8/25/2020 NMCLE BHADRA 9

NMCLE BHADRA 9
WELCOME

Instructions:

1. Do not leave the exam in middle (it will automatically submit if you do so)
2. Score with explanation will be displayed at the end after you submit it.
3. Exam time is 120 minutes.
4. We will send explanation PDF at 10:00 PM today.

Anatomy

1. Which of the following is the feature of Y chromosome (1 point)

⚫ a, Acrocentric
◯ b. Telocentric

◯ c. Submetacentric

◯ d. Metacentric

Explanation:

The answer is a. Acrocentric

Ref: Precid & Strachan Molecular genetics-49,153; Human Histology 4/e .35

Human C chromosome is large submetacentric whereas Y chromosome is small acrocentric chromosome.

Chromosome 13,14,15,21 and 22 are acrocentric. Chromosome 2,4,12,17 & 18 are sub metacentric while
chromosome 1,3,16,19,20 are metacentric

Telocentric chromosomes are not found in humans.

2. Glitter cells are (1 point)

⚫ a. Microglia
◯ b. Modified macrophages

◯ c. Astrocytes

◯ Neutrophils

Explanation:

The answer is a. Microglia

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Ref: Di Fiore's hisotology 7/e p-290

Glitter or Hortega cell is a lipid laden microglial cells commonly seen at the edge of healing brain infarcts. It
phagocytize lipid from necrotic or degenerating brain cells. It is also known as compound granule cell,
gitterzelle( lattice or wire-net) mesoglia or perivesicular glial cell

3. Renal angle lies between (1 point)

⚫ a. 12th rib and lateral border of sacrospinalis

◯ b. 11th rib and lateral border of sacrospinalis

◯ c. 12th rib and lateral border of quadratus lumborum

◯ d. 11th rib and lateral border of quadratus lumborum

Explanation:

The answer is a, 12th rib and lateral border of sacrospinalis

Ref: BDC 4/e, vol-II, p-301, 280

Renal angle lies between the lower border of 12th rib and outer border of erector sinae(sacrospinalis) muscle,
Rena angle is used to elicit tenderness in kidney.

4. Boundary of triangle of auscultation is not formed by (1 point)

⚫ a. Serratus anterior
◯ b. Scapula

◯ c. Trapezius

◯ d. Lattisimus dorsi

Explanation:

The answer is a. Serraus anterior

REf: Moore 6/r p-754,756

Triangle of auscultation is bounded by LATisimus dorsi, Scapula and Trapezius (@ LATeST),

5. Posterior dislocation of tibia on femur is prevented by (1 point)

◯ a. Anterior cruciate ligament

◯ b. Medical meniscus

◯ c. Lateral meniscus

⚫ d, Posterior cruciate ligament

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Explanation:

The answer is d, Posterior cruciate ligament

REf: BDC 4/e vol II p-26

ACL prevents anterior translation of tibia on femur

Biochemistry

6. Insulin stimulated glucose uptake is by (1 point)

◯ a. SGLUT-1

◯ b. GLUT-2

◯ c. GLUT-3

⚫ d. GLUT-4

Explanation:

The anaswer is d. GLUT-4

Insulin stimulated glucose uptake is present in adipose tissue, skeletal muscle and heart mediated by GLUT-4
receptors.

7. Prostaglandins are derived from (1 point)

◯ a. Corticosteroids

◯ b. Oleic acids

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⚫ c. Arachidonic acid
◯ d. Linoleic acid

Explanation:

The answer is C. Arachidonic acid

Arachidonic acid via cycloxygenase pathway generates prostaglandins while via lipoxygenase pathway generate
leukotrienes.

8. Rotenone inhibits the respiratory chain at (1 point)

⚫ a. Between complex I and CoQ

◯ b. NAD-->FMN

◯ c. Coenzyme Q--> cyt b

◯ d. Cyt b--> Cyt c1

Explanation:

The answer is a. between complex I and Coenzyme Q

Ref: Vasudevan 6/e, pg number- 234( table 19.5)

Other complex I to CoQ specific inhibitors: Barbiturates (Amobarbitol), sedative, Chlorpromazine, piercidin,
etc.

9. Fastest enzyme to rise in myocardial infarction is (1 point)

◯ a. CK-MB

⚫ b. Myoglobin
◯ c. Troponins

◯ d. LDH

Explanation:

The answer is b. Myoglobin

Ref; Basudevan 6e/ pg- 267

Myoglobin has onset of 1-4 hour, CK-MB has onset of 3-6 hour, Troponin has onset of 4-10 hours, LDH has
onset of 6-12 hours.

10. Rate limiting step in heme synthesis is (1 point)

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⚫ a. ALA synthesis
◯ b. Formation of Porphobilinogen

◯ c. Formation of uroporphyrinogen

◯ d. Syntheis of coproporphyrinogen

Explanation:

The answer i a. ALA synthesis

Ref: Vasudevan 6e, pg- 243

The synthesis of heme starts with condensation of succinyl CoA and glycine in the presence of pyridoxal
phosphate to form delta- amino levulinic acid(ALA) . Hence, anemia is manifested in pyridoxal deficiency.
ALA synthase enzyme is located in mitochondria and is the rate limiting step in heme synthesis.

Community medicine

11. Disability limitation is mode of intervention for (1 point)

◯ a. Primodial Prevention

◯ b. Primary Prevention

◯ c. Secondary Prevention

⚫ d. Tertiary prevention

Explanation:

The answer is d. Tertiary prevention

Ref: Park 22/e, p-33,40

Primary level is mode of intervention for health promotion and specific protection.

Secondary level is mode of intervention for early diagnosis and treatment

12. Iceberg phenomenon differentiates (1 point)

⚫ a. Apparent and Inapparent

◯ b. Symptomatic and Asymptomatic

◯ c. Cases and Carriers

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◯ d. Diagnosed and Undiagnosed

Explanation:

The answer is a. Apparent and inapparent

Ref: Park 22e, pg- 37

Iceberg phenomenon of disease is also sometimes known as "biological spectrum of disease:

CLINICIAN’S FALLACY: The iceberg phenomenon thwarts attempts to assess the burden of disease and the
need for services, as well as the selection of representative cases for study; this leads to what has been called the
‘clinician’s fallacy’in which an inaccurate view of the nature and causes of a disease results from studying the
minority of cases of the disease that are seen in clinical treatment

13. The analytical study where population is the unit of study is (1 point)

◯ a. Cross sectional

⚫ b. Ecological
◯ c. Case-control

◯ d. Cohort

Explanation:

The answer is b. Ecological

Ref: Park 22 e p-60

• Types of epidemiological studies:

Type of epidemiological study= Unit of study

A. Observational studies

a. Descriptive studies (Hypothesis formulation)

b. Analytical studies (Hypothesis testing)

1. Cohort study Individual=Individual

2. Case control study=Individual
3. Cross sectional study=Individual
4. Ecological study=Population

B. Experimental studies (Hypothesis confirmation)

1. Randomized controlled trial =Patients

2. Field trial =Healthy people
3. Community trial= Community

14. True regarding point source epidemic is (1 point)

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◯ a. Secondary wave occurs

◯ b. There is rapid rise in the wave which flattens

⚫ c. All cases occur in a single incubation period of the disease

◯ d. It is propagative

Explanation:

The answer is c. All cases occur in a single incubation period of the disease

Ref: Park 22e p-621

Endemic: Constant presence of a disease or infectious agent in a defined geographical area. Following patterns
of epidemic outbreaks can be seen:

Common-source: A common-source outbreak is one in which a group of persons are all exposed to an
infectious agent or a toxin from the same source.
Point
Continuous
Intermittent
Propagated: A propagated outbreak results from transmission from one person to another.
Mixed

Pandemic: An epidemic usually affecting a large proportion of the population, occurring over a large
geographical area such as part of a nation, nation, continent or world

Sporadic: Cases which are ‘scattered about’

Cases are widely separated in space and time

Show little or no connection with each other
There is no recognizable source of infection

15. The probability of a test detecting a truly positive person from the population of diseased is the: (1 point)

⚫ a. Sensitivity of test
◯ b. Specificity of test

◯ c. Positive predictive value of the test

◯ d. Likelihood ratio

Explanation:

Ans. (a) Sensitivity of the test

[Ref. Park 21/e p128, Park 22/e p131]

Sensitivity of a screening test detects: true positives among all diseased

Specificity of a screening test detects: true negatives among all healthy
PPV detects: true positives among all those who are positive on a screening test
NPV detects: true negatives among all those who are negative on a screening test

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16. True about citrate in ORS is (1 point)

⚫ a. Increases shelf life

◯ b. Nutritious

◯ c. Cheaper

◯ d. Tastier

Explanation:

The Ans is (a) Increases shelf life

[Ref. Park 21/e p202, Park 22/e p203]

In WHO ORS, sodium bicarbonate has been replaced by trisodium citrate:

Makes the product more stable

Results in less stool output (especially in high-output diarrhoea like cholera) as it increases intestinal
absorption ofsodium and water

17. A convalescent case of cholera remains infective for (1 point)

◯ a. <7 days

◯ b. 7-14 days

⚫ c. 14-21 days
◯ d. 21-28 days

Explanation:

Ans. (c) 14-21 days

[Ref. Park 21/e p208, Park 22/e p209]

Type of carrier:

1. Preclinical(Incubatory)=1-5 days

2. Convalescent= 2-3 weeks

3. Contact(Healthy)= <10 days

4. Chronic= Up to 10 years

18. Most common cancer worldwide is (1 point)

⚫ a. Lung
◯ b. Oral
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◯ c. Stomach

◯ d. Breast

Explanation:

Ans. (a) Lung

[Ref. Park 21/e p353, Park 22/e p353]

19. Overweight BMI (1 point)

⚫ a. 25-29.99
◯ b. 15-18.5

◯ c. 18.5-24.99

◯ d. 30-34.99

Explanation:

Ans. (c) > 25

[Ref. Park 21/e p368, Park 22/e p369]

Normal BMI= 18.5-24.99

>30 BMI is obese

20. A herd immunity of over .......% is considered necessary to prevent epidemic spread of diptheria (1 point)

◯ a. 50%

◯ b. 60%

⚫ c. 70%
◯ d. 80%

Explanation:

Ans. (e) 70%

[Ref. Park 21/e p150, Park 22/e p152]

Forensic Medicine

21. Doctrine of res ipsa loquitor means (1 point)

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⚫ a. Fact speaks for itself

◯ b. Medical maloccurence

◯ c. Common knowledge doctrine

◯ d. Mandatory oral evidence

Explanation:

Answer is a. Fact speaks for itself

Ref: Gautam Biswas, Review of Forensic Medicine and Toxicology 3 e page no- 19

Generally, professional negligence of a doctor must be proved in the court by expert evidence of another
physician.
The patient need not prove negligence in case where the rule of res ipsa loquitur applies, which means ‘the
thing or fact speaks for itself.’
Applies to both civil and criminal negligence.
Error is so self-evident that the patient’s lawyer need not prove the doctor’s guilt with medical evidence.

22. Hostile witness is one who (1 point)

◯ a. Threatens the judge

◯ b. Threatens the prosecutor

◯ c. Refuses to answer

⚫ d. Willfully gives false evidence

Explanation:

Answer is d. Willfully give false evidence

Ref: Gautam Biswas, Review of Forensic Medicine and Toxicology, 3 e, pg-51

23. Two identical twins will not have same (1 point)

⚫ a. Fingerprints
◯ b. Iris color

◯ c. DNA

◯ d. Blood group

Explanation:

Answer is a. Fingerprints

Ref: Gautam Bishwas, Review of Forensic Medicine and Toxicology, 3 e, page -84

Fingerprints do not change throughout life, unless damage has occurred to the dermal skin layer.
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Temporary loss of fingerprints may be seen when there is swelling of the fingers, e.g. when stung by bee,
but returns when the swelling recedes.
Fingerprints can be erased permanently and deliberately by criminals to reduce their chance of conviction.
Erasure can be achieved in a variety of ways including burns, acids and plastic surgery.
Permanent impairment of fingerprint pattern also occurs in leprosy, electric injury and after exposure to
radiation (injury should involve 1–2 mm beneath the skin surface)

24. Last structure to be autopsied in asphyxial death is (1 point)

◯ a. Head

◯ b. Thorax

◯ c. Abdomen

⚫ d. Neck

Explanation:

Answer is d. Neck

First the cranial and thoracic cavity is opened in order to create a bloodless field for neck dissection

25. Algor mortis is (1 point)

◯ a. Cadaveric spasm

◯ b. Hypostasis

⚫ c. Cooling of body
◯ d. Rigor mortis

Explanation:

Answer is c. Cooling of body

26. Mee's line are characteristics of (1 point)

◯ a. Mercury poisoning

⚫ b. Arsenic poisoning
◯ c. Lead poisoning

◯ d. Copper poisoning

Explanation:

Answer is b. Arsenic poisoning

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Ref: Gautam Bishwas Review of Forensic Medicine and Toxicology, 3e, pg-92

Hyperkeratosis of the palms and soles with irregular thickening of the nails and development of white bands of
opacity in nails and finger and toes are called Aldrich- Mees lines.

Delayed putrefaction(due to anti-bacterial action of Arsenic), red velvety appearance of stomach (due to
submucosal and sub-peritoneal hemorrhage are postportem findings in Arsenic poisoning.

Chronic Arsenic poisoning is divided into four stages:

i. GIT disturbances

ii. Catarrhal changes

iii. Skin rashes

iv. Nervous disturbances.

Microbiology

27. Which of the following is immunogenic in typphoid (1 point)

◯ a. O antigen

⚫ b. H antigen
◯ c. Vi antigen

◯ d. Somatic antigen

Explanation:

Ans is b. H antigen

H antigen is found in the flagella and it is a heat labile proteib. This antigen is strongly immunogenic.

28. Primary receptor for HIV is (1 point)

◯ a. CD3

⚫ b. CD 4
◯ c. CD 8

◯ d. CD 56

Explanation:

Ans is b. CD 4

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The primary target of HIV virus are CD4+ T lymphocytes

29. EBV belongs to which group (1 point)

◯ a. RNA virus

⚫ b. Herpes virus
◯ c. Pox virus

◯ d. Retro virus

Explanation:

Ans is b. Herpes virus

Human herpes virus Common Name

1. Type I Herpes Simplex virus type I
2. Type II Herpes Simplex Virus type II
3. Type III Herpes zooster virus type
4. Type IV virus Epstein Barr Virus (EBV)
5. Type V Cytomegalovirus (CMV)
6. Type VI Human B cell lymphotropic virus
7. Type VII R.K. virus

30. The most common organism responsible for formation of pseudomembrane colitis is (1 point)

⚫ a. Clostridium difficile
◯ b. Clostridium perferinges

◯ c. Clostridium botulinum

◯ d. Clostridium tetani

Explanation:

Ans is a. Clostridium difficile

Pseudomembrane or antibiotic associated colitis is due to active multiplication of Clostridium difficile and the
production of an exotoxin as well as cytotoxin by it.

DOC for it is Vancomycin(Metronidazole is often tried as the first line drug).

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Pathology

31. MacCallum plaques are present in (1 point)

◯ a. Right atrium

◯ b. Right ventricle

⚫ c. Left atrium
◯ d. Left ventricle

Explanation:

Ans is c. Left atrium

Subendocardial lesion producing a map like thickening are found in left atrium in rheumatic fever. They are also
known as MacCallum's plaque

32. Russell bodies are found in (1 point)

◯ a. Parkinsonism

⚫ b. Multiple myeloma
◯ c. Gonadial tumor

◯ d. Intracranial neoplasm

Explanation:

Ans is b. Multiple myeloma

Ref: Robbins and Cotrans Pathological Basis of Disease 9 e, pg-599

Globular bodies if present inside nucleus is called Dutcher bodies and if cytoplasmic it is called Russel bodies.

Lewy bodies are found in Parkinson disease.

33. Marker for carcinoma colon is (1 point)

◯ a. HCG

◯ b. CA-125

⚫ c. CEA
◯ d. AFP

Explanation:

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Answer is c. CEA

1. Colon Cancer-CEA(Carcinoembryonic antigen)

2. Hepatic cancer- AFP (Alpha feto protein)

3. Ovarian Cancer- CA-125

4. Choriocarcinoma- HCG

34. Virchow's triad includes all except (1 point)

⚫ a. Venous thrombosis
◯ b. Venous stasis

◯ c. Blood hypercoagulability

◯ d. Injury to veins

Explanation:

Answer is a. Venous thrombosis

Ref: Robbins and Cotrans Pathological Basis of Disease, 9e, pg- 122

Virchow triad deals with primary abnormalities that lead to thrombosis

35. The most common site for bone marrow aspiration is (1 point)

◯ a. Anterior iliac crest

⚫ b. Posterior iliac crest

◯ c. Sternum

◯ d. Tibia

Explanation:

Answer is b. Posterior iliac crest

Bone marrow aspiration

Most common site is posterior iliac crest

Indications: Unexplained anemia, leukemia, lymphoma, splenomegaly, etc
Contraindications: hemophilia, DIC, Thrombocytopenia
Complications: Pain, discomfort, bleeding ath the site of the procedure

36. In non-smokers the most common type of carcinoma lung is (1 point)

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◯ a. Alveolar cell

◯ b. Squamous cell

⚫ c. Adenocarcinoma
◯ d. Small cell

Explanation:

Answer is c. Adenocarcinoma

The most common for of lung cancer arising in nonsmokers, in women, and in patients less than 45 years of age
is adenocarcinoma

37. Psammoma bodies may be seen in all of the following except (1 point)

◯ a. Papillary Carcinoma of thyroid

◯ b. meningioma

◯ c. Serous cystadenocarcinoma of ovary

⚫ d. Follicular carcinoma of thyroid

Explanation:

Ans is d. Follicular carcinoma of thyroid

Psammoma Bodies(Concentric calcification):

1. Papillary carcinoma of thyroid

2. Serous papillary cystadenocarcinoma of ovary

3. Meningioma

4. Renal Cell Carcinoma(RCC)

Pharmacology

38. Drug of choice for PSVT is (1 point)

⚫ a. Adenosine
◯ b. Epinephrine

◯ c. Propanolol

◯ d. Lignocaine

Explanation:
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Ans is a. adenosine

Management of PSVT(Paroxysmal Supraventricular tachycardia): Perform cardiac massage, IV adenosine(6 to

12 mg) or verapamil (2.5 to 10 mg)

39. All of the following act by inhibiting protein synthesis except (1 point)

⚫ a. Cephalosporin
◯ b. Chloramphenicol

◯ c. Erythromycin

◯ d. Aminoglycosides

Explanation:

Ans is a. Cephalosporin

1. Cell wall synthesis inhibitor: Penicillin, Cephalosporin, Vancomycin

2. Protein synthesis inhibitor:
On 50s: Chloramphenicol, Erythromycin
On 30 s: tetracycline, Aminoglycosides
3. Nucleic acid synthesis inhibition
Nucleotide synthesis: Sulfonamide
DNA synthesis: Ciprofloxacin
mRNA synthesis: Rifampicin
4. Cell membrane alteration: Amphotericin and Ketoconazole

40. All of the following drugs can be used in bronchial asthma except (1 point)

◯ a. Salbutamol

◯ b. Theophylline

◯ c. Sodium cromoglycate

⚫ d. Propanolol

Explanation:

Ans is d. Propanolol

Propanolol is a non-selective beta-blocker. Beta-2 blocking may exacerbate shortness of breath by causing
bronchoconstriction.

Contraindications of beta-blocker:

Asthma
COPD
DM
Heart block
Hyperkalemia

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41. Which of the following is the fastest route of drug administration ? (1 point)

◯ a. Topical

◯ b. Oral

◯ c. IM injection

⚫ d. inhalational

Explanation:

Ans is d. Inhalational

Fastest to slowest routes of drug administration:

Inhalational-->IV injection> Sublingual>IM injection> Subcutaneous> Oral > topical

Physiology

42. Ventilation perfusion ratio is (1 point)

◯ a. 0.4

⚫ b. 0.8
◯ c. 1.0

◯ d. 1.2

Explanation:

Ans is b. 0.8

Ventilation-perfusion ratio= Alveolar ventilation/ Cardiac output)

= (Tidal volume-Dead space) x Respiratory rate/cardiac output

= (500 ml -150ml)x12/5000 ml

= 0.8

43. Prothrombin time is (1 point)

◯ a. 2 sec

⚫ b. 12 sec
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◯ c. 22 sec

◯ d. 42 sec

Explanation:

Ans is b. 12 sec

Prothrombin time=12 seconds

Bleeding time=2-6 minutes
Clotting time= 6-10 minutes
ESR= 0-30

44. Christmas disease is (1 point)

◯ a. Factor VIII deificiency

⚫ b. Factor IX deficiency
◯ c. Factor X deficiency

◯ d. Factor XII deficiency

Explanation:

Hemophilia A is the deficiency of Factor VIII while Hemophilia B, also known as Christmas disease is
due to factor IX deficiency
In hemophilia, bleeding time and prothrombin time are normal but coagulation time is prolonged

45. Fastest conduction in heart occurs in (1 point)

◯ a. SA node

◯ b. AV node

⚫ c. Purkinje fibres
◯ d. Bundle of His

Explanation:

Ans is c. Purkinje fibres

Tissue Conduction speed(m/s)

1. SA Node 0.05
2. Atrial pathways 1
3. Av node 0.05
4. Bundle of His 1
5.Purkinje fibers 4

46. In the testes, the cells that secrete testosterone are (1 point)
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◯ a. Sperm cells

◯ b. Sertoli cells

⚫ c. Leydig cells
◯ d. Germinal epithelium

Explanation:

Ans is c. Leydig cells

In male, LH stimulates Leydig cells to form testosterone. FSH stimulates Sertoli cells to form sperm
cells and release inhibin
In female, LH stimulates theca cells to form androgens. FSH stimulates granulosa cells to convert
androgens to estrogen via aromatase enzyme

Anesthesia

47. Shortest acting local anesthetic agent is (1 point)

⚫ a. Procaine
◯ b. tetracaine

◯ c. Lidocaine

◯ d. Bupivacaine

Explanation:

Ans is a. Procaine

Duration of action of various anesthetic agents in descending order are:

Dibucaine>Tetracaine>bupivacaine>Lidocaine>Procaine

Safest LA agent: Prilocaine(Methemoglobinemia may be seen sometimes)

Longest acting LA: Dibucaine
Shortest acting LA: Chlorprocaine
Best LA for regional block: Bupivacaine

48. Which of the following is used for the treatment of postoperative shivering? (1 point)

◯ a. Atropine

⚫ b. Pethidine
◯ c. Thipentone

◯ d. None of the above

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Explanation:

Ans is b. Pethidine

Shivering occurs as a protective mechanismas inhalational agents, spinal/epidural blocks cause

vasodilationleading to heat loss.
Shivering can be abolished by inhibition of hypothalamus
Most commonly shivering is seen with halothane.
treatment of postoperative shivering involves the use of tramadol(DOC), pethidine or pentazocine and
oxygen inhalation.

49. Spinal headache usually occurs on (1 point)

⚫ a. 1st post operative day

◯ b. 2nd post operative day

◯ c. 3rd post-operative day

◯ d. 4th postoperative day

Explanation:

Ans is a. 1st postoperative day

Post-spinal headache starts in first 3 days and last for 1-2 weeks

It is due to seepage of CSF and can be minimized by use of smaller bore needle

50. The site for external cardiac massage is (1 point)

◯ a. Xiphoid process

⚫ b. Lower third of sternum

◯ c. Junction of body and manubrium sterni

◯ d. 2 fingers left to xiphoid process

Explanation:

Ans is b. Lower third of sternum

External chest compression

Position of compression: lower third of the sternum

Force of compression: Depth at least 5 cm
Rate of chest compression: 100-120/ minute
Compression: ventilation ratio- 30:2
Change compression every 2 minute

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51. Color of cylinder of oxygen is (1 point)

◯ a. Blue

◯ b. orange

◯ c. Purple

⚫ d. Black and white

Explanation:

Ans is d. Black and white

Gas Oxygen N2O CO2 Cyclopropane Entonox Air

Blue body and
White shoulder grey body and
Cylinder color Blue grey orange white abd blue
and black body white shoulder
shoulder

52. Agent causing malignant hyperthermia is (1 point)

⚫ a. Succinylcholine
◯ b. Ketamine

◯ c. Gallamine

◯ d. Dantrolene

Explanation:

Ans is a. Succinylcholine

Malignant hyperthermia is an autosomal dominant genetic disorder of skeletal muscle that occurs in
susceptible individuals.
It is precipitated by drug administration, particularly; succinylcholine, halothane.
The drug of choice for treatment of malignant hyperthermia is Dantrolene.

53. Which anesthetic agent has the least cardiovascular side effects (1 point)

⚫ a. Isoflurane
◯ b. Enflurane

◯ c. Ketamine

◯ d. Halothane

Explanation:

Ans is a. Isoflurane

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Isoflurane has the advantage of providing stability to cardiac rhythm and the lack of sensitization of heart
to exogenous or endogenous adrenaline. It causes the least alteration of cardiovascular status.
Isoflurane may cause coronary steal phenomenon, it is a powerful coronary dilator.
It is preferred agent for neurosurgical anesthesia as in low concentration it doesnot cause any increase in
cerebral blood flow.
It is used in day care surgery(DOC)

54. Shortest acting non-depolarizing skeletal muscle relaxant is (1 point)

◯ a. Succinylcholine

⚫ b. Mivacurium
◯ c. Atracuriun

◯ d. Vecuronium

Explanation:

Ans is b. mivacurium

Shortest acting depolarizing agent is succinylcholine.

Shortest acting non-depolarizing agent is Mivacurium

Dental

55. Dental plaque is formed by (1 point)

◯ a. E. coli

⚫ b. Streptococcus mutans
◯ c. S. aureus

◯ d. HSV

Explanation:

Ans is b. Streptococcus mutans

Dental caries: Deficiency of flourine(Streptococcus mutans)

Dental flourosis: Excess of flourine
Dental plaque: Acid forming bacteria(Streptococcus mutans) develops rapidly during sleep
Oral thrush(Oral candidiasis): Candida albicans

56. The nerve that may get injured during removal of third molar is (1 point)

◯ a. Facial nerve

◯ b. vagus nerve

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◯ c. Hypoglossal nerve

⚫ d. Lingual nerve

Explanation:

Ans is d. Lingual nerve

The surgical removal of an impacted third molar may result in damage to the inferior alveolar nerve and lingual
nerve

Dermatology

57. Primary skin lesion are all of the following except (1 point)

◯ a. Macule

◯ b. Plaque

◯ c. Papule

⚫ d. Crust

Explanation:

Ans is d. Crust

1. Primary Lesion: macule, papule, nodule, plaque, vesicle, bulla, pustule, abscess, wheal, papilloma,
petechiae, purpura, hematoma, burrow, telengiectasia, cyst
2. Secondary Lesion: Scale, Ulcer, Crust, Scar, Atrophy, Erosion, Excoriation, fissure, sinus, lichenification

58. Koebner phenomenon is positive in (1 point)

◯ a. Psoriasis

◯ b. Lichen planus

◯ c. Warts

⚫ d. All of the above

Explanation:

Ans is d. All of the above

The phenomenon by which lesions appear in areas of injury is called Koebner phenomenon. It occurs in
psoriasis, lichen planus, vitiligo, warts, erythrema multiforme, verruca plana.

59. Drug of choice in pregnant woman in 2nd trimester with pustular psoriasis is (1 point)

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⚫ a. Prednisolone
◯ b. Methotrexate

◯ c. Dapsone

◯ d. Acitretin

Explanation:

Ans is a. Prednisolone

Treatment of choice in Psoriasis(DOC):

1. Normally: PUVA(DOC)
2. Psoriatic arthroplasty: methotrexate(DOC)
3. AIDS, pustular psoriasis , psoriatic erythroderma: Retinoids(DOC)

Pustular psoriasis in pregnancy is called Impetigo herpetiformis. In pregnancy, safest drug for treatment of
pustular psoriasis is prednisolone.

ENT

60. In children most common sinusitis is (1 point)

◯ a. Frontal

◯ b. Maxillary

⚫ c. Ethmoidal
◯ d. Sphenoid

Explanation:

Ans is c. Ethmoidal

Acute ethmoidal sinusitis is seen in children when infection has spread through the lamina papyracea. Acute
maxillary sinusitis is very uncommon in children and acute frontal sinusitis is seen only in older children

61. Most common cause of acute epiglottitis (1 point)

◯ a. Streptococcus

◯ b. Staphylococcus

⚫ c. H. influenzae
◯ d. Pneumococcus

Explanation:

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Ans is c. H. influenzae

a. Acute otitis media(AOM): Streptococcus pneumoniae

b. Acute tonsillitis : Hemolytic streptococcus

c. sinusitis: Streptococcus pneumoniae

d. Otitis externa: Pseudomonas aeuroginosa

62. Schwartz sign is seen in (1 point)

⚫ a. Otosclerosis
◯ b. meneire's disease

◯ c. Cholesteatoma

◯ d. None of the above

Explanation:

Ans is a. Otosclerosis

Schwartz's sign: A reddish-blue discoloration behind the tympanic membrane, seen in otosclerosis

63. Stridor in an infant is most commonly due to (1 point)

◯ a. Acute epiglottitis

◯ b. Diptheria

⚫ c. Laryngomalacia
◯ d. Foreign body aspiration

Explanation:

Ans is c. laryngomalacia

Laryngomalacia is the most common cause of inspiratory stridor in the neonatal period and early infancy.
Stridor may be exacerbated by crying and feeding.
Placing the patient in a prone position with the head up improves the stridor; supine postition worsens the
stridor.

64. Common site of CSF rhinorrhea is (1 point)

◯ a. Frontal sinus

◯ b. Ethmoidal sinus

⚫ c. Cribiform plate

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◯ d. Petrous

Explanation:

Ans is c. Cribiform plate

CSF rhinorrhoea can follow a head injury, CSF from anterior cranial fossa reaches the nose by way of
cribiform plate, wthmoid air cells or frontal sinus.
CSF from middle cranial fossa reaches the nose via sphenoid sinuses. Sometimes, injuries of the temporal
bone result in leakage of CSF into the middle ear and thence via the Eustachian tube into the
nose(Otorhinorrhoea).

65. Tullio phenomenon refers to (1 point)

⚫ a. Vertigo on hearing high frequency sounds

◯ b. Impedance matching

◯ c. Increased sensitivity to hearing

◯ d. Better hearing in noisy surrounding

Explanation:

Tullio phenomenon consists of dizziness induced by sound. It occurs mainly in 4 ear conditions: a.
meneire's syndrome(most common cause), perilymph fistula, vetibulofibrosis and fenestration.
Tullio phenomenon often is accompanied by hearing loss, tinnitus and pressure sensitivity.

MEDICINE

66. Streptokinase and urokinase are contraindicated in: (1 point)

⚫ a. Intracranial malignancy
◯ b. Pulmonary embolism

◯ c. AV fistula

◯ d. Thrombophlebitis

Explanation:

Answer is a. Intracranial malignancy

Ref: Braunwald's 8th/1237

Malignant intracranial neoplasm is the absolute contraindication for thrombolysis.

Contraindications for fibrinolytic use in STEMI

Absolute contraindications Relative contraindications

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Prior intracranial hemorrhage History of chronic poorly controlled hypertension

Uncontrolled hypertension in presentation (>185/110
Known structural vascular disease
mm of Hg)
Known intracranial malignancy History of prior ischemic strokes > 3 months
Ischemic stroke within three months Recent internal bleeding (2-4 weeks)
Recent traumatic or prolonged CPR(>10 min) of major
Suspected aortic dissection
surgery (<3 weeks)
Active bleeding diasthesis Pregnancy

67. An elderly patient presents with prolonged history of weakness and lethargy. On examination he (1 point)
is found to be anemic and occult blood test positive. Which of the following is the next
investigation of choice?

◯ a. Barium meal

⚫ b. Colonoscopy
◯ c. Barium enema

◯ d. CT abdomen

Explanation:

Answer is b. Colonoscopy

Ref: Primary care medicine by Goroll and Mulley 6th/522

Colonoscopy is the investigations of choice in elderly patients presenting with occult fecal blood and anemia to
evaluate the possibility of colorectal cancer.

68. A truck driver presented with history of fever since four weeks and dry cough. He also gives (1 point)
history of weight loss of about 10 kg. X ray shows bilateral reticulonodular infiltrates. The most
likely diagnosis is:

◯ a. COPD

⚫ b. Pneumocystis carini pneumonia

◯ c. Pneumococcal pneumonia

◯ d. Interstitial Lung disease

Explanation:

Answer is b. Pneumocystis carinii pneumonia

Ref: Harissons's 19th/1358

Presence of prolonged fever, weight loss and bilateral reticulonodilar infiltrates in a person at increased risk of
HIV suggest diagnosis of atypical pneumonia due to Pneumocystis carinii infection.

69. ATT used in patient of renal disease is (1 point)

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◯ a. Pyrazinamide

◯ b. Isoniazid

⚫ c. Rifampicin
◯ d. Ethambutol

Explanation:

Answer is c. Rifampicin

Rifampicin is safe in renal disease

Streptomycin and ehtambutol is safe in liver disease

70. Specific enzyme elevated in alcoholism is (1 point)

⚫ a. Gamma Glutamyl transferase (GGT)

◯ b. Alkaline phosphate

◯ c. AST

◯ d. ALT

Explanation:

Answer is a. Gamma Glutamyl transferase

Laboratory tests in alcoholics:

MCV 91 fl or higher
GGT 30 or more units
Serum uric acid more than 7 mg/dl
Carbohydate-deficient transferrin 20 g/l or more
Triacylglycerides 180 mg/dl or more

71. Hepatomegaly with liver pulsation indicates (1 point)

⚫ a. Tricuspid regurgitation
◯ b. Mitral regurgitation

◯ c. Pulmonary hypertension

◯ d. Mitral stenosis

Explanation:

Answer is a. Tricuspid regurgitation

Ref: Harrisons 19th/1547

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Systolic pulsations of liver and marked hepatomegaly are the characteristics feature of Tricuspid regurgitation.
They are caused by the reversed systolic blood flow in great veins.

72. If a patient of severe hyperglycemia is given iv insulin which of the following can occur? (1 point)

⚫ a. Hypokalemia
◯ b. Hyperkalemia

◯ c. Hyponatremia

◯ Hypernatremia

Explanation:

Asnwer is a. Hypokalemia

Ref: Ganong 22nd/338

Insulin causes potassium to enter cells with a resultant lowering of extracellular potassium concentration.

73. Deposition of Anti ds DNA Ab in kidney, skin, choroid plexus and joints is seen in (1 point)

⚫ a. SLE
◯ b. Good pasture syndrome

◯ c. Sclerodeerma

◯ d. Raynauds syndrome

Explanation:

Answer is a. SLE

Ref: Antibodies against double stranded DMA (Anti ds DNA) and Sm antigen (Anti Sm) are highly specific and
virtually diagnostic of SLE.

74. Best marker for drug induced lupus is (1 point)

⚫ a. Anti histone antibodies

◯ b. Anti ds DNA

◯ c. ANA

◯ d. Anti smith Ab

Explanation:

Answer is a. Anti histone antibodies

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Ref: Robbin's 7/229

The best marker for Drug induced Lupus are antihistone antibodies.

Drug induced lupus is associated with:

Procainamide
Hydralazine
Propylthiouracil
Isnoniazid
Carbamazepine
Phenytoin
Hydrochlorothiazide
Interferon and TNF inhibitors
Lovastatin and Simvastatin

75. Hirsutism is caused by all expect (1 point)

◯ a. Cushing's syndrome

⚫ b. Hyperthyroidism
◯ c. Hyperprolactinoma

◯ d. Acromegaly

Explanation:

Answer is b. Hyperthyroidism

Ref: Harrisons 19th/331

Hyperthyroidism is not associated with hirsutism.

Causes of hirsutism:

Gonadal hyperandrogenism: PCOD, Ovarian neoplasms, Ovarian steroidgenic blocks, Syndrome of

excessive insulin resistance
Adrenal hyperandrogenism: Premature adrenarche, CAH, Adrenal neoplasms
Other endocrine disorders: Cushing syndrome, Acromegaly, Hyperprolactinoma
Drugs: Androgens, Minoxidil, OCP containing androgenic progestins, Phenytoin, cyclosporins

76. In drug addicts endocarditis is common due to: (1 point)

◯ a. Pseudomonas

⚫ b. S. aureus
◯ c. S. viridans

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◯ d. Group D Streptococcus

Explanation:

Answer is b. S aureus

Etiological agents of various types of endocarditis:

Native valve endocarditis Viridans streptococci

IV drug users S. aureus
Prosthetic valves (early onset) Staphylococcus epidrmitis
Prosthetic valves (late onset) Streptococci
Acute endocarditis S aureus
Subacute endocarditis Viridans streptococci

77. Neurocysticercosis is diagnosed by (1 point)

◯ a. Pneumoencephalography

◯ b. EEG

◯ c. Angiography

⚫ d. CT scan

Explanation:

Answer is d. CT scan

Neuroimaging by using a CT scan or MRI is the only diagnostic modality which can satisfactorily demonstrate a
cyst of neurocysticercosis.

78. Hemoptysis is seen in: (1 point)

◯ a. Aortic stenosis

◯ b. Pulmonary stenosis

⚫ c. Mitral stenosis
◯ d. Tricuspid stenosis

Explanation:

Answer is c. Mitral stenosis

In mitral stenosis hemoptysis is due to rupture of pulmonary-bronchial venous connections that is secondary to
pulmonary venous hypertesion.

OBSTETRICS and GYANECOLOGY

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79. Long term tamoxifen therapy may cause (1 point)

⚫ a. Endometrium Ca
◯ b. Ovary Ca

◯ c. Cervix Ca

◯ d. Vagina Ca

Explanation:

Answer is a. Endometrial Ca

Tamoxifen is known to cause hyperplasia and endometrial cancer. Women taking tamoxifen for treatment or
prevention of breast cancer are at the increased risk.

80. Increased nuchal translucency in 14 weeks gestation is seen in: (1 point)

◯ a. Turner's syndrome

⚫ b. Down's syndrome
◯ c. Hydrocephalus

◯ d. Skeletal dysplasia

Explanation:

Answer is b. Down's syndrome

Ref: Ultrasound of Obstetrics and Gynaecology by Merz and Bohimann

Causes of increased nuchal translucency:

Down's syndrome(Trisomy 21)- most common

Trisomy 13
Trisomy 18
Turner's syndrome
Klinefelter's syndrome

81. Which of the following is most commonly associated with carcinoma cervix? (1 point)

⚫ a. HPV 16
◯ b. HPV 6

◯ c. HPV 33

◯ d. HPV 35

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Explanation:

Answer is a. HPV 16

Ref: Williams Gyanecology

Overall HPV 16 is the most common cause of carcinoma cervix followed by HPV 18.

82. Which of the following conditions is associated with polyhydramnios? (1 point)

◯ a. Posterior urethral valve

⚫ b. Cleft palate
◯ c. Congenital diaphragmatic hernia

◯ d. Bladder extrophy

Explanation:

Answer is b. Cleft palate

Ref: Dutta's textbook of obstertics and gynaecology

Facial clefts like cleft palate ad cleft lip are associated with polyhydramnios due to impaired absorption of
amniotic fluid as a result of impaired swallowing.

Other options above mentioned are associated with oligohydramnios.

83. Which of the following drugs is not useful in the management of the post partum hemorrhage? (1 point)

⚫ a. Mifepristone
◯ b. Misoprostol

◯ c. Oxytocin

◯ d. Ergotamine

Explanation:

Answer is a Mifepristone

Ref: Dutta 6th/411

Oxytocin, ergotamine and misoprostol are all the uterine stimulants that can be used in controlling PPH.
Mifepristone is an antiprogestins and is not included in the list of uterine stimulants and has no role in
controlling the PPH.

84. Salpingitis/Endosalpingitis is best confirmed by (1 point)

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⚫ a. Hysteroscopy + Laparoscopy
◯ b. X ray

◯ c. Hysterosalpingography

◯ d. Sonosalpingography

Explanation:

Answer is a. Hysteroscopy + Laparoscopy

Ref: Shaw's 14th/405

The diagnosis of salpingitis is best confirmed by Laparoscopy. Hysteroscopy may also provide confirmatory
evidence of salpingitis. Hence, Hysteroscopy + Laparoscopy is the best choice.

85. The most common complication of ovarian tumor is (1 point)

⚫ a. Torsion
◯ b. Hemorrhage

◯ c. Infection

◯ d. Hyaline change

Explanation:

Answer is a. Torsion

Torsion of the ovarian cyst is the most common complication. Other complications are rupture and hemorrhage,
infection, infarction, pseudomyxoma.

86. The most common lie is: (1 point)

◯ a. Transverse

⚫ b. Longitudinal
◯ c. Oblique

◯ d. All of the above

Explanation:

Answer is b. Longitudinal

The most common lie is longitudinal.

The most common presentation is Vertex (Cephalic).
The most common type of breech presentation is Frank breech.
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87. Maximum cardiac output during pregnancy is seen in: (1 point)

◯ a. 1st trimester

◯ b. 2nd trimester

◯ c. Labour

⚫ d. Immediate postpartum period

Explanation:

Answer is d. Immediate postpartum period.

Maximum cardiac output is seen in the immediate post partum period when cardiac output increases to about
70% more than prelabour values.

88. Best mode of contraception for a newly married lady with rheumatic heart disease: (1 point)

⚫ a. Condom
◯ b. Oral pills

◯ c. Norplant

◯ d. IUCD

Explanation:

Answer is a. Condom

Barrier method of contraceptive is best for patients with heart disease.

Best contraceptive for diabetic female is Condom by husband.
Contraceptive of choice in newly wed female is OCPs

89. Ovulation occurs: (1 point)

⚫ a. 14 days before next menstruation

◯ b. 14 days after menstruation

◯ c. 16 days before next menstruation

◯ d. Within 16 hrs of LH surge

Explanation:

Answer is a. 14 days before next menstruation.

There are two phases of ovarian cycle: follicular and luteal phases. In most of the women, luteal phase is
constant with 14 days before menstruation while follicular phase may vary.

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90. Induction of. labor by amniotomy can lead to the following complications: (1 point)

◯ a Cord prolapse

◯ b. Infection

◯ c. Abruptio placenta

⚫ d. Both a & b

Explanation:

Answer is d. Both a & b.

Artificial rupture of membrane is a way of surgical induction of labour. The hazards are:

Once the procedure is adopted there is no scope of retreating from the decision of termination.
Umbilical cord prolapse, Amnionitis, liquor amni embolism, accidental injury to the placenta, cervix or
uterus, fetal parts or vasa- praevia.

Contraindications of amniotomy:

Intrauterine fetal death

Maternal AIDS
Genital active herpes infection.

Indications of amniotomy:

Abruptio placenta
Chronic hydramnios
Severe pre- eclampsia
Eclampsia
In combination with medical induction
To place scalp electrode for electronic fetal monitoring.

OPHTHALMOLOGY

91. Tonography helps you to determine: (1 point)

◯ a. The field changes

◯ b. The rate of formation of aqueous

⚫ c. The facility of outflow of aqueous

◯ d. None of the above

Explanation:

Answer is c. The facility of outflow of aqueous

Tonography is a noninvasive technique for determining the facility of aqueous outfow.

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Measurement of intraocular pressure by an instrument called tonometer is called tonometry.

92. Commonest causes of blindness in Nepal is: (1 point)

◯ a. Vitamin A deficiency

◯ b. Trachoma

⚫ c. Cataract
◯ d. Glaucoma

Explanation:

Answer is c. Cataract

Commonest cause of blindness in Nepal: Cataract

Commonest cause of childhood blindness: Vitamin A deficiency
Commonest cause of preventable blindness: Trachoma

93. Sunflower type cataract is characteristically seen in: (1 point)

◯ a. Diabetes

◯ b. Chalcosis

⚫ c. Congenital syphilis
◯ d. None of tire above

Explanation:

Answer is b. Chalcosis

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94. Homer’s syndrome is characterized by: (1 point)

◯ a. Ptosis

◯ b. Miosis

◯ c. Enopthalmos

⚫ d. All of the above

Explanation:

Answer is d. All of the above

Horner’s syndrome is the loss or lesion of cervical sympathetic ganglion. It is characterized by ptosis, miosis,
anhydrosis and enophthalmos.

95. A patient of reactive arthritis develops conjunctivitis and urethritis. The most likely diagnosis is: (1 point)

◯ a. Homer’s syndrome

◯ b. Marfan’s syndrome

⚫ c. Reiter’s syndrome
◯ d. None of the above

Explanation:

Answer is c. Reiter's syndrome

Reiter’s syndrome: Triad of urethritis, arthritis and conjunctivitis.

96. In acute anterior uveitis the ding of choice for increased intraocular tension is: (1 point)

⚫ a. 1% atropine ointment
◯ b. 2% Pilocarpine

◯ c. 5% epinephrine

◯ d. Timolol

Explanation:

Answer is a. 1% atropine ointment

In anterior uveitis dilatation of pupil with atropine, hot application and control of acute phase of inflammation
with corticosteroids form the comer stone of therapy.

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ORTHOPEDICS

97. The basic unit of bone is: (1 point)

⚫ a. Osteon
◯ b. Osteoblast

◯ c. Osteoclast

◯ d. Osteocyte

Explanation:

Answer is a. Osteon

Osteon is the basic structural microscopic unit of compact bone and it consists of a haversian canal and the
surrounding lamellae.

98. Total claw hand is seen in the paralysis of: (1 point)

◯ a. Ulnar nerve

◯ b. Median nerve

⚫ c. Both a & b
◯ d. Radial nerve

Explanation:

The ans is c. both a & b

99. Cock-up splint is used in injury of which of the following nerves: (1 point)

◯ a. Ulnar

◯ b. Median

◯ c. Musculocutaneous

⚫ d. Radial

Explanation:

Answer is d. Radial

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100. Which of the following is a "fracture of necessitance"? (1 point)

◯ a. Clavicle #

⚫ b. Lateral condyle # of humerus

◯ c. Both bone # upper limb

◯ d. Both bone # lower limb

Explanation:

Answer is b. Lateral condyle # of humerus

Because lateral condyle fracture almost always needs ORIF it is called facture of necessitance.

101. Carrying angle is for: (1 point)

⚫ a. Elbow
◯ b. Femoral neck

◯ c. # of calcaneum

◯ d. None of the above

Explanation:

Answer is a. Elbow

102. Commonest type of dislocation of the hip is: (1 point)

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◯ a. Anterior

⚫ b. Posterior
◯ c. Dislocation with # of shaft

◯ d. Central

Explanation:

Answer is b. Posterior

PEDIATRICS

103. The content of sodium in ORS solution is mEq/1. (1 point)

◯ a. 30

◯ b. 60

⚫ c. 90
◯ d. 120

Explanation:

Answer is c. 90

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104. Which of the following represents the additional component in pentology of Fallot: (1 point)

◯ a. VSD

◯ b. RVH

◯ c. Pulmonary stenosis

⚫ d. ASD

Explanation:

Answer is d. ASD

Atrial Septal Defect (ASD) or a patent foramen ovale represents the additional (5th component) in Pentalogy of
Fallot.

105. Commonest type of seizure in newborn is: (1 point)

◯ a. Tonic

◯ b. Clonic

◯ c. Myoclonic

⚫ d. Subtle

Explanation:

Answer is d. Subtle

Subtle seizures are the most common sub-type, comprising about half of all seizures in term amd premature
newborns.

106. Neonatal Hypoglycemia is defined as the blood sugar level below: (1 point)

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◯ a. 20 mg/dl

◯ b. 30 mg/dl

⚫ c. 40 mg/dl
◯ d. 50 mg/dl

Explanation:

Answer is c. 40 mg/dl

Neonatal hypoglycemia is defined as blood glucose <40mg/dl irrespective of gestational age.

107. Posterior fontanelle is closes by____weeks: (1 point)

◯ a. 4

⚫ b. 6
◯ c. 10

◯ d. 16

Explanation:

Answer is b. 6

Anterior fontanel: Size 1.5-2 cm at birth, Closure time 18-24 months

Posterior fontanel: Size 0-0.5 cm at birth, Closure time 6-8 weeks.

108. Most common tumor in children is: (1 point)

◯ a. Neuroblastoma

⚫ b. Leukemia
◯ c. Wilm’s tumor

◯ d. Lymphoma

Explanation:

Answer is b. Leukemia

Leukemia is the most common malignant neoplasm in childhood. ALL is the most common childhood leukemia
accounting for 71% of cases of childhood leukemia.

109. A child has microcephaly, blue eyes, fair skin and mental retardation, Ferric chloride test is (1 point)
positive. What is the likely diagnosis?

a. Phenylketonuria
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⚫
◯ b. Alkaptonuria

◯ c. Homocystinuria

◯ d. Tyrosinosis

Explanation:

Answer is a. Phenylketonuria

Phenylketonuria (PKU)

Definition: Phenylketonuria (PKU) is an autosomal recessive genetic disorder characterized by a deficiency in

the enzyme phenylalanine hydroxylase (PAH). This enzyme is necessary to metabolize the amino acid
phenylalanine to the amino acid tyrosine.

Clinical manifestation: Fair skin, fair hair, blue eyes, mental retardation, microcephaly, etc.

Diagnosis: A positive Ferric chloride test (Guthria test) also indicates the diagnosis of phenylketonuria.

Treatment: The goal of treatment is to keep plasma phenylalanine levels within the normal range through diet.
A carefully maintained dietaTy regimen ~can prevent mental retardation and other complications.

110. The earliest indicator of response after starting iron in a 6-year-old girl with iron deficiency is: (1 point)

⚫ a. Rise in reticulocyte count

◯ b. Rise in Hb

◯ c. Rise in ferritin

◯ d. Rise in serum iron

Explanation:

Answer is a. Rise in reticulocyte count

Reticulocyte count is the first to rise. This is followed by elevation of haemoglobin levels. Body iron stores are
restored after correction of haemoglobin levels.

111. The most common cause of urinary obstruction in a male infant is: (1 point)

◯ a. Stone

◯ b. Stricture

◯ c. Anterior urethral valves

⚫ d. Posterior urethral valves

Explanation:

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Answer is d. Posterior urethral valve

Posterior urethral valve is a very common cause of obstructive uropathy in a male infant.

112. Phacomelia is: (1 point)

◯ a. Absence of brain

◯ b. Reduplication of bones

◯ c. Absence of heart

⚫ d. Absence of long bones

Explanation:

Answer is d. Absence of long bones

Phacomelia: It is a term applied to a marked reduction in the size of limbs. The distal part of the limbs are placed
very near the trunk (absent long bones). It is seen in fetuses of mothers who received thalidomide during
pregnancy.

113. Which of the following is the first permanent teeth to appear in the child? (1 point)

⚫ a. First molar
◯ b. First premolar

◯ c. Lateral incisor

◯ d.Canine

Explanation:

Answer is a. First molar

The first permanent teeth to appear is first maxillary molar at 6-7 years of age.

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PSYCHIATRY

114. Wemicke-Korsakoff syndrome is due to the deficiency of: (1 point)

⚫ a. Vitamin B1
◯ b. Vitamin B2

◯ c. Vitamin B6

◯ d. Vitamin B12

Explanation:

Answer is a. B1

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Vitamin B1 (Thiamine) deficiency may involve the cardiovascular (wet beriberi) or nervous systems (dry
beriberi and the Wernicke-Korsakoff syndrome).

115. Delusion is a disorder of: (1 point)

⚫ a. Thought
◯ b. Insight

◯ c. Perception

◯ d. Cognition

Explanation:

Answer is a. Thought

Delusion, OCD, Phobia & Schizophrenia are disorders with disturbed content of thought.
Hallucination & illusion are disorders of perception.
Delirium & Dementia are disorders of cognition and insight is disturbed in psychosis.

RADIOLOGY

116. Radiological finding of Ewing’s sarcoma is: (1 point)

◯ a. Sunray appearance

◯ b. Soap bubble appearance

⚫ c. Onion-skin appearance
◯ d. None of the above

Explanation:

Answer is c. Onion skin appearance

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117. In which of the following a ‘Coeur en Sabot’ shape of the heart is seen: (1 point)

◯ a. VSD

◯ b. PDA

◯ c. ASD

⚫ d. TOF

Explanation:

Answer is d. TOF

Coeur en Sabot’ refers to the radiological appearance of heart in a patient with Tetralogy of Fallot (TOF). The
cardiac silhouette resembles that of a ‘boot’ or wooden shoe in ‘Coeur en Sabot’ (Boot shaped heart).

118. Spalding sign is seen in: (1 point)

◯ a. Starvation

⚫ b. Maceration
◯ c. Drowning

◯ d. Mummification

Explanation:

Answer is b. Maceration

Spalding sign: It is a radiological sign produced by partly overriding skull bones. It may be consequent to
intrauterine maceration of fetus and its presence is a sign of death of fetus in utero.

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SURGERY

119. One unit of fresh blood raises the HB% concentration by: (1 point)

⚫ a. 1 gm %
◯ b. 2 gm%

◯ c. 2.5 gm%

◯ d. 3 gm%

Explanation:

Answer is a. 1 gm%

Red blood cells (packed RBCs) are transfused to increase oxygen carrying capacity in patients who are bleeding
or extremely anemic.

One unit of blood increases the hemoglobin (HB) by 1 g/dl and the hematocrit by 2 to 3 percent.

120. Which is the best method for diagnosing acute appendicitis: (1 point)

◯ a. History

⚫ b. Physical examination
◯ c. X-ray abdomen

◯ d. Barium meal

Explanation:

Answer is b. Physical examination

The diagnosis of appendicitis rests more on through clinical examination of the abdomen than on any aspect of
the history and laboratory investigation.

121. A 65 year old male patient presented with history of chest pain and was diagnosed to have (1 point)
coronary artery disease. During routine evaluation, an ultrasound of the abdomen showed
presence of gallbladder stones. There was no past history of biliary colic or jaundice. What is the
best treatment advice for such a patient for his gallbladder stones:

◯ a. Laparoscopic cholecystectomy

◯ b. Open cholecystectomy

⚫ c. ERCP and removal of gallbladder stones

◯ d. No surgery of gallbladder stones

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Explanation:

Answer is d. No surgery of gall bladder stone

Tire patient in question is a 65 years old male, with no evidence of symptomatic disease or prior history of
complication. Gall stones were accidentally detected on a routine ultrasound examination of the abdomen. No
active intervention is indicated in such a patient for management of gall stones.

122. A lady presents with three day history of epigastric pain radiating to back. Serum amylase lavels (1 point)
were observed to be normal while USG abdomen reveals gall bladder stones and an enlarged
pancreas. CT scan was done which clinched the diagnosis. Which of the following is the most
likely diagnosis:

⚫ a. Acute pancreatitis
◯ b. Acute cholecystitis

◯ c. Acute appendicitis

◯ d. Acute peritonitis

Explanation:

Answer is a. Acute pancreatitis

History of epigastric pain radiating to back along with an • enlarged (edematous) pancreas on
Ultrasonography suggests a diagnosis of acute pancreatitis. Seram amylase levels may be normal during
an attack of acute pancreatitis.
Presence of gall stones in the gall bladder documents cholelithiasis, but does not indicate acute
cholecystitis. Contrast enhanced CT scan is the single most important imaging test in diagnosing acute
pancreatitis, determining its severity and assessing for complications.

123. The commonest site of obstruction in Gall stone ileus is: (1 point)

◯ a. Proximal ileum

◯ b. Distal ileum

⚫ c. Ileocecal junction
◯ d. Transverse colon

Explanation:

Answer is c. Ileocecal junction

‘Gall stone ileus’ refers to mechanical intestinal obstruction resulting from passage of a large gallstone into the
bowel lumen.

The most common site of obstruction by impacted gallstone is the ileocecal valve provided that the more
proximal bowel is of normal caliber. (Note: Ileocecal junction is the narrowest part in the intestine).
The stone most commonly enters the duodenum through a cholecysto-enteric fistula.

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124. A hernia in which only a portion of the wall of the intestine is incarcerated is called: (1 point)

◯ a. Spigelian hernia

◯ b. Sliding hernia

◯ c. Littre’s heniia

⚫ d. Ritcher’s hernia

Explanation:

Answer is d. Ritcher's hernia

Ritcher’s hernia: Hernia involving loop of a bowel (usually small intestine).

125. Curling’s ulcer is a complication of: (1 point)

◯ a. Head injury

⚫ b. Severe burns
◯ c. Old scar of burns

◯ d. Analgesic over dosage

Explanation:

Answer is b. Severe burns

Curling’s ulcer: Acute gastric ulcer associated with severe burns.

Cushing’s ulcer: Acute gastric ulcer associated with CNS trauma.

126. Graft from sister to brother is: (1 point)

⚫ a. Allograft
◯ b. Isograft

◯ c. Xenograft

◯ d. Autograft

Explanation:

Answer is a. Allograft

A graft is tissue separated from its donor bed and relies on in growth of new vessels from the recipient tissues.
A vascularized graft (or, Flap) remains attached to donor blood supply or becomes revascularized via
microvascular anastomoses to recipient vessels.

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127. Anal fissure best diagnosed by: (1 point)

⚫ a. History & clinical examination

◯ b. PR examination

◯ c. USG

◯ d. Anoscopy

Explanation:

Answer is a. History and clinical examination

The diagnosis of anal fissure is secured by the typical history of pain and bleeding with defecation and
confirmed by inspection after gently parting the posterior anus.

128. Dumping syndrome is because of: (1 point)

◯ a. Diarrhea

◯ b. Reduced gastric capacity

⚫ c. Hypertonic content in small intestine

◯ d. Vagotomy

Explanation:

Answer is c. Hypertonic content in small intestine

Gastric dumping syndrome, or rapid gastric emptying is a condition where ingested foods bypass the stomach
too rapidly and enter the small intestine largely undigested. It happens when the small intestine expands too
quickly due to the presence of hyperosmolar (having increased osmolarity) contents from the stomach. This
causes symptoms due to the fluid shift into the gut lumen with plasma volume contraction and acute intestinal
distention.

Dumping syndrome may occur in post-gastrectomy patients with characteristic features like sweating, dizziness,
tachycardia, colicky abdominal pain and diarrhoea after food intake.

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129. The most common type of carcinoma breast is: (1 point)

◯ a. Lobular

◯ b. Paget’s

⚫ c. Ductal
◯ d. Lipomatous

Explanation:

Answer is c. Ductal

Most common variant of breast cancer: Ductal carcinoma

Carcinoma which is often bilateral: Invasive lobular carcinoma

130. Renal calculi associated with Proteus infection: (1 point)

◯ a. Calcium oxalate

◯ b. Uric acid

⚫ c. Triple Phosphate
◯ d. Xanthine

Explanation:

Answer is c. Triple phosphate

Triple Phosphate stones form in the presence of high concentration of ammonia which essentially means that
they fonn when the urine is infected (UTI) with Urea splitting organisms (e.g. Proteus, Kleibsella, Pseudomonas
sp.)

COMPREHENSIVE STRUCTURE QUESTIONS

CASE 1

A 74 y/o male presents to the ED with weakness in his right arm, as well as slurred speech that started suddenly
this morning during breakfast (6 hours before entering to ED). Past medical history is significant for MI 10 years
ago, HTN & BPH. Vital signs are as follows: temperature =96.1°F, RR = 18/min, BP = 150/90 mmHg, pulse =
84 bpm. Oxygen saturation is 98% on room air, physical examination reveals a right facial drop and muscle
strength is decreased in the right arm (2/5 strength) and right leg (3/5 strength). Patient has decreased sensation
to light touch and pin prick in the right arm but normal sensation in his right leg.

131. The patient was diagnosed as a case of acute CVA clinically, where do you think is the site of (1 point)
lesion?

◯ a. Right cerebral hemisphere along ACA distribution

b. Right cerebral hemisphere along MCA

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◯ distribution

⚫ c. Left cerebral hemisphere along MCA distribution

◯ d. Left cerebral hemisphere along PCA distribution

Explanation:

Answer is c. Left cerebral hemisphere along MCA distribution

132. What is the most likely cause of stroke in this patient? (1 point)

◯ a. Thrombotic

⚫ b. Embolic
◯ c. Hemorrhagic

◯ d. All of fhe above

Explanation:

Answer is b. Embolic

Abrupt onset of symptoms indicates embolic cause

133. What should be your first test to order to confirm your diagnosis? (1 point)

◯ a. A CECT Head

⚫ b. A non-contrast CT head
◯ c. A Gladinum-MRI

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◯ d. Spiral CT chest to find foci of emboli

Explanation:

Answer is b. A non-contrast CT head

134. What is the time window for the use of thrombolytic agent in case of ischemic stroke? (1 point)

◯ a. 2 hours

⚫ b. 3 hours
◯ c. 4 hours

◯ d. 6 hours

Explanation:

Answer is b. 3 hours

135. Millard-Gubler syndrome includes all the following except: (1 point)

⚫ a. 5th CN palsy
◯ b. 6th CN palsy

◯ c. 7th CN palsy.

◯ d. Contralateral Hemiparesis

Explanation:

Answer is a. 5th CN palsy

Millard Gubler syndrome from Ventral pontine injury is associated with

1. Lateral rectus palsy (6th CN): leads to internal strabismus (i.e, esotrophia) and loss of power to rotate the
affected eye outward)
2. Ipsilateral facial palsy (7th CN)
3. Distruption of the corticospinal tract: leads to c/l hemiplagia of the extremities

CASE 2

A 56 y/o male patient, known case of Rheumatic heart disease for 6 years presented in ER witH cough and
shortness of breath. On examination, JVP was raised, B/L pitting pedal edem a and B/L fine crepitation on chest
auscultation were present., Patient was diagnosed for congestive heart failure

136. Which of the following is not the feature of LVF according to FRAMINHAM criteria of CHF? (1 point)

⚫ a. Raised JVP
◯ b. Cardiomegaly
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◯ c. Acute pulmonary edema

◯ d. S3-gallop

Explanation:

Answer is a. Raised JVP

137. Pulmonary Capillary Wedge Pressure (PCWP) is not normal in case of pulmonary edema due to: (1 point)

⚫ a. CHF
◯ b. ARDS

◯ c . Heroin inhalation

◯ d. High altitude pulmonary edema

Explanation:

Answer is a. CHF

Options B, C, & D are non- cardiogenic cause of pulmonary edema and with normal PCWP

138. True about beta-blockers in CHF is: (1 point)

◯ a. Not used in acute CHF

◯ b. Inhibits the sympathetic drive and hence decreases heart rate

⚫ c. Carvedilol, bisoprolol and metoprolol are the beta-blockers used in chronic CHF
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◯ d. None of the above

Explanation:

Answer is c. Carvedilol, bisoprolol and metoprolol are the beta-blockers used in chronic CHF.

Beta blocker therapy is appropriate in patients with NYHA class II or class III symptoms resulting from left
ventricular systolic dysfunction. Unless contraindicated, beta blockers should be considered a mainstay of
therapy in these patients to improve symptoms and mortality and to decrease hospitalizations.

Unless contraindicated, patients with LV systolic dysfunction should be treated with one of the three following
beta-blockers:

carvedilol
sustained-release metoprolol (succinate)
bisoprolol

139. True about digoxin is: (1 point)

◯ a. Not used in case of acute CHF

◯ b. safety dose is (0.05-2) ng/dl

◯ c. Ventricular begeming is the most common cardiac effect of digoxin toxicity

⚫ d. All of above

Explanation:

Answer is d. All of above

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140. True about sputum color in case of pulmonary edema is: (1 point)

◯ a. Chocolate colored sputum

◯ b. Rusty sputum

⚫ c. Pink frothy sputum

◯ d. None of the above.

CASE 3

An 18 year old lady has a firm, rubbery mass in the left breast that moves easily with palpation.

141. The most likely diagnosis is: (1 point)

⚫ a. Fibroadenoma
◯ b. Ductal carcinoma in situ

◯ c. Lobular carcinoma in situ

◯ d. Phyllodes tumor

Explanation:

Answer is a. Fibroadenoma

A firm, rubbery, pain-less mobile mass in a female (15-25) likely to be fibroadenoma.

142. Mobile Triple assessment for breast conditions include all except: (1 point)

◯ a Clinical history and examination

◯ b. Mammography

◯ c. FNAC

⚫ d. CT scan

Explanation:

Answer is d. CT scan

Triple assessment of breast symptoms include clinical evaluation {Age & Examination),Imaging ( USG or
Mammography) and histopathological ( FNAC or Corecut biopsy). It leads to diagnosis in 99.9% of cases.

143. Commonest cause of breast abscess: (1 point)

⚫ a. Staphylococcus
◯ b. Streptococcus
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◯ c. E. coli

◯ d. Klebsiella

Explanation:

Answer is Staphylococcus

The commonest organism causing breast abscess is Staphylococcus aureus

144. Mammographic findings of malignant changes are all except: (1 point)

◯ a. New or speculated mass

◯ b. Clustered micro-calcification

⚫ c. Radial scar
◯ d. Nipple retraction

Explanation:

Answer is c. Radial scar

Mammographic findings suggestive of malignant changes are:

New mass lesion

Clustered micocalcification
Asymmetric density
Nipple retraction
Spiculation
Irregular soft tissue shadow in carcinomas
Lobulated mass
Stellate architectural distortion op breast parenchyma
Breast image reporting and data system (BIRADS) is based on mammographic finding.

145. Treatment of cyclical mastalgia are all except: (1 point)

◯ a. Evening primrose oil

◯ b. Danazol

◯ c. Tamoxifen

⚫ d. Clomiphene

Explanation:

Answer is d. Clomiphene

Pronounced cyclical mastalgia may become a significant clinical problem if the pain and tenderness interfere
with the woman's life, disturb her sleep and impair sexual activity. Oil of evening primrose, in adequate doses
given over three months, will help more than half of these women. It appears to achieve higher response rates in
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those over 40 years of age rather than younger women. For those with intractable symptoms, an anti-
gonadotropin, such as danazol, or a prolactin inhibitor, such us bromocriptine, may in tried. Very rarely, it is
necessary to prescribe an anti-estrogen, for example tamoxifen, or a luteinizing hormone-releasing hormone
(LHRH) agonist to deprive the breast epithelium of estrogenic drive.

CASE 4

An elderly man died suddenly after collision who was driving with seat belt.

146. What could be most likely cause of death. (1 point)

◯ a. Tension pneumothorax

◯ b. Cardiac trauma

◯ c. Spinal dissection

⚫ d. Aortic dissection

Explanation:

Answer is d. Aortic dissection

147. Emergency management of tension pneumothorax where chest tube is not available is needle (1 point)
aspiration at

◯ a. Safety triangle

◯ b. Site of collection of air

◯ c. 2nd ICS at anterior axillary line

⚫ d. 2nd ICS at MCL

Explanation:

Answer is d. 2nd ICS at MCL

148. In the above case, radiological finding would be: (1 point)

◯ a. Multiple rib fracture

⚫ b. Widened mediastinum
◯ c. Normal x-ray findings

◯ d. Absence of broncho-vascular marking distal to the shadow indicating collapse

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Explanation:

Ans is b. Widened mediastinum

149. What does it mean by saying patient with aortic dissection is stable? (1 point)

◯ a. Intima is intact

◯ b. Media is intact

◯ c. Adventitia is intact

⚫ d. Both ‘a ' and ‘b’

Explanation:

Answer is d. Both ‘a ' and ‘b’

150. Initial management of this case would be to: (1 point)

⚫ a. Control the high BP

◯ b. Laparotomy

◯ c. High volume of IV fluids

◯ d. Surgical correction without a delay

Explanation:

Answer is a. Control the high BP

CASE 5
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A 21 years old primigravida in her 31 weeks of gestation presents to your health center with swelling of her
limbs. She also complains of headache and epigastric pain, the most fearful condition for her was yesterday she
noticed dimness of vision and black spot in her eye that resolved within minutes. On further asking she accepts
diminution of urine amount over last 10/12 davs. She admitted increased weight gain in this month. .On
examination there was pitting edema over ankles and shin. Her blood pressure was 148/92 mmHg. On
auscultation chest was clear and abdomen was non-tender.

151. What is the likely diagnosis: (1 point)

⚫ a. Pre eclampsia
◯ b. Eclampsia

◯ c. Acute kidney injury superimposed on pregnancy

◯ d. Fluid deficit

Explanation:

Answer is a. Pre eclampsia

152. Which of the followings is required to make the diagnosis of Pre eclamsia in above patient? (1 point)
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⚫ a. Proteinuria
◯ b. Thrombocytopenia

◯ c. Elevated serum uric acid level

◯ d. Elevated serum creatinine level

Explanation:

Ans is a. Proteinuria

To diagnose preeclampsia, you have to have high blood pressure and one or more of the following complications
after the 20th week of pregnancy:

Protein in your urine (proteinuria)

A low platelet count
Impaired liver function
Signs of kidney problems other than protein in the urine
Fluid in the lungs (pulmonary edema)
New-onset headaches or visual disturbances

153. If you are in a remote PHC which of the followings test can be of value in screening a patient of (1 point)
preeclamsia?

◯ a. Evidence of oedem a

◯ b. Elevated blood pressure

⚫ c. Roll over test

◯ d. Urine for protein

Explanation:

Answer is c. Roll over test

The presence of early diastolic notch, increased pulsatility index and resistance index are considered to be a
positive predictor of preeclampsia. A positive Roll Over test is an elevation of 20 mm of Hg or more in
diastolic pressure when the woman rolls over from lateral decubitus to the supine position.

154. Which of the followings can be the complications of pre eclampsia? (1 point)

◯ a. Eclampsia

◯ b. Abruptio placentae

◯ c. HELLP syndrome and ARDS

⚫ d. All of the above

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Explanation:

Answer is d. All of the above

155. On the routine tests of the above patient you noticed proteinuria(3++), serum uric acid level of (1 point)
4.8mg/dl, platelet counts of 1,37,000, normal fundoscopy and CTG. What is the most
appropriate plan of management?

◯ a. Advise for rest, high protein diet and daily checkup and send home

◯ b. Admit the patient and plan for immediate delivery

⚫ c. Admit the patient start treatment plan and observe for response to treatment
◯ d. Antihypertensives are the cornerstone of management o£ pre eclampsia.

Explanation:

Answer is c. Admit the patient start treatment plan and observe for response to treatment

CASE 6

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A 66 y/o nulliparous woman presents with abdominal distension despite a poor appetite. She underwent
menopause 17 years ago. A rectal exam reveals induration in the pouch of Douglas. She has a fluid wave in the
abdomen revealed in USG and a left-sided pleural effusion. A thoracocentesis shows clumps of malignant cells
in that stains positive for CA 125.

156. Which of the following is the most likely diagnosis? (1 point)

◯ a. Metastatic stomach cancer

◯ b. Metastatic cervical cancer

⚫ c. Metastatic ovarian cancer

◯ d. Metastatic endometrial cancer

Explanation:

Answer is c. Metastatic ovarian cancer

Metastatic ovarian cancer is an advanced stage malignancy that has spread from the cells in the ovaries to distant
areas of the body. This type of cancer is most likely to spread to the liver, the fluid around the lungs, the spleen,
the intestines, the brain, skin or lymph nodes outside of the abdomen.

The CA-125 blood test as a tumor marker to help guide treatment in women known to have ovarian cancer,
because a high level often goes down if treatment is working.

157. One of the following is an INCORRECT statement about Krukenberg tumor (1 point)

◯ a. It is the hematogenous spread of gastric cancer to both ovary.

⚫ b. It is the hematogenous spread of ovarian cancer to the stomach.

◯ c. It shows Signet ring cells on histology

◯ d. . All of the above

Explanation:

Answer is b. It is the hematogenous spread of ovarian cancer to the stomach.

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158. In a suspected ovarian cancer, imaging workup is required for all of the following information, (1 point)
EXCEPT:

◯ a. Detection of adnexal lesion.

◯ b. Characterization of the lesion

◯ c. Assess the metastasis

⚫ d. none

Explanation:

Answer is d. none

159. In a case of Dysgerminoma of the Ovary, one of the following tumor markers is likely to be (1 point)
raised:

◯ a. Serum HCG

◯ b. Serum a-fetoprotein

⚫ c. Serum LDH
◯ d. Serum Inhibin

Explanation:

Answer is c. Serum LDH

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Dysgerminomas produce placental alkaline phosphatase and lactate dehydrogenase. Pure dysgerminomas do not
produce AFP and HCG..

160. The most common, pure germ cell tumor of ovary is : (1 point)

◯ a. Choriocarcinoma

⚫ b. Dysgerminoma
◯ c. Embryonal cell tumor

◯ d. Malignant tumor

Explanation:

Answer is b. Dysgerminoma

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CASE 7

A 2 year old child presented in ER department. A/c to parents the child while playing in the garden unattended,
suddenly started to rough gaspingly and the skin of the child turned blue, The cough lasted for 3 minutes and
then cyanosis ceased. At present the child is symptomless.

161. Which of the following response is important to you? (1 point)

◯ a. Parents previous child died of valvular heart disease.

◯ b. Child had pneumonia 2 weeks ago.

⚫ c. Child ate peanuts before the attack.

◯ d. Child often drinks from a dug well.

Explanation:

Answer is c. Child ate peanuts before the attack.

A history of sudden onset of coughing, wheezing and diminished entry of air into the lungs on auscultation
forms a classical triad for diagnosing foreign body.

Children are more often affected; more than half of them are below 4 years.
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Children, peanut is the most common vegetable foreign body; others include almond seed, peas, beans, gram
or wheat seed, watermelon seed, pieces of carrot or apple. Nonvegetable matters include plastic whistle, plastic
toys, safety pins, nails, all-pin, twisted wires or ball bearings.

In adults, foreign bodies are aspirated during coma, deep sleep or alcoholic intoxication. Loose teeth or denture
may be aspirated during anaesthesia.

162. Which of the following diagnostic tests do you order? (1 point)

◯ a. ECG

⚫ b. Chest X-ray
◯ c. USG chest

◯ d. Observation only.

Explanation:

Answer is b. Chest X-ray

Chest xay is very helpful for identifying location and size of FB.

163. Which of the following test do you additionally order? (1 point)

⚫ a. Bronchoscopy
◯ b. Bronchography

◯ c. ECG

◯ d. Swallowing test

Explanation:

Answer a. Bronchoscopy

Tracheal and bronchial foreign bodies can be removed by bronchoscopy with full preparation and under general
anaesthesia.

Laryngeal foreign body. A large bolus of food obstructed above the cords may make the patient totally
aphonic,unable to cry for help.

164. Which of the following therapeutic interventions do you choose? (1 point)

◯ a. Administration of Methylene blue

◯ b. Administration of N-acetyl cysteine

⚫ c. Bronchoscopy.

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◯ d. Administration of Antibiotics

Explanation:

Answer is c. Bronchoscopy.

165. Which view do you suggest for FB In esophagus (1 point)

◯ a. AP view

⚫ b. PA and Lateral view

◯ c. oblique view

◯ d. Schullers view

Explanation:

b. PA and Lateral view

Posteroanterior and lateral views of neck and similar views of the chest including abdomen are taken. They
reveal most of the radio-opaque foreign bodies and their location

CASE 8

An 8 year old boy presented with fever and bilateral cervical lymphadenopathy with prior history of sore throat.
There was no hepatomegaly. The peripheral blood smear shows > 20 % lympho-plasmacytoid cells, The most
likely diagnosis is

166. What is the most likely diagnosis? (1 point)

◯ a. ALL

◯ b. Hepatitis A

◯ c. Malaria

⚫ d. Infectious mononucleosis

Explanation:

Answer is d. Infectious mononucleosis

1. Infectious mononucleosis is the most characteristic disease produced by Epstein Barr Virus.
2. Most infections are asymptomatic.
3. Headache, Abdominal pain,and chills are also seen in few cases. There is fever, malaise ,sore throat,
(exudative pharyngitis), loss of appetite and generalized lymphadenopathy
4. Posterior and anterior cervical LN are almost always enlarged
5. Splenomegaly is found in 50-75% cases while hepatomegaly is found only in 30% cases.

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167. What peripheral blood smear finding do you expect? (1 point)

⚫ a Atypical lymphocytes
◯ b. Plasmodium Species

◯ c. Blast cells

◯ d. Toxic granules

Explanation:

Answer is a Atypical lymphocytes

Atypical Lymphocytosis: Comprising over 10%o of total lymphocytes at sometime in the illness.

168. The most most important diagnostic procedure is (1 point)

◯ a. Liver biopsy

◯ b. Measurement of granulocyte alkaline phosphatase activity

◯ c. lntroduction of Prednisolone therapy

⚫ d. Rapid monocyte test or heterophil antigen determination

Explanation:

Answer is d. Rapid monocyte test or heterophil antigen determination

Monospot test is the screening test

Paul Bunnel test is Positive: Infected B-lymphocytes which subsequently produce a heterophile antibody
which is identified through its reaction with the Paul Bunnell antigen

169. Which of the following carcinoma is associated with the organism causing the disease? (1 point)

◯ a. Nasopharygeal carcinoma

◯ b. Burkitt’s Lymphoma

◯ c. Hodgkin's Lymphoma

⚫ d. All of the above

Explanation:

Answer is d. All of the above

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170. What additional precaution would you advice? (1 point)

⚫ a. Avoid contact sports

◯ b. Avoid salt intake

◯ c. Avoid exercise

◯ d. Avoid mosquitoes

Explanation:

Answer is a. Avoid contact sports

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CASE 9

A 72 years old man fell in bathroom and was unable to stand on right hip.On examination echhymosis was
present around buttock region with external rotation of the leg and lateral border of foot touching the bed.

171. The most probable diagnosis is: (1 point)

⚫ a. Extra capsular fracture neck of femur

◯ b. Anterior dislocation of hip

◯ c. Intra capsular fracture neck of femur

◯ d. Posterior dislocation of hip

Explanation:

Answer is a. Extra capsular fracture neck of femur

Lateral border of foot is touching the bed that means there is extreme external rotation. This occurs in
intertrochanteric fractures. IT # is an extracapsular # between greater and lesser trochanter common in elderly
osteoporotic females of 8th decade, which unites easily.

Examination findings are tenderness over greater trochanter, ecchymosis over buttock, broadening of GT,
straight leg raising (SLR) & ability to walk is always absent and various other finding which are always more
than that of # NOF; e.g. velocity of trauma, pain, swelling, external rotation deformity, shortening (>1 inch)

172. On examination, when you palpate, tenderness will be felt over: (1 point)

◯ a. Scarpa’s triangle

⚫ b. Greater trochanter

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◯ c. Lesser trochanter

◯ d. Knee

Explanation:

Answer is b. Greater trochanter

173. Increase in Pawel’s angle indicate: (1 point)

◯ a. Good prognosis

◯ b. Impaction

⚫ c. More chances of displacement

◯ d. Disrupted trabecular alignment

Explanation:

Answer is c. More chances of displacement

Pauwel’s classification: This classification is based on the angle of inclination of the fracture in relation to the
horizontal plane. The fractures are divided into three types (type I–III). The more the angle the more unstable is

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the fracture, and worse the prognosis.

174. What is the most common complication of this fracture? (1 point)

⚫ a. Malunion
◯ b. Non-union

◯ c. AVN

◯ d. Osteoarthritis

Explanation:

Answer is a. Malunion

Complication

Malunion: Inter-trochanteric fractures almost always unite, but because of possible failure in keeping the
fragments aligned, these often leads to malunion.

Osteoarthritis: Due to changes in the hip biomechanics following trochanteric fractures, osteoarthritis of the hip
develops after a few years

175. Which of the following would be the best treatment for this case? (1 point)

⚫ a. Proximal femoral nail

◯ b. Inlay plates

◯ c. Hemireplacement arthroplasty

◯ d. 3 cannulated screws
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Explanation:

Answer is a. Proximal femoral nail

Operative methods: The fracture is reduced under X-ray control and fixed with internal fixation devices. The
most commonly used ones are:

(i) Dynamic Hip Screw (DHS)

(ii) Ender’s nails and

(iii) Nails such as gamma nail, Proximal femoral nail (PFN).

External fixation is useful for patients with bed sores, and for those who are unfit for a major operation.

CASE 10

Ram Avatar Yadav of Parasi returned after spraying some medicine on crops in his farm. Soon he developed
profuse lacrimation salivation, urination and defecation. He rushed to a nearby PHC where he was diagnosed for
OP poisoning.

176. Antidote for muscarine poisoning is (1 point)

⚫ a. Atropine
◯ b. Thiocyanate

◯ c. Sodium benzoate

◯ d. BAL

Explanation:

Answer is a. Atropine

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177. Pralidoxime acts in OP poisoning by (1 point)

⚫ a. Regenerating cholinesterase
◯ b. Inhibiting cholinesterase

◯ c. Cholinergic action

◯ d None of the above

Explanation:

Answer is a. Regenerating cholinesterase

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178. One of the following is not the side effect of atropine (1 point)

◯ a.Blurring of vision

◯ b.Diarrhea

◯ c. Urinary retension

⚫ d. Confusion of elderly

Explanation:

Answer is b.Diarrhea

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179. Which of the following is not true about OP poisoning? (1 point)

◯ a. Atropine is the antidote for muscarine poisioning

⚫ b. Serum level of acetyl- cholinesterase is more significant than RBC acetyl cholinesterase for assessing
the toxicity level of op poisioning
◯ c. Pralidoxime also reverts nicotinic effect of OP poisoning

◯ d. All of the above

Explanation:

Answer is b.

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180. Atropine causes (1 point)

◯ a. Decrease cardiac output

⚫ b. Mydriasis
◯ c. Sweating

◯ d. None

Explanation:

Answer is b. Mydriasis

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