Sei sulla pagina 1di 46

NIZAM’S INSTITUTE OF MEDICAL SCIENCES

Punjagutta, Hyderabad – 500 082, A.P., India.

Set: D
NIMSET-2011

Question Booklet

Entrance Examination for Admission to MD/MS

Subject NIMSET-2011

20 March 2011 Marks 150 Time: 02hours:30min

• Please verify whether the number printed on this question booklet


corresponds to your hall-ticket number
• Please read the instructions on the OMR-Answer sheet carefully
• Each question in this booklet is followed by four alternative answers
Select the one that is most appropriate and darken the corresponding
Oval in the OMR-Answer sheet
• Please return this question booklet along with your OMR-Answer sheet
• Answer sheets not accompanied with the question booklets will not be
corrected
• Wrong Answers carry negative marks

Q1. A 16-month old male infant presented with an enlarging abdominal mass. Laboratory
investigations revealed increased urinary levels of metanephrine and vanillylmandelic acid.
Biopsy showed small tumor cells with hyperchromatic nuclei and little or no cytoplasm.

1 of 46
Occasional focal groups of tumor cells were arranged in a ring around central space. The most
likely diagnosis is
A) adrenal cortical carcinoma
B) ganglioneuroma
C) neuroblastoma
D) nephroblastoma

Q2. Regarding pathophysiology of atherosclerosis,


Assertion: homocysteine is risk factor for development of atherosclerosis
Reason: homocysteine is metabolized by enzymes which are dependent on vitamin B6,
vitamin B12 and folic acid
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q3. True statements regarding the congenital condition of gastrointestinal tract depicted
in the diagram below

1.associated with renal agenesis


2.enterocolitis is a potential complication
3.colonic distension extends upto the anal canal
4. majority of cases manifest clinically in the first 48 hours after birth
A) only 1, 2, and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

Q4. Which of the following physical findings indicative of compartment syndrome is


typically the earliest to occur
A) pain on passive stretching of muscles
B) loss of pulses
C) paresthesias
D) paralysis of the extremity

2 of 46
Q5. Regarding the presentation depicted in the figure below

Assertion: there is no mechanism for normal delivery


Reason: fundal height is less than expected for the period of gestation
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q6. Given below is a depiction of graphical trends of ventilation (V), perfusion (Q), and
ventilation-perfusion ratio (V/Q) as related to lung zones. The lines 1,2, and 3 represent which
one of the following respectively.

3 of 46
A) V/Q ratio, V, Q
B) V, Q, and V/Q ratio
C) Q, V, and V/Q ratio
D) V, V/Q ratio, Q

Q7. The mechanism of action of vancomycin, erythromycin and metronidazole on


microbials respectively are
A) DNA damage, inhibition of protein synthesis and cell wall damage
B) DNA damage, cell wall damage, and inhibition of protein synthesis
C) cell wall damage, DNA damage, and inhibition of protein synthesis
D) cell wall damage, inhibition of protein synthesis, and DNA damage

Q8. The flowchart shown below depicts few steps of glycolysis indicated by numbers.
Substrate level phosphorylation takes place in step

A) 8
B) 7
C) 6
D) 5
Q9. A well proven psychological treatment in the management of obsessive compulsive
disorder is
A) Flooding
B) Systematic desensitization
C) Exposure and response prevention
D) Jacobsen's progressive muscular relaxation therapy

4 of 46
Q10. A CT-angiography of a patient with peripheral vascular disease is depicted below.
The ideal type of surgical procedure indicated is

A) right axillary femoral bypass


B) femoro-femoral bypass
C) aortobifemoral bypass
D) femoro-popliteal bypass

Q11. Which one of the following is the most common type of congenital cataract
A) coronary cataract
B) blue dot cataract
C) anterior polar cataract
D) zonular cataract

Q12. In a 5-year old male child with history of fever and convulsions, the finding/findings
that can be used to detect meningitis clinically
1.hip flexion induces knee pain
2.loss of knee jerk
3.inability to hold neck
4. spontaneous similar movement of hips and knees upon flexion of neck
A) only 1, 2, and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

5 of 46
Q13. Regarding influenza virus infection
Assertion: outbreaks are difficult to control with vaccination
Reason: influenza virus is known for its frequent change in antigenic structure
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q14. A patient is to be operated on for a tumor of the small bowel.In the preoperative
interview, a history of flushing, diarrhea, and joint pain is elicited.There are also symptoms
compatible with congestive heart failure. A likely diagnosis is
A) carcinoid syndrome
B) pheochromocytoma
C) Peutz-Jegher's syndrome
D) adrenal tumor with metastasis

Q15. The skin lesions shown in the diagram below are most likely to result from which one
of the following conditions

A)allergic contact dermatitis


B)hypersensitivity reaction to drugs
C)fulminant meningococcemia
D)fat embolism
Q16. The most common site of stapedial otosclerosis is
A) round window
B) cochlear capsule
C) promontary
D) fistula ante fenestram

Q17. A 40-year old female patient with severe mitral stenosis underwent hysterectomy. In
the immediate postoperative period, she developed pulmonary edema and died. The correct
sequence of entries in the international death certificate for the following items respectively:
condition directly leading to death, antecedent cause/causes, and other significant conditions ,
is
A) pulmonary edema, hysterectomy, mitral stenosis
B) mitral stenosis, pulmonary edema, hysterectomy

6 of 46
C) pulmonary edema, mitral stenosis, hysterectomy
D) hysterectomy, mitral stenosis, pulmonary edema

Q18. Frequency of tuning forks utilized for Weber's and Rinne's test is
A) 128 Hz
B) 256 Hz
C) 512 Hz
D) 1024 Hz

Q19. A transplant performed between two non identical twins is termed


A) allograft
B) xenograft
C) isograft
D) syngeneic graft

Q20. Mc Naughten's Rule is useful to establish


A) identification of a person
B) criminal responsibility of insane
C) civil responsibility of insane
D) drunkenness

Q21. Ureteric blood supply


1. renal artery
2. testicular or ovarian artery
3. superior vesical artery
4. inferior vesical artery
A) only 1, 2, and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

Q22. Osteochondritis dissecans most commonly affects


A) hip
B) knee
C) elbow
D) ankle

Q23. Shown below is the schematic representation of extent of different types of epithelial
lining of the respiratory tract

7 of 46
The epithelium types 1, 2 and 3 represent which one of the following respectively
A) pseudostratified, ciliated, and simple squamous
B) ciliated, pseudostratified, and simple squamous
C) simple squamous, ciliated, and pseudostratified
D) ciliated, simple squamous, and pseudostratified

Q24. 'Honeycombed' appearance of the liver is seen in cases of


A) post mortem staining
B) putrefaction
C) mummification
D) autolysis

Q25. Regarding schematic representation of the surgical procedure shown below,

8 of 46
Assertion: the procedure is a corrective surgical procedure in the management of a patient
with tetralogy of Fallot
Reason: the procedure corrects the cyanosis by increasing pulomary blood flow
A) Both Assertion and Reason are true, and Reason is the correction explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correction explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q26. Which one of the following laboratory indicators of sepsis is most helpful in
differentiating severe bacterial infections from other infectious or noninfectious causes of
systemic inflammatory response.
A) leukocytosis
B) C-reactive protein
C) procalcitonin
D) blood lactate

Q27. Shown below are few stages in the life cycle of Taenia solium. The stage that infects
the intermediate host i..e. the pig is

9 of 46
A) stage 1
B) stage 2
C) stage 3
D) stage 4

Q28. Radio Iodine treatment is contraindicated in thyrotoxicosis associated with


1.pregnancy
2.toxic solitary nodule
3.active Graves ophthalmopathy
4.patients age more than 40 years
A) only 1,2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

Q29. Aerosol therapy is useful in providing all of the following except


A) humidification
B) a means to deliver medication
C) decrease coughing
D) expectoration promotion

Q30. A mother has brought her 3 months old baby to the pediatrician and informs that the
child is lethargic, has poor suckling and seems uninterested in feeding. In addition, the
mother also informs that the baby's diapers often smell like burnt sugar. The infant likely has
a defect in which of the following enzymes
A) cystathionine synthase
B) homogentesic acid oxidase
C) phenylalanine hydroxylase
D) branched chain alpha ketoacid dehydrogenase

Q31. The cause/causes of positive Trendelenburg test


1.fracture of neck of femur
2.dislocation of hip
3.weakness of hip abductors
4.weakness of hip extensors
A) only 1, 2, and 3 are correct
B) only 1 and 3 are correct

10 of 46
C) only 2 and 4 are correct
D) only 4 is correct

Q32. Regarding methanol poisoning


Assertion: administration of ethanol is one of the treatment modalities
Reason: ethanol inhibits alcohol dehydrogenase
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q33. Shown below is the radiograph of knee of a boy aged 15 years presenting with
swelling on the medial side of the knee. The most probable diagnosis is

A) Ewings sarcoma
B) osteochondroma
C) osteoclastoma
D) aneurysmal bone cyst

Q34. Given below are performance characteristics of a diagnostic test for a particular
disease .

11 of 46
Which one of the following formulae represents that for calculation of predictive value of a
positive test
A) a/(a + c)
B) b/(b +d)
C) a/(a + b)
D) (a+b)/(a + b+c+d)

Q35. The difference between the incidence rates among exposed and incidence rates
among non exposed is
A) incidence rate
B) relative risk
C) attributable risk
D) positive predictive value

Q36. Which one of the ankle brachial pressure index (ABI) values given below indicate
severe peripheral vascular disease of lower extremities with high risk of gangrene
A) 0.9
B) 0.3
C) 1.1
D) 1.6

Q37. The chain terminating codon UAA in a m-RNA has been changed to UAG due to
mutation. As a result, in the protein synthesised
A) one of the amino acids is substituted by a different amino acid
B) number of amino acids is increased
C) number of amino acids is decreased
D) there is no change in either number or sequence of amino acids

Q38. Which one of the following secondary skin lesions represents excessive accumulation
of stratum corneum
A) lichenification
B) scale
C) crust
D) scar

Q39. In kidney, the term "dense deposit disease" refers to


A) rapidly progressive glomerulonephritis type I
B) membranoproliferative glomerulonephritis type I
C) membranoproliferative glomerulonephritis type II
D) rapidly progressive glomerulonephritis type II

Q40. Regarding, treatment of eclampsia


Assertion: magnesium is used to treat hypertension
Reason: magnesium produces peripheral vasodilation
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion

12 of 46
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q41. Regarding screening profile for a pregnant woman in first trimester,


Assertion: Testing for herpes simplex virus 2 is not a part of the screening profile
Reason: It causes perinatal infection
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q42. Consider the following hypothetical situation. A family has 8 members consisting of
2 grandparents and 2 parents (already immune to measles) and 4 children who are susceptible
to measles. There occurs a primary case and within a short time 2 secondary cases among the
remaining children ". What is the secondary attack rate?
A) 75%
B) 66.6%
C) 50%
D) 37.5%

Q43. Cleft palate repair is frequently performed between


A) 3 and 6 months
B) 6 and 18 months
C) 3 and 6 years
D) ideally at birth

Q44. Ondanstetron acts as an antiemetic by


A) suppressing the activity of chemoreceptor trigger zone
B) constricting the lower esophageal sphincter
C) depressing the efferents from vomiting centre
D) virtue of its antidopaminergic activity

Q45. In the schematic representation of designs, the study designs 1, 2 and 3 represent
which one of the following

13 of 46
A) retrospective case-control, prospective cohort, retrospective cohort
B) retrospective cohort, prospective cohort, retrospective case-control
C) retrospective cohort, retrospective case-control, prospective cohort.
D) prospective cohort, retrospective case-control, retrospective cohort

Q46. Regarding diabetes mellitus


Assertion: polyphagia is a symptom of diabetes mellitus
Reason: there is a deficiency of glucose utilization in the cells of the "feeding centre" of
hypothalmus
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q47. For prospective renal allograft recipient hyper acute rejection can be avoided by
A) by detection of sensitisation to HLA class I antigens
B) by HLA crossmatching alone
C) preoperative methyl prednisolone administration
D) testing compatability for Rh Antigens

Q48. In the management of hyperkalemia, which drug acts without reducing serum
potassium level
A) intravenous calcium gluconate
B) insulin and glucose infusion
C) intravenous sodium bicarbonate

14 of 46
D) cation exchange resin enema

Q49. A child is born with Apgar scores of 2 and 5 at 1 minute and 5 minutes of life,
respectively. Initial resuscitation includes all of the following except
A) oxygen
B) radiant heat
C) intubation
D) glucose

Q50. In which one of the following organisms inhibition of lysosomal fusion plays an
important role in bacterial mechanisms for escaping phagocytic clearance
A) Salmonella typhi
B) Staphylococcus aureus
C) Streptococcus pneumoniae
D) Mycobacterium tuberculosis

Q51. In telemedicine, the recommended file formats suitable for transmission of medical
images (e.g. CT scan) from a remote end to the specialist end is
A) powerpoint
B) DICOM
C) JPEG
D) MPEG

Q52. Regarding the human placenta


Assertion: Both the amniotic membrane and the chorionic laeve contribute to the tensile
strength of the foetal membranes
Reason: The amniotic membrane and chorionic laeve are adherent at term
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q53. Shown below is the double reciprocal (Lineweaver-Burk) plot of enyzme kinetics in
the presence and absence of an inhibitor

15 of 46
Assertion: the graph represents reversible non-competitive inhibition
Reason: in this graph, presence of inhibitor changes the Km
A) Both Assertion and Reason are true, and Reason is the correction explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correction explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q54. All of the following are grouped under 'pre-invasive' lesions of vulva except
A) Bowen's disease
B) intraepithelial vulval carcinoma
C) hidradenoma
D) Paget's disease

Q55. Skeletal survey of a 5-year old anaemic boy showed dense bones with fractures. The
most probable diagnosis is
A) osteogenesis imperfecta
B) osteopetrosis
C) achondroplasia
D) chronic renal failure

Q56. Dose response curves for isoprenaline-control both alone and in the presence of two
beta receptor antagonists, drugs 'X' and 'Y' are shown. The responses being measured are
increase in heart rate (graph 1) and relaxation of invitro strip of human bronchiolar smooth
muscle (graph 2). Drug 'X' is most likely

16 of 46
A) metoprolol
B) propranolol
C) pindolol
D) timolol

Q57. Telomerase activity is usually absent in


A) germ cells
B) somatic cells
C) stem cells
D) cancer cells

Q58. With regard to bacterial genetics, mobile genetic nonreplicable elements that can
transfer DNA within a cell, from one position to another in the genome are known as
A) episomes
B) bacteriophages
C) transposons
D) plasmids

Q59. Differential diagnosis of radiolucent filling defect in the pelvi calyceal system on
intravenous urography include all of the following except
A) uric acid stone
B) calcium oxalate dihydrate stones
C) blood clots
D) transitional cell carcinoma

Q60. Elective tracheostomy is usually done by incising


A) cricothyroid membrane
B) thyroid cartilage
C) cricoid and first cartilage
D) 2nd and 3rd cartilages

Q61. Shown below is the schematic representation of characteristic pain patterns for
various causes of colicky abdominal pain. Graph lines 1,2,3 represent which one of the
following respectively

17 of 46
A) intestinal, biliary, ureteric
B) ureteric, biliary, intestinal
C) ureteric, intestinal, biliary
D) biliary, intestinal, ureteric

Q62. Presence of gram negative diplococci within polymorphonuclear cells in Gram's


stained smear of centrifuged deposit of CSF sample indicates
A) tubercular meningitis
B) meningococcal meningitis
C) cryptococcal meningitis
D) poliomyelitis

Q63. Which one of the following statements is correct regarding true labour pain
A) unrelated to hardening of uterus
B) results in progressive cervical dilatation and effacement
C) pain unaffected by walking
D) intensity of pain remains same over time

Q64. Which of the following structures cannot be palpated by a vaginal examination


A) sigmoid colon
B) ureters
C) perineal body
D) iliopectineal line

Q65. The excessive bleeding due to tissue plasminogen activator (alteplase) is best treated
with
A)desmopressin
B)tranexamic acid
C)vitamin K
D)fibrinogen
Q66. In prolonged starvation (after 7 days of fasting), 75% of the fuel needs of the brain
are met by
A) glucose
B) glucogenic aminoacids
C) aceto-acetate
D) acetone

18 of 46
Q67. Shown below is the anterior surface of the right kidney. The areas 1,2 and 3 are
related to which of the following structures respectively

A) coils of small intestine, duodenum, jejunum


B) duodenum, coils of intestine, jejunum
C) jejunum, coils of intestine, duodenum
D) coils of small intestine, jejunum, duodenum

Q68. The factor/factors that differentiate acute lung injury (ALI) from acute respiratory
distress syndrome.
1. timing of etiological factor
2. level of PEEP
3. pattern of infiltrates on chest radiograph
4. PaO2/FiO2 ratio
A) only 1,2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

Q69. In Patey's mastectomy for carcinoma breast, the structure/structures removed


include/includes
1.skin overlying the tumor
2.all fat, fascia and lymph nodes of the axilla
3.nipple
4.pectoralis minor
A) only 1,2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

19 of 46
Q70. Shown below is the risk (relative risk and 95% confidence intervals) of
gastrointestinal (GI) complications of various non-steroidal antiinflammatory drugs with data
derived from a meta-analysis of 12 comparative studies. The risk is shown relative to
ibuprofen. Ibuprofen itself carries relative risk of 2, compared to placebo. Which one of the
following represents the correct interpretation of the graph

A) the relative risk for aspirin compared to ibuprofen is 1


B) the point estimate of relative risk of fenoprofen is 1
C) GI complications of diclofenac are higher than that of placebo but lower than that of
ibuprofen
D) the risk of GI complications of all the 12 drugs is higher than that of ibuprofen

Q71. Shown below is the chest radiograph of a patient with peroforating esophageal ulcer.

20 of 46
Positive findings include
1. suppurative mediastinitisdds
2. pneumothorax
3. colonic interposition surgery
4. pneumopericardium
A) only 1, 2, and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

Q72. Which is the correct statement regarding umbilical cord blood stem cells
A) has less graft versus host disease
B) has more HLA restriction than adult marrow stem cells
C) contamination with herpes virus is more
D) large quantities can be obtained from a single source

Q73. In the schematic diagram shown below, the cell type indicated by arrow typically is

21 of 46
A) CD4 T cell
B) CD 8 T cell
C) dendritic cell
D) B lymphocyte

Q74. Given below is the coronal section of the brain with an arrow pointing to a ventricle

All of the following are true about the ventricle except


A) communicates with fourth ventricle via cerebral aqueduct
B) it communicates with subarachnoid space by a foramen in its roof
C) communicates with the lateral ventricle through interventricular foramina
D) it is situated between the two parts of the thalamus

Q75. Last long bone epiphysis to unite in upper limb is


A) head of humerus
B) medial epicondyle of humerus
C) head of ulna

22 of 46
D) head of radius

Q76. The graph is a record of the changes in intestinal smooth muscle membrane potential
to various agents (physical/chemical).

Agents that produce response Y


1. epinephrine
2. cold
3. sympathetic stimulation
4. acetylcholine
A) only 1, 2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

Q77. All of the following statements regarding lithium carbonate are true except
A) it prevents both manic and depressive relapses
B) it causes neutropenia
C) screening of renal function and thyroid function is required prior to initiation of
lithium therapy
D) levels of 0.8 to 1.2 milliequivalents/L are usually required to treat acute phase

Q78. Good prognostic factor/factors in breast cancer


1.Estrogen Receptor positivity
2.HER-2 receptor overexpression
3.Progesteron receptor positivity
4.Lymph node involvement
A) only 1,2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct

23 of 46
D) only 4 is correct

Q79. Which of the following statements regarding the role of 2,3 disphosphoglycerarate
(DPG) in red blood cell physiology is true
A) it binds with greater affinity to hemoglobin F than to hemoglobin A
B) it decreases in concentration as an adaptive mechanism at high altitudes
C) it decreases the affinity of hemoglobin A for oxygen
D) its synthesis is decreased by tissue hypoxia

Q80. Shown below is a barium swallow radiograph at thoracic level in a patient with
dsyphagia. The image is suggestive of which one of the following

A) squamous cell carcinoma of esophagus


B) leiomyoma of esophagus
C) achalasia cardia
D) esophageal pouch

Q81. The figure shown below represents a trimodal pattern of an event occurring after
major trauma. The 'y' axis best represents the rate of

24 of 46
A) fat embolism
B) infection
C) blood loss
D) mortality

Q82. The bleed in this CT scan is located in the

25 of 46
A) basal ganglia
B) thalamus
C) temporal lobe
D) frontal lobe

Q83. Regarding, Intrauterine contraceptive device (IUD)


Assertion: Copper-T device should be replaced every 3 to 5 years
Reason: The IUD undergoes slow migration in the uterine cavity and may cause uterine
perforation.
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q84. Nutritive sucking in fetus develops by


A) 28 weeks of gestation
B) 32 weeks of gestation
C) 34 weeks of gestation
D) 36 weeks of gestation

Q85. In the schematic diagram of endothelium, conditions 1, 2, and 3 represent which of


the following pathological states respectively

26 of 46
A) inflammation, thrombosis, hypersensitivity
B) hypersensitivity, thrombosis, inflmmation
C) thrombosis, inflammation, hypersensitivity
D) thrombosis, hypersensitivity, inflammation

Q86. Figure below depicts receiver operating characteristic (ROC) curves for four tests (
tests 1,2,3 & 4) for detection of coronary artery disease. Which one of the following
statements is true

27 of 46
A) area under the curve for test 1 is equal to 1
B) test 2 has better utility than test 1
C) test 3 can replace test 1 for routine use
D) test 4 provides no additional information

Q87. Shown in the figure is an entry wound of rifled firearm. A,B and C in the figure
correspond to which of the following respectively

A) A-abrasion collar, B-dirt collar, C-tattooing


B) A-dirt collar, B-abrasion collar, C-tattooing
C) A-tattooing, B-abrasion collar, C-dirt collar
D) A-abrasion collar, B-tattooing, C-dirt collar

Q88. Which one of the following clinical signs would favour a diagnosis of
panophthalmitis in a patient presenting with acute inflammatory proptosis
A) complete loss of vision from the beginning
B) bilateral involvement
C) severe constitutional symptoms
D) clear cornea and anterior chamber

28 of 46
Q89. Regarding endometriosis
Assertion: Pelvic symptoms and infertility are uncommon as presenting features of
endometriosis
Reason: Endometriosis is diagnosed by the presence of stromal and glandular elements
outside the uterus
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q90. Regarding, systemic changes associated with inflammation


Assertion: measure of ESR (erythrocyte sedimentation rate) is a simple test for systemic
inflammatory response
Reason: fibrinogen, an acute phase protein, can cause stacking of erythrocytes
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q91. Which of these organisms mediate their intestinal toxicity through production of a
toxin
A) clostridusim difficile
B) entamoeba histolytica
C) giardia lambia
D) helicobacter pylori

Q92. Regarding post operative management of differentiated thyroid carcinoma


Assertion: Suppressive dose of thyroxin is given for all patients
Reason: The levels of thyroglobulins are increased in recurrent disease after thyroidectomy
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q93. An adolescent aged 18 years presented with multiple umbilicated hypopigmented


papules of 4.5mm in diameter over trunk and arms. He recently attended a swimming camp
for 15 days. Biopsy of lesions revealed cytoplasmic eosinophilic inclusions. Which one of
the following statements is true
A) specific treatment includes topical erythromycin
B) there are no systemic complications

29 of 46
C) vaccination is one of the components in the management
D) the skin lesions will also be photosensitive

Q94. Tenderness in the anatomical snuff box indicates fracture of which one of the
following bones (indicated by numbers) depicted in the diagram given below

A) bone 1
B) bone 2
C) bone 3
D) bone 4

Q95. Isolated conjugated hyperbilirubinemia is seen in


A) haemolytic jaundice
B) Gilbert's syndrome
C) Dubin johnson syndrome
D) Criggler Najjar syndrome

Q96. Frequency of rest tremor in Idiopathic Parkinson's Disease is


A) 2/sec
B) 4-6/sec
C) 8-10/sec
D) 12-16/sec

Q97. A man aged 25 years was evaluated in the emergency services and was found to have
severe metabolic acidosis. The calculated anion gap was 10 mEq/L. The cause can be
A) renal tubular acidosis
B) acute renal failure
C) ethylene glycol poisoning
D) salicylate poisoning

Q98. A 50 year old man has 2x2cm carcinomatous ulcer in the rectum. The ulcer is
situated 6cm from anal verge. On investigation it is staged as T2N0M0. He does not have any
comorbid condition. He would be best managed by

30 of 46
A) abdominoperineal resection
B) low anterior resection
C) Hartmann's operation
D) chemoradiation followed by surgery

Q99. In the evaluation of kidneys, the risk of radiation exposure to the patient is maximum
with which one of the following investigations:
A) Intravenous urography
B) magnetic resonance urography
C) ultrasonograhy
D) renal scintigraphy

Q100. All are alkylating agents except


A) cisplatinum
B) cyclophosphamide
C) methotrexate
D) dacarbazine

Q101. A patient is on category III treatment under DOTS. If his sputum smear examination
at two months is positive, then action to be taken is:
A) extend the intensive phase by one more month
B) reregister the patient and begin category I treatment
C) reregister the patient and begin category II treatment
D) start continuation phase and test sputum again at 4 months

Q102. An important advantage of MRI over CT is that it


A) provides more information on electron density
B) has no geometric distortion
C) provides superior soft tissue delineation
D) precisely defines the bony landmarks

Q103. A 25-year old man who sufferred from a deep penetrating wound has had a booster
dose of tetanus toxoid 12 years ago. The recommendation for prevention of tetanus is
A) one dose of tetanus toxoid
B) nothing more required
C) toxoid complete course plus human tetanus immunoglobulin
D) one dose of toxoid plus human tetanus immunoglobulin

Q104. The role of microbial biofilm in pathogenesis of infections


1.provides protection against epithelial adherence by microbes
2.conisists of many cells and polysaccharides
3.is important in microbial shedding from host
4.contributes to drug resistance of microbes
A) only 1, 2, and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

Q105. Regarding Coombs test.


Assertion: Indirect antiglobulin testing is useful for antibody screening in pre transfusion
testing .

31 of 46
Reason: Direct globulin testing detects the presence of antibody bound to the red cell surface.
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q106. Given below is a figure demonstrating a type of regional block used for anesthesia

All of the following statements are true about the block except
A) the needle enters the required space via sacrococcygeal membrane
B) is an intrathecal block
C) blocks the perineal area
D) suitable technique for anal dilatation in cases of fissure in ano

Q107. A 24-year female involved in a road traffic accident presents in shock with raised
jugular venous pressure and is disoriented. Her heart sounds are feeble. Which of the
following interventions is/are recommended in her initial management.
1. left atrial pressure measurement
2. intravenous fluid replacement
3. central venous pressure monitorng
4. closed pericardiocentesis
A) only 1, 2, and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

Q108. Superantigens activate the immune system through


A) specific contact between antigen presenting cells and the T lymphocytes
B) nonspecific interaction with the T lymphocytes and the MHC class II receptors
C) specific contact with B lypmphocytes

32 of 46
D) direct activation of complement cascade.

Q109. The diagram shown below is a schematic representation of a surgical procedure for
portal hypertension bleed and is known as

A) proximal spleno-renal shunt


B) distal spleno-renal shunt
C) non-selective shunt
D) non-selective shunt with devascularisation

Q110. Regarding sampling of arterial blood acid base gas analysis,


Assertion: Ideally, the sample should be taken to the laboratory in a ice slush and be
analyzed within 15 minutes.
Reason: Heparin anticoagulant used in the sample is acidic
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q111. A newborn baby born to a primi gravida by normal vaginal delivery was referred at 2
hours after birth with severe chest retraction on inspiration, cyanosis. The cyanosis is relieved
during crying. Other systemic examination was normal. The most probable diagnosis is
A) cyanotic congenital heart disease
B) bilateral choanal atresia
C) neonatal tetanus
D) congenital pneumonia

33 of 46
Q112. Subacromial and subdeltoid bursae separate the supraspinatus tendon from
1.pectoralis major muscle
2.deltoid muscle
3.sub scapularis muscle
4.acromion process
A) only 1,2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

Q113. Regarding undescended testis


Assertion: Orchidopexy should be performed at an early age
Reason: There is an increased liability for malignant disease with advancing age
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q114. Figure below shows different phases (numbered 1 to 4) of ventricular diastoli. The
phase number 4 represents which one of the following

34 of 46
A) atrial systole
B) slow ventricular filling
C) isovolumetric relaxation
D) rapid ventricular filling

Q115. Given below is a scheme of chest radiograph with 4 lines a, b, c, d representing


different lengths

Which one of the following correctly represents the formula for calculating cardiothoracic
ratio
A) (a + b) / (2 x d)
B) a / d
C) (a + b) / c
D) (a + b) / d

Q116. Consequent to partial or total absence of the decidua basalis and imperfect
development of fibrinoid layer (Nitabuch layer), the placental villi are attached to
myometrium in
A) placenta accreta
B) placenta increta
C) placenta percreta
D) placenta previa

Q117. Which one of the following diagrams best represents the resection portion (below the
line) for Whipple's surgical procedure

35 of 46
A) diagram 1
B) diagram 2
C) diagram 3
D) diagram 4

Q118. Antiseptic solutions useful for surgical skin preparation


1. isopropyl alcohol
2. hexachlorophane
3. povidone-iodine
4. cetrimide

A) only 1, 2, and 3 are correct


B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct

Q119. How much of glucose is reabsorbed in a minute when the blood glucose level is 100
mg/dL and the GFR 120 ml/min?
A) 60 mg/min
B) 100 mg/min
C) 120 mg/min
D) 180 mg/min

Q120. Scoliosis that disappears on sitting is


A) structural scoliosis
B) sciatic scoliosis
C) congenital scoliosis
D) postural scoliosis

36 of 46
Q121. A 60-year old debilitated woman recovering from an operation for gallstone ileus on
the fifth postoperative day develops fever and complains of pain in the region of the left
parotid gland. The most likely causative organism
A) staphylococcus aureus
B) escherichia coli
C) bacteroides
D) streptococci

Q122. The RMP of the nerve cell is equal to which ions equillibrium potential
A) Na+
B) K+
C) Cl-
D) HCO3-

Q123. All of the following form part of the critieria used to diagnose Systemic Inflammatory
Response syndrome except:
A) a total count of less than 4000/cu.mm
B) a heart rate of more than 90 beats per minute
C) temperature of more than 38o C
D) at least 5% band forms on the differential count

Q124. The deformity of the right upper extremity shown in the diagram below results most
commonly from complication of which one of the following fractures

37 of 46
A) olecrenon fracture
B) coronoid process of ulna
C) supracondylar fracture
D) fracture of upper third of ulna with dislocation of head of radius

Q125. Regarding treatment of bipolar disease


Assertion antidepressants are used in maintenance phase
Reason they can increase the cycle frequency
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q126. A 35yr old female presented with secondary amenorhhea of 8 months duration. The
last child birth was 2yrs ago. Pregnancy test was negative. Thyroid function tests were
normal, prolactin level was normal and estrogens were decreased and FSH was high. This is
most probably
A) Asherman syndrome
B) polycystic ovarian disease
C) premature ovarian failure
D) Sheehan syndrome

Q127. Given below is a schematic representation of spermatogenesis

38 of 46
The stage at which 46 chromosomes become 23 is
A) stage 1
B) stage 2
C) stage 3
D) stage 4

Q128. Regarding prophylaxis for hepatitis B,


Assertion: administration of hepatits B vaccine and hepatitis B immunoglobulin at birth is
indicated to all babies born by normal vaginal delivery to HBsAg positive mothers
Reason: majority of babies acquire the infection in utero
A) Both Assertion and Reason are true, and Reason is the correction explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correction explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q129. The curves 1, 2 and 3 respectively depict the growth pattern of which one of the
following organ systems in a child

39 of 46
A) brain, lymphoid, gonadal
B) lymphoid, brain, gonadal
C) lymphoid, gonadal, brain
D) gonadal, brain, lymphoid

Q130. A person with a myopic eye cannot see objects distinctly beyond 120 cm. The
refractive power of the lens to restore proper vision is
A) -1.2 D
B) -0.83 D
C) -0.0083 D
D) 0.83 D

Q131. Recurrent laryngeal nerve is to be protected in thyroid surgery as it is intimately


related to
A) superior thyroid artery near the gland
B) superior thyroid artery away from the gland
C) inferior thyroid artery near the gland
D) inferior thyroid artery away from the gland

Q132. Regarding treatment of cerebral malaria,


Assertion: quinine in glucose infusion is recommended
Reason:quinine is a powerful stimulant of pancreatic insulin secretion
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion

40 of 46
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q133. Regarding the treatment of acute primary angle closure glaucoma


Assertion: Mechanical pressure applied to the center of cornea may help as an adjunct to drug
therapy
Reason: It increases the pressure in the anterior chamber
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q134. A 12 year old boy complained of painful enlarging mass, fever and X-ray showed an
osteolytic lesion in the diaphysis of femur. The histopathology showed small blue round cells
with rosettes. The most likely diagnosis in this case is
A) osteosarcoma
B) osteoclastoma
C) chondrosarcoma - small cell variant
D) Ewing's sarcoma

Q135. In the pedigree chart shown below, which one of the following statements regarding
the inheritance of disease is true

A) unaffected mother cannot transmit to her children


B) affected father transmits to his children
C) successive generations are always affected
D) all children from an affected mother will inherit the abnormal gene

Q136. Drugs A and B were given by intravenous bolus every 24 hours. From the graph, it
can be concluded that

41 of 46
A) drug A does not maintain persistent therapeutic levels when administered every 24
hours
B) drug A exhibits cumulative properties
C) drug B is non-cumulative when administered every 24 hours
D) drug B is completely destroyed in less than 24 hours

Q137. Regarding immediate complications of tracheostomy,


Assertion: Apnoea follows the opening of trachea in a patient who had prolonged respiratory
obstruction
Reason: loss of respiratory stimulus resulting from sudden wash out of carbon dioxide
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q138. The surgical needle types shown in figures 1, 2 and 3 represent which one of the
following respectively

42 of 46
A) standard cutting, reverse cutting and round bodied
B) reverse cutting, standard cutting, and round bodied
C) reverse cutting, round bodied and standard cutting
D) round bodied, standard cutting and reverese cutting

Q139. A 12 years old otherwise healthy girl sleeping on floor bed woke in the midnight with
pain in abdomen, nausea, vomiting, followed by weakness in four limbs, ptosis and bulbar
palsy. The most likely diagnosis is
A) Guillain barre syndrome
B) periodic paralysis
C) myasthenia gravis
D) krait bite

Q140. Regarding laryngeal cancers


Assertion: prognosis is better in glottic cancers compared to supraglottic cancers
Reason: true vocal cords possess little or no lymphatic drainage
A) Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for
Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true

Q141. The diameter used in obstetric practice shown in the diagram below is described as

43 of 46
A) anterior sagittal diameter
B) anatomic anteroposterior diameter
C) posterior sagittal diameter
D) obstetric anteroposterior diameter

Q142. In paralysis of the left superior oblique muscle, patients head is tilted
A) downwards and towards right shoulder
B) downwards and towards left shoulder
C) upwards and towards right shoulder
D) upwards and towards left shoulder

Q143. Which one of the following manifestations of menopausal syndrome is not


responsive to local estrogen therapy
A) dyspareunia
B) vaginal relaxation
C) atrophic vaginitis
D) urethral syndrome

Q144. Fetal assessment by bio-physical profile includes all except


A) fetal gross body movements
B) amniotic fluid index
C) fetal weight
D) fetal breathing movements

Q145. A woman aged 20 years presents to emergency with complaints of pain in the
hypogastrium and history of not passing urine since last 12 hours. She had no history of fever
or any other complaints. Her last menstrual period was 3 months back. On examination the
vital signs were normal, no pallor was noted. Abdominal examination revealed a soft palpable
mass in hypogastrium and vaginal examination showed cervix to be high under pubic

44 of 46
symphysis and a separate mass palpable in pouch of Douglas. The most probable diagnosis is
A) ectopic pregnancy with rupture
B) retention of urine due to retroverted gravid uterus
C) acute renal failure in pregnancy
D) urinary tract infection

Q146. The disorders 1,2, and 3 depicted in the figure below represent which of the following
gynecological conditions respectively

A) cystocele, rectocele, and enterocele


B) cystocele, enterocele, and rectocele
C) rectocele, cystocele, and enterocele
D) rectocele, enterocele, and cystocele

Q147. Early signs of fat embolism in a patient with multiple fractures


A) breathlessness
B) mild mental confusion
C) slight rise of temperature and pulse rate
D) restlessness

Q148. Both unfractionated heparin and low molecular weight heparin are similar with
respect to which of the following biologic properties
A) microvascular permeability
B) anti-Xa activity
C) platelet inhibition
D) anti-IIa activity

Q149. A 54-year old man becomes ill 3 hours after eating Chinese fried rice. He began
vomiting, and developed watery diarrhoea without blood. The most most likely cause of his
illness is
A) Camphylobacter jejuni
B) Salmonella typhi
C) Bacillus cereus
D) Staphylococcus aureus

45 of 46
Q150. Shown below is the schematic diagram of cell cycle phases.

The numbers 1,2 and 3 depicted in the boxes correspond to which one of the following
correctly

A) mitogens, mitosis, DNA replication


B) mitosis, DNA replication, mitogens
C) DNA replication, mitogens, mitosis
D) mitogens, DNA replication, mitosis

46 of 46