UPSC-CMS 2025 - Internal Medicine Practice Questions

Q: Which of the following statements are correct regarding Cauda equine syndrome? I. Its presenting symptoms are perineal numbness, painless urinary retention and fecal incontinence. II. Urgent investigation with MRI is required. III. It is present most commonly in the 45-60 year age group. IV. Confirmed cases require early surgical decompression. Select the answer using the code given below :

I, II and IV. ***I, II and IV*** - Perineal numbness leading to **saddle anesthesia**, painless urinary retention, and fecal incontinence are classic red-flag symptoms of **cauda equina syndrome (CES)** indicating compression of the nerve roots [1]. - Early diagnosis via **urgent MRI** and prompt surgical decompression are critical to prevent permanent neurological deficits due to irreversible nerve damage [2]. *I, II and III* - While statements I and II are correct, statement III is inaccurate as CES can affect adults of any age due to various causes like **herniated discs** [1] or trauma [2]. - **Urgent intervention** is prioritized over age group considerations in managing this condition [2]. *I, III and IV* - Although statements I and IV are correct, statement III incorrectly restricts CES to a specific age group, as it can occur across a **broad age spectrum**. - The primary focus in CES is on symptom recognition and **rapid surgical intervention** [2]. *II, III and IV* - While statements II and IV are correct, statement III is factually incorrect regarding the typical age of presentation for Cauda Equina Syndrome. - **Accurate identification of symptoms** (statement I) is crucial for triggering the necessary urgent investigations and treatment [1].

Q: Which of the following treatments are recommended for a pregnant woman suffering from sickle cell disease ? I. Folic acid 1 mg daily II. Azathioprine III. Penicillin prophylaxis IV. Thromboprophylaxis with low molecular weight heparin Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - **Folic acid 5 mg daily** (not 1mg) is essential in pregnancy, especially for women with **sickle cell disease**, to prevent **megaloblastic anemia** due to increased red cell turnover [1]. - **Penicillin prophylaxis** is crucial to prevent **Bacterial infections** as patients with sickle cell disease are at increased risk of infection, especially from encapsulated organisms, due to **functional asplenia** [1]. - **Thromboprophylaxis with low molecular weight heparin** is recommended because pregnancy in sickle cell disease significantly increases the risk of **venous thromboembolism** [1]. *I, II and IV* - **Azathioprine** is an immunosuppressant typically used for autoimmune conditions or organ transplantation, and it is **not a standard treatment** for managing sickle cell disease itself during pregnancy. - While folic acid and thromboprophylaxis are indicated, the inclusion of azathioprine makes this option incorrect. *I, II and III* - This option incorrectly includes **azathioprine**, an immunosuppressant not indicated for routine sickle cell management in pregnancy. - It also omits crucial **thromboprophylaxis**, which is vital given the increased risk of blood clots. *II, III and IV* - This option correctly includes **penicillin prophylaxis** and **thromboprophylaxis** but **incorrectly omits folic acid**, which is a cornerstone of daily management for all pregnant women with sickle cell disease. - It also incorrectly includes **azathioprine**, which is not a standard treatment.

Q: The best drug for maintenance therapy of Systemic Lupus Erythematosus (SLE) during pregnancy is :

Hydroxychloroquine. ***Hydroxychloroquine*** - **Hydroxychloroquine** is the cornerstone of SLE treatment, including during pregnancy, due to its efficacy in preventing flares and its established safety profile for both mother and fetus. - Continuation of **hydroxychloroquine** throughout pregnancy is recommended to reduce the risk of disease activity, which can lead to adverse maternal and fetal outcomes. *Tacrolimus* - **Tacrolimus** is an immunosuppressant typically reserved for patients with severe organ-threatening lupus, such as lupus nephritis, especially when other treatments fail or are contraindicated. - While it can be used in pregnancy under close monitoring, it is not considered the first-line or best drug for routine maintenance therapy due to potential risks and the availability of generally safer options. *Progestins* - **Progestins** are hormones primarily used in contraception or hormone replacement therapy and have no direct role in the treatment or maintenance of systemic lupus erythematosus. - They do not possess immunomodulatory properties essential for managing SLE disease activity. *Sulfasalazine* - **Sulfasalazine** is an anti-inflammatory and immunomodulatory drug primarily used for inflammatory bowel disease and rheumatoid arthritis, and sometimes for psoriatic arthritis. - It is not a standard treatment for **Systemic Lupus Erythematosus (SLE)** and is less effective for systemic manifestations of lupus.

Q: Consider the following statements regarding Wernicke's encephalopathy : I. It is caused by niacin deficiency. II. It is often seen in alcoholics. III. Ophthalmoplegia, polyneuritis and ataxia are some of its characteristic features. IV. It occurs occasionally in people who fast. Which of the statements given above are correct?

II, III and IV. ***II, III and IV*** - Wernicke's encephalopathy is primarily caused by **thiamine (vitamin B1) deficiency**, not niacin [1]. It is indeed often seen in **alcoholics** due to poor nutrition and impaired thiamine absorption [1], [3]. - The classic triad of Wernicke's encephalopathy includes **ophthalmoplegia** (often nystagmus or gaze palsies), **ataxia**, and **confusion** (or global confusion), and polyneuritis is also associated with chronic thiamine deficiency [2]. It can occur in people who fast or have other conditions leading to severe malnutrition. *I, III and IV* - This option incorrectly states that Wernicke's encephalopathy is caused by **niacin deficiency**. Niacin deficiency causes **pellagra**. - The remaining statements regarding its occurrence in alcoholics, characteristic features (including polyneuritis), and occurrence in people who fast are correct. *I, II and III* - This option incorrectly attributes the cause of Wernicke's encephalopathy to **niacin deficiency**. - While statements II and III are correct regarding its association with alcoholism and its characteristic features [1], [2], the error in statement I makes this option incorrect. *I, II and IV* - This option is incorrect because it states that Wernicke's encephalopathy is caused by **niacin deficiency**. - While the statements regarding its occurrence in alcoholics and in people who fast are accurate, statement I is fundamentally false.

Question 1

Which of the following statements are correct regarding Cauda equine syndrome?
I. Its presenting symptoms are perineal numbness, painless urinary retention and fecal incontinence.
II. Urgent investigation with MRI is required.
III. It is present most commonly in the 45-60 year age group.
IV. Confirmed cases require early surgical decompression.

Select the answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, II and III

Answer

I, III and IV

Answer

II, III and IV

Question 2

Which of the following treatments are recommended for a pregnant woman suffering from sickle cell disease ?
I. Folic acid 1 mg daily
II. Azathioprine
III. Penicillin prophylaxis
IV. Thromboprophylaxis with low molecular weight heparin
Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

I, II and IV

Answer

I, II and III

Answer

II, III and IV

Question 3

The best drug for maintenance therapy of Systemic Lupus Erythematosus (SLE) during pregnancy is :

Accepted Answer

Hydroxychloroquine

Answer

Tacrolimus

Answer

Progestins

Answer

Sulfasalazine

Question 4

Consider the following statements regarding Wernicke's encephalopathy :
I. It is caused by niacin deficiency.
II. It is often seen in alcoholics.
III. Ophthalmoplegia, polyneuritis and ataxia are some of its characteristic features.
IV. It occurs occasionally in people who fast.

Which of the statements given above are correct?

Accepted Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Answer

I, II and IV

UPSC-CMS 2025 — Internal Medicine