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210
Total Marks 1200 Duration
minutes
a. TATA box
c. CAAT box
d. TGG box
Answer. d
a. Apoprotein A2
b. Apoprotein B100
c. Apoprotein C1
d. Apoprotein E
Answer. b
a. Phosphofructokinase
b. Protein kinase
c. Phosphoglucomutase
d. Hexokinase
Answer. b
5. After a 72-hour fast the substance likely to the involved in the formation of energy would be :
a. Muscle glycogen
b. Liver glycogen
c. Aminoacid
d. Acetoacetate
Answer. d
a. Increased Vmax
b. Decreased Vmax
c. Increased Km
d. Decreased Km
Non competitive
Competitive inhibition
inhibition
Acting on Active site May or may not
Structure of
Substrate analogue Unrelated
inhibitor
Inhibition is Reversible Generally irreversible
Excess substrate Inhibition relieved No effect
Km Increased No change
Vmax No change Decreased
Significance Drug action Toxicological
Answer. b
a. Fibrinogen
b. Hepcidin
c. Plasminogen
Answer. b
a. RNA polymerase
b. Aminoacyl – tRNA
c. Ribosomes
d. Peptidyl transferase
Solution.
Answer. a
9. If consecutive nucleotides code for an amino acid, how many amino acid can be theoretically
coded by nucleic acid?
a. 4
b. 64
c. 16
d. 256
If there would have been two nucleotides in each codon the chance of their varied
combination will be 42 i.e. 16, and three nucleotide in each codon means there will
occur 43 i.e. 64 codons are possible.
According to the above calculation, if there occurs 4 nucleotides in a codon, the chance of
their varied combination will be 44 i.e. 256.
Answer. d
a. Gene regulation
b. RNA splicing
c. Translation initiation
Micro RNA and si RNA are both involved in negative gene regulation
Difference between miRNA and si RNA :
miRNA si RNA
- Involved in negative gene - Involved in negative gene
regulation regulation
Answer. a
a. Acetyl Coenzyme A
b. Biotin
c. THFA
d. Pyridoxine
Sol :
Folic Acid
Function : Transporterfor single carbon units (-CH3, - Ch2, COOH) for purine, thymidylate
synthesis and methionine synthesis from homocysteine – requires B12.
Deficiency :
Answer. c
b. GTP
c. elF
d. Ribosomes 40s
Answer. c
a. Selenium
b. Copper
c. Zinc
d. Iron
Solution.
(d) Iron
Iron is not an an�oxidant.
It can catalyse the forma�on of reac�ve oxygen species and cause oxidant damage.
Selenium, copper, zinc are examples of an�oxidants
An�oxidants :
Vitamins : C, E and A (beta carotene) (Think: “ACE”)
Minerals : Selenium, Zinc, Copper (minor)
Others : Cysteine, Glutathione, Caffeine, allopurinol
Transport proteins : Transferring, Ferri�n, Lactoferrin, Ceruloplasmin.
Answer. d
a. 200 μgm/day
b. 300 μgm/day
c. 400 μgm/day
d. 500 μgm/day
The RDA of free folate is 200 μg/day. In pregnancy, the requirement is increased to
400μg/day and during lactation to 300 μg/day.
Folic Acid Therapy : Therapeutic dose is 1 mg of folic acid per day orally. Folic acid alone
should not be given in macrocytic anemia. Because it may aggravate the neurological
manifestations of B12 deficiency. So folic acid and vitamin B12 are given in
combination to patients.
Toxictiy of Folic Acid : Doses over 1 mg may cause aggravation of vitamin B12 deficiency
and may precipitate nerve damage. Since solubility of folic acid is low, large doses should
not be given parenterally, as there is danger of crystallization in kidney tubules leading to
renal damage.
Answer. a
15. Using written convention, which one of the following sequences is complementary to
TGGCAGCCT?
a. ACCGTCGGA
b. ACCGUCGGA
c. AGGCTGCCA
d. TGGCTCGGA
Sol :
Since a chain of DNA are polar, with one end having a 5’-OH group and the other end a
3’-OH group, a conventional means for simply communicating linear structure is
necessary.
Convention dictates that base sequences are written in a 5’ to 3’ direction, much like amino
acids are written in an amino end to carboxyl end direction.
Thus, the complement to 5’ – AGCT – 3’ is 5’ – AGCT -3’ when written
conventionally and 3’-TCGA-5’ when written ina truly complementary way.
Answer. c
16. The following statements concerning the abdominal part of the sympathetic trunk are not
true except:
Solution. (d) Gray Rami Communicantes are given off to the lumbar spinal nerves
· The abdominal portion of the sympathetic trunk is situated in front of the vertebral 1
· Gray rami communicantes pass from all the ganglia to the lumbar spinal nerves. The first and
second, and sometimes the third, lumbar nerves send white rami communicantes to the
corresponding ganglia.
· The rami communicantes are of considerable length, and accompany the lumbar arteries
around the sides of the bodies of the vertebrae, passing beneath the fibrous arches from which
some of the fibers of the Psoas major arise.
Answer. d
- Projection Fibers : Connect cerebral cortex with lower level in brain (Eg. Brainstem, spinal
cord)
Answer. c
18. Distal end of humerus develops from how many centres
a. 2
b. 3
c. 4
d. 5
Solution. (c) 4.
· centers are :- capitulum with the lateral part of the trochlea, the medial part of the
trochlea, and one for each epicondyle. The centre for the medial epicondyle forms a separate
epiphysis whereas Thecentres for the lateral epicondyle, capitulum and trochlea fuse around
puberty and form the composite epiphysis
· About the sixteenth or seventeenth year, the lateral epicondyle and both portions of the
articulating surface, having already joined, unite with the body, and at the eighteenth year the
medial epicondyle becomes joined to it.
Answer. c
19. Which nerve lesion could produce the condition where stimulation of right cornea results in
blinking of the left eye but not the right eye?
a. Left trigeminal
b. Left facial
c. Right trigeminal
d. Right facial
Answer. d
20. Atrophy of intrinsic muscles of hand, sensory deficit on medial side of forearm and hand, and
diminished radial pulse on turning the head on the affected side could be because of :
b. Cervical rib
- Cervical ribs (present in upto 1% of people) articulate with the C7 vertebra and are clinically
significant because they may compress spinal nerves C8 and T1 or the inferior trunk of the
brachial plexus supplying the upper limb. Tingling and numbness may occur along the medial
border of the forearm. They may also compress the subclavian artery, resulting in ischemic
muscle pain (caused by poor blood supply) in the upper limb.
Answer. b
a. Peroneus longus
b. Biceps femoris
c. Semimembranosus
d. Adductormagnus
· Oblique popliteal ligament is a continuation of semimembranosus muscle. It lies in the floor
of popliteal fossa.
· The tibial collateral ligament represents the degenerated part of adductor magnus.
· The sacrotuberous ligament represents the degenerated part of the long head of biceps
femoris.
Answer. a
a. Infrapatellar
b. Prepatellar
c. Suprapatellar
d. Lateral patellar
Solution.
(c) Suprapatellar
· The suprapatellar bursa communicates with the cavity of knee joint.
· Inflammation of infrapatellar bursa is known as Clergymen knee. & prepatellar bursa is known as Housemaids knee.
· The Anserine bursa separates the insertions of Semitendinosus, Sartorius &Gracilis from tibia.
Answer. c
23. Which of the following is usually responsible for the tumor as shown in the pic?
a. Primary Yolk Sac
b. Hypoblast
c. Primitive Streak
d. Notochord
Sol :Given pic shows sacrococcygeal teratoma:- Sometimes, remnants of the primitive streak
persist in the sacrococcygeal region. These clusters of pluripotent cells proliferate and form
tumors, known as sacrococcygeal teratomas, which commonly contain tissues derived from all
three germ layers
Answer. c
24. A 45-year-old man presents with a loss of taste sensation over the back of his tongue.
There is no history of regurgitation of fluids through the nose while swallowing, nor any change
in his voice or facial asymmetry. Physical examination shows an absence of the gag reflex.
Palatal movements are normal. There is no deviation, wasting, or fasciculations in the tongue.
Size and movements of the tongue are normal. There is no nasal tone in his speech.
What neural structure is likely to be affected?
a. Vagus nerve
b. Facial nerve
c. Hypoglossal nerve
d. Glossopharyngeal nerve
Glossopharyngeal nerve is afferent and Vagus nerve is efferent for gag reflex. In given question
Gag reflex is absent so either of IX & X or both are injured.There is no history of regurgitation of
fluids through the nose while swallowing, nor any change in his voice andPalatal movements are
normal, this rules out X nerve injury. No deviation, wasting, or fasciculations in the tongue, this
rules out XII nerve injury. no change in facial asymmetry,this rules out VII nerve injury.
Answer. d
25. The mammary glands are modified versions of which type of gland?
a. Sebaceous gland
b. Lymph gland
c. Sweat gland
d. Endocrine gland
Answer. c
26. A 23-year-old woman wearing high-heeled shoes inverts and sprainsher ankle while running
down a flight of stairs.
Which of the following ligaments did she most likely injure?
a. Anterior talotibial
b. Calcaneofibular
c. Calcaneotibial
d. Deltoid
- Ankle was sprained during inversion so there will be injury on lateral aspect of
ankle.
Answer. b
c. Subcostal artery
· The internal thoracic artery gives rise to anterior intercostal arteries for intercostal
spaces 1 – 6.
· The musculophrenic artery gives rise to anterior intercostal arteries for intercostal spaces
7–9.
Answer. a
28. A 35-year-old woman presents with abdominal tenderness and acute pain. On examination,
her physician observes that an abdominal infection has spread retroperitoneally
Which of the following structures is most likely affected?
a. Stomach
b. Transverse colon
c. Jejunum
d. Descending colon
Answer. d
29. The marked structure in the diagram is involved with motor activities. It receives afferents
from all of the following EXCEPT:
a. Spinal cord
b. Thalamus
c. Cerebral cortex
d. Substantia nigra
Answer. a
30. A 23-year-old women is brought to the emergency department unconscious after a motor
vehicle accident. The patient was texting on the cell phone & was not wearing a seat belt during
the incident. She has no known medical problems & takes no medications. Her temperature is
36.7°C, blood pressure is 155/90 mmHg, pulse is 62/min & respiratory rate is 10/min. A linear
fracture of skull at the junction of frontal, parietal, temporal & sphenoid bone is seen on head
CT scan. A branch of which of the following arteries is severed in this patient –
a. Facial
b. Maxillary
c. Middle cerebral
d. Occipital
Solution. b Maxillar
a. Exp: point of skull at the junction of frontal, parietal, temporal & sphenoid bone is known as
Pterion. Deep to it lies Middle meningeal artery which is a branch of Maxillary artery.
Answer. b
31. Depolarization phase of the action potential is due to Ca2+ influx in which of the following?
a. Paraspinal muscle
b. Cardiac muscle
c. Extraocular muscle
d. Vascular muscle
Answer. d
a. Calbindin
b. Troponin
c. Calmodulin
d. Calcineurin
Solution. D Calcineurin
Many different Ca2+-binding proteins have been described, including troponin, calmodulin, and
calbindin.
Calbindin-D28k was first shown to be present in the intestine in birds and then found in the
mammalian kidney. It is also expressed in a number of neuronal and endocrine cells, particularly
in the cerebellum. It is encoded in humans by the CALB1 gene.
Calbindin-D28k is a vitamin D responsive gene in many tissues, in particular the chick intestine,
where it has a clear function in mediating calcium absorption.In the brain, its synthesis is
independent of vitamin-D.
Troponin is the Ca2+-binding protein involved in contraction of skeletal muscle.
Calmodulin contains 148 amino acid residues and has four Ca2+-binding domains. It is unique in
that amino acid residue 115 is trimethylated, and it is extensively conserved, being found in
plants as well as animals. When calmodulin binds Ca2+, it is capable of activating five different
calmodulindependent kinases (CaMK), among other proteins. One of the kinases is myosin
light-chain kinase, which phosphorylates myosin. This brings about contraction in smooth
muscle. CaMKI and CaMKII are concerned with synaptic function, and CaMKIII is concerned
with protein synthesis.
Calcineurin is a calmodulin-activated protein. Calcineurin is a phosphatase that inactivates Ca 2+
channels by dephosphorylating them. It also plays a prominent role in activating T cells and is
inhibited by some immunosuppressants.
Answer. d
b. Fibrous astrocytes
c. Protoplasmic astrocytes
Blood brain barrier is formed by tight junctions between the endothelial cells of cerebral
capillariers.
Schwann cells are involved in myelin formation in the peripheral nervous system.
Astrocytes, which are found throughout the brain, are further subdivided into two groups.
Fibrous astrocytes, which contain many intermediate filaments, are found primarily in white
matter.
Protoplasmic astrocytes are found in gray matter and have a granular cytoplasm.
Both types of astrocytes send processes to blood vessels, where they induce capillaries to form
the tight junctions making up the blood–brain barrier. They also send processes that envelop
synapses and the surface of nerve cells. Protoplasmic astrocytes have a membrane potential that
varies with the external K+ concentration but do not generate propagated potentials. They
produce substances that are tropic to neurons, and they help maintain the appropriate
concentration of ions and neurotransmitters by taking up K+ and the neurotransmitters
glutamate and γ-aminobutyrate (GABA).
Answer. d
Solution.
The impulse arriving at the end of the A alpha motor neuron causes release of acetylcholine.
Acetylcholine diffuses to nicotinic cholinergic (NM) receptors that are concentrated at the tops
of the junctional folds of the membrane of the motor endplate. Binding of acetylcholine to these
receptors increases the Na+ and K+ conductance, though the movement of sodium
predominates. The resultant influx of Na+ produces a depolarizing potential, the endplate
potential. The current sink created by this local potential depolarizes the adjacent muscle
membrane to its firing level. Action potentials are generated on either side of the endplate and
are conducted away from the endplate in both directions along the muscle fiber. The muscle
action potential, in turn, initiates muscle contraction. Acetylcholine is then removed from the
synaptic cleft by acetylcholinesterase, which is present in high concentration at the
neuromuscular junction.
Answer. d
35. Identify the correct sequence of the spread of depolarization in the ventricles
Depolarization of the ventricular muscle starts at the left side of the interventricular septum and
moves first to the right across the mid portion of the septum. The wave of depolarization then
spreads down the septum to the apex of the heart. It returns along the ventricular walls to the
AV groove, proceeding from the endocardial to the epicardial surface. The last parts of the heart
to be depolarized are the posterobasal portion of the left ventricle, the pulmonary conus, and the
uppermost portion of the septum.
Answer. a
a. Hyperkalemia
b. Hypercalcemia
c. Hypernatremia
d. Hypercapnia
Solution. B Hypercalcemia
As the plasma K+ level rises, the first change in the ECG is the appearance of tall peaked T
waves, a manifestation of altered repolarization. Ventricular arrhythmias may develop. At higher
K+ levels, paralysis of the atria and prolongation of the QRS complexes occur.The resting
membrane potential of the muscle fibers decreases as the extracellular K + concentration
increases. The fibers eventually become unexcitable, and the heart stops in diastole.
Clinically, a fall in the plasma level of Na+ may be associated with low-voltage
electrocardiographic complexes.
Answer. b
a. GFR/ RBF
b. GFR/ RPF
c. RBF/ GFR
d. RPF/ GFR
Solution.
B GFR/ RPF
The GFR varies less than the RPF. When there is a fall in systemic blood pressure, the GFR falls
less than the RPF because of efferent arteriolar constriction and consequently the filtration
fraction rises.
Answer. b
38. Parathormone increases calcium reabsorption in which of the following segments of the
nephron?
a. PCT
b. TAL
c. DCT
d. CD
Solution. C DCT
PTH increases calcium absorption in the DCT. But the maximum calcium absorption takes place
in the PCT. PTH decreases absorption of inorganic phosphorus in the PCT (k/a phosphaturic
action of PTH).
Answer. c
39. Maximum work done in quiet breathing is against which of the following?
b. Tissue elasticity
c. Airway resistance
d. Viscous resistance
Work is performed by the respiratory muscles in stretching the elastic tissues of the chest wall
and lungs (elastic work; approximately 65% of the total work), moving inelastic tissues (viscous
resistance; 7% of total), and moving air through the respiratory passages (airway resistance;
28% of total). The dimensions of pressure × volume (g/cm2 × cm3 = g × cm) has the same
dimensions as work (force × distance; g × cm). The amount of elastic work required to inflate
the whole respiratory system is less than the amount required to inflate the lungs alone because
part of the work comes from elastic energy stored in the thorax. Estimates of the total work of
quiet breathing range from 0.3 up to 0.8 kg-m/min. The value rises markedly during exercise,
but the energy cost of breathing in normal individuals represents less than 3% of the total
energy expenditure during exercise. The work of breathing is greatly increased in diseases such
as emphysema, asthma, and heart failure with dyspnea and orthopnea. The respiratory muscles
have length tension relations like those of other skeletal and cardiac muscles, and when they are
severely stretched, they contract with less strength. They can also become fatigued and fail
(pump failure), leading to inadequate ventilation.
Answer. a
d. Is a glycolipid complex.
With expiration as the alveolar size decreases, concentration of surfactant molecules per unit
area increases. The low surface tension when the alveoli are small is due to the presence of
surfactant in the fluid lining the alveoli. Surfactant is a mixture of
dipalmitoylphosphatidylcholine (DPPC), other lipids, and proteins. If the surface tension is not
kept low when the alveoli become smaller during expiration, they collapse in accordance with
the law of Laplace. In spherical structures like an alveolus, the distending pressure (P) equals
two times the tension (T) divided by the radius (r; P = 2T/r); if T is not reduced as r is reduced,
the tension overcomes the distending pressure. Surfactant also helps prevent pulmonary edema.
It has been calculated that if it were not present, the unopposed surface tension in the alveoli
would produce a 20 mm Hg force; such a force would greatly favour transudation of fluid from
the blood into the alveoli.
Answer. a
a. Saliva
b. Gastric secretions
c. Pancreatic juice
d. Intestinal secretions
Answer. c
a. Ebner’s glands
b. Oxyntic cells
c. Chief cells
d. Parietal cells
Solution. C Chief cells
The most characteristic secretions derive from the glands in the fundus or body of the stomach.
These contain the distinctive parietal cells, which secrete hydrochloric acid and intrinsic factor;
and chief cells, which produce pepsinogens and gastric lipase.
Answer. c
43. The major secretion of the adrenal medulla is which of the following?
a. Nor epinephrine
b. Epinephrine
c. Dopamine
d. Adrenomedulin
Solution. B Epinephrine
Norepinephrine, epinephrine, and small amounts of dopamine are synthesized by the adrenal
medulla. Cats and some other species secrete mainly norepinephrine, but in dogs and humans,
most of the catecholamine output in the adrenal vein is epinephrine. Norepinephrine also enters
the circulation from noradrenergic nerve endings.
In the medulla, epinephrine and nor epinephrine are stored in granules with ATP. The granules
also contain chromogranin A. Secretion is initiated by acetylcholine released from the
preganglionic neurons that innervate the secretory cells. Acetylcholine activates cation channels
allowing Ca2+ to enter the cells from the ECF and trigger the exocytosis of the granules. In this
manner, catecholamines, ATP, and proteins from the granules are all released into the blood
together. Epinephrine-containing cells of the medulla also contain and secrete opioid peptides.
The precursor molecule is preproenkephalin. Most of the circulating metenkephalin comes from
the adrenal medulla. The circulating opioid peptides do not cross the blood–brain barrier.
Adrenomedullin, a vasodepressor polypeptide found in the adrenal medulla.
Answer. b
a. Surgery
b. Trauma
c. Haemorrhage
Answer. d
a. Thyroid gland
b. Parathyroid gland
c. Thymus
d. Adrenal gland
Answer. a
a. Ventroposteromedial
b. Ventroposterolateral
c. Dorsomedial
d. Intralaminar
Solution. A Ventroposteromedial
Answer. a
48. Which of the following is used to compare mortality pattern between 2 populations?
a. Age specific death rates- To compare risk of death in two different age groups
b. Age standardized death rates- To compare morality pattern between 2 populations.
c. Case fatality rate –Killing power of disease
Answer. b
Solution.
Answer. d
a. Rabies
b. Plague
c. Anthrax
d. Polio
Solution.
D: Polio
Zoonosis
Answer. d
a. Specificity of association
b. Sensitivity of association
c. Temporal association
Solution.
B: Sensitivity of association
1. Temporal association :
2. Strength of association :
- Large relative risk
- Duration-response relationship
- Cessation (↓ in risk on cessation) in smoking & ca lung
3. Specificity of association :
Answer. b
b. Control of tobacco
c. Radiation protection
d. Cancer education
Primary Prevention-
a) Actions taken prior to onset of disease which removes the possibility that a disease
will ever occur
c) risk factors are present but disease has not yet taken place
Answer. a
53. “Open vial policy” is not applicable to the following vaccines except:
a. DPT
b. BCG
c. Measles
d. JE vaccine
Solution. A: DPT
Under the UIP, vaccines are supplied in multi-dose packing and can be categorized in two
groups:
Liquid vaccines which can be administered directly: DPT, Hep-B, OPV, Pentavalent and TT
vaccines
Vaccines requiring reconstitution i.e. BCG, Measles and JE need to be used within 4 hours of
reconstitution.
The remaining vaccines (non-reconstituted, liquid vaccines i.e. DPT, TT, Hep B, OPV and
Pentavalent) retain their ability to be reused within 28 days if maintained under appropriate cold
chain conditions i.e. +2 C to +8 C temperature.
The multi-dose open vial policy (OVP) applies to multi-dose vials of DPT, TT, Hepatitis B, Oral
Polio and Liquid Pentavalent vaccines.
Answer. a
54. Out of total cases, 60% are exposed and out of controls, 20% are exposed. Calculate odds
ratio.
a. 4
b. 6
c. 8
d. 12
Solution.
B: 6
CASES CONTROLS
EXPOSED 60 20
NON EXPOSED 40 80
OR = 60 x 80 / 20 x 40 = 6
Answer. b
55. The incidence of bladder carcinoma is 3 times more in exposed compared to non-exposed.
Based on this, what is the attributable risk in proportion?
a. 40%
b. 66%
c. 50%
d. 80%
Solution. B: 66%
The incidence of bladder carcinoma is 3 times more in exposed compared to non exposed.
So , RR = 3 / 1 = 3
= 3-1 / 3
Answer. b
56. The number of patients you need to treat to prevent one additional bad outcome or to
benefit one patient is:
a. Level of significance
d. Sample size
· NNT: is a statistic that summarizes the effectiveness of a therapy, or a preventive
measure, in achieving a desired outcome.
· It is one way to indicate the clinical significance of an intervention. The simple idea is
that no treatment works for everybody, so how many do you need to treat to benefit one.
· NNT is the number of patients you need to treat to CURE one patient or to PREVENT
one bad outcome (death, stroke, etc.)
· Ex:If a drug has an NNT of 5, it means you have to treat 5 people with the drug to
prevent one additional bad outcome OR we should treat 5 patients to CURE one.
· The ideal NNT would be 1, where all the patients in the treatment group have
improved, but no-one has in the control arm.
Higher the NNT, the less effective is treatment, because more people need to receive the
treatment to see a benefit in one.
Answer. b
57. Period between the possible time of detection and the actual time of diagnosis is :
a. Lead time
b. Screening time
c. Generation time
d. Serial interval
58. A test for Hepatitis C is performed for 200 patients with biopsy proven disease and 200
patients known to be free from disease. The test shows positive result in 180 patients with the
disease and negative result in 150 patients without the disease. Which of the following is true?
Answer. d
59. A category 1 TB patient on treatment is sputum positive after 2 months of intensive phase.
What is the next line of management ?
a. Extend 1 month of intensive phase
Answer. c
60. Which of the following is false regarding Pradhan Mantri Surakshit Matritva Abhiyan
(PMSMA) :
a. The free antenatal check-up will take place on 9th of every month.
b. ANC will take place at government and private hospitals and private clinics across the
country.
Solution. D: Green sticker on their MCP card indicates high blood pressure.
· A minimum package of antenatal care services (including investigations and drugs)
would be provided to the beneficiaries on the 9th day of every month
· At identified public health facilities (PHCs/ CHCs, DHs/ urban health facilities etc)
in both urban and rural areas in addition to the routine ANC at the health facility/
outreach.
· A sticker indicating the condition and risk factor of the pregnant women would be
added onto MCP card for each visit:
Answer. d
61. Which of the following is not true as per recent “Malaria drug policy’ except:
Answer. c
d. All of above
Age Dose
Biweekly : 1 ml IFA syrup
Children (6-59
months) 1 ml contains 20 mg elemental iron and 200 μg folic
acid
Daily IFA
Pregnant
6 months from second trimester and for 6 months
postpartum
Red tablet
Weekly IFA
Red tablet
Answer. d
63. Which of the following is used to study association of risk factor for a rare disease?
b. Cohort study
d. RCT
Solution.
Answer. c
64. Which of the following is used to represent relationship between two variables?
a. Bar chart
b. Line diagram
c. Histogram
d. Scatter diagram
Scatter diagram
Answer. d
- Tells about presence or absence of an association between two variables
-Can be used when more than two groups are to be compared
Answer. c
66. Which of the following is true for the contingency table given below?
d. All of above
Answer. b
b. equal to 1- beta .
c. Is the chance that the presence of difference is not concluded when actually there is
difference.
Solution. D : When p- value is less than alpha , the result is statistically significant .
p - value :
- Is the chance that the presence of difference is concluded when actually there is none
-When p- value is less than alpha , the result is statistically significant
Answer. d
a. Malaria
b. Kala azar
c. Dengue
d. Plague
Answer. b
69. Which of the following is the minimum standards for Indian foods:
a. PFA standards
b. FSSAI
c. Codex alimentarius
d. AGMARK
Solution. B: FSSAI
Answer. b
b. Carcinogenic substance
c. Biohazard substance
d. Cytotoxic waste
Answer. c
a. MOHFW
c. MWCD
Answer. b
72. Which one of the following anti diabetic drug needs dosage adjustment both in renal and
hepatic failure patient?
a. Sitagliptin
b. Vildagliptin
c. Linagliptin
d. Saxagliptin
Solution. B: Vildagliptin
Vildagliptin dose reduction is needed both in liver and kidney disease (Ref KDT,7 th edn, page
292)
Alogliptin,saxagliptin, sitagliptin, and vildagliptin are excreted largely in the urine; lower
dosesshould be given to patients with reduced renal function (Ref- G&G, page1709, 13 th edn)
Answer. b
73. Which one of the following antipsychotic drugs has partial dopaminergic agonistic activity?
a. Clozapine
b. Aripiprazole
c. Olanzapine
d. Risperidone
Answer. b
74. Which one of the following drugs acts by inhibiting thromboxane synthase enzyme?
a. Aspirin
b. Dezoxiben
c. Losartan
d. Vorapaxer
Solution. B: Dezoxiben
Answer. b
c. Multiple myeloma
vandetanib and cabozantinib are thyroisine kinase inhibitor useful in medullary cancer of thyroid
Answer. b
a. CD 20
b. CD 52
c. CD 38
d. CD 33
Solution. B: CD 52
Answer. b
77. Regarding Acetazolamide, effects on urinary excretion all are true except
Answer. b
d. Prazosin has been found to prolong life in patients with congestive heart failure
Solution. D: Prazosin has been found to prolong life in patients with congestive heart failure
Prazosin has not been found to prolong life in patients with congestive heart failure.
Answer. d
b. Cytolytic Reactions
c. Arthus Reactions
thrombocytopenic purpura, and sulfonamide-induced granulocytopenia- all are example for Type
II reaction( Cytolytic Reactions)
Answer. b
a. Systemic hypertension
b. Pulmonary hypertension
c. Erectile dysfunction
d. Prophylaxis of migraine
Oral administration
Answer. b
Increased clearance
Enzyme induction (mainly CYP1A2) by coadministered drugs (e.g., rifampicin, barbiturates,
ethanol)
Smoking (tobacco, marijuana) via CYP1A2 induction
High-protein, low-carbohydrate diet
Barbecued meat
Childhood
Decreased clearance
CYP inhibition (cimetidine, erythromycin, ciprofloxacin, allopurinol, fluvoxamine, zileuton,
zafirlukast)
Congestive heart failure
Liver disease
Pneumonia
Viral infection and vaccination
High-carbohydrate diet
Old age
Theophylline causes Histone deacetylase activation
therapeutic range isnow taken as 5–15 mg/L.
Answer. c
c. Given orally
Answer. c
b. Acute psychosis
c. Smoking cessation
d. Obesity
Solution.
D: Obesity
Clinically, bupropion iswidely used in combination with SSRIs with the intent of obtaining a greater antidepressant
response.
Answer. d
b. Panobinostat
c. Pentostatin
d. Ipilimumab
Solution. A: Palbociclib
CDK4/6 inhibitor palbociclib, Abemaciclib and ribociclib were recently approved for the
treatment of breast cancer.
Answer. a
a. CLL
b. CML
c. AML
d. ALL
Solution. A:CLL
(Ref- G&G, page 2369 13th edn)
small-molecule inhibitor of BCL2.
USE- CLL
Answer. a
86. All of the following agents will inhibit intestinal epithelial secretion of chloride except
a. Linaclotide
b. Alosetron
c. Crofelemer
d. Budesonide
Solution. A:Linaclotide
(Ref- G&G, page1807, 13th edn)
Linaclotide will stimulate Cl− and water secretion.
Alosetron inhibit serotonin 5-HT3 receptors
Crofelemer, and budesonide inhibits CL secretion .
Answer. a
a. Trimethoprim
b. Captopril
c. Heparin
d. Amphotericin B
Solution.
D:Amphotericin B
RAAS blocker
ENaChannel blocker-
Amiloride, triamterene,
Trimethoprim, pentamidine
Nafamostat
NSAIDs
cyclosporine
Succinylcholine
Heparin
Treatment forHyperkalemia
intracellularly
myocardium
Answer. d
88. Co administration of cisplatin with didanosine aggravates which of the following adverse
effects of didanosine?
a. Neuropathy
b. Hepatoxicity
c. Pancreatitis
d. Nephrotoxicity
Solution. A :Neuropathy
The most serious toxicities associated with didanosine include peripheral neuropathy and
pancreatitis
Coadministration of other drugs that cause pancreatitis or neuropathy (i.e., stavudine) will
increase the risk and severity of these symptoms.
Ethambutol, isoniazid, vincristine, cisplatin, and pentamidine should be avoided. Serious hepatic
toxicity occurs rarely but can be fatal
Other reported adverse effects include elevated hepatic transaminases, headache, and
asymptomatic hyperuricemia; noncirrhotic portalhypertension can occur years after exposure to
didanosine.
Answer. a
b. Quinidine
c. Clarithromycin
d. Rifampicin
Solution. D:Rifampicin
P-glycoprotein inhibitors
Quinidine
Amiodarone, dronidaron
Verapamil
Cyclosporine
Itraconazole
Erythromycin, clarithromycin
Answer. d
a. CYP2C19
b. CYP3A4
c. CYP2D6
d. CYP2E1
Solution. D:CYP2E1
Isoniazid is a potent inhibitor of CYP2C19 and CYP3A and a weak inhibitor of CYP2D6 isoniazid
induces CYP2E1
Answer. d
Pharmacokinetics are affected by renal impairment, sofosbuvir should not be used in patients
with eGFR of less than 30 mL/min/1.73 m2 or those with ESRD..
the efflux transporters Pgp and BCRP and should not be used with potent inducers of these
transporters (e.g., rifampin, St. John’s wort, phenytoin,
carbamazepine).
Answer. b
92. The minimum age at which an individual is responsible for his criminal act is
a. 16 years
b. 21 years
c. 7 years
d. 12 years
Solution. C: 7 years
Act of a child under seven years of age.Nothing is an offence which is done by a child under
seven years of age.
Answer. c
a. Supreme Court
b. High Court
c. Sessions Court
d. All
Reference: The Essentials of Forensic Medicine & Toxicology, 34th edition, Dr. K.S. Narayan
Reddy, Page No. 7.
Supreme court and High Courts act as Courts of appeal only in criminal cases and do not hold
trial prima facie.
Answer. c
a. Precipitin test
d. Benzidine test
Reference: The Essentials of Forensic Medicine & Toxicology, 34th edition, Dr.K.S. Narayan
Reddy, Page No. 423.
Precipitin test is a species- specific test and is used to differentiate between different species
and humans. Neutron activation analysis is used to identify metals. Spectroscopic examination is
confirmatory test for blood. Benzidine test is a presumptive test for blood.
Answer. a
a. Typical drowning
b. Near drowning
c. Submersion of an unconscious
d. Post-mortem submersion
Reference: The Essentials of Forensic Medicine & Toxicology, 34th edition, Dr. K.S. Narayan
If a dead body is kept in water at a depth of 2 meters and over a period of 20 hours, (Post-
mortem submersion) ,due to hydrostatic pressure, there will be oedema but without froth,
known as Hydrostatic lung.
Answer. d
96. Which one of the following is the disciplinary action for ‘Professional Misconduct’?
a. Fine
b. Imprisonment
c. Penal erasure
d. Warning notice
Reference: The Essentials of Forensic Medicine & Toxicology, 34th edition, Dr. K.S. Narayan
Fine and imprisonment can be passed only by the Court of Law. Warning notice is a code of
conduct issued by MCI or SMC, containing certain practices which are regarded as falling
within the
meaning of the term “Professional Misconduct”, which is issued to all thendoctors at the time of
registration. It is not a disciplinary action.
Answer. c
97. Declaration of Sydney deals with
a. Terminal illness
b. Brain death
d. Organ trafficking
Solution.
B: Brain death
The Declaration of Istanbul deals with organ trafficking and transplant Tourism.
Answer. b
a. Distant shot
b. Intermediate shot
c. Near shot
d. Close shot
Reference: The Essentials of Forensic Medicine & Toxicology, 34th edition, Dr.K.S. Narayan
Intermediate range means the target is beyond the reach of soot and smoke but within the reach
of powder particles, which cause tattooing around the wound of entry on impact. There is no
singeing of hair and blackening in intermediate shot.
Answer. b
a. Legitimacy
b. Atavism
c. Supposititious child
Reference: The Essentials of Forensic Medicine & Toxicology, 34th edition, Dr. K.S. Narayan
Affiliation cases (suits for adoption): A woman may allege a particular man to be the father of
her illegitimate child and file a case in the court for fixing the paternity.
As per Sec 125 Cr.P.C., a First class Magistrate can sanction a monthly allowance of any sum
depending upon the circumstances of the case for the maintenance of such child.
Answer. d
100. If the muscles are not stiff in lower limbs, post-mortem hypostasis is not blanching on
pressure, then the post-mortem interval is
a. 8 - 12 hours
b. 2 - 8 hours
c. 8 - 20 hours
d. 6 - 12 hours
Solution. D: 6 - 12 hours
Reference: The Essentials of Forensic Medicine & Toxicology, 34th edition, Dr. K.S. Narayan
The muscles not stiff in lower limbs means, the rigor mortis has not been fully established. It
takes around 12 hours for full establishment of rigor mortis all over the body. So time since
death is less than 12 hours. The post-mortem hypostasis not blanching on pressure means, it has
fixed. Hypostasis fixes at 6-12 hours. So time since death is more than 6 hours.
Answer. d
a. Fever
b. Chills
c. Malaise
d. Wheezing
Solution. D: Wheezing
Reference: The Essentials of Forensic Medicine & Toxicology, 34th edition, Dr. K.S. Narayan
All the metals on melting may give rise to a condition called Metal Fume Fever, but it is most
common in case of zinc (Due to inhalation of Zinc oxide). Also known as Monday fever, Foundry
fever, Brass chills, Brazier disease, Smelter shakes. The symptoms are fever, chills and
malaise(resembles with malaria).
Answer. d
102. A 32 year male was clinically diagnosed as a case of Traveller’s diarrhoea. His stool
examination reveals a pear shape structure with falling leaf motility. What is your interpretation?
a. Entamoeba coli
b. Escherichia coli
c. Trichomonas vaginalis
d. Giardia intestinalis
Answer. d
103. A 36-year-old male residing in a crowded camp area presents with cough for 4 weeks and
significant weight loss. Which of the following factors is known to be most important in
triggering the granulomatous reaction to wall off and contain the infection?
a. Cord factor
b. Mycolic acid
d. Wax D
· Though Cord factor is not a main virulent factor, it helps trigger the Th1 response, which helps
contain the infection.
· Important virulent factor is Lipoarabinomannan.(LAM)
Answer. a
104. A patient who has been diagnosed with sarcoidosis experiences severe hemoptysis.
Imaging studies are strongly suggestive of bronchiectasis and cavitation. In addition, several
movable masses are detected within the cavitation. Surgical resection of the affected area is
performed and the contents of these cavitary masses are cultured. Microscopic view of the 3-day
culture is shown in the image. Which of the following microbes was isolated?
a. Aspergillus
b. Candida
c. Cryptococcus
d. Pneumocystis
· Movable cavitary mass and hemoptysis in a patient with a history of sarcoidosis is strongly
suggestive of aspergillomas.
· Itraconazole may be indicated, however, if the patient does not prove to be a viable
candidate for surgery.
Answer. a
105. A chest physician performs bronchoscopy on an HIV positive patient suffering from
pulmonary tuberculosis. To make the bronchoscopy safe for use for next patient, the most
appropriate method to disinfect the endoscope is by :
c. Autoclaving at 1930C
· Bronchoscopy is heat labile equipment and come under semi critical category of Spaulding
classification.
· Semi critical category treated with high level disinfectant. Example – 2% Glutaraldehyde
(cidex)
· Alcohol& Sodium hypochloriteis not effective against M.tuberculosis and endoscopes cannot
tolerate autoclave temperature.
Answer. b
106. Multiple branched lipopolysaccharides in Gram-negative bacteria
a. Inhibit B cells
c. Are nonantigenic
d. Are haptens
Answer. b
107. Which of the following stains allows differentiation of fungus from human tissue by staining
the fungus a pink-red color?
· Calcofluor white stain, Gomori methenamine-silver stain and periodic acid Schiff stain are
all differential stains, but only the periodic acid-Schiff stain turns fungi a pink-red color.
· The hematoxylin and eosin stain turns fungi a pink-red color also but does not differentiate
between the fungi and human tissue, so it is not a correct answer
Answer. c
a. Fasciola hepatica
b. Hepatitis G virus
c. Clostridium perfringens
d. Histoplasma capsulatum
Solution. (c) Clostridium perfringens
· Pyogenic liver abscess caused by Clostridium perfringens (C. perfringens) is a rare, but
rapidly fatal, infection.
· Massive haemolysis and gas-forming liver abscess are classical features of this infection
which leads to foamy liver appearance.
Answer. c
a. VDRL antigen
b. O139 Antigen
c. PPD
d. Forsmann antigen
Solution.
Answer. a
110. Of the following complement components, which one is the most potent in attracting
neutrophils to the site of infection (i.e., acting as a chemokine)?
a. C1
b. C2
c. C3b
d. C5a
Answer. d
111. Regarding cytomegalovirus (CMV), which one of the following is most accurate?
c. Reactivation of CMV in sensory ganglion cells leads to painful vesicles along nerves.
d. CMV infection of a foetus during the first trimester results in more congenital abnormalities
than infection in the third trimester.
Solution. (d) CMV infection of a foetus during the first trimester results in more congenital
abnormalities than infection in the third trimester.
· Congenital abnormalities are more common when a foetus is infected during the first
trimester than later in gestation, because the first trimester is when development of organs
occurs and the death of any precursor cells can result in congenital defects.
· CMV is transmitted by a variety of modes. Early in life, it is transmitted across the placenta,
within the birth canal, and quite commonly in breast milk.
· In young children, its most common mode of transmission is via saliva.
· Later in life it is transmitted sexually; it is present in both semen and cervical secretions.
· It can also be transmitted during blood transfusions and organ transplants. CMV infection
occurs worldwide, and more than 80% of adults have antibody against this virus.
· CMV enters a latent state primarily in monocytes and can be reactivated when cell-mediated
immunity is decreased. CMV can also persist in kidneys for years. Reactivation of CMV from the
latent state in cervical cells can result in infection of the newborn during passage through the
birth canal.
Answer. d
112. Your patient is a 75-year-old man who has smoked cigarettes (two packs a day for more
than 50 years) and consumed alcoholic drinks (a pack of 6 beers each day) for most of his adult
life. He now has the signs and symptoms of pneumonia. Gram stain of the sputum reveals
neutrophils but no bacteria. Colonies appear on buffered charcoal yeast (BYCE) agar but not on
blood agar. Which one of the following bacteria is most likely to be the cause of his pneumonia?
a. Bordetella pertussis
b. Haemophilus influenzae
c. Klebsiella pneumoniae
d. Legionella pneumophila
· The typical candidate for Legionnaires’ disease is an older man who smokes and consumes
substantial amounts of alcohol.
· The organism fails to grow on ordinary media, but it will grow on charcoal-yeast agar, a
special medium supplemented with iron and cysteine.
Answer. d
113. Regarding haemolytic disease of the newborn (erythroblastosis fetalis), which one of the
following is the most accurate?
a. Maternal red cells are the source of the antigen that induces the antibody.
b. It typically occurs when the father is Rh-positive and the mother is Rh-negative.
c. Maternal IgM anti-Rh antibody enters the fetus and causes damage to the fetal red cells.
d. Symptomatic disease is more likely to occur in the first child than in the subsequent children.
Solution. (b) It typically occurs when the father is Rh-positive and the mother is Rh-negative.
· Left panel: Fetal red cells (RBCs) bearing the Rh antigen enter the mother’s blood when the
placenta separates during the birth of the first Rh-positive child. IgG antibodies to Rh antigen
are then produced by the mother.
· Center panel: During a second pregnancy with an Rh-positive fetus, IgG antibodies pass
from the mother into the fetus via the placenta. The antibodies bind to the fetal red cells,
complement is activated, and the membrane attack complex lyses the fetal red cells.
· Right panel: Anemia and jaundice occur in the fetus/newborn. As a result of the anemia,
large numbers of erythroblasts are produced by the bone marrow and are seen in the blood of
the newborn.
Answer. b
114. Which of the following statements regarding infection with the mumps virus is correct?
Solution.
(a) After initial replication, viremic spread can occur to various organs.
· After initial replication in the upper respiratory tract and salivary glands, viral particles are also transmitted to distant
organs such as the kidneys, testes, ovaries, and CNS through viremic spread.
· It can be cultured in lab.
· Active immunization by vaccine prevents disease.
· There is only one serotype.
Answer. a
115. A sexually active 17-year-old man presents to the local free clinic to check some small
papules that appeared on his penis. The papules are small and white and contain a central
depression in their center. There is no penile discharge, nor is there pain on urination. To what
group is the organism most likely associated with?
a. Poxviridae
b. Papovaviridae
c. Adenoviridae
d. Parvoviridae
· The disease in question is Molluscum contagiosum, which belongs to the Poxviridae and is
characterized by small white papules with a central umbilication usually found in the genital
region; answers B, C and D are incorrect: (B) Papovaviridae include human papillomavirus and
BK, JC polyomavirus, and although HPV causes genital warts, they do not have the central
umbilication present in Molluscum contagiosum; (C) Adenoviridae include a variety of viral
serotypes which cause respiratory, ocular, and gastrointestinal diseases; (D) Parvoviridae include
erythema infectiosum characterized by the slapped cheek appearance.
Answer. a
a. Oxidase production
b. Catalase production
c. Urease production
d. Curved shape
Solution.
Answer. c
117. A foul-smelling specimen was obtained from a 26-year-old woman with a pelvic abscess.
Culture grew both aerobic and anaerobic gram-negative bacteria. The most likely organisms are
which of the following?
a. Actinomyces israelii and Escherichia coli
· In infections, such as intra-abdominal abscesses, Bacteroides species are often associated
with other organisms.
· The only other organism in the list above that is solely aerobic and gram-negative is N.
gonorrhoeae.
Answer. c
118. Regarding haptens, which one of the following is the most accurate?
b. A hapten cannot induce antibody by itself but can do so when covalently bound to a carrier
protein.
c. A hapten can bind to the antigen receptor of CD4-positive T cells without being processed by
macrophages.
d. A hapten is defined by its ability to bind to the smaller of the two polypeptides that comprise
the class I MHC proteins.
Solution. (b) A hapten cannot induce antibody by itself but can do so when covalently bound to
a carrier protein.
· A hapten is a molecule that is not immunogenic by itself but can react with specific
antibody.
· Haptens are usually small molecules, but some high-molecular-weight nucleic acids are
haptens as well.
· Many drugs (e.g., penicillins) are haptens, and the catechol in the plant oil that causes
poison oak and poison ivy is a hapten.
· Haptens are not immunogenic because they cannot activate helper T cells. The failure of
haptens to activate is due to their inability to bind to MHC proteins; they cannot bind because
they are not polypeptides and only polypeptides can be presented by MHC proteins.
Furthermore, haptens are univalent and therefore cannot activate B cells by themselves.
· Although haptens cannot stimulate a primary or secondary response by themselves, they
can do so when covalently bound to a “carrier” protein
.
Answer. b
119. A premature infant on intravenous nutrients and high-lipid fluids has developed fungemia
that cultures out on blood agar only when overlaid with sterile olive oil. Microscopy shown in the
image revealed the pathogen. What is the most likely causative agent?
a. Aspergillus
b. Candida
c. Cryptococcus
d. Malassezia
· Malassezia furfur is a lipophilic fungus that is found primarily in premature infants on
high-lipid intravenous supplements.
· In LPCB, it is having Spaghetti Meat ball appearance or Banana and Grapes appearance.
Answer. d
a. Q fever
b. Scrub typhus
c. Trench fever
d. Rickettsial pox.
Solution. (b) Scrub typhus
Weil felix test is used to diagnose typhus fever, tick-borne spotted fever ,scrub fever.
It can not diagnose Brill zinsser’s disease, rickettsial pox and Q fever.Also trench fever can not
be diagnosed by it.
Answer. b
d. Internal autoinfection
· Ascaris is acquired by ingesting infective eggs, as are the whipworm, Trichuris trichiura,
and the pinworm, Enterobius vermicularis.
· Filariform larvae penetrating unprotected skin is the route by which a person becomes
infected by other intestinal nematodes, hookworms and Strongyloides; eating uncooked pork
could lead to trichinosis; and internal autoinfection is caused only by Strongyloides.
Answer. b
122. Following is a histopathological picture from an abdominal mass. The finding is suggestive
of
a. Hyperplasia
b. Dysplasia
c. Metaplasia
d. Anaplasia
Solution. D: Anaplasia
Marked variation in cell and nuclear sizes, the hyperchromatic nuclei, and the presence of
tumour giant cells is suggestive of malignancy and hence the answer is anaplasia.
Answer. d
123. Which of the following chronic inflammatory states can predispose to cancer?
b. Hashimoto thyroiditis
c. Chronic cholecystitis
Answer. d
b. Helicobacter pylori
c. Barret’s oesophagus
d. EBV
Solution. A: CDH1 gene mutation
Answer. a
125. All of the following are high risk cytogenetic findings of plasma cell myeloma except
a. t(11;14)
b. deletion 17p
c. t(14;16)
d. t(14;20)
Solution. A: t(11;14)
Answer. a
Answer. b
127. All of the following are false about ER positive Her 2 neu negative breast cancers except
Answer. c
a. Takayasu arteritis
c. Polyarteritis nodosa
d. Buerger’s disease
Large vessel vasculitis, Churg Strauss syndrome, Wegener’s granulomatosis and Buerger’s
disease may all show granulomas. Polyarteritis nodosa and Microscopic polyangiitis are
characterised by lack of granulomas.
Answer. c
a. Ductular reaction
c. Spotty necrosis
d. Interface hepatitis
a. Down’s syndrome
b. Neurofibromatosis type I
c. Neurofibromatosis type II
d. Turner’s syndrome
NF1, the first syndrome found to be associated with a germline mutation in the RAS pathway,
can manifest in early childhood with cafe-au-lait spots, JMML, plexiform neurofibromas, optic
pathway tumours, and bone lesions. In children with NF1, the risk of developing JMML is
estimated to be 200- 350 times the risk in children without the syndrome. For about half of the
patients with JMML and NF1, a positive family history is known .In most affected children, the
clinical diagnosis of NF1 can be made at the time of leukaemic presentation; JMML may be the
first manifestation of NF1 in some of these infants.
Answer. b
b. Myeloperoxidase
The distinctive feature of the red-staining (Wright’s stain) eosinophil granule is its crystalline
core consisting of an arginine-rich protein (major basic protein) with histaminase activity,
important in host defence against parasites. Eosinophil granules also contain a unique
eosinophil peroxidase that catalyzes the oxidation of many substances by hydrogen peroxide and
may facilitate killing of microorganisms.
Answer. c
Following are the causes of massive splenomegaly, defined as spleen extending >8 cm below left
costal margin and/or weighing more than 1000 gms-
Answer. d
133. All of the following are true about Crohn’s disease except
Crohn’s disease, also known as regional enteritis, may occur in any area of the gastrointestinal
tract but the most common sites involved at presentation are the terminal ileum, ileocecal valve,
and cecum. Disease is limited to the small intestine alone in about 40% of cases; the small
intestine and the colon both are involved in 30% of patients; and the remainder of cases are
characterized by colonic involvement only. Infrequently, Crohn’s disease may involve the
oesophagus or stomach. The presence of multiple, separate, sharply delineated areas of disease,
resulting in skip lesions, is characteristic of Crohn’s disease and may help in differentiation from
ulcerative colitis. Strictures are common. The earliest lesion, the aphthous ulcer, may progress,
andmultiple lesions often coalesce into elongated, serpentine ulcers oriented along the axis of
the bowel. Oedema and loss of normal mucosal folds are common. Sparing of interspersed
mucosa results in a coarsely textured, cobblestone appearance in which diseased tissue is
depressed below the level of normal mucosa.
Answer. c
134. Which of the following is true about Polyarteritis nodosa?
Answer. b
135. A 25 years old male patient with painless left cervical lymphadenopathy, night sweats,
significant weight loss, plethora and facial oedema is being investigated. The biopsy from the
enlarged lymph node shows atypically large cells, mononuclear mixed with binucleate cells.
Some of these cells appear to have their nuclei in empty spaces. The immunophenotype of these
cells on IHC is expected to be-
a. CD 45 + CD 30 – CD 15 –
b. CD 45 – CD 30 + CD 15 +
c. CD 45 –CD 30 – CD 15 –
d. CD 45 + CD 30 + CD 15 +
Solution. B: CD 45 – CD 30 + CD 15 +
The clinical history and histopathology is suggestive of Nodular sclerosis type of Classical
Hodgkin lymphoma. Immunophenotype of option B is most suitable.
Answer. b
136. Which of the following is the least commonly involved artery in Takayasu arteritis?
a. Subclavian
b. Pulmonary
c. Renal artery
d. Vertebral artery
Solution. B: Pulmonary
Reference: Harrison’s Principles of Internal Medicine, 20th edition
Answer. b
a. Mast cells
b. Eosinophil
c. Neutrophil
d. Macrophages
Histamine
· It causes vasodilation and increased permeability (immediate transient response) and
bronchoconstriction.
Answer. a
a. DNA helicase
b. DNA topoisomerase
c. MENIN
d. RET
Solution. C: MENIN
· It's a dramatic, rapid appearance of features associated with normal aging.
· Individuals with this disorder typically grow and develop normally until they
reach puberty
Answer. c
139. A young female had a surgery and post operatively she was found to have the below lesion.
She complains of pain and itching. What type of collagen one would see predominantly in the
below lesion?
a. Collagen 1
b. Collagen 2
c. Collagen 3
d. Collagen 4
Solution. A: Collagen 1
· The diagnosis is Keloid – owing to the nature of lesion outgrowing the margins of the
injury and also complaints of pain and itch. Both points towards the diagnosis of Keloid.
Microscopy
· Wide bands of collagen with large, brightly eosinophilic, glassy fibers
Answer. a
140. What is the defect in the person with the below finding in peripheral smear?
The above picture shows bite cells. It’s a clue for the diagnosis of G6PD deficiency
G6PD deficiency
· On exposure to oxidant stress the amount of free radicals produced is beyond
the capacity of RBC’s to remove them, resulting in free radical mediated damage to
the RBC’s
· The membrane of RBC’s is not stained in the part of the Hb coagulum formed
resulting in the formation of bite cells
Answer. b
a. Fragile X syndrome
b. Hemophilia
c. MELAS
d. Marfan’s syndrome
Incomplete penetrance is a feature of dominant disorders. Of the four options only Marfan’s is
an autosomal dominant disorder.
Answer. d
142. Stellate cells and loose matrix are features of which the following
a. Rhabdomyoma of heart
b. SCC
c. Myxoma of heart
Myxoma of heart
· Myomas are the most common primary tumor of the heart in adults
· They are benign neoplasms thought to arise from primitive multipotent
mesenchymal cells.
· Myxomas are gelatinous tumors as the name says they have abundance of
myxoid matrix
Rhabdomyoma - histologic processing often artifactually reduces the abundant cytoplasm to thin
strands that stretch from the nucleus to the surface membrane, an appearance referred to as
“spider” cells
Answer. c
b. Hashimoto thyroiditis
c. Riedel thyroiditis
Hurthle cell is an example for oncocytic cell. Now the question needs no explanation. Answer is
hashimoto thyroiditis
· Hurthle cells are - metaplastic response of the normally low cuboidal follicular
epithelium to ongoing injury
Answer. b
a. Neuroblastoma
b. Medulloblastoma
c. Retinoblastoma
d. Ependymoma
Solution. C: Retinoblastoma
Rosettes are little round groupings of cells found in tumors. They usually consist of cells in a
spoke-wheel or halo arrangement surrounding a central, acellular region
Flexner-Wintersteiner Rosettes
· They consist of tumor cells surrounding a central lumen that contains cytoplasmic
extensions from the tumor cells.
· Tumor cells under electron microscopy, they have features of primitive photoreceptor cells
Answer. c
a. Pemphigus vegetans
b. Pemphigus foliaceus
c. Pemphigus vulgaris
d. Pemphigus erythematosus
Solution.
C:Pemphigus vulgaris
· Oral mucosa; also scalp, face, eye, pharynx, larynx, axilla, groin, trunk; nail involvement
Microscopy
· Numerous small, flaccid, suprabasilar bullae with single row of keratinocytes attached to
basement membrane
Answer. c
146. Which of the following is not the criteria for IgG4 mediated disease?
a. Storiform fibrosis
b. Neutrophil infiltrates
c. Obliterative phlebitis
The disease spectrum include Mikulicz syndrome (enlargement and fibrosis of salivary and
lacrimal glands), Riedel thyroiditis, idiopathic retroperitoneal fibrosis, autoimmune pancreatitis,
and inflammatory pseudotumors of the orbit, lungs, and kidneys.
Answer. b
147. Tuberculosis of the spine commonly affects all of the following parts of the vertebra except:
a. Body
b. Lamina
c. Spinous process
d. Pedicle
Answer. c
148. In Supracondylar fracture of humerus in children, if the radial pulse is absent, what is next
line of management?
Answer. b
149. All the following are causes of a painful limp except :
c. Perthes disease
Answer. d
Answer. a
151. Patient presents with knee problem. He gives history of injury during playing hockey 3
months back. On testing knee was unstable anteriorly in extension but was stable in 90 degree
of flexion. Probably injury involves?
c. PCLAnteromedial bundle
Answer. b
a. Skin
Answer. d
a. Femur
b. Tibia
c. Fibula
d. Talus
Solution. b: Tibia
Toddler fracture- seen in children - minimally displaced spiral/oblique fracture of tibia without
fracture of fibula and is also known as CAST ( Childhood Accidental Spiral Tibial) fracture.
Answer. b
154.
d. Chondroblastoma
Answer. c
c. Hoffas’ Fracture
d. Bumper’s Fracture
156. A patient presents with loss of sensation over lateral three and a half fingers. Which of the
following will be seen additionally :
d. Opponens palsy
Answer. d
157. Walking up and downstairs with support usually begins at what age?
a. 15 months
b. 18 months
c. 24 months
d. 30 months
Solution. B: 18 months
Ref: Nelson 20th Ed, WHO-MGRS
Explanation: Stair walking
• Crawls/creeps upstairs: 15 months
• Walking upstairs and downstairs with support: 18 months
• Walking upstairs without support (2 feet at each step): 24 months
• Walking upstairs without support (Alternate feet): 30 months
• Walking downstairs without support (2 feet at each step): 36-42 months
• Walking downstairs without support (Alternate feet): 44-48 months
Answer. b
158. Gas bubbles in portal vein first appear in what stage of necrotising enterocolitis?
a. IIa
b. IIb
c. IIIa
d. IIIb
Solution. B: IIb
Ref: Cloherty’s textbook, Avery
Explanation: Modified Bell’s staging for NEC
Answer. b
159. Which among the following is likely to be the most common heart disease in the child
shown below if he also shows low IQ and hypercalcemia?
a. Pulmonic stenosis
c. ASD
Answer. b
160. A preterm neonate developed asphyxia but was resuscitated. MRI revealed periventricular
leukomalacia. What is the likely sequela in this child?
a. Spastic diplegic CP
b. Spastic quadriplegic CP
c. Choreoathetoid CP
d. Atonic CP
Solution. A: Spastic diplegic CP
Ref: Nelson 20th Ed/ 2897
Explanation: The most common neuropathologic finding in children with spastic diplegia is PVL,
which is visualized on MRI in more than 70% of cases. MRI typically shows scarring and
shrinkage in the periventricular white matter with compensatory enlargement of the cerebral
ventricles.
Answer. a
a. Nasal polyps
b. Pseudomonas pneumonias
c. Diabetes mellitus
d. Hypochloremic alkalosis
Answer. c
162. Drug of choice for chest-indrawing pneumonia in a one-year old child is?
a. Oral amoxicillin
b. Oral cotrimoxazole
c. IV Ampicillin + Gentamicin
d. IV Ceftriaxone
Answer. a
b. Ondansetron
c. Probiotics
d. Ciprofloxacin
Solution. A: Loperamide
Ref: Nelson 20th Ed/1873
Explanation: Antimotility agents (loperamide) are contraindicated in children with dysentery and
probably have no role in the management of acute watery diarrhoea in otherwise healthy
children. Similarly, antiemetic agents, such as the phenothiazines, are of little value and are
associated with potentially serious side effects (lethargy, dystonia, malignant hyperpyrexia).
Ondansetron is safe and a useful adjunct in troublesome vomiting. Probiotics can be given but
are not routinely indicated.
Remember: Ciprofloxacin is the drug of choice in childhood dysentery (WHO-SEAR update,
Nelson 20th Ed).
Answer. a
164. Not seen in infant born to mother with uncontrolled diabetes during pregnancy?
b. Shoulder dystocia
c. Severe anaemia
Answer. c
165. Drug of choice in childhood steroid-resistant nephrotic syndrome?
a. Levamisole
b. Cyclophosphamide
c. Cyclosporine
d. Rituximab
Solution. C: Cyclosporine
Ref: Nelson 20th Ed, ISPN guidelines, KDIGO guidelines
Explanation: Drugs of choice in childhood nephrotic syndrome
• First episode: Prednisolone
• Any relapse: Prednisolone
• Frequent relapses or Steroid dependent nephrotic syndrome: Cyclophosphamide
• Relapse with steroid toxicity: Cyclophosphamide
• Steroid resistant nephrotic syndrome: Calcineurin inhibitors
(Cyclosporine/Tacrolimus)
Answer. c
a. Apathy
b. Hepatomegaly
Answer. c
167. The Tympanic reflex is an involuntary muscle contraction that occurs in the middle ear in
response to high-intensity sound, reaction time for the reflex is about:
a. 10-20 ms
b. 20-40 ms
c. 40-160 ms
d. 160-200 ms
Answer. c
168. Spot Diagnosis:
a. Quinke's disease
b. Quinsy
c. Palatal hematoma
d. Ca Tongue
Answer. a
169. A hyperemic edema of the larynx and epiglottis that rapidly leads to respiratory
obstruction in young children is most likely to be caused by
a. Streptococcus
b. M. pneumoniae
c. Neisseria meningitidis
d. H. influenzae
Answer. a
c. Organ or Corti
d. Brain stem
Answer. b
171. The adduction of the vocal cords cannot occur while talking but can occur with a good
cough is a condition associated with
a. Dysphonia
b. Temporary aphonia
c. Functional aphonia
d. Complete aphonia
Answer. c
a. 1 cc
b. 6 cc
c. 12 cc
d. 15 cc
Solution. (b) 6 cc
• Middle ear volume (MEV), defined as the continuous volume occupied by the tympanic cavity
and mastoid air cells, has been characterized in the setting of various middle ear pathologies
using.
• Determining MEV size by tympanometry has proved clinically useful in various settings.
• The normal, average volume of the middle ear and mastoid is 6 cc
Answer. b
173. Unilateral blood-stained nasal discharge in a child aged three years, is most probably due
to ?
a. Sinusitis
b. Dental infection
c. Viral rhinitis
Answer. d
174. Appearance of fever with rigor in a person with otitis media should make you suspect ?
a. Cerebellar abscess
b. Extradural abscess
d. Apex petrositis
Answer. c
175. In the internal auditory canal, the vertical crest (Bill’s bar) marks a plane between?
• Facial nerve transverses in the anterior superior quadrant of the IAC separated by the
falciform crest inferiorly and Bill’s bar posteriorly.
Other quadrants
• Superior vestibular nerve [superior posterior]
• Inferior vestibular nerve [inferior posterior]
• The cochlear nerve [inferior anterior]
Answer. d
Answer. c
177. The minimal angle of resolution for a patient whose visual acuity on Snellen’s chart is 6/36
a. 4 min of arc
b. 5 min of arc
c. 6 min of arc
d. 10 min of arc
Answer. c
178. Which is false for left trochlear nerve nucleus lesion
Answer. c
c. Hypertensive retinopathy
Answer. b
180. Gyrate atrophy is a retinal condition that occurs with deficiency of Ornithine
aminotransferase enzyme. Which of the following will have the most benefit for patient of gyrate
atrophy?
Answer. b
181. Which drug has been approved by FDA for Acanthamoeba ulcers?
a. Miltefosine (Impavido)
b. Netarsudil (Rhopressa)
c. Latanoprosene (Vyzulta)
d. Voretigene (Luxturna)
Answer. a
182. On Hirshberg corneal reflex test as shown in the figure, the right eye shows reflex in the
center of pupil, while the left eye has reflex temporal to pupil.What is the probable diagnosis?
a. Right esotropia
b. Left esotropia
c. Right hypotropia
d. Left hypertropia
Answer. b
b. Rosette cataract
c. Morgagnian cataract
Answer. c
184. A pregnant woman has open angles and IOP 26, 34 mm Hg (OD, OS) and CDR 0.6, 0.8.
Which of the following should be done?
b. Laser iridotomy
c. Start brimonidine
d. Start prostaglandins
Answer. c
a.
b.
c.
d.
Solution. B:
A lesion in right temporal lobe will produce left homonymous upper quandrantopia due to the
damage of the Meyers loop. This will involve upper nasal field in the right eye and upper
temporal field in the left eye.
A is lesion at junction right optic nerve and chiasma (junctional scotoma).
C is left parietal lobe lesion causinfright homonymous lower quandrantopia.
D is bitemporal hemianopia due to optic chiasma lesion.
Answer. b
c. Opto-kineto-nystagmogram
Solution. C: Opto-kineto-nystagmogram
A subjective test is evaluated by asking an opinion from the patient.
Optokinetonystagmogram (OKN) is an objective test and is thought to occur because the eyes
are trying to keep a moving image stationary on the fovea. The reflex is fully developed by 5-6
months, but is present in a crude form in newborn infants. When a subject views a rotating
striped drum, his or her eyes involuntarily follow a stripe with a “slow eye movement” (pursuit),
then return with a fast eye movement (saccade) to fixate on a new stripe. The whole cycle can be
repeated indefinitely as long as the subject views the moving drum.
Answer. c
187. Which of the following is avoided in epilepsy patients
a. Scoline
b. Atracurium
c. Mivacurium
d. Rocuronium
Solution. B:ATRACURIUM
Atracurium is metabolised by Hoffman degradation(1/3) and alkaline ester hydrolysis (2/3). It
produces metabolite laudonosine which can cause convulsions. Atrcurium causes histamine
release, is doc for renal failure,hepatic failure, pt with atypical pseudocholinesterase.
Answer. b
a. Endotracheal tubes
b. LMA
c. Laryngoscope
d. Tracheostomy
Solution. C:LARYNGOSCOPE
It is curved laryngoscope blade, straight one is called miller. Laryngoscopy is done in sniffing
position, ie extension at atlanto-occipital joint and flexion in the neck.
Answer. c
a. Auscultation
d. Capnography
Solution. D:CAPNOGRAPHY
Golden test for intubation is capnography, normal values are 35-45 mm Hg, capnography
doesnot rule out endobronchial intubation. Best site for auscultation is left base. The cuff should
lie in suprasternal notch 2 to 2.5 cm below vocal cords.
Answer. d
a. 1-2 days
b. 2-3 days
c. 3-5 days
d. >7 days
Answer. c
a. Humphry davy
b. Joseph priestly
c. Simpson
d. Carl koller
Answer. b
a. Sebaceous glands
b. Apocrine glands
c. Holocrine glands
d. Eccrine Glands
Answer. d
193. A 24 middle aged female has flaccid bullae in the skin and persistent painful oral erosions.
Histopathology shows intraepidermal acantholytic blister. The most likely diagnosis is
a. Bullous Pemphigoid
b. Erythema multiforme
c. Pemphigus vulgaris
d. Dermatitis herpetiformis
Answer. c
a. Erythema infectiosum- TB
Answer. d
195. Which of these statements is false for the painful lesions shown in the image below?
a. A form of vasculitis
c. Commonly ulcerates
Answer. d
196. A 10 years old boy presented with painful boggy swelling of scalp, multiple sinuses with
purulent discharge, easily pluckable hair and enlarged lymph nodes in the occipital region.
Which one of the following would be most helpful for diagnosis?
a. KOH mount
c. Bacterial culture
d. Patch test
Answer. a
a. Lupus erythematosus
b. Telogen effluvium
c. Lichen planus
d. Tinea
Answer. b
Answer. d
199. The most common association with irregular pitting of nails and onycholysis is:
a. Violaceous papules
b. Extensor plaques
c. Cicatricial alopecia
d. Exclamation hair
Solution. B: Extensor plaques
The nail changes are of psoriasis. Hence B is the answer.
Answer. b
b. Lymphocytic infiltration
Answer. a
a. Crotamiton
b. Permethrin
c. Lindane
d. Tacrolimus
Solution. D: Tacrolimus
Answer. d
a. Tafazzin
b. Titin
d. NOTCH-2
Solution. b : Titin
Important one liners on Dilated cardiomyopathy
1. DCM is the most common cardiomyopathy
2. 30% cases of DCM are familial
3. Most common pattern of inheritance of familial DCM - Autosomal dominant
4. Most common genetic mutation in DCM - Titin gene
5. Most common cause of DCM - Idiopathic
6. Most common identifiable cause of DCM - Alcohol
7. Most common infective cause of DCM - T.cruzi
8. Most common toxin implicated in DCM- Alcohol
9. Most common drug implicated in DCM - Doxorubicin
Answer. b
203. Drug of choice for IgG4 related disease is?
a. Azathioprine
b. Mycophenolate mofetil
c. Cyclophosphamide
d. Steroids
Solution. d : Steroids
Steroids are the drug of choice for IgG4 related disease. Rituximab can be used as add on agent.
Steroid sparing agents like Azathioprine and mycophenolate mofetil are of doubtful benefit only
in IgG4 related disease.
Answer. d
204. A 19-year-old female who has been in good health and takes no chronic medications,
presents to you for new-onset severe fatigue and left upper abdominal pain. She was treated 2
days ago in the health centre for presumed gonorrhoea with ceftriaxone and azithromycin.
Physical examination showed splenomegaly. Stool is negative for heme. Laboratory examination
is notable for a haemoglobin of 5 g/dL with normal WBC and platelets. Peripheral blood smear
shows evidence of haemolysis and excess of spherocytes. Which of the following tests will most
likely confirm the diagnosis?
c. Flow cytometry
d. Hemoglobin electrophoresis
Answer. b
b. Dermatomyositis
d. All
Solution. b: Dermatomyositis
PERIFASCICULAR ATROPHY is a highly specific feature of muscle biopsies of patients with
dermatomyositis (specificity > 90%) .
Answer. b
a. Glucocorticoids
b. Cyclosporine
c. Antithymocyte globulin
d. All
Solution. d: All
All are treatment options for pure red cell aplasia.
Answer. d
207. What percentage of patients with generalised myasthenia gravis have anti AchR antibody?
a. 25%
b. 50%
c. 85%
d. 100%
Solution. c: 85%
IMPORTANT TOPIC - ANTIBODIES IN MYASTHENIA GRAVIS
•Antibodies to acetylcholine receptor antibodies (anti-AChR) is virtually diagnostic of MG, but
negative test does not exclude the disease.
•Anti-AChR antibodies are detected in the serum of ~ 85 % of all myasthenic patients,but only in
about 50 % of patients with weakness confined to the ocular muscles.
•40 % of generalised MG patients who are negative for anti-AChR antibody have antibodies to
MuSK.
•MuSK antibodies are rarely present in anti-AChR antibody positive patients or in patients with
ocular MG.
•Patients with MuSK antibody positive MG responds less well to thymectomy than those with
AChR antibody.
•Patients with MuSK antibody positive MG responds less well to anticholinesterase medications
than those with AChR antibody
Answer. c
a. Transthyretin
b. Apolipoprotein A1
c. PARK-1
d. Gelsolin
Solution. a: Transthyretin
Familial amyloid polyneuropathy is caused by mutations in the gene coding for transthyretin,
apolipoprotein A1 or gelsolin. Most commonly it is due to transthyretin
mutation. It is predominantly an axonal neuropathy.
Answer. a
a. Systemic sclerosis
b. Myasthenia gravis
c. Hypothyroidism
d. Myotonic dystrophy
Answer. d
a. Metoprolol
b. Amiodarone
c. Vancomycin
d. Chloramphenicol
Solution. b: Amiodarone
Long term amiodarone therapy is associated with dermatological side effects. Most common is
photosensitivity. Sometimes, there can be a bluish-slate gray discoloration of the skin ( called
"blue man syndrome"), which is most prominent on the face.
Answer. b
c. Paramyotonia congenita
Answer. a
212. Which of the following conditions is not associated with calcium pyrophosphate crystal
deposition disease?
a. Hemochromatosis
b. Hypermagnesemia
c. Gitelman’s syndrome
d. Hypophosphatasia
Solution. b: Hypermagnesemia
Conditions associated with CPPD disease are :
- Primary hyperparathyroidism
- Hemochromatosis
- Hypophosphatasia
- Hypomagnesemia
- Gitelman’s syndrome
Answer. b
a. Ataxia telangiectasia
b. Spinocerebellar ataxia
c. Facioscapulohumeral dystrophy
d. Neuroacanthocytosis
Solution. c: Facioscapulohumeral dystrophy
The genetic causes of chorea are :
- Neuroacanthocytosis
- Ataxia telangiectasia
- Spinocerebellar ataxia
- Dentatorubropallidoluysian atrophy
- Benign hereditary chorea
Answer. c
a. Type I
b. Type II
c. Type III
d. Type IV
Solution. a:Type I
Most common type of MPGN is type I. Type I is commonly associated with persistent
hepatitis C infections, autoimmune diseases or neoplastic diseases.
Answer. a
a. Congenital condition
b. Intravascular haemolysis
Answer. a
c. P-pulmonale
Answer. b
217. A 56-year-old construction worker with hypertension and a prior history of tobacco abuse
presents to the emergency department with 30 minutes of acute-onset nausea, dyspnoea and
chest pressure. His initial ECG is shown. All of the following are present in this ECG EXCEPT:
c. Sinus tachycardia
d. Ventricular tachycardia
Answer. d
218. Preferred option for treatment of alcoholic hepatitis with discriminant function above 32?
a. Steroid
b. Azathioprine
c. Pentoxifylline
d. Cyclophosphamide
Solution. a: Steroid
Answer. a
219. Which of the following is a small molecule inhibitor that acts in rheumatoid arthritis by
inhibiting JAK1 and JAK3 ?
a. Tofacitinib
b. Tocilizumab
c. Rituximab
d. Abetacept
Solution. a: Tofacitinib
Tofacitinib is a small molecule inhibitor that primarily inhibits JAK1 and JAK3 which mediate
signalling of the receptors for the common cytokines that promote inflammation in Rheumatoid
arthritis.
Answer. a
220. Which of the following diseases produces this characteristic skin change ?
a. SLE
b. Systemic sclerosis
c. Sjogren syndrome
d. Sarcoidosis
Answer. b
a. Pituitary hyperplasia
b. Atrial myxomas
c. Hyperparathyroidism
d. Schwannomas
Solution. c: Hyperparathyroidism
Carney complex is an autosomal dominant disorder. The gene mutation implicated is
PRKAR1A.
Features are :
- Cushing’s syndrome
- Pituitary hyperplasia and adenomas
- Atrial myxomas
- Schwannomas
- Adrenal hyperplasia
- Lentigines
Answer. c
222. Hunt-Hess scale and World Federation of Neurologic Society Scale are used for?
a. ST elevation MI
b. Non-ST elevation MI
c. Extradural hemorrhage
d. Subarachnoid haemorrhage
Answer. d
b. Root pain
d. Sacral sparing
a. HNF 4 alpha
b. Glucokinase
c. HNF 1 alpha
d. HNF 1 beta
c. Ventricular pacing
d. Closure of ASD
Answer. d
c. Aortic regurgitation
d. Mitral regurgitation
Answer. a
227. Which of the following neurologic disease can have the peripheral smear finding?
a. Alzheimer’s disease
b. Parkinson’s disease
c. Steinert’s disease
d. Abetalipoproteinemia
Solution. d: Abetalipoproteinemia
The peripheral smear shows acanthocytosis.
Three neurological syndromes are associated with acanthocytes in peripheral smear
---> Abetalipoproteinemia
---> Neuroacanthocytosis
---> McLeod syndrome
Answer. d
228. The following is the umbilical artery Doppler of a woman with preeclampsia at 35 weeks of
POG, what is the management?
b. Dexamethasone
c. Termination of pregnancy
d. Continue pregnancy upto 37 weeks
Answer. c
229. All the following are correct about progesterone only pills except
Answer. a
a. Fallopian tube
c. Ovarian ligament
Answer. d
231. A 44 year old woman has undergone hysterectomy for menorrhagia and dysmenorrhoea
and the following is her uterus specimen. What is the likely pathology?
a. Fibroid uterus
b. Bicornuate uterus
c. Adenomyosis
d. Endometrial cancer
Solution. C Adenomyosis
This is a globular uterus with symmetrical growth, this combined with symptoms and age is
characteristic to adenomyosis. The treatment of choice for adenomyosis is hysterectomy.
Answer. c
232. All the following are true about cervical incompetence except
Answer. a
a. Previous ectopic
d. History of PID
Answer. b
234. A woman with preeclampsia after vaginal delivery presents with PPH and was given
oxytocin but continues to bleed what is the next step in the management of this patient
d. Do balloon tamponade
Answer. c
235. All the following are surgeries for vault prolapse except
a. Latzko
b. Sacrocolpopexy
c. Sacrospinous fixation
d. Le Forts repair
Solution. A Latzko
Latzko is a surgery for repair of VVF and not for vault prolapse. Leforts repair or vaginal
obliteration can be done for vault prolapse when longer surgeries cannot be done .The various
surgeries done for vault prolapse are sacrospinous ligament suspension, modified Mc Calls
culdoplasty, uterosacral ligament suspension and sacrocolpopexy and iliococcygeus suspension.
Answer. a
236. Which of the following is not associated with increased risk for abruption ?
a. Smoking
c. Preeclampsia
d. Primigravida
Solution. D Primigravida
Increasing parity is a risk factor for abruption and not primigravida. The highest risk of
abruption is with history of previous abruption as the risk of recurrence is 10-15 fold higher.
Hypertensive woman have 5 fold higher risk. Smoking increases the risk by 2.5 fold. Abdominal
trauma, polyhydramnios and PROM are other important risk factors
Answer. d
b. Karyotyping
Solution. A TTTS
Diagnosis of TTTS is based on ultrasound and not on amniocentesis, amniocentesis may be done
in TTTS to relieve symptoms. Amniocentesis is the safest method for obtaining sample for
karyotyping and is done between 16-18 weeks most commonly. For neural tube defects, we look
for amniotic fluid acetylcholinesterase and AFP. We assess the L/S ratio in the amniotic fluid for
fetal lung maturation.
Answer. a
238. All the following drugs can be given for acute hypertension in pregnancy except
a. Labetalol
b. Intravenous NTG
c. Methyldopa
d. Hydralazine
Solution. C Methyldopa
a) The drugs to be used for acute hypertension in pregnancy are intravenous labetalol as first
line therapy as it is effective, has a rapid onset and good safety profile. The other drugs to be
used are hydralazine, nifedipine and nicardipine, NTG is an option for treatment of hypertension
with pulmonary edema. Sodium nitroprusside is administered as last resort. Methyldopa is the
safest antihypertensive but it has a delay in the onset of action and is also a mild hypertensive
and hence is not used in the management of acute hypertension.
Answer. c
239. A woman with PCOS is high risk for all the following except
a. Endometrial cancer
b. Osteoporosis
c. CAD
Solution. B Osteoporosis
Women with PCOS have either normal estrogen level or higher estrogen level and hence they
are not an increased risk of osteoporosis.
Long term risks in women PCOS are :
1) Type 2 DM
2) Hypertension
3) CAD
4) Endometrial cancer
5) Ovarian cancer
6) Non alcoholic steatohepatitis
7) Psychiatric disturbances
8) Sleep apnea
9) Metabolic syndrome
10) Dyslipidemia
Answer. b
240. Which of the following is the first maneuver in the management of shoulder dystocia ?
a. Zavanelli
c. Suprapubic pressure
d. McRoberts
Solution. D McRoberts
Mc Roberts alone is the first maneuver followed by Mc roberts with suprapubic pressure.
The other maneuvers are removal of posterior arm or shoulder(jaquemiers maneuver).
Woods corkscrew and rubins are rotational maneuvers.
Gaskin all fours and clavicle fracture .
The last resort is zavanelli method which needs repositioning the head in the pelvis followed by
CS.
Answer. d
Answer. d
a. Exertional dyspnoea
b. Neutrophilic leucocytosis
c. Fasting hyperglycaemia
d. Proteinuria up to 300mg/day
Solution. C Fasting hyperglycaemia
Pregnancy is a state of insulin resistance and hence is characterised by fasting hypoglycaemia
and postprandial hyperglycaemia. There is exertional dyspnoea due to hemodilution and
proteinuria upto 300mg/ day can be seen as physiological changes.
Answer. c
243. 16 year old girl presents with primary amenorrhoea with breast development
corresponding to tanner 2. On ultrasound, uterus is absent and pubic and axillary hair are
sparse. Which of the following is the likely diagnosis?
a. Mullerian agenesis
c. Turners syndrome
d. Imperforate hymen
Answer. b
244. The following are true about the type of breech shown except
Answer. a
245. Most reliable indicator of dichorionic twin pregnancy on ultrasound is?
b. Intertwin membrane
c. Lambda sign
d. Number of layers
Answer. a
246. All the following are used for screening for cervical cancer except
a. PAP smear
b. Colposcopy
c. VIA
d. HPV testing
Solution. B Colposcopy
Colposcopy is not a done for screening it is done for follow up of an abnormal PAP smear.
HPV DNA testing, VIA and PAP smear are used for screening of cervical cancer. HPV test has
higher
sensitivity while PAP has higher specificity
A cotest is when PAP and HPV are performed together while reflex test is when HPV is used as a
follow up test .
VIA can be used either alone or with HPV for cervical cancer screening in resource limited
countries.
Answer. b
a. Smoking
b. OCP
c. Breast feeding
d. Tubal ligation
Answer. d
248. Which of the following is not a germ cell tumour of the ovary?
a. Dysgerminoma
c. Fibroma
d. Embryonal cancer
Solution. C Fibroma
FIBROMA is not a germ cell tumour of ovary. It is sex cord stromal tumour. It is a solid ovarian
tumour and is also associated with meigs syndrome.
Dysgerminoma has the best prognosis among germ cell malignancies, while endodermal sinus
tumour has the worst prognosis.
Germ cell tumours are unilateral and most commonly occur in younger girls between 10-30
years of age.
Answer. c
249. Which of the following statements is not true about the reproductive hormones ?
Answer. d
250. A 36 year old woman presents with amenorrhoea for 6 months and infertility. Her lab
evaluation shows FSH levels 45IU. All of the following statements are correct for her
management except
251. The following is the HSG film of a 32 year old woman who presents with primary infertility. What is the treatment
of choice for her?
a. Hysteroscopy
b. IUI
c. IVF
d. GIFT
Solution. C IVF
This is an HSG image of bilateral hydrosalpinx and the treatment of choice for this is IVF. IUI
and GIFT cannot be done when there is tubal factor infertility as they need patent fallopian
tubes.
Hysteroscopy is done as management of proximal tubal or cornual block but not for distal block.
Answer. c
252. All the following are long term complications of PID except
a. Infertility
b. Ectopic pregnancy
d. Cervical cancer
Answer. d
253. The following statements are true about Pre Implantation Genetic Testing except
c. Requires IVF
d. Useful for stem cell therapy
Answer. a
Answer. b
b. Management is delivery
c. It is a clinical diagnosis
d. Enlarged liver
Answer. d
a. AFI <8
b. Associated with Bilateral renal agenesis
Answer. a
257. What is the next step in the evaluation of a 32 year old woman who presents with
progressive dysmenorrhoea and bilateral adnexal masses?
a. Diagnostic laparoscopy
b. TVS
c. MRI
d. CA125
Solution. B TVS
The IOC for adnexal mass is TVS. This is most likely a case of endometriosis with bilateral
chocolate cyst. TVS will further confirm the presence of adnexal mass and its nature, which will
guide the further treatment planning of the patient. CA 125 is done in premenopausal women if
ultrasound appearance of mass raises sufficient suspicion of malignancy.
Answer. b
Answer. c
259. A patient was asked where she lived and she replied: ‘Birmingham, Kingstanding; see the
king he’s standing, king, king, sing, sing, bird on the wing, wing, wing on the bird, bird, turd,
turd.’ This is an example of:
a. Derailment
b. Neologism
c. Flight of ideas
d. Perseveration
Answer. c
Answer. a
a. Children
b. Young adults
c. Middle aged
d. Elderly
Answer. a
262. What is the most common chief complaint of all men treated for sexual disorders?
a. Erectile dysfunction
b. Premature ejaculation
d. Delayed ejaculation
Answer. a
a. Serotonin
b. Norepinephrine
c. Acetylcholine
d. Dopamine
Answer. c
264. The head circumference growth decelerates in which of the childhood onset psychiatric
disorder?
a. Rett's syndrome
b. Heller's syndrome
c. Infantile Autism
d. Asperger's syndrome
Answer. a
Answer. b
a. Basal cell ca
b. Squamous cell ca
c. Mycosis fungoides
Answer. c
267. Proton Beams have been widely used with clinical advantage in the management of
b. Paediatric tumours
c. Craniospinal irradiation
Answer. d
d. The lower photon energy makes radiation protection easier than radium or cesium.
Answer. c
b. Right coronary
d. IVC
Answer. a
270. What is the name of the structure marked by tip of the arrow ?
a. Aorta
b. IVC
c. Hemiazygous vein
Solution. B: IVC
The IVC is formed by the confluence of the two common iliac veins at the L5 vertebral level.
The IVC has a retroperitoneal course within the abdominal cavity. It runs along the right side of
the vertebral column with the aorta lying laterally on the left.
IVC should be distinguished from dilated azygous vein by tracing superiorly. Normal IVC
opacification must be noted to rule out IVC thrombosis.
Answer. b
271. On DEXA, T-score between -1 to -2.5 indicates
a. Osteoporosis
b. Osteopenia
c. Osteopetrosis
d. Normal
Solution. b) Osteopenia
T score <-2.5 is osteoporosis.
Between -1 to -2.5 is osteopenia
DEXA is IOC for bone mineral density assessment.
Answer. b
a. Shouldering
c. Crescentic appearance
Answer. c
273. What is the name of the structure marked by tip of the arrow ?
a. Thalamus
b. Putamen
c. Head of caudate
d. Globus pallidus
Solution. A: Thalamus
The thalamus is composed of two symmetrical egg-shaped masses which are usually connected
at the midline by a band of grey matter, the inter-thalamic adhesion. The anterior pole narrows
to form the posterior boundary of the interventricular foramen. Thalamus hyperintensity has
many causes like viral infection, venous infarcts.
Answer. a
274. What is the name of the structure marked by tip of the arrow ?
a. Spleen
b. Left Adrenal
c. Stomach
d. Pancreas
Answer. b
275. A 25 year old male presented with persistent back ache. Symptoms are aggravated by
hyperextension. Coronal section of CT and IVP are given below. Which of the following is a false
statement about this condition?
a. This condition is more common in males
Answer. d
276. A young patient presented with acute ureteric colic. USG showed a 4 mm stone at right
uretero-vesical junction without any hydronephrosis. What should be best advice for this
patient?
c. ESWL
d. open surgery
Answer. a
c. Extragonadal germ cell tumor has better prognosis and twice the survival as compared to
germ cell tumor.
d. Most common urological tumor of young age
Solution. (c) Extragonadal germ cell tumor has better prognosis and twice the survival as
compared to germ cell tumour.
Answer. c
278. A 27-year-old pregnant women came with history of thyroid swelling. FNAC report was
suggestive of papillary carcinoma thyroid and the nodule was “cold” on scan. Which of the
following will not be a treatment option for her?
b. Total thyroidectomy
c. Right hemithyroidectomy
Answer. a
279. A 18-year-old boy presented to the emergency unit with history of fever and abdominal
pain. On examination he was febrile and pulse rate was 104/min,the resident was eliciting the
sign shown below.Identify the sign.
a. Rovsing’s sign
b. Balance sign
c. Blumberg sign
d. Psoas sign
Answer. c
280. A total autogenous latissimus dorsi flap can provide a maximum muscle volume of which
one of the following?
a. 50 – 100 cc
b. 100 – 200 cc
c. 200 – 300 cc
d. 300 – 400 cc
Answer. d
281. A 56-year-old gentleman came to casualty with history of massive hemoptysis. His chest
Xray and other investigations are normal. Which of the following you will not do to prevent
hemoptysis?
d. Procoagulant drugs
a. Hereditary pancreatitis
b. Peutz-jeghers syndrome
c. FAP
d. FAMMM syndrome
Answer. b
283. What is the percentage that USG can detect lymph node metastases in a patient with
breast cancer and clinically negative lymph nodes?
a. 10-20%
b. 20-30%
c. 30-50%
d. 50-60%
Answer. d
284. All except one are true for Sclerosing Encapsulating Peritonitis
b. At peak of inspiration
Answer. a
286. The inframammary crease is better preserved in which of the following TRAM flap?
c. Bipedicled TRAM
Answer. a
287. Which of the following is regarded as the Management of Choice in a case of rectal
carcinoma at 5 cm from the anal verge?
a. Anterior resection
c. Posterior resection
d. Local resection
Answer. b
288. A young patient presents with a massive injury to proximal duodenum, head of pancreas
and distal common bile duct. The procedure of choice in this patient should be:
a. Roux-en-Y anastomosis
d. Retrograde jejunostomy
Answer. b
289. A male aged 72 underwent routine medical examination. Digital rectal examination shows
a nodule on prostate. Serum examination shows elevated PSA levels. The next step of
investigation will be:
a. CT scan pelvis
b. IVP
In general, six to twelve cores are taken for evaluation and the areas that are abnormal on DRE
may receive more biopsy attempts.
Also Know:
• Prostate specific antigen (PSA) is a protein produced and secreted by both normal prostate
and prostate cancer cells.
• It provides a sensitive but not highly specific screening test, as it is also elevated with BPH,
inflammation, and infection of the prostate.
• The proposed cutoff is 4.0 ng/mL, but studies have shown that 15% of men with normal PSA
levels will have prostate cancer and 2% will have high-grade prostate cancer.
Answer. d
290. After an alcoholic binge a 50 yrs old person had an episode of vomiting followed by
hematemesis. Endoscopic picture is given below. Which is the best treatment for this patient?
a. Conservative treatment
b. Endoscopic sclerotherapy
c. Band ligation
Answer. a
291. A 4 week old boy presented with non-bilious projectile vomiting. USG reveals a thickened
pylorus of length 19mm and 5mm thickness. What electrolyte abnormality is most probable in
this patient?
Answer. a
292. Injury to posterior sector duct will lead to damage of biliary drainage of which lobes?
a. V and VIII
b. V and VI
c. VI and VII
Answer. c
293. Which of the following is not a reversible bariatric surgery?
b. Gastric balloon
d. Sleeve gastrectomy
Answer. d
a. RTS+AGE+GCS
c. ISS+GCS+AGE
d. ISS+GCS+HR
Answer. b
Answer. a
b. Gillies flap
c. Karapandzic flap
d. Tessier operation
297. 42 year male admitted with blunt trauma abdomen with suspected renal injury . Identify
the grade of injury mentioned in the image :
a. Grade I
b. Grade V
c. Grade III
d. Grade IV
Solution. d- Grade IV
Answer. d
b. Pringle’s maneuver
d. Mattox Maneuver
Answer. a
a. TULIP
b. PUL
c. TPUL
d. TURP
Solution. b : PUL
PUL(Prostatic Urethral Lift; also known as Urolift) .
Transprostatic placement of spring loaded T shaped sutures causing mechanical opening of
prostatic urethra
Answer. b
300. A 26 years old pregnant female presents with sudden onset pain with bluish discoloration
of the left lower extremity. Image below shows the current patient status .All except one are
true:
Answer. b
Test Answer