1.

Cannon ’a' waves are seen in:

0/1
Atrial flutter

Atrial fibrillation
Complete heart block
Cardiac tamponade

Correct answer
Complete heart block
Feedback
Cannon a waves occur in--
-Complete heart block when the right atrium and right ventricle contract simultaneously with a closed
-Tricuspid valve
-Ventricular tachycardia
-Ectopic beats

2. In Torsades de pointes the ECG finding is:

0/1
Shortened QT interval
Short QRS interval
Prolonged QT interval
Prolonged QRS interval

Correct answer
Prolonged QT interval
Feedback
Torsades de pointes (twisting of the points) or polymorphic ventricular tachycardia is ventricular
tachycardia characterised by polymorphic QRS complexes that change in amplitude and cycle length
giving the impression of oscillations around the baseline. This rhythm is
always associated with QT prolongation. QT prolongation may result from electrolyte disturbances (such as
hypokalemia and hypomagnesemia).

3. In SABE diagnosis is made by

1/1
Anti-Streptolysin
ASO Titer
Anti DNAase
Serial Blood Culture

Feedback
Criteria for diagnosis of SABE depend heavily on blood culture and cardiac echocardiography
4. A 20 year young man presents with exertional dyspnoea, headache, and giddiness. On
examination, there is hypertension and LVH. X-ray picture shows notching of the anterior
ends of the ribs The most likely diagnosis is:
0/1
Phaeochromocytoma
Carcinoid syndrome

Coarctation of the aorta

Superior Mediastinal syndrome

Correct answer
Coarctation of the aorta
Feedback
Coarctation of Aorta is Narrowing of the aorta at the aortic isthmus, which is a distal part of the aortic arch,
close to the ductus arteriosus (juxtaductal) and left subclavian artery

The above features are suggestive of the diagnosis Coarctation of aorta.

Patients with long standing unrepaired coarctation develop extensive collateral circulation through
dilatation of intercostal arteries. These arteries run on the inferior aspect of the ribs. These patients can
show inferior rib notching bilaterally from third to eighth ribs on chest X-ray.

Classic “figure of three” sign can be seen on some patients with CoA.

5. Most common clinical feature of multiple myeloma:

0/1
Bone pain

Anemia
Hypercalcemia
Bleeding

Correct answer
Anemia
Feedback
Multiple myeloma (Kahler's disease, plasma cell myeloma, myelomatosis) is a malignant plasma cell
dyscrasia characterized by uncontrolled proliferation and the diffuse infiltration of monoclonal (=same type)
plasma cells in the bone marrow.
Proliferating plasma cells suppress normal bone marrow function, which leads to clinical findings of
anemia, bleeding and/or infection.
Classical tetrad of signs/symptoms of Multiple Myeloma is given by mnemonics CRAB standing for Calcium
elevation, renal impairment, anemia and bone pain.
Anemia is the most common feature seen followed by bone pain, renal impairment, fatigue and
hypercalcemia.

6. A 24-year old man with progressive, painless enlargement of cervical lymph nodes
presented to TUTH OPD. He also gives history of drenching sweats, fever and >10% weight
loss in last 6 months. A routine chest film followed by CT scan demonstrates marked
enlargement of mediastinal nodes. No nodules are seen in the liver or lung. What is the most
likely diagnosis?
0/1
Hodgkin’s lymphoma
Non-hodgkin’s lymphoma
Chronic myeloid leukemia

None

Correct answer
Hodgkin’s lymphoma
Feedback
Most patients with Hodgkin's lymphoma present with palpable lymphadenopathy that is nontender; in most
patients, these lymph nodes are in the neck, supraclavicular area, and axilla. More than half the patients will
have mediastinaladenopathy at diagnosis, and this is sometimes the initial manifestation. One-third of
patients present with fevers, night sweats, and/or weight loss.

7. Which of the following drugs requires serial monitoring of Prothrombin time:

1/1
Aspirin
Lepirudin
Digoxin
Warfarin

Feedback
Warfarin requires serial monitoring of Prothrombin time or INR International Normalized Ratio (INR):
Standardizes PT measurement and is used to monitor Warfarin (Coumadin) therapy

8. A woman has bilateral headache that worsens with emotional stress. She has two children
, both doing badly in school. Diagnosis is:
1/1
Migraine headache
Cluster headache
Tension headache

Trigeminal neuralgia
Feedback
-Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common
type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes or other
muscle groups in the body typically affecting both sides of the head
-Cluster headache (CH) is characterized by recurrent severe unilateral headaches, typically around the eye.
There is often accompanying eye watering, nasal congestion, or swelling around the eye on the affected
side. These symptoms typically last 15 minutes to 3 hours.
-Migraine headache and trigeminal neuralgia also presents as unilateral headache.
9. Which of the following sensation is preserved on the side of the lesion in Brown- sequard
syndrome :
0/1
Touch
Temperature
Vibration
All of the above

Correct answer
Temperature
Feedback
Brown-Séquard syndrome is an incomplete spinal cord lesion characterized by findings on clinical
examination which reflect hemisection of the spinal cord (cutting the spinal cord in half on one or the other
side).

Pure Brown-Séquard syndrome is associated with the following:

Interruption of the lateral corticospinal tracts:

-Ipsilateral spastic paralysis below the level of the lesion
-Babinski sign ipsilateral to lesion
-Abnormal reflexes and Babinski sign may not be present in acute injury

Interruption of posterior white column:

-Ipsilateral loss of tactile discrimination, vibratory, and position sensation below the level of the lesion

Interruption of lateral spinothalamic tracts:

-Contralateral loss of pain and temperature sensation. This usually occurs 2–3 segments below the level of
the lesion.

10. Not a feature of DKA

1/1
Kussmaul's Respiration
Dehydration
Bradycardia

Abdominal Pain/Tenderness
Feedback
Signs and Symptoms of DKA
• Polyuria, polydipsia
– Enuresis
• Dehydration
– Tachycardia
– Orthostasis
• Abdominal pain
– Nausea
– Vomiting
• Fruity breath
– Acetone
• Kussmaul breathing
• Mental status changes
– Combative
– Drunk
– Coma

11. A patient of reactive arthritis develops red eye and urethritis. The most likely diagnosis
is:
1/1
Horner’s syndrome
Marfan’s syndrome
Reiter’ssyndrome

None of the above

Feedback
Reiter’s syndrome: Triad of non gonococcal urethritis, arthritis and uveitis.@ can’t see, can’t pee and can’t
climb a tree.

12. Most common cause of death in a patient with renal failure on dialysis :
0/1
Infection

Uraemia
Respiratory failure
Cardiovascular disease

Correct answer
Cardiovascular disease
Feedback
The most common cause of sudden death in patients with ESRD is hyperkalemia, which often follows
missed dialysis or dietary indiscretion.
The most common cause of death overall in the dialysis population is cardiovascular disease;
cardiovascular mortality is 10-20 times higher in dialysis patients than in the general population.

13. While inserting a central venous catheter a patient develops respiratory distress. The
most likely cause is :
1/1
Pleural effusion
Pneumothorax

Hemothorax
Hypovolemia
Feedback
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall.
A primary spontaneous pneumothorax is one that occurs without an apparent cause and in the absence of
significant lung disease.
A secondary spontaneous pneumothorax occurs in the presence of existing lung disease.

Smoking increases the risk of primary spontaneous pneumothorax, while the main underlying causes for
secondary pneumothorax are COPD, asthma, and tuberculosis.

A traumatic pneumothorax can develop from physical trauma to the chest (including a blast injury) or from
a complication of a healthcare intervention like inserting CVP, brachial plexus block etc.

14.Investigation of choice to diagnose Hirschsprung's disease is

0/1
rectal manometry
barium enema

rectal biopsy
laparatomy

Correct answer
rectal biopsy
Feedback
Confirmation of diagnosis of Hirschsprung's disease depends on histological demonstration of
aganglionosis and hypertrophic nerve fibers in the nerve plexus. In children this can be obtained by a
suction rectal biopsy or in adults by full thickness rectal biopsy.

15. A blood stained discharge from the nipple indicates:

0/1
breast abscess

fibroadenoma
duct papilloma
fat necrosis of breast

Correct answer
duct papilloma
Feedback
A blood stained discharge may be caused by intraductal papilloma (most common cause), other causes
being carcinoma, duct ectasia

16. Most common 'artery’ used for coronary artery bypass graft is:
1/1
Internal mammary artery

Intercostal artery
Radial artery
Dorsalis pedis artery
Feedback
The long saphenous vein is the most commonly used conduit but the internal mammary artery is now used
for the left anterior descending graft in more than 60% cases

17. Punctum is characteristic of:

0/1
dermoid cyst
sebaceous cyst
Bartholin's Cyst
Branchial Cyst

Correct answer
sebaceous cyst
Feedback
Sebaceous cyst or Epidermal cyst is a retention cyst occurring due to obstruction of one of the sebaceous
ducts. The common sites are scalp, face, back, scrotum but it never occurs in palm and sole. The central
keratin filled punctum is diagnostic of this cyst

18. Ranula is :
1/1
Extravasation cyst of submandibular gland
Extravasation cyst of sublingual gland

Retention cyst of submandibular gland

Retention cyst of sublingual gland
Feedback
A ranula is a mucus extravasation cyst involving a sublingual gland and is a type of mucocele found on the
floor of the mouth. Ranulae present as a swelling of connective tissue consisting of collected mucin from a
ruptured salivary gland caused by local trauma.

19. Bleeding in subdural hematoma (SDH) is from:

1/1
Middle meningeal artery
Bridging veins

Emissary veins
Dural sinuses
Feedback
A subdural hematoma (SDH) is a type of bleeding in which a collection of blood—usually associated with a
traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the
meninges surrounding the brain. It usually results from tears in bridging veins that cross the subdural
space.
20. Which of the following nutrients are not included in Total Parenteral Nutrition ( TPN)?
1/1
Fibers

Proteins
Carbohydrates
Lipids
Feedback
Parenteral nutrition solutions contain essential nutrients including protein,carbohydrates,fat,electrolytes,
vitamins,trace elements and water.
Dietary fibre can not be provided by parenteral nutrition.

21. A 78 years old male presents with jaundice associated with increased itching and a
palpable gall bladder. Possible diagnosis is-
0/1
Periampullary carcinoma
Hepatocellular Carcinoma

Gastric Carcinoma
Abdominal lymphoma

Correct answer
Periampullary carcinoma
Feedback
-Courvoisier’s law states states that in the presence of an enlarged gall bladder which is nontender and
accompanied with jaundice the cause is unlikely to be gallstones. This is because gall stones are formed
over a longer period of time, and this result in a shrunken, fibrotic gall bladder which does not distend
easily
-In contrast, the gall bladder is more often enlarged in pathologies that cause obstruction of the biliary tree
over a shorter period of time such as malignancy of bile duct, pancreas (periampullary Ca), leading to
passive distention from backpressure.

22. A 30-year-old farmer who is a chronic smoker develops gangrene of foot. Most common
cause of this is:
0/1
Myocardial Infarction
Thromboangitis Obliterans
Atherosclerosis

Raynaud's Disease

Correct answer
Thromboangitis Obliterans
Feedback
-Thromboangiitis obliterans or Buerger's disease is an inflammatory occlusive small and medium sized
arteries and veins in the distal upper and lovver extremities.
-Clinical features include a triad of claudication of the effected extremity, Raynaud's phenomenon and
migratory; superficial vein thrombophlebitis.
-Smoking is a risk factor for Thromboangiitis obliterans

23. In which of the following condition, hour glass deformity of stomach is seen:
1/1
Corrosive stricture
Gastric lymphoma
Gastric ulcer

Gastric carcinoma
Feedback
Hour glass stomach is a chronic complication of peptic ulcer.

24. Strangulation is most common with which hernia

1/1
Inguinal
Epigastric
Obturator
Femoral

Feedback
A hernia becomes strangulated when the blood supply of its contents is seriously impaired. Although
inguinal hernia is more common than femoral hernias femoral-hernia is more likely to strangulate because
of the narrowness of the neck of sac and its rigid walls. Also strangulation in epigatsric or obturator hernia
is rare.

25. . In which of the following condition, malignant changes in testis occurs:

1/1
Pyocele
Hydrocele
Trauma
Cryptorchidism

Feedback
Cryptorchidism is associated with a several fold higher risk of germ cell tumor. Abdominal cryptorchid
testes are at a higher risk than inguinal cryptorchid testes.

26. Ureterosigmoidostomy leads to which of the following condition:

0/1
Hyperchloremic alkalosis
Metabolic acidosis
Hypochloremic acidosis

Hyperchloremic acidosis

Correct answer
Hyperchloremic acidosis
Feedback
Ureterosigmoidostomy is a method of urinary diversion.
In this procedure the ureters are cut obliquely and pulled into the gut by a stitch. The typical biochemical
changes are hyperchloremic acidosis with potassium depletion. These changes are due to a combination of
reabsorption of urea and chloride and progressively diminishing renal function due to chronic
pyelonephritis.

27. The commonest site for ectopic pregnancy is:

1/1
Isthmus
Infundibulum
Fimbriae
Ampulla

Feedback
Ectopic pregnancy in which the fertilized ovum is implanted in a location other than the endometrium, most
commonly occurs in the fallopian tube (97% of all ectopics) of which most common site is ampulla (55% of
tubal) followed by isthmus (25% of tubal ). Symptoms include amenorrhea, abdominal pain, and vaginal
bleeding. Can rupture and result in life-threatening intraperitoneal hemorrhage

28. Corpus luteum cyst occurs due to:

1/1
HCG
LH

Estrogen
Progesterone
Feedback
High FSH leads to a Follicular cyst.
High LH leads to a Corpus luteum cyst.

29. Multiparous pregnancy predisposes to all, except:

1/1
Postpartum hemorrhage
Malpresentation
Anaemia
Pregnancy induced hypertension
Feedback
Complications of multiparous pregnancy:
-Pregnancy: Abortion (Spontaneous and induced), Malpresentation, Multiple, pregnancy, Placenta previa,
Anaemia, Prematurity.
-Labour: Cord prolapse, CPD, Obstructed labour, Postpartum hemorrhage, Shock,etc.

PIH, preeclampsia or eclampsia is more common in first pregnancy or primigravida than in multigravida.
But If there is PIH in previous pregnancy risk increases in subsequent pregnancies.

30. What is the most common type of vaginal carcinoma?

1/1
Columnar cell carcinoma
Adenocarcinoma
Transitional cell carcinoma
Squamous cell carcinoma

Feedback
Squamous cell carcinoma is the most common type of vaginal carcinoma. The age of presentation is from
48 to 55 years and the most important symptom is abnormal bleeding.

31. Most common site for genital tuberculosis is:

1/1
Fallopian tube

Ovary
Broad ligament
Cervix
Feedback
Genital tuberculosis is almost always secondary to focus somewhere in the body and primary focus is
most often situated in lungs, lymph node, urinary tract, bones and joints in decreasing order. The
hematogenous spread is commonest mode of spread. Commonest complication is ectopic pregnancy. The
fallopian tubes are most commonly involved.

32. Peg cells are seen in :

1/1
Fallopian tubes

Ovary
Vagina
Vulva
Feedback
The peg cells present in the inner lining of fallopian tube capacitate spermatozoa, making them capable of
fertilizing an ovum in the ampulla. Nutrients secreted by the peg cells aid in maintenance of the
spermatozoa and the ovum. The cilia beat toward the uterus, helping to maintain sterility of the tube.
33. Amniotic fluid pH is:
1/1
6.3 to 6.5
6.4 to 6.8
7.4 to 7.6
7.01 to 7.5

Feedback
Normal vaginal secretions have a pH of 4.5 to 5.5, whereas amniotic fluid has a pH of 7.0 to 7.5.

34. A pregnant woman in 3rd trimester has normal blood pressure when standing and sitting.
When supine, BP drops to 90/50. What is the diagnosis?
0/1
Compression of uterine artery
Compression of aorta
Compression of IVC (inferior vena cava)
Compression of internal iliac vessels

Correct answer
Compression of IVC (inferior vena cava)
Feedback
Supine hypotension syndrome
During late pregnancy the gravid uterus produces a compression effect on the inferior vena cava, when the
patient is in the supine position.This, generally results in opening up of collateral circulation by means of
paravertebral and azygous veins.
In some cases (10%) when the collateral circulation fails to open, the venous return of the heart may be
seriously curtailed which results in production of hypotension, tachycardia and syncope. Normal blood
pressure is quickly restored by turning the patient to lateral position.

35. Variable deceleration is seen in:

0/1
Head compression

Uteroplacental insufficiency
Umbilical cord compression
Artifact

Correct answer
Umbilical cord compression
Feedback
In CTG
-Early deceleration: Head compression
-Late deceleration: Utero-placental insufficiency
-Variable deceleration: Umbilical cord compression

36. Which of the following is a tocolytic:

0/1
Oxytocin
Ergotamine
Ritodrine
None of the above

Correct answer
Ritodrine
Feedback
Tocolytics are medicines that attempt to stop labor. They are used if labor begins before term. Tocolytics
can stop labor or delay labor to give the fetal lungs time to mature.
Terbutaline, ritodrine, nifedipineand magnesium sulfate are all used as tocolytic drugs

37. Jadelle is
0/1
Non steroidal contraceptive
Subcutaneous implant
Hormonal IUCD

Depot

Correct answer
Subcutaneous implant
Feedback
-Jadelle is one of the several Long Acting Reversible Contraceptives (LARC).
-It is made of two rod-shaped implants.
-Mean daily in vivo release rate of levonorgestrel is approximately
100 μg/day at Month 1, 40 μg/day at 12 months, and 30 μg/day at
24 months and beyond.
-Two implants each containing 75 mg of levonorgestrel are inserted
subdermally using aseptic technique in the medial aspect of the
non-dominant upper arm by a healthcare provider. Total
administered (implanted) dose is 150 mg.
JADELLE must be removed no later than by the end of the fifth
year

38. The most common form of fatal fetal traumatic injury incurred during breech extraction
is:
1/1
Rupture of the liver
Rupture of the spleen
Intraadrenal hemorrhage
Intracranial hemorrhage

Feedback
The most frequent single cause of death in breech presentation is intracranial haemorrhage due to tentorial
tears, these tears are the result of sudden excessive pressure on the after coming head.

39. Normal weight of infant at 2 year from birth is:

0/1
Doubled

Tripled
Quadrupled
< 10 kg

Correct answer
Quadrupled
Feedback
Normal Weight of newborn increase as follows:
• Weight doubles by 6 months of age.
• Weight triples by 1 year of age.
• Weight quadruples by 2 years of age.
• Annual increase (Ages 2-9): 2.0 kg/year.

40. The earliest indicator of response after starting iron in a 6-year-old girl with iron
deficiency is:
0/1
Rise in reticulocyte count
Rise in Hb
Rise in ferritin

Rise in serum iron

Correct answer
Rise in reticulocyte count
Feedback
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.
However the most sensitive test to detect IDA is Serum ferritin level.

41. A child with pyoderma becomes toxic and presents with respiratory distress. His chest
radiograph shows patchy areas of consolidation and multiple bilateral thin walled air
containing cyst. The most likely diagnosis is:
0/1
M. tuberculosis
S. aureus
M. avium intracellulare
P. carinii

Correct answer
S. aureus
Feedback
Pneumatoceles (thin walled air containing cyst) are characteristics findings in Staphylococcal pneumonia.
The history of pyoderma makes the diagnosis more clear.

42. Most common etiological agent for acute bronchiolitis in infancy is:
1/1
Rhino virus
RSV

Influenza virus
Parainfluenza virus
Feedback
RSV is human orthopneumo virus is a virus that causes respiratory tract infections, with the infected cells
of the mucosa fusing together to form a syncytium.
It is a major cause of lower respiratory tract infections and hospital visits during infancy and childhood.
It is most common cause of bronchiolitis which occurs usually in children < 2 years old.

43. A school going boy was noted with vacant stare several times a day. There was no
history of fever, seizures and neurological deterioration. What is the diagnosis:
0/1
Atonic seizures
Absence seizures
Myoclonic seizures
School phobia

Correct answer
Absence seizures
Feedback
-Absence seizure is characterized by a few seconds of impairment of consciousness without loss of
postural control.
-There is associated eye blinking or staring which may occur as clustered events.

44. 10 year old girl presented with fever convulsions, neck rigidity. CSF findings are protein
150 mg, sugar 40 mg, chloride 2500 mg with lymphadenopathy. What is the diagnosis?
0/1
Viral meningitis
Pyogenic meningitis

Cryptococcal meningitis
Tubercular meningitis

Correct answer
Tubercular meningitis
Feedback
Typical signs of meningitis (Fever, convulsion and neck rigidity) with increased CSF protein and decreased
sugar level and decreased chloride level associated with lymphadenopathy suggest the diagnosis of
tubercular meningitis.

CSF in TB meningitis:

-Low sugar
-Predominant cells: lymphocytes
-Opening pressure is elevated
-High protein
-Very low chloride

45. A 5 year old boy comes with overnight petechial spots in the extremities and bleeding
from nose. 2 weeks back he had history of abdominal pain and no hepatosplenomegaly.
Diagnosis is:
1/1
Acute lymphocytic leukemia
Aplastic anemia
Idiopathic thrombocytopenic purpura

Acute viral infection

Feedback
-Petechial spots and epistaxis without hepatosplenomegaly in a 5 year old boy suggest the diagnosis of
ITP.
-Idiopathic thrombocytopenia purpura (ITP) is an autoimmune disorder characterized by platelet,
destruction by autoantibodies of class lgG.
-Destruction of platelets takes place in spleen, still the spleen size remains normal, a characteristic finding.

46. Which of the following does not indicates respiratory distress in neonate:
0/1
Wheeze
Grunt
Tachypnea
Retraction

Correct answer
Wheeze
Feedback
The principle features of the respiratory distress in a neonate:-
•Tachypnoea
•Use of accessory muscles for respiration
•Use of intercostal or subcostal muscles for respiration resulting in intercostal or subcostal recession -
lower chest wall indrawing.
•Audible grunting
•Cyanosis

47. NADA’s criteria are used for:

1/1
Assessment of child for degree of malnutrition
Assessment of child for degree of dehydration
Assessment of child for degree of mental retardation
Assessment of child for presence of heart disease

Feedback
NADA's criteria can be used for assessing whether congenital heart disease is present or not.
Presence of 1 major or 2 minor criteria indicates very high possibility of congenital heart disease.
The major criteria are :
1. systolic murmur grade 3 or more specially with a thrill
2. diastolic murmur
3. cyanosis
4. congestive cardiac failure
The minor criteria are :
1. systolic murmur less than grade 3 in intensity
2. abnormal second heart sound ( S2)
3. abnormal ECG
4. abnormal X-ray
5. abnormal blood pressure

48. A 10-year-old male was transferred to a tertiary center from an outside hospital with a 4-
day history of bloody diarrhea, thrombocytopenia, anemia, and elevated blood urea nitrogen
(BUN) and creatinine with concern for a disease X. On admission, significant laboratory
findings included the following: hemoglobin 10.5 g/dL, platelets 45 × 109/L, BUN 43 mg/dL,
creatinine 2.46 mg/dL, and lactate dehydrogenase of 5455 U/L. Stool culture grew out E coli
O157:H7, though Shiga 1 and 2 toxins were not detected. Complement factors (C3, C4, CH50,
complement factors H, B, and I) and genetic panel were found as normal. What do you think
of the disease X as?
1/1
DIC
TTP
HUS

ITP
Feedback
-Hemolytic uremic syndrome (HUS) is an acute syndrome defined by a triad of hemolytic anemia,
thrombocytopenia, and acute renal failure.
-Shiga toxin-producing Escherichia coli (often E coli O157:H7 strain) is a leading cause of HUS, although
Streptococcus pneumonia and human immunodeficiency virus (HIV) infection can also cause HUS.
-HUS triggered by an infection presents with hematochezia, fever, abdominal pain, nausea, and emesis.
Clinical findings related to acute renal failure can include anuria or oliguria, hypertension, elevated
creatinine, elevated blood urea nitrogen (BUN), proteinuria, microscopic hematuria, and pyuria.
-Hemolytic anemia, thrombocytopenia, and acute renal failure can present insidiously with lethargy and
uremia, or patients may present with a petechial rash, scattered ecchymosis, or hematuria. In these cases,
a family history of HUS can help inform consideration of the diagnosis, as many of the complement
pathway mutations are inherited.

49. Cubitus varus deformity occurs most commonly due to:

0/1
Mal-united supracondylar #
Mal-united lateral condyle #

Medial epicondyle #
Elbow dislocation

Correct answer
Mal-united supracondylar #
Feedback
Cubitus varus or gunstock deformity is most obvious when the elbow is extended and the arms are
elevated. The most common cause is mal-union of a supracondylar fracture and the deformity can be
corrected by a ‘wedge osteotomy’ of the lower humerus.

50. Manoeuvre carried out for diagnosing medial meniscus injury is

1/1
McMurray’stest

Lachmann’s test
Varus stress test
Valgus stress test
Feedback
McMurray’s test: For meniscus injury
Lachman’s test :Best for ACL injury
Valgus and varus stress test are for medial and lateral collateral ligament injury respectively.

51. In which of the following Bankart's lesion is seen:

0/1
Posterior border of head of humerus

Anterior border of head of humerus

Posterior rim of glenoid cavity
Anterior rim of glenoid cavity

Correct answer
Anterior rim of glenoid cavity
Feedback
A Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior
shoulder dislocation.
Bankart lesions may be treated through conservative methods such as rest, immobilization and physical
therapy, particularly in older patients. However, many cases require surgery to reattach the torn labrum to
the socket of the shoulder.

52. Commonest site of TB spine is :

0/1
Cervical
Dorsolumbar
Lumbar

Lumbosacral

Correct answer
Dorsolumbar
Feedback
Spinal TB (Pott's disease) is the most common as well as one of the most dangerous forms of skeletal TB
and accounts for 50% of all cases of skeletal TB.
Although the thoracolumbar junction seems to be the most common site of the spinal column involvement
in spinal TB, any part of the spine can be affected

53. Histology of Ewing’s sarcoma shows small round cells filled with:
1/1
Glycogen

Fat
Iron
Mucin
Feedback
Ewing’s sarcoma or endothelial sarcoma of bone is a highly malignant but uncommon sarcoma that arises
in the bone marrow.
Histologically the tumor is composed of sheaths of uniform, small cells resembling lymphocytes. Presence
of intracytoplasmic glycogen is a distinctive but not pathognom ic feature of Ewing’s sarcoma as it is also
seen in other primitive tumor cells such as those found in osteosarcomas, rhabdomyosarcomas
and neuroblastomas.

54. False regarding Perthes disease is:

1/1
It is a type of subluxation of hip

Boys are affected more commonly

Osteochondritis of hip
Avascular necrosis of head of femur
Feedback
Legg-Calve-Perthes disease (coxa plana; pseudocoxalgia; osteochondritis of the femoral capital epiphysis;
Perthes disease) is an avascular necrosis of the head of femur usually seen in children. Boys are affected
more commonly .
Currently, a number of factors have been implicated as a cause , including heredity, trauma, endocrine
dysfunction, inflammation, nutrition, and altered circulatory hemodynamics.

55. Cold chain is related to:

1/1
Common cold
Transmission of disease in cold regions
Vaccine transportation

Allergic reactions from vaccines stored in cold temperature

Feedback
Cold chain: System of storage and transportation of vaccines under low temperature. It takes a chain of
precisely coordinated events in temperature-controlled environments to store, manage and transport these
life-saving products.
Vaccines must be continuously stored in a limited temperature range – from the time they are manufactured
until the moment of vaccination.
Temperatures that are too high or too low can cause the vaccine to lose its potency (its ability to protect
against disease). Once a vaccine loses its potency, it cannot be regained or restored. A high-quality cold
chain allows health workers to deliver life-saving vaccines to every last child.

56. Early diagnosis and treatment falls under

1/1
Primary prevention
Secondary prevention

Tertiary prevention
Primordial prevention
Feedback
Secondary prevention -Early diagnosis and treatment and survelliance of disease to check further
progression.It starts after onset of disease
Primary prevention: Health promotion and specific protection
Tertiary prevention: Disability limitation and Rehabilitation
Primordial prevention: Health education/promotion to prevent risk factors from entering a community.
Screening is secondary prevention.

57. The 12th National Population Census in Nepal ,scheduled for June 8 2021 to June 22
2021 , has been postponed indefinitely due to the surge in corona virus cases. When was the
last National Population Census held in Nepal ?
1/1
2066 BS
2070 BS
2072 BS
2068 BS
Feedback
In Nepal National Population Census is held in every 10 years by Central Beaurau Of Statistics. The last
census was held in 2068 BS and the first census was held in 1968 BS/1911 AD.

58. Chi square test is used to measure degree of :

1/1
Association between two variables

Correlation between two variables

Agreement between two observations
None of above
Feedback
The test of association between two events is the most important application of the Chi-square test in
statistical methods.
It measures the probability of association between two discrete attributes.

59. When a person reject the null hypothesis ,this is :

1/1
Type I error

Type II error
Type III error
Type IV error
Feedback
There are two types of error :
Type I error: null hypothsis (Ho) is rejected when it is true
Type II error: null hypotheis (Ho) is not rejected when it is false.
@ Not rejected=false Negative=Type II or Beta error

60. Acculturation is :
1/1
Mingling with other cultures

Exchange ideas
Abroad going
Brain washing
Feedback
Acculturation is a process of social, psychological, and cultural change that stems from the balancing of
two cultures while adapting to the prevailing culture of the society. Acculturation is a process in which an
individual adopts, acquires and adjusts to a new cultural environment.

61. BCG vaccine is given :

0/1
Subcutaneous
Intradermal
Intramuscular

Oral

Correct answer
Intradermal
Feedback
BCG is live attenuated vaccine intradermal on skin over left deltoid muscle.
Dose is 0.05 ml in neonates and 0.1 ml for infants.
It does not have protective efficacy against pulmonary tuberculosis. It is contraindicated in pregnancy and
immunocompromised states.
BCG is given in the left upper arm in India and in right upper arm in Nepal.

62. Study in which population is considered as unit of study:

0/1
cross-sectional
ecological
case-control
cohort

Correct answer
ecological
Feedback
An ecological study is an observational study defined by the level at which data are analysed, namely at the
population or group level, rather than individual level. Ecological studies are often used to measure
prevalence and incidence of disease, particularly when disease is rare.

63. Glycemic index denotes :

0/1
Food's ability to stimulate insulin release
Food's ability to stimulate glucagon release
Food's ability to release blood sugar
All are correct

Correct answer
Food's ability to release blood sugar
Feedback
The Glycemic Index (GI) is a relative ranking of carbohydrate in foods according to how they affect blood
glucose levels. Carbohydrates with a low GI value (55 or less) are more slowly digested, absorbed and
metabolised and cause a lower and slower rise in blood glucose and, therefore usually, insulin levels.
64. The freshly prepared ORS should not be used after:
1/1
6 hrs
12 hrs
18 hrs
24 hrs

Feedback
Generally ORS solution should be covered and not kept for more than 24 hours, due to the risk of
bacteriological contamination.

65. Induction agent that may cause adrenal cortex suppression is:
1/1
Ketamine
Etomidate

Propofol
Thiopentone
Feedback
•Etomidate can block the adrenal gland's production of cortisol and other steroid hormones, resulting in
temporary'adrenal gland failure'. This may cause abnormal salt and water balance, lowered BP, and, finally,
shock.
•Postoperative or critically ill patients may require adrenocorticoid supplementation.

66. Pneumothorax is a complication of which of the following blocks:

0/1
Axillary

Brachial
High spinal
Epidural

Correct answer
Brachial
Feedback
Complications of brachial plexus block (Supraclavicular technique):
• Paralysis of phrenic nerve
• Puncture of vessels (including subclavian artery)
• Pneumothorax due to piercing of Sibson’s fascia

67. Which one of the following anaesthetic agents causes a rise in the intracranial pressure
1/1
Lignocaine
Propofol
Thiopentone sodium
Sevoflurane

Feedback
Agents causing increased ICP: Sevoflurane, nitrous oxide, methoxyflurane, isoflurane, halothane,
enflurane, desflurane, ketamine

68. Agent causing malignant hyperthermia is:

1/1
Succinylcholine

Ketamine
Gallamine
Dantroline
Feedback
•Life threatening genetic abnormality of skeletal muscle characterized by sympathetic stimulation
tachycardia, tachypnoea, Incresed BMR, Hyperkalemia, Muscle Rigiditym Hypertension, DIC and Fever
•Seen in children of muscle dystrophy
•Triggered by
o Suxamethonium(Succinyl choline)
o Halothane
o Methylflurane
o Isoflurane etc
•DOC in Malig Hyperthermia: Dantrolene Sodium

69. Post-spinal headache is due to:

1/1
Increased ICP
CSF leak

Meningitis
Encephalitis
Feedback
Post Spinal Headache /Post dural puncture headache
•Most commonly due to CSF leak
•Post spinal headache lasts for 7-10 days,
•Usually Bifrontal or Occipital
•Post Spinal Headache can be prevented by Smaller Needle Gauze (thinner Needle)
•Risk of Post Dural Puncture Headache is increased with Large Diameter Needle, Cutting Needle, Pregnancy
and Younger Adults (NOT ELDERLY)

70. Drug which is contraindicated in head injury is

1/1
Oxygen
IV Fluids
Antibiotics
Morphine

Feedback
• Morphine is contraindicated in head injury or increased intracranial pressure or intracranial lesions
because of risk of respiratory depression and further elevation of CSF pressure.
• Morphine and other Opoids increase the tone of common bile duct and sphincter of oddi. Its uses in
• patient with biliary colic may produce an increase in pain rather than relief

71. Spinal anaesthesia should be injected into the space between:

1/1
L1-L2
L3-L4

Below L5
T12-L1
Feedback
Spinal Anesthesia
•Spinal anesthesia is given at L2-3 or L3-4 in adult & at L4-5 in infant.
•Spinal cord in adults ends at the level of L2 (lower border of L1) & upto L3 in children.

To avoid potential needle trauma to spinal cord, lumbar puncture is usually not performed above L2 in adult
and above L3 in children.

72. Which one of the following is not an amide linked local anaesthetic:
1/1
Bupivacaine
Lignocaine
Dibucaine
Procaine

Feedback
•Ester Linked (Cocaine, Procaine, Chlorprocaine, Tetracaine, Benzocaine) (One I and have Allergic
Phenomenon)
•Amide Linked (Lignocaine, Bupivacaine, Dibucaine, Prilocaine, Ropivacaine, Mepivacaine) (Amide 2 i So
No Allergic Phenomenon)

73. Koebner phenomenon is positive in

1/1
Psoriasis
Lichen planus
Warts
All of above

Feedback
The phenomenon by which lesions appear in areas of injury is called Koebner’s phenomenon. It occurs in
psoriasis, lichen planus, vitiligo, warts, erythema multiforme, verruca plana.
In viral skin infections (warts) actually it is called pseudoKoebner phenomenon.

74. Melanin is produced in:

1/1
Keratinocytes
Melanocytes

Langerhans cells
Merkel cells
Feedback
Melanocytes (melanin synthesis)
Langerhans cells (immunological function, APC of skin)
Merkel cells (sensory receptor cell)

75. Chancroid is caused by:

1/1
H. ducreyi

HSV
HPV
T. pallidum
Feedback
Chancroid is a sexually transmitted infection caused by the bacteria Haemophilus ducreyi.
It is characterized by genital ulceration and inguinal adenitis. A painful genital ulcer with an irregular shape,
associated with painful lymphadenopathy.

76. Delusion is a disorder of:

1/1
Thought

Insight
Perception
Cognition
Feedback
•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.

77. Hallucinations are:

1/1
Perception occurring without external stimulation
Mis-interpretation of stimuli arising from external object
Feeling of familiarity with unfamiliar things
Alteration of perception of ones reality
Feedback
•Hallucination are Perception occurring without external stimulation Hallucination: A perception that occurs
in absence of stimulus.
•Illusion: Mis-interpretation of stimuli arising from external object

78. Normal intraocular pressure is:

0/1
10-15 mm Hg
15-20 mmHg
20-30 mmHg

30-40 mmHg

Correct answer
15-20 mmHg
Feedback
Intraocular pressure is the pressure inside the eyeball and it is determined by the rate of aqueous
production by the ciliary process and amount of its drainage through trabecular meshwork.
The intraocular pressure in a human eye usually ranges from 15-20 mm Hg.

79. The refractive power of a normal human eye is:

1/1
+10 D
+20 D
+30 D
+60 D

Feedback
Total power of Eye: 60 Dioptres (Cornea = 45D & Lens = 15D).

80. Infant’s eye is:

1/1
Myopic
Hypermetropic

Astigmatic
None of the above
Feedback
All eyes at birth are hypermetropic and with the growth of body their anterioposterior diameter increases
and reaches normal length in adolescence.
81. Keyser-Fleischer Ring is seen in:
1/1
Wilson disease

Gaucher disease
Niemann Pick disease
Cystic fibrosis
Feedback
Wilson’s disease is a disorder of copper metabolism, in which copper deposits in peripheral cornea to give
brown ring called the Keyser-Fleischer (KF) Ring. They are deposited in Descemet's membrane.

82. Herbert’s pits are seen in:

1/1
Trachoma

Cataract
Glaucoma
Spring catarrh
Feedback
Follicles like infiltrations seen near the limbus in a patient of trachoma are known as Herbert’s pits.

83. Chalazion is the infection of:

1/1
Sebaceous glands
Meibomian glands

Zeis’ gland
Conjunctiva
Feedback
Chalazion is a chronic granulomatous inflammation of the meibomian gland. Meibomian glands (also called
tarsal glands) are holocrine type exocrine glands, along the rims of the eyelid inside the tarsal plate. They
produce meibum, an oily substance that prevents evaporation of the eye's tear film.

84. Nasolacrimal duct opens in:

1/1
Superior meatus of nose
Inferior meatus of nose

Middle meatus of nose

Sphenoethmoidal recess
Feedback
Meatuses of Nose:
•Inferior meatus: - Opening of Nasolacrimalduct
•Middle meatus : Opening of maxilary, frontal and anterior&middle ethmoidal air sinus
•Superior meatus: - Opening of posterior ethmoidalairsinus
•Sphenoethmoidal recess: - Opening of sphenoid sinus

85. Meniere’s disease is characterized by the triad of:

1/1
Deafness, tinnitus, vertigo

Deafness, tinnitus, tremors

Deafness, vertigo, nystagmus
Deafness, tremors, nystagmus
Feedback
•Classic triad of vertigo, tinnitus and sensorineural hearing loss, usually in one ear is characteristic of
Meniere’s disease.
•Trotter‟syndrome is a clinical triad of signs associated with NPC. The pathognomonic features could be
stated as unilateral deafness, pain in the area supplied by the mandibular nerve and asymmetry of the soft
palate due to due to involvement of vagus nerve.
•Classical triad of Gradenigo’s syndrome seen in Petrositis
o Deep seated orbital or retro-orbital pain due to involvement of 5th nerve.
o 6th cranial nerve palsy.
o Persistent ear discharge.

86. Cauliflower ear is due to……….. of the auricle:

1/1
Herpes
Fungal infection
Hematoma

Carcinoma
Feedback
Cauliflower ear is a traumatic condition (hematoma in boxers).

87. Stridor in an infant is most commonly due to:

1/1
Acute epiglottitis
Diphtheria
Laryngomalacia

Foreign body aspiration

Feedback
Laryngomalacia is the most common cause of inspiratory stridor in the neonatal period and early infancy.
Stridor may be exacerbated by crying or feeding.
88. Young’s operation is done for.
1/1
Allergic rhinitis
Atrophic rhinitis

Vasomotor rhinitis
None of the above
Feedback
Young’s operation is a surgery designed for the treatment of atrophic rhinitis

89. Tullio phenomenon refers to:

1/1
Vertigo on hearing high frequency sounds

Impedance matching
Increased sensitivity to hearing
Better hearing in noisy surrounding
Feedback
The ‘Tullio phenomenon’ consists of dizziness induced by high frequency sound
Tullio's occurs mainly in five ear conditions: Superior canal dehiscence, perilymph fistula, Meniere's
syndrome, post fenestration surgery, and vestibule fibrosis.

90. Notching of ribs on X- ray is seen in

1/1
PSD
ASD
Ebstein anomaly
Coarctation of aorta

Feedback
Rib notching: a radiographic sign caused by collateral circulation between the internal thoracic and
intercostal arteries

91. Sun ray appearance is seen in:

1/1
Osteoclastoma
Fibrous dysplasia
Osteosarcoma

Chondrosarcoma
Feedback
Sunburst appearance of lytic bone lesions and/or codman triangle is seen in Osteosarcoma
92. Bone density is best studied by
1/1
CT scan
DEXA scan

MRI
Bone scan
Feedback
DEXA scan (Dual Energy X ray Absorptiometry) is the gold standard for measuring bone density.

93. Hypoglossal nerve is :

1/1
III CN
V CN
VII CN
XII CN

Feedback
III CN- Occulomotor
V CN - Trigeminal
VII CN- Facial

94. Total number of spinal nerve pairs are:

1/1
30
31

32
33
Feedback
Cervical: 8 pairs
Thoracic: 12 pairs Lumbar : 5 pairs Sacral : 5 pairs Coccygeal : 1 pair

95. Oesophagus cross the diaphragm at level of :

0/1
T6
T8

T10
T12

Correct answer
T10
Feedback
T10 Venacava (8 letters)- T8 Oesophagus(10 letters)-T10 Aortic Hiatus (12 letters)- T12

96. Root supply of knee jerk is:

0/1
L2 to L3

L1 to L4
L2 to L4
L4 to S5

Correct answer
L2 to L4
Feedback
Knee jerk is supplied by L2, L3 and L4.
Ankle jerk = S1, S2
Biceps = C5, C6
Triceps = C6, C7

97. Shortest part of male urethra is:

0/1
Membranous
Prostatic
spongy
Penile

Correct answer
Membranous
Feedback
Male urethra has 3 parts:
prostatic part (3 cm) Membranous part (1.5-2 cm) Spongy part (15 cm)

98. Which of following is water soluble vitamin:

1/1
Folic acid

VitaminA
VitaminD
VitaminK
Feedback
Fat soluble vitamins: A,D,E & K
Water soluble vitamins: B and C
99. Protein synthesis occurs in :
1/1
Mitochondria
Ribosomes

Endoplasmic Reticulum
Nucleus
Feedback
Transcription takes place in nucleus ,Translation occurs in cytoplasm where ribosomes are located.

100. Gluconeogenesis mostly occurs in :

1/1
Liver

Muscle
Heart
Kidney
Feedback
Gluconeogenesis occurs in liver (90%) and kidney (10%)

101. Urea cycle occurs in liver. Urea is formed by:

1/1
CO2
NH3
CO2 &NH3

None
Feedback
Urea is formed by ornithine cycle. Ammonia is very toxic to body .

102. A codon consist of:

0/1
2 complementary base pairs

3 complementary base pairs

4 complementary base pairs
6 complementary base pairs

Correct answer
3 complementary base pairs
Feedback
-64 codons code 20 amino acids.
-Coding sequence is known as extrons, comprise 3% of human genome
-Non coding sequence is known as introns ,comprise 97% of human genome

103. Pin point pupils' are seen in all of following conditions except :
1/1
Cerebellar pontine hemorrhage
Opioid Poisoning
OP poisoning
Dhatura poisoning

Feedback
In Dhatura poisoning dilated pupils are seen.

104. In rigor mortis;

1/1
Muscle stiffens
Muscle shorten
Muscle lengthens
Both a and b

Feedback
Rigor mortis is characterized by stiffening ,shortening ,opacity of the muscles.

105. Drug of choice for mushroom poisoning is;

1/1
Atropine

Adrenaline
Physostigmine
None of the above
Feedback
Atropine is specific antidote for early mushroom poisoning.

106. Which of following is not a cause of death due to suffocation:

0/1
Throttling
Smothering
Choking
Gagging

Correct answer
Throttling
Feedback
Throttling (Manual strangulation with hands )

107. Which of the following drugs is used for narcoanalysis?

0/1
Atropine
Phenobarbitone
Scopolamine
Pethidine

Correct answer
Scopolamine
Feedback
Drugs used for narcoanalysis are:
 Scopolamine (hyoscine)
 Sodium thiopental (Sodium Pentothal)
 Amobarbital (Amytal Sodium)
 Secobarbital sodium (Seconal)

108. Sparrow's foot mark is seen in

0/1
Gunshot injuries

Stab injury of face

Windshield glass injury
Vitrolage

Correct answer
Windshield glass injury
Feedback
Sparrow's foot marks refer to the bizarre lacerations over the faces seen in the first row occupants in the
motor vehicle accidents as a result of contact with the shattered windscreen glass.

109. Most specific test for diagnosing syphilis is:

0/1
Treponema Pallidium Immobilization(TPI)
VDRL

Western blot
Weil Felix

Correct answer
Treponema Pallidium Immobilization(TPI)
Feedback
There are treponemal test and non treponemal test for serological test for syphilis.

Treponema Pallidium Immobilization(TPI): serological test for syphilis in which a solution containing the
living causative spirochete (Treponema pallidum) is combined with serum in the presence of complement
with immobilization of the active spirochetes indicating a positive result

110. Paul Bunell Test is done in:

1/1
Entericfever
Typhusfever
Infectious mononucleosis

Measles
Feedback
Infectious Mononucleosis is caused by Epstein Barr Virus (EBV)

111. Urine culture is done in

0/1
LJ medium

Blood agar
Choclate agar
McConkey agar

Correct answer
McConkey agar
Feedback
Most common organism responsible for urinary tract infections is E.coli which is grown in McConkey agar

112. Intermediate host for hydatid disease is:

0/1
Man
Dog
Cow
Pig

Correct answer
Man
Feedback
Hydatid disease is a parasitic infestation by a tapeworm of genus Echinococcus. Liver is most common
organ involved, followed by lungs.
113. All of following are local signs of acute inflammation except :
1/1
Rubor
Calor
Tumor
Pallor

Feedback
Cardinal signs of acute inflammation are
Rubor
Calor
Dolor
Tumor
Function laesa

114. Gandy gamma bodies are seen in :

0/1
Iron deficiency anemia
Pernicious anemia

Sickle cell anemia

Thalessemia

Correct answer
Sickle cell anemia
Feedback
Sickle cell anemia is caused due to mutation in Hemoglobin-Beta gene found on chromosome 11. In this,
missense mutation results in glutamate being replaced by valine at the 6th position of Beta globin gene.

115. Biomarkers to rise earliest in myocardial infarction is :

1/1
CK-MB
Myoglobin

Troponin
Homocysteine
Feedback
Myoglobin is first to rise (2-3 hr) and troponin is last to disappear

116. Flask shaped ulcer is charcteristics of :

1/1
Amoebic ulcer

Tubercular ulcer
Ulcerative Colitis
Crohn's disease
Feedback
Amoebic ulcer is Caused by Entamoeba histolytica

117. Most common malignancy in AIDS is:

1/1
Leukemia
Kaposi's sarcoma

Burkitt's Lymphoma
B cell lymphoma
Feedback
Kaposi sarcoma (KS) is a cancer that causes patches of abnormal tissue to grow under the skin, in the
lining of the mouth, nose, and throat, in lymph nodes, or in other organs. These patches, or lesions, are
usually red or purple. They are made of cancer cells, blood vessels, and blood cells.

118. Marker for carcinoma colon is :

1/1
HCG
CEA

CA-125
AFP
Feedback
Hepatic cancer tumor marker is AFP
Ovarian cancer tumor marker is CA-125
Choriocarcinoma tumor marker is HCG

119. Howell jolly bodies may be seen after :

1/1
Cholecytectomy
Hepatectomy
Splenectomy

Pancreactomy
Feedback
Howell Jolly bodies seen in :Megaloblastic anemia , Hemolytic anemia, Post splenectomy

120. Orphan drugs are

1/1
Drugs to treat rare disease usually
Commercially difficult to obtain
Both a & b

None
Feedback
Orphan drugs are not marketed by the manufacturing companies . They are commercially difficult to obtain.

121. Which is true about muscarinic receptors :

1/1
M1-Glands
M2-Heart

M3-Nerves
None of above
Feedback
M1- Nerves
M2-Heart,
M3-Glands,smooth muscle,endothelium

122. Which of following antitubercular drug is contraindicated in pregnancy ?

1/1
Isoniazid
Rifampicin
Pyrazinamide
Streptomycin

Feedback
@PRISE are antitibercular drug.
Pyrazinamide, Rifampicin, Isoniazid, Streptomycin, Ethambutol

123. Drug of choice for MRSA is :

1/1
Erythromycin
Cotrimoxazole
Streptomycin
Vancomycin

Feedback
MRSA means Methicillin Resistant S.Aureus. Vancomycin is DOC for MRSA while Linezolid can be used for
VRSA

124. Which immunoglobulin is maximum in newborn?

0/1
IgG
IgA
IgM

IgD

Correct answer
IgG
Feedback
IgG(75%)-crosses placenta
IgA(15%)
IgM(9%) IgD(0.2%)
IgE(0.004%)

125. All of following hormones are secreted by anterior pituitary gland except :
0/1
GH
FSH
TSH

GnRH

Correct answer
GnRH
Feedback
GnRH (Gonadotropin releasing hormone) is secreted by hypothalamus

126. Normal pH of blood is :

0/1
7.2

7.3
7.4
7.5

Correct answer
7.4
Feedback
Normal pH of blood is 7.35-7.45

127. Ventilation perfusion ratio is:

0/1
0.4
0.8
1.0
1.2

Correct answer
0.8
Feedback
Ventilation perfusion ratio = Alveolar ventilation / cardiac output
= 4 lit/min / 5 lit/min
= 0.8

128. Prothrombin time is

0/1
2 sec
12 sec
22 sec
42 sec

Correct answer
12 sec
Feedback
Bleeding time: 2-6 minutes
Clotting time :6-10 minutes
PT: 10-12 seconds
The reference range of the aPTT is 30-40 seconds. The reference range of the PTT is 60-70 seconds

129. The total number of milk teeth (temporary teeth) is:

1/1
20

26
30
32
Feedback
Total number of milk teeth is 20 while permanent teeth is 32

130. Dental plaque is formed by:

1/1
E. coli
Streptococcus mutans

S. auteus
HSV
Feedback
Dental plaque: Acid forming bacteria (Streptococcus mutans)

131. A 15 years old male child from rural Chitwan landed in Emergency of CMC-TH with
complains of low grade fever for 2 months. Child looked lethargic and tachypenic. On
examination, liver was palpable 5 cm below the right costal margin and massive
splenomegaly was also noted. Eschar was absent. Pancytopenia was found in the
hematological examination. What is the most likely diagnosis? (NEXT FOUR QUESTIONS
FOLLOWING THIS QUESTION ARE BASED ON THIS SCENARIO)
0/1
Dengue fever

Scrub typhus
Leptospirosis
Kalaazar

Correct answer
Kalaazar

132. What is the causative agent of this condition?

0/1
Mosquito

Mites
Sandfly
Leishmania donovani

Correct answer
Leishmania donovani

133. Drug of choice for the treatment of this patient is

0/1
Ampicillin
Ceftriaxone

Doxycycline
Amphotericin B

Correct answer
Amphotericin B

134. Presence of eschar is suggestive of

0/1
Endemic typhus
Babesiosis
Chiggerosis
Relapsing fever

Correct answer
Chiggerosis

135. Kala azar is transmitted by:

1/1
Droplet infection
Sandflies

Anopheles
Black fly
Feedback
Kala-azar
• Presence of long duration of fever along with hepatosplenomegaly, endemic area and pancytopenia
suggest diagnosis of Kala-azar.
•Kala-azar is caused by Leishmania donovani while transmitted by Sandfly.
• Clinical feature includes High Fever, Abdominal Discomfort, Emaciation, Pallor, Marked Splenomegaly and
Moderate Hepatomegaly
• Investigation: rK-39, Bone marrow and splenic aspiration to demonstrate LD Bodies
•DOC: Liposomal Amphotericin B
Chiggerosis is another name for Scrub typhus and eschar caused by bite of chigger mite is specific
examination finding for this disease.

136. A 69 year old male, known case of hypertension for 5 years, under medication
presented to ER with complaints of slurring of speech for 3 hours. On examination, BP is 160
/100 mm of Hg, he has irregularly irregular pulse, facial deviation towards the left side.
Muscle strength over the right arm is 1/5, right leg 4/5 and is 5/5 over left arm and left leg. He
has decreased sensation to light touch and has pain in right side of body. Which of the
following is most likely diagnosis: (NEXT FOUR QUESTIONS FOLLOWING THIS QUESTION
ARE BASED ON THIS SCENARIO)
0/1
Hemorrhagic stroke
Ischemic stroke

SAH
Brain tumor

Correct answer
Hemorrhagic stroke

137. What is the site of lesion in the above case:

1/1
Left cerebral hemisphere along MCA distribution

Right cerebral hemisphere along MCA distribution

Left cerebral hemisphere along PCA distribution
Right cerebral hemisphere along ACA distribution

138. Most common site of Berry aneurysm is:

0/1
Junction of anterior communicating artery with anterior cerebral artery
Junction of posterior communicating artery with internal carotid artery
Middle cerebral artery bifurcation

Vertebral artery

Correct answer
Junction of anterior communicating artery with anterior cerebral artery

139. Most common cause of Sub-arachnoid hemorrhage is

1/1
HTN
AV malformation
Rupture of berry aneurysm

Tumors

140. Lateral medullary syndrome includes all of the following except:

1/1
CN V
CN IX
CN X
CN XII

Feedback
•Hypertensive patient, so hemorrhagic stroke likely
•Right sided complete hemiplegia seen in this case, so lesion should be in left side along MCA, as arms
more affected than legs and right sided facial palsy seen as face deviated to left
•ACA strokes usually affect the leg more than the arm or face. MCA infarctions predominantly affect the
face and upper extremity. PCA infarctions cause visual field deficits.
•Vertebrobasilar syndrome can present in numerous ways but there are usually crossed signs. There may
be an ipsilateral cranial nerve deficit associated with contralateral hemiplegia.
•Cerebellar infarcts usually present as ataxia associated with nausea and vomiting. Cranial nerve findings
may also be evident.
•Most common cause of sub arachnoid hemorrhage is Berry aneurysm.
•Lateral medullary syndrome/ Wallenberg syndrome is due to ischemia in the lateral part of the medulla
oblongata in the brainstem. The ischemia is a result of a blockage most commonly in the vertebral artery or
the posterior inferior cerebellar artery.This syndrome is characterized by sensory deficits that affect the
trunk and extremities contralaterally (opposite to the lesion), and sensory deficits of the face and cranial
nerves ipsilaterally (same side as the lesion). It involves CN V, VIII, IX, X.

141. A 55 year old patient of ulcerative colitis presents to a Gastro clinic with severe
abdominal pain, leukocytosis and high temperature with massively distended colon on X-
ray. Most likely diagnosis would be: (NEXT FOUR QUESTIONS FOLLOWING THIS QUESTION
ARE BASED ON THIS SCENARIO)
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Toxic Megacolon

Pseudomembranous colitis
Boerhaave's rupture
Mallory Weiss Syndrome

142. Ulcerative colitis is commonly associated with the following except

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toxic megacolon
perforation

massive bleeding
stricture of colon

Correct answer
stricture of colon

143. "Skip lesion" Is seen In which of the following condition:

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Crohn's disease

Ulceratice colitis
Hodgkin's disease
Sarcoidosis

144. Sulphonamide used for the treatment of colitis Is:

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Sulphacetamide
Sulphasalazine
Sulphamethizole
Sulphadiazine

Correct answer
Sulphasalazine
145. All of the following are known predisposing factors for cholangiocarcinoma except:
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CBD stones
Clonorchis sinensis
Ulcerative colitis

Primary sclerosing cholangitis

Correct answer
CBD stones
Feedback
• Since the patient is of Ulcerative colitis with severe abdominal pain, leukocytosis and high temperature
with massively distended colon on X-ray, it is most probably Toxic megacolon
• Stricture of colon are most commonly associated with Crohn's disease
• A skip lesion is a wound or inflammation that is clearly patchy, "skipping" areas that thereby are
unharmed. It is a typical form of intestinal damage in Crohn's disease.
• Common bile duct stones are not found associated with the incidence of cholangiocarcinoma

146. A 27 years old intoxicated man smashes his car against a tree. He is tender over the left
lowerchest wall. Chest X-ray shows fractures of the 8th, 9th and 10th ribs on the left. He has
a BP of 80 over 50 and a pulse rate of 128 bpm. The most likely injured organ is: (NEXT
FOUR QUESTIONS FOLLOWING THIS QUESTION ARE BASED ON THIS SCENARIO)
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Liver
Stomach
Spleen

Left kidney

147. The following signs can be elicited in this case except:

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Kehr's sign

Ballance sign
Murphy's sign
Seagesser's sign

Correct answer
Murphy's sign

148. Occurrence of acute pain in the tip of the left shoulder due to the presence of blood or
other irritants in the peritoneal cavity when a person is lying down and the legs are elevated
indicate
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Kehr's sign

Ballance sign
Cullen's sign
Seagesser sign

149. Investigation of choice in this unstable patient is:

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CT scan abdomen

FAST scan
MRI abdomen
X-ray abdomen and pelvis

Correct answer
FAST scan

150. Preoperative vaccination in case of elective splenectomy does not include

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Pneumococcal vaccine
Hemophilus influenza type B vaccine
Meningococcal vaccine

Staphylococcal vaccine

Correct answer
Staphylococcal vaccine
Feedback
 MC organ damaged in blunt trauma is spleen.
 Ballance sign - the presence of a dull percussion note in both flanks, constant on the left side but shifting
type (with change of position) on the right side , said to indicate ruptured spleen; the dullness is due to the
presence of blood, fluid blood on the right side but coagulated on the left.
 Kehr's Sign refers to left shoulder pain that is caused by the irritation of the inferior surface of the
diaphragm due to bleeding from a splenic rupture
 The Saegesser sign also seen in splenic trauma is a pressure pain in the phrenic pressure point or spleen
point . This is located between the edge of the left sternocleidomastoid muscle and the anterior scalene
muscle about two to four centimeters above the collarbone . The cause of this pain is a sudden contraction
of the left side of the diaphragm and the associated irritation of the phrenic nerve
 Focused assessment with sonography in trauma (commonly abbreviated as FAST) is a rapid bedside
ultrasound examination performed by surgeons, emergency physicians, and paramedics as a screening
test for blood around the heart (pericardial effusion) or abdominal organs (hemoperitoneum) after
trauma.The four classic areas that are examined for free fluid are the perihepatic space (including Morison's
pouch or the hepatorenal recess), perisplenic space, pericardium, and the pelvis.
 Vaccine for splenectomy: H. influenza, Pneumococcus, Meningococcus (Encapsulated organisms)

151. A 30- year-old female comes to your office for her first prenatal visit. She has been
married for 3-years and has been trying to conceive for the past year. She has been
unsuccessful; however, she now has a 2- month history of amenorrhea. She has been
experiencing morning sickness and has had abdominal distension and breast fullness over
the past two weeks. She states that her home urine pregnancy test is positive. She seems
happy and excited about this long awaited pregnancy. She has no previous medical
problems. She has been taking prenatal vitamins for the past 3 weeks after she first missed
her period. Physical examination shows a tympanic abdomen. Ultrasonogram shows a
normal endometrial stripe. Pregnancy testing in the office is negative. Which of the following
is the most likely diagnosis? (NEXT FOUR QUESTIONS FOLLOWING THIS QUESTION ARE
BASED ON THIS SCENARIO)
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Missed abortion
Molar pregnancy
Pseudocyesis

Early pregnancy

152. Not a feature of pseudocyesis

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weight gain
morning sickness
amenorrhea
uterine enlargement

153. Pregnancy is confirmed by

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Morning sickness
Amenorrhea
Fetal heart activity

Uterine souffle

154. Pregnancy is contraindicated in all except:

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Eisenmenger syndrome
Primary pulmonary hypertension

Marfan syndrome with aortic root dilatation

WPW syndrome

Correct answer
WPW syndrome

155. Maximum increase in cardiac output during pregnancy is seen in:

1/1
32 weeks
36 weeks
During labor
Just after delivery

Feedback
Pseudocyesis is a false belief of being pregnant that is associated with objective signs and reported
symptoms of pregnancy, which may include abdominal enlargement and NOT Uterine enlargement,
reduced menstrual flow, amenorrhea, subjective sensation of fetal movement, nausea, breast engorgement
and secretions, and labor pains at the expected date of delivery.
Positive or absolute signs of pregnancy includes:
1. Palpation of fetal parts and perception of active fetal movements by the examiner at ~ 20th week
2. Auscultation of fetal heart sounds
3. Ultrasound evidence of embryo as early as 6th week and later fetus
Pregnancy is not contraindicated in WPW syndrome.
Maximum increase in cardiac output during pregnancy is seen just after delivery.

156. A 38 year old female presented the gynecology department with history of heavier
menstruation than usual. On pelvic examination, she had an enlarged uterus about the size
of 8-weeks pregnant uterus. Urine pregnancy test was negative. Her CBC is normal. A pelvic
ultrasound shows 2 fibroids within the uterine wall measuring 2 cm each. If malignant
change is found on further study it is known as: (NEXT FOUR QUESTIONS FOLLOWING THIS
QUESTION ARE BASED ON THIS SCENARIO)
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Uterine sarcoma
Fibrosarcoma
Rhabdomyosarcoma

Fibromyoma

Correct answer
Uterine sarcoma

157. If the patient had completed her family then what would be the treatment of choice in
this case?
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Hysterectomy

Myomectomy
TAH with BSO
Hormonal therapy

158. What is the most common type of fibroid?

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Subserosal
Intramural

Submucosal
Cervical

159. Fibromyoma is dependent on which of the following hormones?

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Progesterone
LH
Estrogen
Both estrogen and progesterone

Correct answer
Estrogen

160. All of the following causes shrinkage of fibroid EXCEPT:

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Mifepristone
Danazol
Tranexamic acid

GnRH analogues
Feedback
Uterine sarcomas are rare high malignancy tumours that arise from smooth muscles and connective tissue
elements and represent about 1% of all malignant gynaecologic tumours and about 3–7% of all uterine
malignancies. Three most common types of sarcomas are leiomyosarcoma, carcinosarcoma, and
endometrial stromal sarcoma.
Whereas, Fibroids are estrogen dependent benign smooth muscle tumour of the uterus (most common
gynecological tumour). Intramural is most common type of fibroid followed by subserosal myoma;
Remember submucosal myoma are least common but most symptomatic (bleeding, infertility).
Drugs used in Medical management of fibroid uterus includes Mifepristone, Danazol and GnRH analogues.
Definite surgical treatment of Fibroid includes: Myomectomy (removal of myoma) to preserve fertility and
Hysterectomy in patients aged >40yrs with family completed.

161. A 3-year-old boy is brought to the clinic due to an abdominal mass that his mother
noted while she was bathing him. She seems distressed about the matter, and seeks your
"expert opinion." The patient does not have any significant past medical history. On
examination, he is calm and quiet. A firm abdominal mass is palpated in the left quadrant,
which does not cross the midline. The mass is tender on deep palpation but is not pulsatile.
Urinalysis reveals a trace amount of blood. What is the most likely diagnosis? (NEXT FOUR
QUESTIONS FOLLOWING THIS QUESTION ARE BASED ON THIS SCENARIO)
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pheochromocytoma
wilms tumor

neuroblastoma
lymphoma

162. This tumor commonly metastasis to which of the following organ

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liver
brain
lymph node
lung

163. Wilm's tumor is associated with all the following except

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Aniridia
Beckwith syndrome
polycystic kidney
hemi-hypertrophy

Correct answer
polycystic kidney

164. True about Wilms tumor Is:

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Wilms tumor involves chromosome 11
It has the highest cure rates.
most common primary tumor of childhood
all of the above

165. Sustained severe hypertension In children is most commonly suggestive of

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Coarctation of aorta
Pheochromocytoma
Renal parenchymatous disease

Drug induced
Feedback
•Since the patient is 3 years old and the mass is present in left quadrant which does not extend beyond
midline, Most likely diagnosis is wilms tumor proven until otherwise
•Wilms tumor is the most common primary renal tumor of childhood
•Triad of Wilm's Tumor includes Fever, Hematuria and Abdominal Mass
• Mutations of the WT1 gene which is located on the short arm of chromosome 11 (11p13) are observed in
approximately 20% of Wilms' tumors
• Wilm's tumor is associated with WAGR (Wilm's Tumor, Aniridia, Genitourianry Abnormalites & mental
Retardation), Deny Drash Syndrome and Beckwith-Wiedemann syndrome
• The 5-year survival rate for children with a Wilms tumor is 93%. However, the rate varies according to the
stage of the disease. Stage I, II, and III tumors with a favorable histology have a 4-year survival rate that
ranges from 95% to 100%.
• The most common site of metastatic spread of Wilms tumor is the lungs; chest CT scan is the preferred
imaging modality for evaluating this site.

166. A 14 year old boy presents with intermittent claudication of B/L lower limbs. On
examination the BP was raised in upper limbs while the pulse was feeble on both lower
limbs. On chest X ray, notching of the ribs were present. Which of the following congenital
valvular diseases is most likely cause? (NEXT FOUR QUESTIONS FOLLOWING THIS
QUESTION ARE BASED ON THIS SCENARIO)
0/1
the hypo plastic left heart syndrome
severe and critical valvular aortic stenosis
mitral stenosis

coarctation of the aorta

Correct answer
coarctation of the aorta

167. All of the following conditions are associated with a systolic murmur, EXCEPT:
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anemia
mitral incompetence
aortic incompetence

ventricular septal defect

168. Which of the following congenital valvular heart diseases is associated with severe
cyanosis manifested during the first few days of life?
0/1
aorto-pulmonary fenestration

VSD
transposition of the great arteries
patent ductus arteriosus

Correct answer
transposition of the great arteries
169.If the vascular tracings of the lungs are decreased on a chest x-ray of a cyanotic
newborn, which of the following congenital valvular diseases is a possible cause
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complete transposition of the great vessels
complete transposition of the pulmonary veins
pulmonary atresia

ASD

170. All of the following statements concerning an isolated ventricular septal defect are
correct, EXCEPT:
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left to right shunt become more severe with time

decompensation might occur

signs of pulmonary congestion might occur
cyanosis, which is present in all cases, improves late

Correct answer
cyanosis, which is present in all cases, improves late
Feedback
• Coarctation of the aorta is a birth defect in which a part of the aorta is narrower than usual. Since the
narrowing of the aorta is usually located after arteries branch to the upper body, coarctation in this region
can lead to normal or high blood pressure and pulsing of blood in the head and arms and low blood
pressure and weak pulses in the legs and lower body.
• In babies with d-TGA (dextro), oxygen-poor blood from the body enters the right side of the heart. But,
instead of going to the lungs, the blood is pumped directly back out to the rest of the body through the
aorta. Oxygen-rich blood from the lungs entering the heart is pumped straight back to the lungs through
the main pulmonary artery. So severe cyanosis is manifested
• Causes of Pansystolic murmur are Mitral Regurgitation, Tricuspid Regurgitation and VSD, whereas
ejection systolic murmur are Anemia, Aortic Stenosis and Pulmonary Stenosus
• Aortic incompetence is associated with the diastolic murmur
• Decreased in Pulmonary Vascular Markings (Pulmonary Oligemia) is seen in tetrology of Fallot and
Pulmonary Atresia

171. Raju, a 5 years old child presents with poor weight gain. On examination you noticed
Bow leg deformity of the legs and expansion of the anterior rib ends at the costochondral
junction. The most likely diagnosis is: (NEXT FOUR QUESTIONS FOLLOWING THIS
QUESTION ARE BASED ON THIS SCENARIO)
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Osteogenesis imperfecta
Perthe's disease
Rickets

Osteopetrosis
172. What is the biochemical status of a child suffering from rickets?
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Low calcium, low phosphate, low ALP & high PTH
Low calcium, high phosphate and high ALP & PTH

Low calcium, low phosphate and high ALP & PTH

Low calcium, low phosphate, high ALP & low PTH

Correct answer
Low calcium, low phosphate and high ALP & PTH

173. Mode of inheritance of hypophosphatemic rickets is:

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Autosomal dominant
Autosomal recessive
X-linked dominant
X-linked recessive

Correct answer
X-linked dominant

174. Not a radiographic feature of rickets:

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Increase in width of growth plate
Rickety rosary
Subperiosteal bleeding

Decrease in bone density

175. How would you like to manage this condition?

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Amputation
Management of fracture and bone marrow transplant
Radiotherapy
Supplementation of calcium and Vit D

Feedback
 Rickets is a defect in mineralization of osteoid matrix caused by inadequate calcium and phosphate that
occurs prior to closure of the physes.
 Orthopedic manifestations include
o brittle bones with physeal cupping/widening
o bowing of long bones
o ligamentous laxity
o flattening of skull
o enlargement of costal cartilage (rachitic rosary)
o kyphosis
 In rickets there is decreased Vit. D, so Calcium and Phosphate is low. PTH becomes increased as
compensation and as a result ALP is also increased due to bone resorption.
 Vitamin D-resistant (familial hypophosphatemic) is X linked dominant while Vitamin D dependent rickets
is autosomal recessive
 X ray findings
o physeal widening
o metaphyseal cupping
o decreased bone density
o Looser's zones
 pseudofracture on the compression side of bone
o rachitic rosary
 prominence of rib heads at the osteochondral junction
o lower extremity bowing
 often genu varum
o codfish vertebrae
 Nutritional rickets is treated by supplementation of Vit D and calcium.

176. A 42 year old man presented in medicine OPD taking Enalapril since 2 years with
complaining of postural hypotension and angioedema. What is Enalapril ? (NEXT FOUR
QUESTIONS FOLLOWING THIS QUESTION ARE BASED ON THIS SCENARIO)
1/1
ACE inhibitor

Beta blocker
ARB
Calcium channel blocker

177. Enalapril use isn't advisable in conditions except:

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single kidney
Bilateral Renal artery stenosis
Hyperkalemia
Diabetic nephropathy with albuminuria

178. Enalapril also increase of which of the following causing cough ?

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Bradykinin

Substance P
Cytokine
CD 4+ lymphocyte

179. Most common side effect of enalapril is:

1/1
Increased creatinine
Low blood pressure
Dizziness
Dry cough

180. Peak effect of enalapril is seen after:

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4-6 hrs

15-30 mins
1-2 hrs
15-30 seconds