Nimhans Mock 1 (DM) Mock Exam Explanatory Key

NIMHANS MOCK 1 ( DM ) MOCK EXAM EXPLANATORY KEY
1 Hangmans Fracture is fracture of? C; Axis

Jeffersons fracture: Atlas
Clay Shoveler's Fracture: C6 Vertebra
Base of skull
Atlas
Axis
Hyoid Bone
2 Alopecia is associated with which peripheral neuropathy? D;Thallium
Guillian Barre Syndrome

Arsenic Poisoning
Lead
Thallium
3 Exchange of segments between non-homologous chromosomes is called C;Translocations are the chrmosomal abberations, responsible for
unilateral or bilateral transfer ofchromosome segments from one
chromosome to another. The segmental interchanges involvingmutual
exchange of chromosome segments between two pairs of non-
homologous chromosomomesare known as reciprocal translocations.
Inversion
Duplication
Translocation
Deletion
4 In which phase of mitosis the chromosome move forward the poles ? D; At the start of anaphase, the centromere of each duplicated
chromosome divides. Daughter
chromosomes each with a centromere and single chromatid, begin to
move toward opposite poles
Prophase
Metaphase
Telophase
Anaphase
5 Tay-sachs disease results due to lack of enzyme- B; Tay-sachs is a disease which begins to shows neurological impairment
and psychomotor difficulties.Tay-sachs disease results form a lack of the
enzyme hexosaminidase A and the subsequent storageof its substrate a
glycosphingolipid in lysosomes.
Glucokinase
HexosaminidaseA
Pyruvate kinase
Na+–K+ ATPase
6 A patient has marked dizziness and unsteadiness during walking. On B; posterior inferior cerebellar artery occlusion. Also known as
examination, he has a left sided Horner's syndrome and left sided weakness. Wallenberg's syndrome, the signs are vertigo, ipsilateral cerebellar signs
There is loss of sensation to pinprick on the right side. What is the likely and weakness, contralateral sensory loss. There is also cranial nerve
diagnosis? involvement causing dysphagia and dysarthria.
Left internal capsule infarct
Posterior inferior cerebellar artery occlusion
Medullary infarct
Multiple sclerosis
7 A 65 year old patient has progressive dementiA. His wife mentions that he has C; large ventricles. The diagnosis is normal pressure hydrocephalus.
urinary incontinence and an ataxic gait. What is his CT scan likely to show? Dementia, urinary incontinence and unsteady gait are seen. Typically
there is no papilloedema. There are large ventricles caused by
communicating hydrocephalus. Ventricular shunting may help improve
the symptoms.
Parasagittal mass
Multiple infarcts
Multiple infarcts
Cerebellar tumour
8 A 65 year old man is assessed on the ward for weakness in his legs. He is an ex B; CSF for Anti Hu and anti Yo antibodies. Anti Hu and anti Yo antibodies
smoker and drinks 15 units of alcohol in a week. His wife mentions that he is would help confirm a diagnosis of paraneoplastic syndrome. Multiple
confuseD. On examination, his MMSE score is 20/30. He has an ataxic gait. There sclerosis is unlikely in view of late presentation and is not commonly
is bilateral pyramidal weakness and coordination is impaireD. Routine blood associated with dementia.
tests are normal. An MRI scan of the head shows diffuse white matter changes,
more in the cerebellar region than the cerebrum. Which of these tests would
help most in confirming the diagnosis?
CSF for oligoclonal bands
CSF for anti Hu and anti Yo antibodies
CSF for TB culture
EEG
9 A 36 year old female gave a recent history of sensory impairment and imbalance C; Multiple sclerosis.
in left half of the body. She also complained of tingling .She had recurrent History of patchy sensory loss, and ataxia which improves on occasion is
episodes of ataxia in last year – each episode resolved spontaneously. What is suggestive of an inflammatory disorder, in this case most likely multiple
the likely diagnosis of this episode? sclerosis.
Transient ischaemic attack
Intracranial space occupying lesion
Multiple sclerosis
CVA
10 A 25 year old biology student is referred by her GP with possible UTI and B; hypomania. Persistent mood elevation with occasional irritability is
confusion. She has few urinary symptoms. Her MTS score is 10 /10 but she has typical of hypomania. Hypomania is a mild form of mania, and can occur
difficulty answering questions directly. She also gets occasionally gets annoyed in bipolar disorder.
but her friend describes her as a very pleasant character who is fun and very
sociable in the puB. Which diagnosis would fit?
Korsakoff's psychosis
Hypomania
Anxiety disorder
Depressive psychosis
11 A 50 year old man has a history of hypertension and is a smoker. He complains of C; left occipital lobe. In homonymous hemianopia, the contralateral
visual loss. Assessment shows the presence of a right homonymous hemianopiA. occipital lobe is affected (usually infarct).
Which of the following structures is damaged?
Optic chiasm
Optic radiation
Left occipital lobe
Right occipital lobe
12 A 22 year old man has unilateral headaches. There was associated watery eyes. D; cluster headache. Cluster headache is a separate entity from migraine.
Neurological examination was unremarkable. Each episode lasted for 4-6 hours. It presents with very intense pain localised around one eye that lasts for
The history goes back 10 months. What is the diagnosis? one to two hours. There may be simultaneous lacrimation and nasal
congestion.
Cavernous sinus thrombosis
Somatoform disorder
Tension headaches
Cluster headache
13 25 year old lady complains of unilateral throbbing headache for 10 months. Each B; migraine. Hemiplegic migraine is a term used to describe t he migraine
time she has headaches, she also complains of unilateral weakness in the arm syndrome that is associated with a weakness or sensory loss of the limbs
which resolve spontaneously when the headaches improve. CT head was normal. on one side of the body. The headache usually precedes the weakness by a
What is the diagnosis? day or more. The limbs gradually return to normal over several days
Cluster headache
Migraine
Tension headache
Somatoform disorder
14 A 40 year old patient has been diagnosed with migraine recently. The migraines A; propanolol. In migraines, beta blockers, calcium channel blockers and
seem to have increased in frequency since being on a triptan. What is the next antidepressants may be helpful in prophylaxis.
medication to use?
Propanolol
Tramadol
Carbamazepine
Neurofen
15 A 36 year old female gave a recent history of sensory impairment and imbalance C; Multiple sclerosis.
in left half of the body. She also complained of tingling .She had recurrent History of patchy sensory loss, and ataxia which improves on occasion is
episodes of ataxia in last year – each episode resolved spontaneously. What is suggestive of an inflammatory disorder, in this case most likely multiple
the likely diagnosis of this episode? sclerosis.
Transient ischaemic attack
Intracranial space occupying lesion
Multiple sclerosis
CVA
16 A 35 year old alcoholic presents with unsteadiness whilst walking. On D; Brown Sequard syndrome. Brown Sequard syndrome causes ipsilateral
examination he has increased tone and brisk reflexes in the right leg. UMN signs and proprioception loss, and contralateral sensory loss. The
Proprioception is abnormal in the right leg. There is patchy decrease in pin prick rest of the conditions (syringomyelia, subacute degeneration of cord,
sensation upon testing both legs. He also has a cerebellar tremor in the hands. Friedrich's ataxia) can cause cerebellar signs or patchy sensory loss but
Which of the following conditions is most likely to be responsible for his should be bilateral.
weakness?
Syringomyelia
Subacute combined degeneration of cord
Friedrich's ataxia
Brown Sequard syndrome
17 A 40 year old lady presents with drooping of her eye lids and double vision. She D; pyridostigmine improves symptoms. The condition described is
does not have proptosis. There is no muscle wasting around the face. She has Mysthenia Gravis rather than Grave's eye disease (raised anti-thyroid Ab)
diplopia on downgaze during examination and also proximal muscle weakness or Myotonic dystrophy (frontal balding). Pyridostigmine is an
of her upper limbs. Which of the following is most likely? anticholinesterase which reduces acetylcholine breakdown and hence
improve symptoms of fatiguability in myasthenia gravis.
It is an X-linked disease
Abnormal anti thyroid antibodies
Associated autonomic disturbance
Pyridostigmine improves symptoms
18 A 40 year old patient has a first seizure. What advice should be given regarding C; no driving for 1 year. For a single seizure, driving is not permitted for 1
driving a car? year. Also, a medical review is required before one is to do so
No driving for 1 month
No driving for 6 months
No driving for 1 year
Driving is allowed if EEG is normal
19 A 25 year old secretary has had several episodes of brief jerking of the right arm A; carbamazepine. Brief episodes of jerking suggests simple partial
over the past few weeks. There is no loss of consciousness. A CT scan of the head seizures. Carbamazepine is first line therapy for this.
is unremarkable. Which is the best medication to commence?
Carbamazepine
Phenytoin
Lorazepam
Diazepam
20 A 34-year-old woman has had migraine with aura since a teenager. Recently she D; sumatriptan
presents to an emergency department (ED) complaining of severe migraine. She First line treatment of migraines include: soluble aspirin 600-900 mg stat
has had worsening attacks up to twice a day over the past 2 months. She is in adults, paracetamol 1 g - adult dosage, or non-steroidal anti-
suffering from a migrainous headache with visualisation of flashing lights. inflammatory drugs (NSAIDs) such as ibuprofen 1.2-1.6 g daily in divided
Ibuprofen and paracetamol have not helpeD. What should be prescribed? doses.
Triptans are indicated for the treatment of attacks unresponsive to
adequate doses of analgesics with an anti-emetic, especially if migraine
occurs despite optimal prophylaxis. Sumatriptan 50mg is recommended
as second line treatment.
Morphine
Propanolol
High dose paracetamol
Sumatriptan
21 The mot common site of meastases to brain is B;
The sources of most cerebral metastases are (in decreasing frequency) the
lung, breast, kidney, GI tract, and melanoma. Lung and breast cancers
account for more than half of cerebral metastases. Metastatic cells usually
travel to the brain hematogenously and frequently seed the gray-white
junction. Other common locations are the cerebellum and the meninges.
The latter leads to carcinomatous meningitis, also known as
leptomeningeal carcinomatosis. MRI pre– and post–contrast
administration is the study of choice for evaluation.
Breast
Lung
Kidney
Melanoma
22 The most common primary CNS neoplasm is A;
Astrocytomas
Ependymoma
Oligodendroglioma
Choroid plexus papilloma
23 The most common type of astrocytoma is D; Astrocytoma is the most common primary CNS neoplasm. The term
glioma is often used to refer to astrocytomas specifically, excluding other
glial tumors. Astrocytomas are graded from I to IV. Grades I and II are
referred to as low-grade astrocytoma, grade III as anaplastic astrocytoma,
and grade IV as glioblastoma multiforme (GBM). Prognosis varies
significantly between grades I/II, III, and IV, but not between I and II.
Median survival is 8 years after diagnosis with a low-grade tumor, 2 to 3
years with an anaplastic astrocytoma, and roughly 1 year with a GBM.
GBMs account for almost two-thirds of all astrocytomas, anaplastic
astrocytomas account for two-thirds of the rest, and low-grade
astrocytomas the remainder.
I
II
III
IV
24 Calcification or hemorrhage in a suspected tumor in CT or MRI suggests C;
Oligodendroglioma accounts for approximately 10% of gliomas. They
often present with seizures. Calcifications and hemorrhage on CT or MRI
suggest the diagnosis. Oligodendrogliomas are also graded from I to IV;
grade portends prognosis. Prognosis is better overall than for
astrocytomas. Median survival ranges from 2 to 7 years for highest and
lowest grade tumors, respectively. Aggressive resection improves
survival. Many oligodendrogliomas will respond to procarbazine,
lomustine (CCNU), vincristine (PCV) chemotherapy. Radiation has not
been clearly shown to prolong survival.
Astrocytomas
Ependymoma
Oligodendroglioma
25 The term is appled as microadeonoma to adenoma in pituitary if size is less than B;
Pituitary adenomas arise from the anterior pituitary gland (the
adenohypophysis). Tumors less than 1 cm diameter are microadenomas;
larger tumors are macroadenomas. Pituitary tumors may be functional
(i.e., secrete endocrinologically active compounds at pathologic levels) or
nonfunctional (i.e., secrete nothing or inactive compounds). Common
symptoms include visual field deficits due to compression of the optic
chiasm, or panhypopituitarism due to compression of the gland.
Hemorrhage into a pituitary tumor causes abrupt symptoms of headache,
visual disturbance, decreased mental status, and endocrine dysfunction.
This is known as pituitary apoplexy. Pituitary tumors should be
decompressed surgically to eliminate symptomatic mass effect and/or to
attempt endocrine cure. Prolactinomas usually shrink with dopaminergic
therapy. Consider surgery for prolactinomas with persistent mass effect
or endocrinologic dysfunction in spite of adequate dopamine agonist
therapy. Most pituitary tumors are approached through the nose by the
transsphenoidal approach. Endoscopic sinus surgery techniques may be
helpful and are increasingly being used.
1mm
10mm
15mm
20mm
26 The most common extradural tumor in spinal cord is D;
Metastatic tumors are the most common extradural tumors. Spinal
metastases most commonly occur in the thoracic and lumbar vertebral
bodies because the greatest volume of red bone marrow is found therein.
The most common primary tumors are lymphoma, lung, breast, and
prostate. Other sources include renal, colon, thyroid, sarcoma, and
melanoma. Most spinal metastases create osteolytic lesions. Osteoblastic,
sclerotic lesions suggest prostate cancer in men and breast cancer in
women. Patients with progressing neurologic dysfunction or debilitating
pain should undergo urgent surgery or radiation therapy.
Meningioma
Hemangioma
Ependymoma
Metastases
27 The most common intramedullary tumour in adults is B;
Ependymomas are the most common intramedullary tumors in adults.
Astrocytomas are the most common intramedullary tumors in children,
although they also occur in adults. Intradural extramedullary tumors
comprise 40% of spinal tumors and arise from the meninges or nerve root
elements
Meningioma
Ependymoma
Astrocytoma
Dermoids
28 the most common site for disc herniation in lumbar level is D;
Lumbar Disc Herniations and Symptoms by Level
Lev Frequen Root Refle Weakness Numbne

el cy Injure x ss
d
L3– 5% L4 Patell Quadriceps Anterior
L4 ar thigh
L4– 45% L5 Tibialis Great toe
L5 anterior
(foot drop)
L5– 50% S1 Achill Gastrocnem Lateral
S1 es ius foot
L1 – L2
L2- L3
L3-L4
L4-L5
29 The most common peripheral nerve tumour is B;
Schwannomas are the most common peripheral nerve tumors, also
referred to as neurilemomas or neurinomas. Most occur in the third
decade of life. These benign tumors arise from Schwann cells, which form
myelin in peripheral nerves. The most characteristic presentation is a
mass lesion with point tenderness and shooting pains on direct palpation.
Neurofibroma
Schwannoma
Neuoepithelioma
Neurolipoma
30 The most common organism responsible for skull osteomyelitis is A;
Osteomyelitis of the skull may develop by contiguous spread from
pyogenic sinus disease or from contamination by penetrating trauma.
Staphylococcus aureus and S. epidermidis are the most frequent causative
organisms
Staph. Aureus
E. Coli
Bacteroides
Strep. Pyogenes
31 Gamma knife stands for A;
The term stereotactic radiosurgery (SRS) refers to techniques that allow
delivery of high-dose radiation that conforms to the shape of the target
and has rapid isodose fall-off, minimizing damage to adjacent neural
structures. The two most common devices used for conformal SRS for
intracranial lesions are the LINAC (linear accelerator) and the gamma
knife. LINAC delivers a focused beam of x-ray radiation from a port that
arcs part way around the patient's head. Linear accelerators are
commonly used to provide fractionated radiation for lesions outside the
CNS. They are found in most radiation oncology departments. SRS can be
performed with these existing units, after upgrades to the software and
collimators. The gamma knife delivers approximately 200 focused beams
of gamma radiation from cobalt sources through a specially designed
colander-like helmet.
Used in stereo tactic surgery
Used to coagulate blood vessels during neurosurgery
It is latest investigative modality in tumours
It is a used for giving chemotherapy in brain
32 Which of the following statements about craniopharyngiomas is true? D; Craniopharyngiomas are cystic tumors with areas of calcification and
originate in the epithelial remnants of Rathke’s pouch. These usually
benign tumors are found in the sellar and suprasellar region and lead to
compression of the pituitary, optic tracts, and third ventricle. As a result
they show up on radiographic
imaging as an area of sellar erosion with calcification within or above the
sella. Craniopharyngiomas are most commonly found in children but may
also present in adulthood. In children they can cause growth retardation
because of hypothalamic-pituitary dysfunction. Treatment consists of
subfrontal or transsphenoidal excision with adjuvant radiotherapy if total
removal is not possible.
The tumors are uniformly solid
The tumors are usually malignant
Children with these tumors often develop signs and symptoms of acromegaly
The tumors may cause compression of the optic tracts and visual symptoms
33 Which of the following statements regarding skull fractures is true? C;
Most skull fractures do not require surgical treatment unless they are
depressed or compound. A general rule is that all depressed skull
fractures, defined as fractures in which the cranial vault is displaced
inward, should be surgically elevated, especially if they are depressed
more than 1 cm, if a fragment is over the motor strip, or if small, sharp
fragments are seen on x-ray (as they may tear the underlying dura).
Compound fractures, defined as fractures in which the bone and the
overlying skin are broken, must be cleansed and debrided and the wound
must be closed. When a skull fracture occurs in an area of the paranasal
sinuses, the mastoid air cells, or the
middle ear, a tear in the meninges may result in cerebrospinal fluid
drainage from the ear or nose. The presence of rhinorrhea or otorrhea
requires observation and prophylactic antibiotics, because meningitis is a
serious sequel. Otorrhea usually heals within a few days. Persistent
cerebrospinal fluid from the nose or ear for more than 14 days requires
surgical repair of the torn dura.
Depressed fractures are those in which the patient’s level of consciousness is
diminished or absent
Compound fractures are those in which the skull is fractured and the underlying brain
is lacerated
Any bone fragment displaced more than 1 cm inwardly should be elevated surgically
Drainage of cerebrospinal fluid via the ear or nose requires prompt surgical treatment
34 False localizing sign is due to involvement of --- cranial nerve D; Raised ICP may be associated with papilloedema on fundoscopy There
may also be diplopia due to a sixth nerve palsy; this nerve is vulnerable to
downwards cerebral shift of any cause due to its long intracranial course,
sometimes called a false localising sign
3
4
5
6
35 Which of the following is not a type of obstructive hydrocephalus? D;
Aetiology of hydrocephalus
Obstructive hydrocephalus
Lesions within the ventricle
Lesions in the ventricular wall
Lesions distant from the ventricle but with a mass effect
Communicating hydrocephalus
Post haemorrhagic
CSF infection
Raised CSF protein
Excessive CSF production (rare)

Choroid plexus papilloma/carcinoma
Lesions within ventricle
Lesions in the ventricular wall
Lesions distant from the ventricle but with a mass effect
36 The most common organism found in meningitis in adult patient is C;
Organisms causing meningitis
Neonate
Group B Streptococcus
Listeria
Enterobacteriae
Infant
Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Young child/adult
Streptococcus pneumoniae
Neisseria meningitidis
Immunocompromised patient
Cryptococcus
Mycobacterium tuberculosis
Listeria
Group B streptococcus
N. meningitides
S. Pneumoniae
Cryptococcus
37 A mature cerebral abscess with capsule is formed by --- days C;
A 2- to 3-day period of early cerebritis with inflammatory cell
inflammation is followed by late cerebritis over days 4–9, with the
formation of a necrotic core and increasing numbers of macrophages and
fibroblasts After 10 days, a capsule begins to form and is firm and mature
by day 14.
Intracerebral abscess may occur as a result of direct spread from air sinus
infection, following surgery or from haematogenous spread especially
associated with respiratory infection, endocarditis or dental infection. In
around 25% of cases no cause is found.
Patients at increased risk of cerebral abscess formation include those with
cyanotic heart disease and those who are immunocompromised: patients
with diabetes, solid organ transplant, haematological malignancy or long-
term steroids
5
9
14
21
38 Following surgical drainage of cerebral abscess, antibiotics are usually given for B;
--- weeks Cerebral abscess is usually treated by surgical drainage followed by
administration of intravenous antibiotics for at least 6 weeks. Steroids are
reserved for cases with significant oedema or mass effect and their
routine use is discouraged because of their negative impact on antibiotic
therapy. Owing to the high risk of seizures, patients should also be treated
with anticonvulsants.
4
6
8
10
39 The most common site for pilocytic astocytoma in a children is C;
Pilocytic astrocytoma is most common in children and young adults, with
a peak incidence at the age of 10 years. Common sites include the
cerebellum, optic nerve and chiasma, hypothalamus and brainstem. It may
be possible to cure posterior fossa tumours by complete surgical excision.
High-grade gliomas, including anaplastic astrocytomas (WHO grade III)

and glioblastoma (WHO grade IV) are most common in the fifth and sixth
decades of life respectively. Glioblastoma is the most common adult glial
tumour. Treatment includes surgery to confirm the diagnosis and achieve
a macroscopic excision when possible. Surgery is usually followed by
high-dose (60 Gy) focused irradiation for those patients with a good
performance status. Chemotherapy options include oral temozolomide,
either concurrently or after radiotherapy. Chemotherapy wafers
impregnated with carmustine may be inserted into the surgical cavity at
the time of resection. Despite recent advances, the prognosis for
a glioblastoma remains poor with a median survival of 12 months and 2-
year survival of only 26% T e prognosis for a patient with a glioma
depends on the histological grade, cell type, tumour size and patient
factors such as age and perf.rmance status.
Occipital lobe
Corpus collasum
Cerebellum
Optic chiasma.
40 The most common cause for SAH is A;
The most common cause of SAH by far is trauma. On the other hand, non-
traumatic SAH is caused by:
• Aneurysms (75%);
• Arteriovenous malformations (avms; 10%);
• Idiopathic causes (10%);
• Tum
Trauma
Aneurysm
Idiopathic
Tumours
41 A 25-year-old man returns from holiday to ooty and develops sudden weakness B; This man most likely has Guillain-Barre syndrome (GBS) i.e. a
of the legs followed a few days later by weakness in the arms. On examination he peripheral neuropathy. His reflexes are absent - a lower motor neurone
has weakness in all four limbs and his reflexes are absent. lesion. Acute ascending weakness in a lower motor neurone pattern is
most likely caused by GBS.
Brown-Sequard syndrome
Peripheral neuropathy
Myopathy
Brainstem lesion
42 A 65-year-old woman develops weakness in both legs. She has weakness mostly C; This woman has a posterior spinal cord lesion characterized by dorsal
of the flexor muscles in a symmetrical pattern with brisk reflexes. She also has column impairment with intact spinothalamic tracts.
vibration and proprioception impairment in the legs but intact pain and
temperature sensation.
Neuromuscular junction disorder
Plexopathy
Posterior spinal cord lesion
Motor cortex lesion
43 A 50-year-old woman has increasing difficulty rising from a chair over a two B; This woman has a myopathy characterized by symmetrical proximal
month period. On examination she has symmetrical proximal weakness of the weakness.
legs and also the arms with some pain in the same muscles.
Myopathy
Brainstem lesion
Spinal cord compression
44 A 71-year-old man with known prostate cancer presents with increasing A; This gentleman has a spinal cord lesion affecting the whole cord
difficulty walking over the last couple of weeks. He has weakness of the flexor (corticospinal tracts, dorsal columns and spinothalamic tracts). He has a
muscles in the legs and brisk reflexes. All sensory modalities are impaired in the sensory level suggesting a lesion affecting the spinal cord about T10.
legs with light touch and pinprick sensation impaired onto the abdomen up to
the umbilicus.
Anterior spinal cord lesion
Plexopathy
45 A 50-year-old woman presents with difficulty keeping her head up. She has neck D; This lady has myasthenia gravis, a neuromuscular junction disorder,
flexion weakness on examination as well as proximal weakness in the arms with characteristic fatigability.
which is fatigable.
Brainstem lesion
Anterior spinal cord lesion
46 All of the above investigations are subsequently performed. Brain imaging does D; Benign intracranial hypertension
not reveal any abnormality. What is the most likely diagnosis?
Glioma
Meningioma
Pituitary adenoma
Benign intracranial hypertension
47 A 35 year old alcoholic presents with unsteadiness whilst walking. On D; Brown Sequard syndrome. Brown Sequard syndrome causes
examination he has increased tone and brisk reflexes in the right leg. ipsilateral UMN signs and proprioception loss, and contralateral sensory
Proprioception is abnormal in the right leg. There is patchy decrease in pin prick loss. The rest of the conditions (syringomyelia, subacute degeneration of
sensation upon testing both legs. He also has a cerebellar tremor in the hands. cord, Friedrich's ataxia) can cause cerebellar signs or patchy sensory loss
Which of the following conditions is most likely to be responsible for his but should be bilateral.
weakness?
Syringomyelia
Subacute combined degeneration of cord
Friedrich's ataxia
Brown Sequard syndrome
48 A 65 year old man has muscle weakness. EMG shows reduced amplitude and A; dermatomyositis. These EMG changes are consistent with a myositis.
duration of motor units. Which of the following conditions is likely? In motor neuron disease, fibrillation is seen. In myasthenia, there is
diminished response to repetitive stimulation.
Dermatomyositis
Myasthenia gravis
Myotonic dystrophy
49 A 25 year old lady has a five day history of frontal headache and visual blurring. B; pink. Although optic neuritis causes pale optic disc, in the acute period
On examination, there is a left sided afferent pupillary defect. What is the left eye (as in this case), the disc colour remains normal.
appearance likely to be?
Large cup/disc ratio
Pink
Pale
Swollen disc margin
50 A 40 year old accountant has bipolar disorder. He has recently become very C; olanzepine. Lithium is used for prophylaxis in bipolar disorder.
talkative and is unable to concentrate at work. Hypomania is diagnosed. Which Olanzepine or benzodiazepines are more effective during episodes of
of the following is most likely to be effective? hypomania.
ECT
Lithium
Olanzepine
Procyclidine
51 30 year old of average height and weight presents with polyuria and thirst. He D; commence on gliclazide and reassessment with BM monitoring at
has a blood glucose of 15 mmol/l. There is no ketonuria and pH on the blood gas home. He is a type 1 diabetic but there are no features of ketonuria or
is 7.35. How should he be treated? acidosis. He may have some residual β islet cell function and hence
sulphonylureas may help to stimulate insulin production.
Start metformin
A fasting blood glucose should be sent before treatment
Subcutaneous insulin should be started
Commence on gliclazide and reassessment with BM monitoring at home
52 The frequency of attendance of a 100 medical students at lectures were recorded B; Spearmann correlation. Spearmann's correlation is the best method
by an observer over a 3 month period. The students were then assessed at the to determine two variables which do not follow a normal distribution.
end with a multiple choice exam with a test score marked out of a hundred.
Which of these statistical methods is best used to analyse the effectiveness of
frequency of attendance on higher test scores
Mann-Whitney test
Spearmann correlation
Chi square test
Fisher's exact test
53 An 80- year- old man, previously fi t and healthy, presents with severe fl inging C; The presence of severe flinging movements indicates hemiballistic
movements of the left arm. movements. The site of lesion is the contralateral subthalamic nucleus.
Where is the neurological lesion? The commonest cause is stroke. Usually the flinging movements stop
spontaneously within 4–8 weeks. Tetrabenazine is the treatment of
choice.
Caudate nucleus
Globus pallidus
Subthalamic nucleus
Substantia nigra
54 A 29-year- old news presenter from Pimlico attended Outpatient clinic after a A; Women on anticonvulsant therapy are advised to plan their
positive pregnancy test. She was diagnosed with epilepsy at the age of 19, having pregnancies carefully so that any adjustments in therapy can be made
suffered two tonic- clonic seizures. At the time of diagnosis, she was started on prior to becoming pregnant. Ideally, reducing switching therapy should be
sodium valproate. She took this subsequently without any further seizure. She done over a period of several months. Anticonvulsant agents are likely to
last had a period 13 weeks previously, having usually had a regular 28 day produce foetal malformations before 13 weeks. Therefore, the best option
menstrual cycle. What decision is most appropriate regarding her at this stage is to
anticonvulsant therapy? continue her current therapy.
Continue sodium valproate
Convert sodium valproate to carbamazepine
Convert sodium valproate to lamotrigine
Reduce the dose of sodium valproate
55 A 23- year- old woman presents to her GP complaining of impaired sweating in A; This is a classical history of Holmes- Adie pupil, of a large pupil which
hot weather. She feels that the onset of her symptoms was sudden, and on reacts sluggishly to light. There is normally delayed constriction in
examination she has a sluggishly reactive pupil. The only other physical sign is response to near vision, and accommodation may also be impaired. There
absent ankle jerks, even with reinforcement. She otherwise feels well. is sometimes segmental palsy and spontaneous movement of the iris.
The nature of the pathology is best described as: Absent ankle jerks is sometimes an associated finding.
Holmes-Adie pupil
Ptosis
Horner’s syndrome
Argyll- Robinson pupil
56 A 60- year- old woman presented with a small right pupil, right sided ptosis, and D; This patient has Horner’s syndrome, consisting of miosis, ptosis,
impaired sweating over the ipsilateral forehead. Sweating on the rest of the face anhydrosis (and enophthalmos). Because the sympathetic plexus
was unaff ected. The most likely site of the lesion is: accompanying the internal carotid artery innervates sweat glands only to
the medial forehead, facial anhydrosis does not occur significantly with
postganglionic Horner’s syndrome.
Cervical spinal cord
Common carotid artery
Hypothalamus
Internal carotid artery
57 A 36- year- old presents with severe unsteadiness, difficulty in swallowing, and A; The unifying diagnosis is Wallenberg’s syndrome (otherwise known as
intractable hiccups, accompanied by nausea, deafness, and vomiting. On the lateral medullary syndrome).
examination, he has marked limb ataxia, impairment of sensation on the left side
of his face, impairment of left sided eye abduction, a left facial nerve palsy, and a
mild
left- sided Horner’s syndrome. He has loss of contalateral pain and temperature
sensation. Cerebellar signs are elicited on the left. The vessel most likely to be
occluded is:
Left posterior inferior cerebellar artery
Right posterior inferior cerebellar artery
Left anterior carotid artery
Right anterior carotid artery
58 A 47- year- old man presented to the Casualty department following sudden D; The typical presentation of vertebral artery dissection is a young
onset of left posterior auricular pain while in his garage working under his car. person (average age 40 years) with severe occipital headache and neck
On examination he had a degree of neck pain and stiff ness and also impaired pain following a recent head or neck injury. The trauma is often trivial, but
coordination of the left hand and weakness and increased tone in his right limbs. is usually associated with some form of cervical distortion. About 85% of
What is the most likely diagnosis? patients develop focal neurological signs due to ischaemia of the brain
stem or cerebellum.
The commonest neurological manifestations are symptoms attributable to
lateral medullary dysfunction (i.e. Wallenberg’s syndrome). The vessel
that is usually occluded is likely to be the posterior inferior cerebellar
artery, a branch of the vertebral artery
Cervical dislocation
Migraine
Subarachnoid haemorrhage
Vertebral artery dissection
59 A 60- year- old man has the clinical diagnosis of idiopathic Parkinson’s disease. B; Anticholinergic drugs such as benzhexol remain the treatment of choice
He is commenced on treatment with L- dopa and dopa decarboxylase inhibitor in Parkinsonian tremor. L- dopa, selegiline and dopamine agonists are less
therapy. However, he continues to have a troublesome tremor. effective in tremor.
Which of the following drugs would be most likely to help?
Amantadine
Trihexyphenyl (benzhexol)
Propanolol
Ropinirole
60 A 20- year- old woman has a history of paroxysmal episodes of dysarthria, ataxia B; The most likely diagnosis is basilar migraine. The history, normal MRI
and diplopia lasting for 20–30 minutes followed by right- sided severe headache brain and MR angiogram effectively exclude other possibilities offered
associated with vomiting, lasting for 1–3 days. The episodes occur once every here.
month. MRI brain and MRA (angiogram) are normal.
What is the most likely diagnosis?
Basilar artery TIAs
Basilar migraine
Brainstem arteriovenous malformation
Giant cell arteritis
61 A 55- year- old man with poorly controlled hypertension presented with D; The patient is stable and has a normal GCS. If there is evidence of raised
headache and right- sided weakness. He was right- handed. The CT scan revealed intracranial pressure, therapies which could be considered include
a left- sided intracerebral haematoma in the frontoparietal area. The blood intravenous mannitol, barbiturate sedation and artifi cial
pressure measured 160/90 mmHg. The Glasgow Coma Scale was 15/15. The hyperventilation. The treatment of choice is intravenous mannitol;
patient’s condition had remained unchanged for two hours. steroids are not useful. Surgical intervention should only be considered if
What is the appropriate management? there is evidence of a cerebellar haemorrhage > 3 cm in diameter, as this
is a risk for brainstem compression and ischaemia. In all other situations,
surgery should only be contemplated in patients with an intermediate
GCS who have had a recent presentation and are continuing to deteriorate
(it should not be considered in patients who are fully rousable or totally
obtunded). Surgery should be avoided if possible if the dominant
hemisphere is involved. Blood pressure should only be treated if the blood
pressure > 170 mmHg. Ideally, the BP is maintained at 140–160 mmHg
systolic in patients with recent intracerebral haemorrhage.
Control of blood pressure immediately
Neurosurgical referral
Intravenous mannitol
Dexamethasone
62 A 60- year- old man presented with acute weakness and pain of his right lower D; The most likely diagnosis is sacral plexopathy. Thigh abduction and
limb. He had awoken one morning after playing football with his grandson and extension weakness indicate gluteal medius and maximus involvement
had been aware of marked pain and weakness of his right leg. On examination (L5, S1). This finding distinguishes it from the sciatic nerve palsy.
there was weakness of ankle dorsifl exion, plantar fl exion, eversion and
inversion, and thigh abduction and extension.What is the most likely diagnosis?
Common peroneal nerve palsy
L4 root lesion
Sacral plexopathy
Sciatic nerve palsy
63 Astrocytoma is most commonly associated with the following phakomatosis : B;
Neurofibromatosis
Tuberous sclerosis
Von Hippel Lindau disease
Sturge Weber syndrome
64 Commonest cause of metastatic tumor in orbit in children is: A;
Neuroblastoma
Chloroma
Ewings sarcoma
Wilms tumor
65 All of the following make the diagnostic criterion for Vogt-Koyanagi- B; Vogt-Koyanagi-Harada (VKH) syndrome is a rare systemic disease
Harada Syndrome EXCEPT: involving various melanocyte-containing organs. Bilateral panuveitis
associated with cutaneous, neurologic, and auditory abnormalities are
manifestations of this inflammatory granulomatous
disorder. The American Uveitis Society has recommended that in addition
to an absence of prior trauma or surgery, at least 3 of the following 4
criteria be met to confirm the diagnosis of VKH syndrome:
 Bilateral iridocyclitis
 Posterior uveitis, which may include exudative retinal detachment,
optic nerve swelling, or atrophy of the retinal pigment epithelium
 CSF pleocytosis or evidence of tinnitus, dysacusis, headache or
meningismus, or cranial nerve involvement
Cutaneous findings of vitiligo, alopecia, or poliosis
Neuroiogical features
Auditory features
Cutaneous features
Posterior uveitis
66 HLA Bw51 is associated with: B;
There is a Close association of HLA-Bw51 with Behçet's disease
Ankylosing spondylitis
Behcet's disease
Sire shot chorioretinopathy
Rheumatoid arthritis
67 SOKAL score is used to assess the prognosis in B; Prognostic score is used to assess prognosis in CML
AML
CML
ALL
CLL
68 Which of the following statements about the segmental anatomy of the liver are D; Segments are the major subdivision of the right and left lobes of the
not true? liver. In either the classic lobar (American) or the segmental (French)
system, the most variable aspect is the biliary system. Therefore the
hepatic venous or portal system defines most segments. The French
system depicts eight segments, with the caudate lobe as segment I and the
other seven segments defined primarily by the hepatic venous system.
Segments are not well-depicted by topography.
Segments are subdivisions in both the French and American systems.
Segments are determined primarily by the hepatic venous drainage.
The French anatomic system is more applicable than the american system to clinical
hepatic resection.
Segments are important to the understanding of the topographic anatomy of the liver.
69 The hepatic artery: D; The portal vein provides two thirds to three quarters of the total
hepatic blood flow. The portal vein is incapable of direct autoregulation.
The hepatic artery after transplantation classically infarcts portions of the
biliary system, whereas hepatic metastases often arrive there via the
portal vein. Most of hepatic metastasis blood supply comes from the
hepatic artery.
Supplies the same amount of blood to the liver as the portal vein.
Provides less blood to the bile ducts than the portal vein.
Is autoregulated just as the portal vein is.
Supplies most of the blood to hepatic metastases.
70 Generally, the two most important hepatic functions to consider after hepatic B; While other functions undoubtedly may be important postoperatively,
resection are: the most common abnormalities occurring after a major hepatic resection
are related to loss of protein synthesis and consequences of glucose
metabolism. Therefore, it is usually advisable to administer supplemental
amounts of protein and sugar postoperatively.
Hepatic detoxification function.
Glucose metabolism.
The liver's role in lipid metabolism.
The liver's role in vitamin metabolism.
71 Which of the following statements about pyogenic abscess of the liver are true? A; Involvement of the right lobe with abscess formation approximates
70% of pyogenic abscesses. This is thought to be due to the streaming
effect of superior mesenteric venous inflow to the right lobe. In addition,
the greater volume of the right lobe predisposes more tissue to seeding by
bacterial organisms. While appendicitis comprised 25% to 40% of cases
in early series, early recognition and operative therapy for appendicitis
have reduced its importance significantly. In current series, malignant or
benign biliary obstruction is the underlying cause of 35% to 50% of cases.
Recent studies have shown that the underlying disease or an
immunocompromised host is more important prognostically than solitary
versus multiple abscesses.Mortality rate is greater than 40%
The right lobe is more commonly involved than the left lobe.
Appendicitis with perforation and abscess is the most common underlying cause of
hepatic abscess.
Mortality is largely determined by the underlying disease and is currently greater than
80%
All the above
72 The pattern of normal TSH, high T4, and high T3 is seen often with C; Estrogens increase thyroxine-binding globulin, elevating total T4 and
T3, whereas free T4, free T3, and TSH remain normal
Hyperthyroidism
Nonthyroidal illness (sick euthyroidism)
Estrogen therapy
Familial (euthyroid) dysalbuminenic hyperthyroxinemia
73 Panda eyes is seen in: B;

Raccoon eyes ( panda eyes) or periorbital ecchymosis is a sign of basal
skull fracture.It results from blood from skull fracture tracking down into
the soft tissue around the eyes.Raccoon eyes may also be a sign of
disseminated neuroblastoma[ amyloidosis & Multiple Myeloma.
Orbital roof fracture
Basal skull fracture
Blowout fracture
Medial wall fracture
74 Which one of the following has not been shown to be associated with cataract D;
formation? Cataract has been associated with various
Systemic conditions, such as connective tissue disorders (myotonic
dystrophy which causes ‘Christmas tree’ cataracts) and Marfan’s
syndrome (also associated with lens dislocation). It is also associated with
intraocular diseases such as uveitis, and high myopia is a risk factor.
Myasthenia gravis, a myopathy causing fatiguable ptosis and reduced eye
movements, is not
Associated with cataract itself. (However, patients may require sustained
oral steroids for its treatment and may develop cataracts as a result.)
High myopia
Marfan’s syndrome
Myotonic dystrophy
Myasthenia gravis
75 Which one of the following is associated with cortical cataract? D;
Cortical cataract is associated with
Increasing age, and is more common in
Women and people of Afro Caribbean descent. Ultraviolet light, in the
form of sunlight, has been assoiciated with cortical cataract also. Smoking
is not associated with cortical cataract, and while steroids may increase
the risk of all types of cataract, they are particularly associated with
posterior subcapsular cataract
Steroid intake
Smoking
Vitamin d
Ultraviolet light
76 Sinus of morgagni is seen A; Between the upper border of superior constrictor and skull base
Between the upper border of superior constrictor and skull base
Between the superior and middle constrictor
Between the middle and inferior constrictor
In between the fibers of inferior constrictor muscles
77 The earliest cells of the myeloid serious which contain granules is the: C; – Myelocyte
Myeloblast
Mature granulocyte
Myelocyte
Eosiniphil
78 Kluver-Bucy syndrome is associated with lesion in the following area of brain A; Amygdala
Kluver-Bucy syndrome is a behavioral disorder that occurs when both the
right and left medial temporal lobes of the brain malfunction . The
amygdala has been a particularly implicated brain region in the
pathogenesis of this syndrome. They may display oral or tactile
exploratory behavior (socially inappropriate licking or touching);
hypersexuality; bulimia; memory disorders; flattened emotions
(placidity): and an inability to recognize objects or inability to recognize
faces. This disorder may be caused by any conditions. including facial or
cerebral trauma; infect ions; Alzhe imer's disease; Niemann Pick disease
of the brain; or cerebro Vascular disease:
Amygdala
Cerebral cortex
Hippocampus
Mammillary body
79 Most common cause of pleural effusion in HIV patients includes D; Kaposi's sarcoma
Pleural effusions are uncommon in AIDS patients. The most common
cause is Kaposi's sarcoma followed by parapneumonic effusion. Other
common causes are TB, cryptococcosis. and primary
effusion lymphoma. Pleural effusions are very uncommon
with Pneumocystis carinii infection.
Mycobacterium tuberculosis infection
P. Carnii infection
MAC infection
Kaposi's sarcoma
80 In the case of hookworm disease, which is infectious to man C; Infective stage is Filariform larva
Eggs
Rhabditiform larva
Filariform larva
Transitional larva
81 Katayama fever is due to acute C; Acute schistosomiasis (Katayama's fever) may occur weeks after the
initial infection, by S. mansoni and S. japonicum. Manifestations include:
Abdominal pain , Cough , Diarrhea , Eosinophilia , Fever , Fatigue ,
Hepatosplenomegaly & Genital sores
Fasciolopsiasis
Clonorchiasis
Schistosomiasis
Paragonimiasis
82 A 70-year-old male with a dementing disorder dies in a car B; Pick's disease accounts for 2.5% of cases of dementia. Clinically it is
accident. Pathological examination of his brain shows fronto- distinguishable from Alzheimer's disease due to the prominence and early
temporal atrophy, gliosis of the frontal lobes " white metter, onset of personality changes. disinhibition or apathy, socially
intracellular inclusions, and swollen neurons. Choose the correct inappropriate behavior, mood changes (elation or depression), and
diagnosis: psychotic symptoms. Language is affected early in the disease but the
memory loss, apraxia, and agnosia characteristic of Alzheimer's disease
are not prominent until the late stages of the disorder. Temporofrontal
atrophy. demyelination and gliosis of the frontal lobes, Pick bodies
(intracellular inclusions), and Pick cells (swollen neurons) are the
characteristic pathological findings.
Alzheimer's disease
Picks disease
Creurzfeldt-jakob disease
B 12 deficiency dementia
83 Which one of the listed types of antibodies is the best example of B; An anti-i IgM antibody associated with infectious
a cold agglutinin that is associated with cold autoimmune mononucleosis
hemolytic anemia? Antibody-mediated destructlon of red cells result from
either autoinmmune reactions or isoimmune reactions.
The latter are due to antibodies from one person that react with red cells
from another person. This isoimmune destruction is seen with blood
transfusions and hemolytic disease of the newborn.
Autoimmune hemolytic anemias (AIHAs) are hemolytic anemias that are
due to the presence of antibodies that destroy red cells.
The AIHAs arc divided into two main types; those secondary to "warm"
antibodies and those secondary to "cold" antibodies.
The antibodies seen in warm-antibody autoimmune hemolytic anemias
react at 37°C in vitro, are composed of IgG. and do not fix complement.
Instead, immunoglobulin-coated red blood cells are removed by splenic
macrophages that recognize the Fc portion of the immunoglobulin. These
warm IgG antibodies are found in patients with malignant tumors. espe-
cially leukemia-lymphoma; they are associated with the use of such drugs
as C-methyldopa; and they are also found in the autoimmune diseases,
especially lupus erythematosus.
Cold-antibody autoimmune hemolytic anemia (cold AIHA) is
subdivided into two clinical categories based on the type of
antibodies involved. These two types of cold antibodies are
cold agglutinins and cold hemolysins.
Cold agglutinins are rnonoclonal IgM antibodies that react at 4 to 6°C.
They are called agglutinins because the IgM can agglutinate red cells due
to its large size (pentamer),
Additionally, IgM can activate complement, which may result in IV
hemolysis. Mycoplasma pneumonitis and infectious mononucleosis are
classically associated with cold-agglutinin formation. In contrast, cold
hemolysins are seen in patients with paroxysmal cold hemoglobinuria
(PCH)
These cold hemolysins are unique because they are biphasic

antierythrocytic autoantibodies. These antibodies arc IgG that is directed
against the P blood group antigen. They are called biphasic because they
attach to red cells and bind complement at low temperatures, but the acti-
vation of complement doesnot occur until the temperature is increased.
This antibody, called the Donath-Landsteiner antibody was previously
associated with syphilis, but may follow various infections, such as
mycoplasmal pneumonia.
An anti- IgM antibody associated with isoimmune blood transfusion reaction
An anti-IgM antibody associated with infectious mononucleosis
An anti- IgG antibody associated with rheumatoid arthritis
An anti-P IgG antibody associated with paroxysmal cold hemoglobinuria
84 In a patient with Thalesemmia peripheral smear for red cell morphology shows A; Hyphochromic Microcytic Anaemia Ref (1038 Davidson’s Principles
and Practice of Medicine)
Hyphochromic Microcytic Anaemia
Normochromic Normocytic Anaemia
Hyphochromic Normocytic Anaemia
Normochromic Microcytic Anaemia
85 Gene for WT1 in wilm’s tumor is located at A; Chr. 11p 13 Page Nelson – 2140 Mutations of the WT1 gene on
chromosome 11p13 are observed in approximately 20% of Wilms
tumors. At least half of the Wilms tumors with mutations in WT1 also
carry mutations in CTNNB1, the gene encoding the proto-oncogene beta-
catenin.A gene on the X chromosome, WTX, is inactivated in up to 30% of
Wilms tumor cases, according to research published in 2007.
Chr. 11p 13
Chr. 19q 13
Chr. 19q 13
Chr. 7p 13
86 Long-term high-dose glucocorticoid therapy is required for a patient with C; Cataracts of crystalline lens are an important complication of
systemic lupus erythematosus complicated by severe lupus nephritis. This is systemic therapy with glucocorticoids. Cataracts can be caused by
most likely to eventuate which of the following ocular complications? aging, diabetes mellitus, glaucoma. ultraviolet light, or irradiation.
Retinopathy is most often a feature of diabetes mellitus or
hypertension. Macular degeneration is a disease of aging.
Granulomatous uveitis occurs with sarcoidosis. Stromal dystrophies
are inherited conditions that affect the cornea.
Background retinopathy
Macular degeneration
Cataracts
Corneal stromal dystrophy
87 A 41-year-old woman complains of diminished hearing on the left for C; Such a tumor in this location is also known as a cerebellopontine
several months. A head CT scan shows a sharply circumscribed, 4-cm mass angle tumor. Schwannomas in this location arise from the eighth
located adjacent to the left pons that extends into left inferior cerebellar cranial nerve and therefore are also called acoustic neuromas. Most
hemisphere. This lesion is most likely a (an) schwannomas are benign, slow-growing tumors that can be resected.
Meningiomas are rare at this location. Astrocytomas involve the
hemispheres of adults and the cerebellum of children most often.
Medulloblastomas likewise typically arise in the cerebellum of
children. Ependymomas arise in the ventricular system, often the
fourth ventricle.
Meningioma
Astrocytoma
Schwannoma
Medulloblastoma
88 Nerve Fibers, Axons, Neurofibrillary Tangles are best stained using A; Bielschowsky's Silver Stain
DeltaNp63 highlights myoepithelial cells in breast or basal cells in
prostate to distinguish invasive from noninvasive disease; distinguish
pancreatic intraductal metaplasia from intraductal neoplasia. The
Bielschowsky silver impregnation can be used as a single stain for the
diagnosis of Alzheimer's disease. It impregnates both the amyloid and
neuritic components of the senile plaques and it reliably stains
neurofibrillary tangles.
Bielschowsky's Silver Stain
Calponin – Stains
Chromogranin Neuro Immunostain
DeltaNp63 stain
89 Which of the following risk factors plays the most important role in the B; Male breast cancers are rare, and they occur primarily among the
development of male breast carcinoma? elderly. Unlike female breast cancers, a family history does not have
major significance. Causes of gynecomastia, including drug therapy
with digitalis compounds, Klinefelter syndrome, obesity, and
hyperestrinism from chronic alcoholism, are not major risks for male
breast carcinoma.
Obesity
Age older than 70 years
Klinefelter syndrome
Chronic alcoholism
90 A 44-year-old female notices some lumps in her right breast. Mammography D; Of all the primary malignancies of the breast, lobular carcinoma is
reveals several 0.5- to l-cm foci of irregular density in both breasts. A fine- most likely to be bilateral. Invasive lesions may have been preceded
needle aspirate of one lesion in the left breast shows malignant cells to be for several years by LCIS. Lobular carcinoma may be mixed with ductal
present, and a similar result is obtained for a right breast lesion. Which of carcinoma, and it may be difficult to distinguish them histologically.
the following breast carcinomas is most likely?
Infiltrating ductal carcinoma
Colloid carcinoma
Medullary carcinoma
Infiltrating lobular carcinoma
91 Weakness is caused by diseased anterior horn cells in which of the following B; The weakness of ALS (“Lou Gehrig’s disease”) is due to diseased motor
disorders? neurons in the anterior horn cells. The weakness in the other disorders is
caused by impaired neuromuscular transmission—by impaired calcium
channel function in aminoglycoside-associated weakness, by autobodies
to the calcium channels in Lambert-Eaton syndrome, by toxins that
prevent neurotransmitter release in botulism, and by auto antibodies to
neurotransmitter receptors in myasthenia gravis.
Botulism
Amyotrophic lateral sclerosis
Aminoglycoside antibiotic–associated weakness
Lambert-Eaton myasthenic syndrome
92 A research physiologist is performing an experiment in which he stimulates C; The vast majority of sweat glands in the body are innervated by
sympathetic cholinergic neurons. Which of the following responses is expected? sympathetic cholinergic neurons. Sympathetic cholinergic neurons are
sympathetic postganglionic neurons that happen to release acetylcholine
instead of norepinephrine.
Bradycardia , bronchoconstriction, and increased gastrointestinal
motility would all result from stimulating parasympathetic cholinergic
neurons.
Bradycardia
Bronchoconstriction
Diaphoresis
Increased gastrointestinal motility
93 During a fast, a brief phase of intense sequential contractions begins in the D; Motilin is a hormone released by the small intestine during the fasting
stomach and gradually migrates to the ileum. Release of which of the following state. Its waxing and waning blood levels correlate with the initiation and
intestinal hormones is most likely responsible for this observed effect? ending of migrating motor complexes (MMC). Furthermore, injection of
motilin has been shown to evoke MMC activity. The MMC typically begins
in the stomach, and over a 90-120 minute period, migrates to the ileum,
where it dies out. As one complex dies out in the ileum, another complex
begins in the stomach provided the fasting state continues. Eating a meal
interrupts the MMC activity.
Cholecystokinin
Gastrin
Gastrin-releasing peptide
Motilin
94 During the passage of an intravenous catheter, numerous endothelial cells are D; Von Willebrand factor (vWF) is a self-polymerizing clotting protein
dislodged from the lining of the popliteal vein. What substance allows platelet present in the serum and the subendothelial basal lamina, which has
adhesion to the exposed collagen fibers? binding sites for collagen, platelets, and fibrin. At a site of injury, vWF
forms the bridge between the exposed collagen fibers and platelets in
circulation, stimulating platelet degranulation and initiating the cellular
component of the clotting cascade. An equally important role for vWF is
binding platelets to the newly formed fibrin strands in a blood clot.
Factor VIII
Factor IX
Fibronectin
Von Willebrand factor
95 A medical student, whose baseline alveolar PCO2 level was 40 mm Hg, begins to B; When you hyperventilate, CO2 is blown off. The amount of CO2 blown
voluntarily hyperventilate for an experiment during his respiratory physiology off is inversely proportional to alveolar ventilation. This is shown by the
laboratory. If his alveolar ventilation quadruples and his CO2 production alveolar ventilation equation:
remains constant, approximately what will be his alveolar PCO2? VA = VCO2/PACO2, where
VA = alveolar ventilation
VCO2 = CO2 production
PACO2 = alveolar PCO2
So, if VCO2 remains the same, and VA quadruples, PACO2 must decrease
by 4 fold; 40 mm Hg decreases to 10 mm Hg.
4 mm Hg
10 mm Hg
20 mm Hg
80 mm Hg
96 Lesions of which of the following nuclei cause hypothalamic obesity A; Functional disruption by colchicine injected in the hypothalamic
arcuate (ARC), paraventricular (PVN), and ventromedial (VMN) cell
groups produced increased food intake and hypothalamic obesity;
disruption of the dorsomedial nuclei (DMN) produced decreased food
intake.
ventromedial nucleus
dorsomedial nucleus
suprachiasmatic nucleus
supraoptic nucleus
97 Compared with a healthy individual, lymph nodes from a person with a A;
deficiency in B lymphocytes would have The major cell type within follicles is the B cell; a germinal center is a
follicle where cells are undergoing active proliferation. A deficiency in B
cells would result in decreased size and number of follicles. The
paracortex is predominately a T cell area. Heinz bodies (red cell inclusion
body of denatured hemoglobin) and Howell-Jolly bodies (red cell
inclusion body of parasites) are found in the spleen.
Few or no primary follicles
Enlarged germinal centers
Few Howell-Jolly bodies
No paracortex
98 Which of the following associations is correct? D; Electrolyte abnormalities affect various portions of the surface ECG.
Both hypercalcemia and hypocalcemia affect ventricular repolarization
and are thus represented by changes in the QT interval. Hypercalcemia
results in a shortened QT interval, whereas hypocalcemia results in a
prolonged QT interval. Calcium does not affect the T wave; it specifically
changes the ST portion of the QT interval. Hyperkalemia may be
represented by very tall peaked T waves as potassium affects ventricular
repolarization.
Hypokalemia: shortened Q–T interval
Hypercalcemia: long Q–T interval
Hypercalcemia: flattened T waves
None of the above
99 A 75 year old lady has sudden movements of her arm where she throws her arm D; subthalamic nucleus. Hemiballismus is caused by a subthalamic
outwards, and uncontrollably injures herself. Which one of the following areas nucleus lesion, which is commonly due to an infarct.
could have sustained an infarct?
Globus pallidus
Pontine nucleus
Corpus callosum
Subthalamic nucleus
100 Which of these organelles have DNA which can self replicate? C; mitochondria. Only mitochondria have self replicating DNA.
Golgi apparatus
Nuclear membrane
Mitochondria
Peroxisomes

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NIMHANS MOCK 1 ( DM ) MOCK EXAM EXPLANATORY KEY

1 Hangmans Fracture is fracture of? C; Axis

Guillian Barre Syndrome

Lev Frequen Root Refle Weakness Numbne

Excessive CSF production (rare)

High-grade gliomas, including anaplastic astrocytomas (WHO grade III)

73 Panda eyes is seen in: B;

These cold hemolysins are unique because they are biphasic

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