UPSC-CMS 2025 - Internal Medicine Practice Questions

Q: Which one of the following hereditary tubulo-interstitial kidney diseases has an autosomal recessive mode of inheritance?

Nephronophthisis. ***Nephronophthisis*** - This is a group of **autosomal recessive** disorders characterized by tubulointerstitial nephritis, renal cysts, and progression to **end-stage renal disease (ESRD)**, often in childhood or adolescence [1]. - It is the most common genetic cause of ESRD in children, with classic features including **polydipsia, polyuria**, and anemia [1]. *Juvenile hyperuricaemic nephropathy* - This condition is typically inherited in an **autosomal dominant** pattern. - It is characterized by early-onset hyperuricemia, gout, and progressive renal insufficiency due to changes in **urate transport**. *Medullary cystic kidney disease type 1* - Previously known as **medullary cystic kidney disease**, this is now often referred to as **Autosomal Dominant Tubulointerstitial Kidney Disease (ADTKD)**. - It is caused by mutations in the **UMOD gene** (encoding uromodulin) and is inherited in an **autosomal dominant** fashion [1]. *Medullary cystic kidney disease type 2* - Also categorized under **ADTKD**, this form is caused by mutations in the **REN gene** (encoding renin). - Like type 1, it follows an **autosomal dominant** inheritance pattern leading to progressive chronic kidney disease.

Q: Which of the following findings in a patient are suggestive of acute nephritis? I. Hematuria II. Oliguria III. Reduced size of both kidneys IV. Edema Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - **Hematuria**, **oliguria**, and **edema** are classic signs of acute nephritis, indicating inflammation and impaired kidney function [1]. - Oliguria results from reduced **glomerular filtration**, while edema is due to fluid retention secondary to kidney dysfunction. *I and II only* - This option is incomplete as **edema** is also a significant finding in acute nephritis due to fluid overload from impaired renal excretion. - While hematuria and oliguria are key, omitting edema overlooks a critical systemic manifestation. *I and III* - **Reduced size of both kidneys** (III) is typically associated with **chronic kidney disease** [1], not the acute inflammation seen in acute nephritis. - Acute nephritis usually presents with **normal or enlarged kidneys** due to inflammation and swelling. *III and IV* - This option incorrectly includes **reduced kidney size**, which is characteristic of chronic, not acute, kidney disease. - While edema (IV) is present in acute nephritis, the presence of hematuria and oliguria is also crucial for diagnosis.

Q: A 35 year old male presents with increased urine output. On evaluation, his urinary output was around 4L/day; urinary osmolality was 200 mosmol/L. Which of the following are various differential diagnosis? I. Psychogenic polydipsia II. Solute diuresis III. Central diabetes insipidus IV. Nephrogenic diabetes insipidus Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - **Polyuria** with a **low urine osmolality** (200 mosmol/L, which is less than plasma osmolality) indicates the excretion of a large volume of dilute urine [1]. - This pattern is characteristic of conditions involving water diuresis, specifically **psychogenic polydipsia**, **central diabetes insipidus**, and **nephrogenic diabetes insipidus**, where the body fails to concentrate urine appropriately [2]. *I and IV only* - While **psychogenic polydipsia** and **nephrogenic diabetes insipidus** can cause polyuria with dilute urine, this option incorrectly excludes **central diabetes insipidus**, which presents with very similar urinary findings [2]. - **Central diabetes insipidus** is a primary disorder of ADH secretion, leading to an inability to concentrate urine [1]. *II and IV* - **Solute diuresis** typically results in urine with a relatively normal or slightly elevated osmolality as it's due to the excretion of osmotically active substances, not pure water. The urine osmolality of 200 mosmol/L points away from significant solute diuresis. - This option also omits **central diabetes insipidus** and **psychogenic polydipsia**, which are strong differentials for dilute polyuria. *I and III only* - This option includes **psychogenic polydipsia** and **central diabetes insipidus** but incorrectly excludes **nephrogenic diabetes insipidus**. - **Nephrogenic diabetes insipidus** also results in the inability to respond to ADH, leading to the excretion of dilute urine and polyuria [2].

Q: Which of the following are clinical features of migraine? I. It is associated with dilatation of extracranial vessels II. Common migraine is seen without Aura III. Aura is most often visual Select the correct answer using the code given below :

II and III only. ***II and III only*** - **Common migraine** (migraine without aura) is the most prevalent form of migraine, characterized by recurrent headaches lacking a preceding aura [1]. - An **aura** preceding a migraine attack is most frequently visual, presenting as flashing lights, zigzag lines, or blind spots due to transient cortical dysfunction [1], [2]. *I, II and III* - **Dilatation of extracranial vessels** is largely a secondary phenomenon, occurring after the initial vasoconstriction associated with migraine and does not fully explain migraine pathophysiology [1]. - While migraine involves vascular changes, the primary mechanism is complex and involves **neural activation** and release of inflammatory neuropeptides, not just simple vessel dilatation [1]. *I and II only* - The claim regarding **dilatation of extracranial vessels** as a primary feature is not universally accepted or sufficient to explain migraine [1]. - This option incorrectly includes an imprecise pathophysiological description and omits the accurate statement about the commonality of **visual aura**. *I and III only* - Similar to the above, the role of **extracranial vessel dilatation** as a core clinical feature is oversimplified and not a primary pathogenic event [1]. - This option correctly identifies visual aura but misrepresents the vascular component and omits the fact that **common migraine** is without aura [1].

Q: A 50 year old man presents with brief episodes of lancinating unilateral facial pain, involving the buccal distribution. Pain is triggered by washing face with cold water. What is the most likely diagnosis?

Trigeminal neuralgia. ***Trigeminal neuralgia*** - This condition presents with **brief, lancinating, unilateral facial pain** affecting one or more branches of the trigeminal nerve. - Pain is often **triggered by tactile stimuli** like washing the face, touching the face, or cold water, consistent with the patient's presentation. *Chronic paroxysmal hemicrania* - This type of headache is characterized by **frequent, short-lived attacks of severe, unilateral head pain**, often accompanied by autonomic symptoms (e.g., lacrimation, rhinorrhea). - It is crucial to note that these headaches are **responsive to indomethacin**, and while unilateral, they typically involve periorbital or temporal regions and not specifically the trigeminal distribution or tactile triggers in the same way. *Migraine* - Migraines are typically characterized by **pulsating, moderate to severe head pain**, often unilateral, lasting from hours to days [1]. - They are usually associated with **nausea, vomiting**, and sensitivity to light (photophobia) and sound (phonophobia), which are absent in this patient's presentation [2]. *Medication overuse headache* - This headache is a **chronic daily or near-daily headache** that develops or worsens due to the overuse of acute headache medications [2]. - It does not present with **brief, lancinating pains** or specific triggers like washing the face with cold water.

Q: Which of the following are trigger factors for seizures? I. Sleep deprivation II. Missed doses of antiepileptic drugs III. Recreational drug misuse IV. Physical exhaustion Select the correct answer using the code given below:

I, II, III and IV. ***I, II, III and IV*** - **Sleep deprivation** significantly lowers the **seizure threshold** by altering brain excitability and neurochemical balance. - **Missed doses of antiepileptic drugs** lead to subtherapeutic drug levels, increasing the likelihood of breakthrough seizures in individuals undergoing treatment. - **Recreational drug misuse** (e.g., cocaine, amphetamines, alcohol withdrawal) can directly cause seizures by neurotoxic effects or by unmasking an underlying seizure disorder. - **Physical exhaustion** can act as a stressor, disrupting brain homeostasis and making individuals more susceptible to seizures, similar to sleep deprivation. *II and III only* - This option is incomplete as **sleep deprivation** and **physical exhaustion** are also well-established seizure triggers. *I and IV only* - This option is incomplete because **missed doses of antiepileptic drugs** and **recreational drug misuse** are critical and common triggers for seizures. *I, II and III only* - This option overlooks **physical exhaustion**, which can, similar to sleep deprivation, significantly reduce the seizure threshold.

Q: Consider the following pleural fluid analysis : pH-7.6 Pleural fluid protein -0.5 g / dL Serum total protein -6.5 g / dL Pleural fluid LDH - 100 U / L Serum LDH - 300 U / L What is the most likely diagnosis?

Myxedema. ***Myxedema*** - The pleural fluid analysis shows a **transudative effusion** (pleural fluid protein/serum protein ratio < 0.5 and pleural fluid LDH/serum LDH ratio < 0.6), a characteristic of myxedema (hypothyroidism) [1]. - While other causes of transudates exist, a **high pH** in a transudate, as seen here (pH 7.6), is suggestive of myxedema or a parapneumonic effusion that is not infected, but the latter would likely be an exudate [1]. *Sarcoidosis* - Sarcoidosis typically causes an **exudative pleural effusion**, characterized by higher protein and LDH levels in the pleural fluid. - The pleural fluid pH in sarcoidosis is usually normal to slightly low, but not as high as 7.6 in an exudative process. *Rheumatoid arthritis* - Pleural effusions due to rheumatoid arthritis are typically **exudative**, with low glucose and very low pH (often <7.0 to 7.1) [1]. - The given pleural fluid composition does not match the typical findings of a rheumatoid effusion. *Pancreatitis* - Pancreatitis can cause an **exudative pleural effusion**, particularly on the left side, with very high amylase levels. - The protein and LDH ratios in this case are consistent with a transudate, not an exudate as seen in pancreatitis.

Q: Which one of the following conditions is a complication of bacterial pharyngitis involving extension of infection into the internal jugular veins leading to thrombosis and metastatic dispersal of the organism?

Lemierre syndrome. ***Lemierre syndrome*** - This syndrome is characterized by **bacterial pharyngitis** that extends to the **internal jugular vein**, leading to **thrombosis** and subsequent septic emboli [3]. - The most common causative organism is ***Fusobacterium necrophorum***, and it can result in metastatic infections in organs like the lungs. *Wegener's granulomatosis* - This is an **autoimmune vasculitis** affecting small to medium-sized vessels, primarily in the respiratory tract and kidneys [2]. - It is distinct from infection-related venous thrombosis and is characterized by **granulomatous inflammation** and **ANCA positivity**. *Chronic Pulmonary Aspergillosis* - This is a fungal infection of the lungs, typically occurring in individuals with pre-existing lung conditions or immunosuppression [1]. - It does not involve the initial presentation of bacterial pharyngitis followed by internal jugular vein thrombosis. *Cystic Fibrosis* - This is an **autosomal recessive genetic disorder** affecting exocrine glands, leading to thick, sticky mucus, primarily impacting the lungs and digestive system. - While it causes chronic respiratory infections, it is not initiated by bacterial pharyngitis leading to septic thrombophlebitis of the jugular vein.

Q: A 42-year old man with history of alcohol dependency presents with progressive abdominal distension. Abdominal examination reveals a shifting dullness. Which one of the following is the most appropriate drug to relieve this abdominal distension?

Spironolactone. **Spironolactone** - **Spironolactone** is an **aldosterone antagonist**, which is the **first-line diuretic** used in the management of **ascites** due to **cirrhosis**, often developing secondary to alcohol dependency. - It works by blocking aldosterone receptors in the **renal collecting duct**, leading to increased sodium and water excretion while conserving potassium, effectively reducing fluid accumulation. *Lactulose* - **Lactulose** is a non-absorbable disaccharide primarily used to treat and prevent **hepatic encephalopathy** by reducing ammonia levels. - It does not directly relieve abdominal distension caused by ascites, and its use is unrelated to fluid overload. *Propranolol* - **Propranolol** is a **non-selective beta-blocker** used to reduce **portal pressure** and prevent **variceal bleeding** in patients with cirrhosis. - While it addresses a complication of chronic liver disease, it does not directly manage or relieve ascites. *Octreotide* - **Octreotide** is a **somatostatin analog** used to treat complications like **acute variceal bleeding** or **hepatic encephalopathy** by reducing splanchnic blood inflow. - It is not indicated for the management of ascites or relief of abdominal distension caused by fluid accumulation.

Question 1

Which one of the following hereditary tubulo-interstitial kidney diseases has an autosomal recessive mode of inheritance?

Accepted Answer

Nephronophthisis

Answer

Juvenile hyperuricaemic nephropathy

Answer

Medullary cystic kidney disease type 1

Answer

Medullary cystic kidney disease type 2

Question 2

Which of the following findings in a patient are suggestive of acute nephritis?
I. Hematuria
II. Oliguria
III. Reduced size of both kidneys
IV. Edema

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I and II only

Answer

I and III

Answer

III and IV

Question 3

A 35 year old male presents with increased urine output. On evaluation, his urinary output was around 4L/day; urinary osmolality was 200 mosmol/L. Which of the following are various differential diagnosis?
I. Psychogenic polydipsia
II. Solute diuresis
III. Central diabetes insipidus
IV. Nephrogenic diabetes insipidus

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

I and IV only

Answer

II and IV

Answer

I and III only

Question 4

Which of the following are clinical features of migraine?
I. It is associated with dilatation of extracranial vessels
II. Common migraine is seen without Aura
III. Aura is most often visual

Select the correct answer using the code given below :

Accepted Answer

II and III only

Answer

I, II and III

Answer

I and II only

Answer

I and III only

Question 5

A 50 year old man presents with brief episodes of lancinating unilateral facial pain, involving the buccal distribution. Pain is triggered by washing face with cold water. What is the most likely diagnosis?

Accepted Answer

Trigeminal neuralgia

Answer

Chronic paroxysmal hemicrania

Answer

Migraine

Answer

Medication overuse headache

Question 6

Which of the following are trigger factors for seizures?
I. Sleep deprivation
II. Missed doses of antiepileptic drugs
III. Recreational drug misuse
IV. Physical exhaustion

Select the correct answer using the code given below:

Accepted Answer

I, II, III and IV

Answer

II and III only

Answer

I and IV only

Answer

I, II and III only

Question 7

Consider the following pleural fluid analysis :
pH-7.6
Pleural fluid protein -0.5 g / dL
Serum total protein -6.5 g / dL
Pleural fluid LDH - 100 U / L
Serum LDH - 300 U / L

What is the most likely diagnosis?

Accepted Answer

Myxedema

Answer

Sarcoidosis

Answer

Rheumatoid arthritis

Answer

Pancreatitis

Question 8

Which one of the following statements is correct in respect of pulmonary involvement in rheumatoid disease?

Accepted Answer

Rheumatoid pulmonary nodules are usually asymptomatic and detected incidentally on imaging

Answer

Pleural effusion in these patients is transudative and usually bilateral

Answer

Rheumatoid pulmonary nodules are often solitary and located near hilum

Answer

Combination of pleural effusion and pneumoconiosis in these patients is known as Caplan syndrome

Question 9

Which one of the following conditions is a complication of bacterial pharyngitis involving extension of infection into the internal jugular veins leading to thrombosis and metastatic dispersal of the organism?

Accepted Answer

Lemierre syndrome

Answer

Wegener's granulomatosis

Answer

Chronic Pulmonary Aspergillosis

Answer

Cystic Fibrosis

Question 10

A 42-year old man with history of alcohol dependency presents with progressive abdominal distension. Abdominal examination reveals a shifting dullness. Which one of the following is the most appropriate drug to relieve this abdominal distension?

Accepted Answer

Spironolactone

Answer

Lactulose

Answer

Propranolol

Answer

Octreotide

UPSC-CMS 2025 — Internal Medicine