UPSC-CMS 2025 - Internal Medicine Practice Questions

Q: Which of the following conditions are contraindications for noninvasive positive-pressure ventilation in patients with respiratory failure? I. Craniofacial abnormalities II. Significant burns III. Respiratory failure with PaCO_2 of 60 mm Hg IV. Cardiovascular instability Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - **Craniofacial abnormalities** (I) can prevent a proper mask seal, leading to air leaks and ineffective ventilation. - **Significant burns** (II), especially on the face, can make mask application impossible due to pain, skin integrity issues, and infection risk. - **Cardiovascular instability** (IV), such as severe hypotension or active myocardial ischemia, can be worsened by the positive intrathoracic pressure applied by NPPV, which can decrease venous return and cardiac output. *I, III and IV* - While **craniofacial abnormalities** (I) and **cardiovascular instability** (IV) are contraindications, NPPV can be beneficial for **respiratory failure with a PaCO2 of 60 mm Hg** (III) as it helps reduce CO2 levels and avoids intubation. - Therefore, including III as a contraindication makes this option incorrect. *II, III and IV* - **Significant burns** (II) and **cardiovascular instability** (IV) are clear contraindications. However, **respiratory failure with a PaCO2 of 60 mm Hg** (III) is often an indication for NPPV, not a contraindication. - This option incorrectly identifies a key indication as a contraindication. *I, II and III* - **Craniofacial abnormalities** (I) and **significant burns** (II) are valid contraindications for NPPV. - However, **respiratory failure with a PaCO2 of 60 mm Hg** (III) is a common indication for NPPV, especially in conditions like COPD exacerbations, as it helps improve ventilation and reduce hypercapnia.

Q: Which one of the following terms denotes the extensive sclerosis of the skin of the chest wall which restricts chest wall movement and is seen as a rare complication of systemic sclerosis?

Hidebound Chest. ***Hidebound Chest*** - This term precisely describes the **extensive cutaneous sclerosis** over the chest wall seen in **systemic sclerosis**, leading to restricted chest movement [1]. - The hardened, thickened skin reduces chest wall compliance, making breathing difficult [1]. *Barrel Chest* - Characterized by an **increased anterior-posterior diameter** of the chest, commonly seen in chronic obstructive pulmonary disease (COPD) due to hyperinflation. - It is not primarily caused by skin sclerosis but rather by lung pathology. *Flail Chest* - Occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. - This results in **paradoxical movement** of the chest wall during respiration, and is an acute traumatic injury. *Pigeon Chest* - Also known as **Pectus Carinatum**, this chest wall deformity is characterized by a **protrusion of the sternum and costal cartilages**. - It is typically a developmental anomaly rather than a consequence of skin sclerosis.

Q: In clinical assessment of an elderly patient, 'the get up and go test' is used to evaluate which of the following?

Gait and balance. Gait and balance - The **Timed Up and Go (TUG) test** is a widely used clinical tool designed to assess a person's **mobility**, **balance**, and **fall risk**. [2] - It measures the time taken for an individual to rise from a chair, walk 3 meters, turn, walk back, and sit down again. *Cognition* - While physical and cognitive functions are related, the TUG test does not directly assess **cognitive abilities** like memory, executive function, or language. - Cognitive assessment typically involves tools such as the **Mini-Mental State Examination (MMSE)** or **Montreal Cognitive Assessment (MoCA)**. [1] *Urinary incontinence* - The TUG test does not evaluate **urinary function** or the presence of incontinence. - Assessment of urinary incontinence involves patient history, bladder diaries, and physical examination. *Driving ability* - Although mobility and balance are important for driving, the TUG test alone is not a direct measure of **driving ability**. - Driving assessments are more comprehensive, often involving on-road tests and specialized cognitive and visual evaluations.

Q: Treatment of first choice in acute Gout is

Oral Colchicine. ***Oral Colchicine*** - **Colchicine** is highly effective in treating **acute gout attacks** by reducing inflammation caused by uric acid crystal deposition. - It works best when initiated within **24-36 hours** of symptom onset. - Considered a **first-line option** for acute gout, particularly in patients with contraindications to NSAIDs or corticosteroids. - **Mechanism:** Inhibits microtubule polymerization, thereby reducing neutrophil migration and phagocytosis of urate crystals. *Oral Methotrexate* - **Methotrexate** is an **immunosuppressant** primarily used for chronic inflammatory conditions, such as **rheumatoid arthritis** or **psoriasis**. - It is not a first-line treatment for the rapid relief of acute gout symptoms. *Sulfasalazine* - **Sulfasalazine** is an anti-inflammatory and immunomodulatory drug, commonly used in **inflammatory bowel disease** and **rheumatoid arthritis**. - It has no role in the immediate treatment of an acute gout flare. *Allopurinol* - **Allopurinol** is a **xanthine oxidase inhibitor** used for the **long-term prevention** of gout by lowering uric acid levels. - It is generally *not initiated* during an acute attack, as it can potentially worsen the flare by mobilizing urate crystals. - Used for **prophylaxis** in patients with recurrent gout attacks or chronic tophaceous gout.

Q: Which one of the following is a contraindication to wireless capsule endoscopy?

Small bowel stricture. ***Small bowel stricture*** - A **small bowel stricture** is a major contraindication for wireless capsule endoscopy due to the significant risk of the capsule becoming **retained** at the narrowed segment [1]. - Capsule retention can lead to **obstruction** requiring surgical intervention, thus posing a serious safety concern. *Small bowel Crohn's disease* - While Crohn's disease *can* cause strictures, the existence of Crohn's disease itself is not an absolute contraindication unless a **significant stricture** is already known or highly suspected [1]. - Capsule endoscopy is often used to *diagnose* and *monitor* small bowel Crohn's disease [1]. *Coeliac disease* - **Coeliac disease** is not a contraindication; in fact, capsule endoscopy can be a useful tool in evaluating the small bowel mucosa in refractory cases or for confirming diagnosis [1]. - There is no increased risk of capsule retention or other adverse events directly attributable to coeliac disease itself. *Obscure gastrointestinal bleeding* - **Obscure gastrointestinal bleeding** is considered a primary *indication* for wireless capsule endoscopy, rather than a contraindication [1]. - The capsule can visualize the entire small bowel, often identifying bleeding sources that are not accessible by conventional endoscopy [1].

Q: Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

Sinusoidal - Veno-occlusive disease. ***Sinusoidal - Veno-occlusive disease*** - **Veno-occlusive disease** (also known as sinusoidal obstruction syndrome) specifically affects the blood flow within the **sinusoids** of the liver [1]. - This obstruction at the sinusoidal level directly leads to **sinusoidal portal hypertension** [1]. *Post-hepatic - Schistosomiasis post sinusoidal* - **Schistosomiasis** primarily causes **presinusoidal portal hypertension**, specifically due to periportal fibrosis in the liver. - **Post-hepatic portal hypertension** typically involves obstruction *after* the liver sinusoids, such as in **Budd-Chiari syndrome** or right heart failure [1]. *Pre-hepatic - Portal vein presinusoidal thrombosis* - **Portal vein thrombosis** occurring *before* the liver sinusoids would indeed be classified as **pre-hepatic portal hypertension** [2]. - However, the description **"presinusoidal thrombosis"** describes the *location* of the thrombosis but does not inherently define it as pre-hepatic versus intrahepatic. **Pre-hepatic** explicitly means before the liver substance. *Intrahepatic - Cirrhosis presinusoidal* - **Cirrhosis** is a classic cause of **intrahepatic portal hypertension**, but the obstruction in cirrhosis is predominantly **sinusoidal and post-sinusoidal**, due to fibrosis and regenerating nodules [2]. - While some early fibrotic changes may have presinusoidal components, the dominant site of obstruction in established cirrhosis is at the sinusoidal and perisinusoidal levels, not strictly presinusoidal.

Q: Which one of the following is a secondary cause of headache?

Medication overuse headache. ### Medication overuse headache - This is a form of **secondary headache** caused by the chronic overuse of acute headache medications, which can lead to a *vicious cycle* of increasing headache frequency and medication use [1]. - It arises as a direct consequence of an **external factor** (medication overuse), distinguishing it from primary headache disorders [1]. *Tension-type headache* - This is a **primary headache disorder**, meaning the headache itself is the main problem and not a symptom of another condition [1]. - It is characterized by a **mild to moderate, bilateral, pressing or tightening pain** that is not aggravated by physical activity. *Migraine* - This is a **primary headache disorder** characterized by recurrent headaches affecting one side of the head, and often accompanied by symptoms such as **pulsating pain**, nausea, vomiting, and sensitivity to light and sound [1]. - While it can be debilitating, it is not caused by an **underlying structural or systemic disease**. *Trigeminal autonomic cephalalgia* - These are a group of **primary headache disorders** characterized by severe, strictly unilateral pain with associated **ipsilateral cranial autonomic symptoms** (e.g., conjunctival injection, lacrimation, nasal congestion) [1]. - Examples include cluster headache and paroxysmal hemicrania, and they are not caused by an identifiable **secondary cause**.

Q: A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Kayser-Fleisher rings in the cornea. Detailed clinical features point towards Wilson's disease. ***Kayser-Fleisher rings in the cornea*** - The history of **recurrent jaundice** and **facial grimacing** (likely dystonia/tremors) points towards a **neuropsychiatric disorder** with liver involvement, which is characteristic of **Wilson's disease** [1]. - **Kayser-Fleisher rings** are copper deposits in the Descemet's membrane of the cornea, a pathognomonic sign of Wilson's disease. *Adenoma sebaceum in the mid face* - **Adenoma sebaceum** (facial angiofibromas) is a characteristic skin lesion associated with **tuberous sclerosis complex**, which typically presents with seizures, intellectual disability, and characteristic skin lesions, not recurrent jaundice or facial grimacing indicative of movement disorders. - This condition does not primarily involve recurrent jaundice or movement disorders like facial grimacing. *Erythema nodosum on the skin* - **Erythema nodosum** is an inflammatory condition characterized by painful, red nodules, typically on the shins. - It is often associated with conditions like **sarcoidosis**, inflammatory bowel disease, infections, or drug reactions, and does not commonly present with recurrent jaundice and facial grimacing. *Osler's nodes at the finger tips* - **Osler's nodes** are painful, tender, red or purple lesions found on the fingertips and toes, indicative of **infective endocarditis**. - This symptom is related to immune complex deposition and systemic infection, rather than genetic disorders causing liver disease and neurological dysfunction.

Q: Which of the following statements are correct regarding Weil's disease? I. It is caused by a virus named leptospira II. Acute kidney injury can lead to oliguria in this disease III. Microscopic agglutination is the investigation of choice IV. Ceftriaxone given parenterally is effective treatment Select the correct answer using the code given below :

II, III and IV. ***II, III and IV*** - **Weil's disease**, a severe form of leptospirosis, frequently causes **acute kidney injury (AKI)**, which can manifest as **oliguria** due to renal tubular damage and interstitial nephritis [2]. - The **microscopic agglutination test (MAT)** is considered the gold standard for diagnosing leptospirosis due to its high specificity and sensitivity in detecting specific antibodies against *Leptospira* serovars [2]. - **Ceftriaxone** is an effective parenteral antibiotic for treating severe leptospirosis, including Weil's disease, particularly when oral antibiotics are insufficient or the patient is critically ill. *I, II and III* - Statement I is incorrect because Weil's disease is caused by a **spirochete bacterium**, *Leptospira interrogans*, not a virus [1]. - While statements II and III are correct regarding **AKI and oliguria** and the utility of **MAT**, the incorrectness of statement I makes this option wrong. *I, III and IV* - Statement I is incorrect as Weil's disease is caused by a **bacterium** (*Leptospira*), not a virus [1]. - While statements III and IV are correct, the presence of an incorrect statement (I) makes this composite option incorrect. *I, II and IV* - Statement I is factually incorrect; Weil's disease is caused by the **bacterium *Leptospira***, not a virus [1]. - Although statements II and IV are correct—**AKI with oliguria** is a feature and **ceftriaxone** is a treatment—the fundamental error in statement I invalidates this option.

Q: Which of the following are components of SOFA scoring system? I. PaO_2 / FiO_2 ratio II. Mean arterial pressure III. Glasgow coma scale IV. Prothrombin Time with INR Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - The **Sequential Organ Failure Assessment (SOFA) score** evaluates organ dysfunction based on six systems: respiration, coagulation, liver, cardiovascular, central nervous system, and renal. - **PaO2/FiO2 ratio** assesses respiratory function, **Glasgow Coma Scale (GCS)** assesses central nervous system function [1], [3], and **Prothrombin Time with INR** assesses coagulation function, all of which are included in the SOFA score calculation. *I, II and IV* - This option incorrectly includes **Mean Arterial Pressure** as a primary component for calculating the cardiovascular SOFA score, though it is indirectly considered when evaluating the use of vasopressors [2]. - The SOFA cardiovascular component primarily relies on **vasopressor dosage** required to maintain blood pressure, rather than absolute mean arterial pressure alone. *II, III and IV* - This option omits the **PaO2/FiO2 ratio**, which is a crucial parameter for assessing respiratory organ dysfunction within the SOFA scoring system. - It incorrectly focuses on **Mean Arterial Pressure** as a direct component instead of the vasopressor requirement. *I, II and III* - This choice omits **Prothrombin Time (PT) with INR**, which is a vital indicator for assessing the **coagulation system** within the SOFA score. - It incorrectly includes **Mean Arterial Pressure** as a direct, standalone component rather than vasopressor support for the cardiovascular system.

Question 1

Which of the following conditions are contraindications for noninvasive positive-pressure ventilation in patients with respiratory failure?
I. Craniofacial abnormalities
II. Significant burns
III. Respiratory failure with PaCO_2 of 60 mm Hg
IV. Cardiovascular instability

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and III

Question 2

Which one of the following terms denotes the extensive sclerosis of the skin of the chest wall which restricts chest wall movement and is seen as a rare complication of systemic sclerosis?

Accepted Answer

Hidebound Chest

Answer

Barrel Chest

Answer

Flail Chest

Answer

Pigeon Chest

Question 3

In clinical assessment of an elderly patient, 'the get up and go test' is used to evaluate which of the following?

Accepted Answer

Gait and balance

Answer

Cognition

Answer

Urinary incontinence

Answer

Driving ability

Question 4

Treatment of first choice in acute Gout is

Accepted Answer

Oral Colchicine

Answer

Oral Methotrexate

Answer

Sulfasalazine

Answer

Allopurinol

Question 5

Which one of the following is a contraindication to wireless capsule endoscopy?

Accepted Answer

Small bowel stricture

Answer

Small bowel Crohn's disease

Answer

Coeliac disease

Answer

Obscure gastrointestinal bleeding

Question 6

Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

Accepted Answer

Sinusoidal - Veno-occlusive disease

Answer

Post-hepatic - Schistosomiasis post sinusoidal

Answer

Pre-hepatic - Portal vein presinusoidal thrombosis

Answer

Intrahepatic - Cirrhosis presinusoidal

Question 7

Which one of the following is a secondary cause of headache?

Accepted Answer

Medication overuse headache

Answer

Tension-type headache

Answer

Migraine

Answer

Trigeminal autonomic cephalalgia

Question 8

A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Accepted Answer

Kayser-Fleisher rings in the cornea

Answer

Adenoma sebaceum in the mid face

Answer

Erythema nodosum on the skin

Answer

Osler's nodes at the finger tips

Question 9

Which of the following statements are correct regarding Weil's disease?
I. It is caused by a virus named leptospira
II. Acute kidney injury can lead to oliguria in this disease
III. Microscopic agglutination is the investigation of choice
IV. Ceftriaxone given parenterally is effective treatment

Select the correct answer using the code given below :

Accepted Answer

II, III and IV

Answer

I, II and III

Answer

I, III and IV

Answer

I, II and IV

Question 10

Which of the following are components of SOFA scoring system?
I. PaO_2 / FiO_2 ratio
II. Mean arterial pressure
III. Glasgow coma scale
IV. Prothrombin Time with INR

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

I, II and IV

Answer

II, III and IV

Answer

I, II and III

UPSC-CMS 2025 — Internal Medicine