C associated liver disease** can also lead to secondary iron overload due to impaired iron metabolism and chronic inflammation. - It dismisses a known cause of secondary iron accumulation. *I and III only* - This option is incomplete because **thalassemia**, particularly **transfusion-dependent thalassemia**, is a classic example of secondary iron overload due to frequent blood transfusions and ineffective erythropoiesis. - It overlooks a major cause of transfusion-related iron accumulation. [1] *II and III only* - This option is incomplete as **transfusion-related iron load** is a direct and common cause of secondary iron overload, especially in patients requiring regular blood transfusions for conditions like anemia. [1] - It ignores the most direct mechanism of iron accumulation in many chronic diseases.

Q: Which of the following are features of Alzheimer's disease? I. It is a disorder of cerebral cortical function II. Only short term memory is affected III. Patients deny that there is anything wrong IV. Depression is commonly present Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - Alzheimer's disease is indeed a **disorder of cerebral cortical function** [1], primarily affecting areas responsible for memory, language, and executive functions. - Patients often exhibit **anosognosia** (denial of illness), failing to recognize their cognitive deficits, and **depression** is a common comorbidity [2] that can complicate diagnosis and management. *II, III and IV* - This option incorrectly states that **only short-term memory is affected** in Alzheimer's disease; both short-term and long-term memory are progressively impaired [2]. - While denial of illness and depression are common, the underlying memory impairment is more global than just short-term memory [2]. *I, II and III* - This option incorrectly includes the statement that **only short-term memory is affected**, which is not characteristic of Alzheimer's disease. - Alzheimer's patients experience a decline in various cognitive domains, including **long-term memory** [2], language, and executive functions. *I, II and IV* - This option incorrectly includes the statement that **only short-term memory is affected**; Alzheimer's disease impacts both short-term and long-term memory [2]. - While cerebral cortical dysfunction and depression are relevant features, the denial of illness (anosognosia) is also a significant clinical presentation not included here.

Q: Which of the following are causes of reversible dementia? I. Hypothyroidism II. Vitamin B12 deficiency III. Dementia with lewy body IV. Thiamine deficiency Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - **Hypothyroidism** can cause cognitive impairment, including memory loss and slowed thinking, which are often reversible with **thyroid hormone replacement**. - **Vitamin B12 deficiency** can lead to neurological symptoms such as memory problems and cognitive decline, which can improve significantly with **B12 supplementation** [1]. - **Thiamine deficiency**, particularly in the context of Wernicke-Korsakoff syndrome, can cause severe amnesia and cognitive deficits that may be partially or fully reversible with **thiamine repletion** [1], [2]. *II, III and IV* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is a progressive and irreversible neurodegenerative disease. - While II and IV are correct, the inclusion of III makes this option incorrect. *I, III and IV* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is a progressive neurodegenerative dementia. - Although I and IV are correct, the presence of III makes this an invalid choice. *I, II and III* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is an **irreversible neurodegenerative disorder**. - While I and II are correct, the miscategorization of III leads to this option being incorrect.

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.

Q: Which of the following is the most favourable prognostic parameter in Bell's palsy?

Incomplete paralysis in the first week. ***Incomplete paralysis in the first week*** - The most favorable prognostic factor in Bell's palsy is **incomplete facial paralysis** at presentation or within the first week [1]. - This suggests a less severe nerve injury, making **full recovery** more likely [1]. *Pain behind the ear* - While common in Bell's palsy, **retroauricular pain** is not a specific prognostic indicator for recovery. - It can occur in both mild and severe cases and does not correlate with the degree of paralysis or recovery outcome. *Denervation in EMG after 10 days* - Evidence of **denervation on electromyography (EMG)** after 10 days indicates significant nerve damage and is a **poor prognostic sign**. - This suggests that the nerve fibers have degenerated, leading to a longer and less complete recovery. *Mild CSF lymphocytosis* - **Mild CSF lymphocytosis** can be found in some cases of Bell's palsy, particularly if the cause is thought to be viral. - However, it is not a direct prognostic factor for the extent of facial nerve recovery or the overall outcome of the palsy.

Q: Consider the following statements regarding oculocutaneous albinism : I. The disease results from genetic abnormalities leading to destruction of melanocytes II. Type 1 albinism is due to a defect in the tyrosinase gene III. Patients may present with poor vision, rotator nystagmus and alternating strabismus IV. Patients are at an increased risk of sunburn or developing skin cancer Which of the statements given above are correct?

II, III and IV. ***II, III and IV*** - **Type 1 oculocutaneous albinism (OCA1)** is caused by mutations in the **tyrosinase gene (TYR)**, which encodes the enzyme tyrosinase essential for melanin synthesis [1]. - Patients commonly exhibit **poor vision**, **rotatory nystagmus**, and **alternating strabismus** due to abnormal foveal development and misrouting of optic nerve fibers [1]. - Due to the **lack of melanin**, which protects against UV radiation, these patients are at a significantly increased risk of **sunburn** and developing **skin cancers** like basal cell carcinoma and squamous cell carcinoma [1]. *I, II and IV* - The first statement is incorrect; albinism is characterized by a **defect in melanin production**, not the destruction of melanocytes. Melanocytes are present but are unable to produce or distribute melanin effectively [1]. - Statements II and IV are correct, but the inclusion of the incorrect statement I makes this option incorrect overall. *I, III and IV* - The first statement is incorrect because oculocutaneous albinism is due to **impaired melanin synthesis**, not the destruction of melanocytes. Melanocytes are typically present [1]. - Statements III and IV are correct, but the inaccuracy of statement I makes this choice incorrect. *I, II and III* - Statement I is factually incorrect; albinism stems from a **defect in melanin production or transport**, not the destruction of melanocytes [1]. - Statements II and III are correct, but the inclusion of the incorrect statement I renders this option invalid.

Q: A 42 year old man presented with recurrent oral ulcers since one year, episodes of redness of eye and genital ulcers. Which one of the following tests is of diagnostic value?

Pathergy test. ***Pathergy test*** - The constellation of **recurrent oral and genital ulcers** along with **ocular inflammation (redness of eye)** is highly suggestive of **Behçet's disease**. - The **pathergy test** assesses for a hyper-reactivity of the skin to needle prick, which is characteristic of Behçet's disease and thus of diagnostic value. *Drug-sensitivity test* - This test is primarily used to identify allergic reactions or sensitivities to specific medications. - It would not be indicated for diagnosing a systemic inflammatory condition like Behçet's disease. *Patch test* - A **patch test** is used to identify substances that cause allergic contact dermatitis by applying potential allergens to the skin. - It is not relevant for the diagnosis of Behçet's disease, which involves inflammatory rather than allergic reactions. *Mantoux test* - The **Mantoux test** (tuberculin skin test) is used to screen for **tuberculosis infection** [1]. - This patient's symptoms are not consistent with tuberculosis, and the Mantoux test has no role in diagnosing Behçet's disease [2].

Question 1

The murmur of mitral regurgitation is best heard at

Accepted Answer

Cardiac apex

Answer

Tricuspid area

Answer

Aortic area

Answer

Pulmonary area

Question 2

A 28 year female presented to emergency with fever, agitation and delirium. She was on regular medication of Carbimazole 40 mg daily, but missed her doses for the last 2 days. Which of the following scoring systems would you like to do to assess severity of disease?

Accepted Answer

Burch-Wartofsky score

Answer

Sequential Organ Failure Assessment Score

Answer

DAS 28 score

Answer

Expanded Disability Status Scale

Question 3

Out of the following areas of brain, which area is most commonly affected on brain imaging in Wilson's disease?

Accepted Answer

Basal ganglia

Answer

Thalamus

Answer

Sub-cortex

Answer

Cerebellum

Question 4

Which of the following are secondary iron overload conditions?
I. Transfusion related iron load
II. Thalassemia
III. Hepatitis C associated liver disease

Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

I and II only

Answer

I and III only

Answer

II and III only

Question 5

Which of the following are features of Alzheimer's disease?
I. It is a disorder of cerebral cortical function
II. Only short term memory is affected
III. Patients deny that there is anything wrong
IV. Depression is commonly present

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and III

Answer

I, II and IV

Question 6

Which of the following are causes of reversible dementia?
I. Hypothyroidism
II. Vitamin B12 deficiency
III. Dementia with lewy body
IV. Thiamine deficiency

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 7

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 8

Which of the following is the most favourable prognostic parameter in Bell's palsy?

Accepted Answer

Incomplete paralysis in the first week

Answer

Pain behind the ear

Answer

Denervation in EMG after 10 days

Answer

Mild CSF lymphocytosis

Question 9

Consider the following statements regarding oculocutaneous albinism :
I. The disease results from genetic abnormalities leading to destruction of melanocytes
II. Type 1 albinism is due to a defect in the tyrosinase gene
III. Patients may present with poor vision, rotator nystagmus and alternating strabismus
IV. Patients are at an increased risk of sunburn or developing skin cancer

Which of the statements given above are correct?

Accepted Answer

II, III and IV

Answer

I, II and IV

Answer

I, III and IV

Answer

I, II and III

Question 10

A 42 year old man presented with recurrent oral ulcers since one year, episodes of redness of eye and genital ulcers. Which one of the following tests is of diagnostic value?

Accepted Answer

Pathergy test

Answer

Drug-sensitivity test

Answer

Patch test

Answer

Mantoux test

UPSC-CMS 2025 — Internal Medicine