UPSC-CMS 2025 - Internal Medicine Practice Questions

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: Which one of the following oral drugs may be used as adjunctive therapy in the management of super-refractory status epilepticus?

Topiramate. ***Topiramate*** - **Topiramate** is an antiepileptic drug with multiple mechanisms of action, including potentiation of **GABAergic** activity, blockade of **voltage-gated sodium channels**, and antagonism of **AMPA/kainate glutamate receptors**. - Its broad-spectrum action and ability to be administered orally make it a suitable **adjunctive therapy** in complex cases like **super-refractory status epilepticus (SRSE)**, where patients have failed other conventional treatments. *Clobazam* - **Clobazam** is a **benzodiazepine** primarily used as an **anxiolytic** and antiepileptic drug, particularly for Lennox-Gastaut syndrome. - While supportive in status epilepticus, its primary role is in acute seizure termination rather than as a long-term adjunctive therapy for **super-refractory status epilepticus** post-acute phase. *Clonazepam* - **Clonazepam** is another **benzodiazepine** with potent **antiepileptic** properties. - It is effective in terminating acute seizures but is not typically used as a primary oral adjunctive agent for **super-refractory status epilepticus** due to its sedative side effects and potential for tolerance. *Lamotrigine* - **Lamotrigine** is an **antiepileptic drug** that primarily works by inhibiting **voltage-sensitive sodium channels**, thereby stabilizing neuronal membranes and modulating the release of excitatory neurotransmitters. - While effective for various seizure types, including focal and generalized seizures, it is not a first-line or common choice as an **adjunctive oral therapy** in **super-refractory status epilepticus**, which often requires drugs with faster onset or broader mechanisms beyond sodium channel blockade.

Q: Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus? I. Upto two doses may be used 5 minutes apart, if seizures are not controlled II. For Lorazepam, only a single dose should be used, even if seizures are not controlled III. Dose of midazolam at this stage is 1-15 mcg / kg / min infusion IV. Dose of both lorazepam and midazolam is 0.1 mg / kg Select the answer using the code given below :

I and IV. ***I and IV*** - According to current guidelines, **up to two doses** of a benzodiazepine may be administered 5 minutes apart if the **seizures are not controlled** after the initial dose. - The recommended dose for both **lorazepam and midazolam** in the initial management of status epilepticus is **0.1 mg/kg**. *II and IV* - This option is incorrect because statement II is false, as **multiple doses of lorazepam** can be administered if seizures are not controlled. - While statement IV is correct regarding the dosage of lorazepam and midazolam. *I and III* - This option is incorrect because statement III is false, as **1-15 mcg/kg/min infusion** is the dose for **continuous infusion** of midazolam in refractory status epilepticus, not the initial bolus dose. - Statement I is correct but paired with an incorrect statement. *II and III* - This option is incorrect because both statements II and III are false regarding the initial management of status epilepticus. - As previously stated, **multiple doses of lorazepam** can be used, and the given midazolam dose is for **continuous infusion**, not the initial bolus.

Q: Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?

High resolution manometry. ***High resolution manometry*** - **High-resolution manometry (HRM)** is considered the **gold standard** for diagnosing oesophageal motility disorders because it provides detailed, real-time pressure topography of the entire oesophagus during swallowing [1]. - It allows for precise identification and classification of conditions such as **achalasia**, diffuse oesophageal spasm, and **scleroderma oesophagus** based on objective metrics [1]. *Upper GI endoscopy* - While essential for evaluating **mucosal abnormalities** and ruling out structural causes (e.g., tumours, strictures), it does not directly assess oesophageal motility [1]. - An **endoscopy** provides visual information but cannot quantify or characterize the contractile function of the oesophageal muscle [1]. *Contrast enhanced CT scan (CECT) oesophagus* - A **CECT scan** is primarily used for evaluating **extramural compression**, mediastinal involvement, or the presence of mass lesions, not for assessing the functional contractions of the oesophagus. - It provides anatomical information but offers very limited insight into the dynamic pressure changes associated with **oesophageal peristalsis**. *Barium swallow* - A **barium swallow** can suggest motility disorders by visualizing the passage of contrast and identifying abnormalities like **tertiary contractions** or delayed emptying, but it is less precise than manometry [1]. - It provides an anatomical overview and may show gross motility disturbances, but it lacks the quantitative and detailed pressure data that **HRM** offers for definitive diagnosis [1].

Q: Which of the following are considered aetiological factors for Adenocarcinoma oesophagus? I. Barrett's oesophagus II. Gastro-oesophageal reflux III. Obesity IV. Alcohol intake Select the correct answer using the code given below :

I, II and III. ***I, II and III*** - **Barrett's oesophagus** is a known precursor to **oesophageal adenocarcinoma** due to **metaplasia** of the squamous epithelium to columnar epithelium with goblet cells, increasing the risk of dysplasia and subsequent cancer [1]. - **Gastro-oesophageal reflux disease (GERD)** is a major risk factor, as chronic reflux of gastric acid can lead to inflammation, oesophagitis, and eventually **Barrett's oesophagus** [1]. - **Obesity** is strongly associated with an increased risk of **oesophageal adenocarcinoma**, primarily through its links to **GERD** and increased intra-abdominal pressure [1]. *I, II and IV* - This option correctly identifies **Barrett's oesophagus** and **gastro-oesophageal reflux** as risk factors. - However, **alcohol intake** is not as strongly linked to **oesophageal adenocarcinoma** as it is to squamous cell carcinoma of the oesophagus [1]. *II, III and IV* - This option correctly identifies **gastro-oesophageal reflux** and **obesity** as risk factors. - However, it incorrectly includes **alcohol intake** as a primary risk factor for **adenocarcinoma**, and incorrectly omits **Barrett's oesophagus**, which is a direct precursor. *I, III and IV* - This option correctly identifies **Barrett's oesophagus** and **obesity** as risk factors. - However, it incorrectly includes **alcohol intake** and omits **gastro-oesophageal reflux**, which is a fundamental link between obesity, Barrett's, and adenocarcinoma.

Q: Consider the following statements regarding Plummer-Vinson syndrome : I. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia. II. It is a rare disease, mainly affecting middle-aged women. III. There is predisposition to postcricoid, cervical oesophageal cancer. IV. Treatment is usually surgical. Which of the statements given above are correct?

I, II and III. **I, II and III** - **Plummer-Vinson syndrome** is characterized by the triad of **dysphagia**, **iron deficiency anemia**, and an **esophageal web**, typically in the **cervical esophagus**. - It predominantly affects **middle-aged women** and is associated with an increased risk of **postcricoid esophageal cancer**. *I, II and IV* - While statements I and II are correct, statement IV is incorrect because the primary treatment for Plummer-Vinson syndrome is usually medical management of **iron deficiency** and endoscopic dilation of the web, not surgery. - Surgical intervention is generally reserved for complications or malignancy. *II, III and IV* - While statements II and III are correct, statement IV is incorrect as surgery is not the usual first-line treatment for Plummer-Vinson syndrome. - Statement I, which describes the characteristic findings of the syndrome, is also correct and is excluded from this option. *I, III and IV* - While statements I and III are correct, statement IV regarding surgical treatment is incorrect. - The syndrome is indeed rare and mainly affects middle-aged women, making statement II correct, which is excluded from this option.

Q: 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?

Sestamibi scan. ***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.

Q: 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 :

I, II and III. 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].

Q: 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?

Breast. **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 1

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 2

Which one of the following oral drugs may be used as adjunctive therapy in the management of super-refractory status epilepticus?

Accepted Answer

Topiramate

Answer

Clobazam

Answer

Clonazepam

Answer

Lamotrigine

Question 3

Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus?
I. Upto two doses may be used 5 minutes apart, if seizures are not controlled
II. For Lorazepam, only a single dose should be used, even if seizures are not controlled
III. Dose of midazolam at this stage is 1-15 mcg / kg / min infusion
IV. Dose of both lorazepam and midazolam is 0.1 mg / kg

Select the answer using the code given below :

Accepted Answer

I and IV

Answer

II and IV

Answer

I and III

Answer

II and III

Question 4

Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?

Accepted Answer

High resolution manometry

Answer

Upper GI endoscopy

Answer

Contrast enhanced CT scan (CECT) oesophagus

Answer

Barium swallow

Question 5

Which of the following are considered aetiological factors for Adenocarcinoma oesophagus?
I. Barrett's oesophagus
II. Gastro-oesophageal reflux
III. Obesity
IV. Alcohol intake

Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Question 6

Consider the following statements regarding Plummer-Vinson syndrome :
I. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia.
II. It is a rare disease, mainly affecting middle-aged women.
III. There is predisposition to postcricoid, cervical oesophageal cancer.
IV. Treatment is usually surgical.

Which of the statements given above are correct?

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Question 7

Which one of following statements is correct regarding Budd-Chiari Syndrome (BCS)?

Accepted Answer

Abdominal discomfort and ascites are the main presenting features.

Answer

Venous drainage of the liver is occluded by IVC thrombus.

Answer

It principally affects young males.

Answer

Quadrate lobe (Segment 4) undergoes hypertrophy.

Question 8

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?

Accepted Answer

Sestamibi scan

Answer

MRI neck

Answer

CECT head and neck

Answer

NCCT head and neck

Question 9

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 :

Accepted Answer

I, II and III

Answer

I, III and IV

Answer

I, II and IV

Answer

II, III and IV

Question 10

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?

Accepted Answer

Breast

Answer

Large intestine

Answer

Adrenal

Answer

Small intestine

UPSC-CMS 2025 — Internal Medicine