Test Questions

Q1. Remodelling phase of wound healing is characterised by?

A. Type I collagen replacing type III

B. Type III collagen replacing type I

C. Type II collagen replacing type IV

D. Type IV collagen replacing type II

Correct Answer: A. Type I collagen replacing type III

Explanation: Correct Answer (A) Early scar (initial phase of final scar)- • Type III: Type I ratio is 1:1:-
• Raised hard pink itchy Final scar – • Collagen Type I: III= 4:1 • Soft pale flat supple
Q2. Which among the following regarding surgical blade is true?

A. 22 No. is used for abdominal incisions

B. 15 No is used for minor procedures

C. 11 No is used for arteriotomy

D. Bevelling angle during skin incision should be 60 0

Correct Answer: D. Bevelling angle during skin incision should be 60 0

Explanation: Correct Answer (D) Bevelling angle should be 90 0

Q3. Main use of half buried sutures is in?

A. Elliptical incisions

B. V-Y closures

C. Long straight incisions

D. Tendon repair

Correct Answer: B. V-Y closures

Explanation: Correct Answer (B)

Q4. Identify the instrument?

A. Balfour retractor

B. Pozzi retractor

C. Finochietto retractor

D. Morris retractor

Correct Answer: C. Finochietto retractor

Explanation: Correct Answer (C) Finochietto Thorax retractor- It is a self-retaining retractor used to
spread open the ribs or sternum during thoracotomy.
Q5. A 28 year old female farmer came to OPD with multiple painful chronic
discharging sinus tracts over B/L foot with enraged inguinal nodes. X ray
showed foot bone scalloping and bone spicules. MRI revealed dot in circle sign.
Most common pathogen in this case is?

A. Mycobacterium

B. B hemolytic Strep

C. Mycetoma

D. Clostredium

Correct Answer: C. Mycetoma

Explanation: Correct Answer (C) Mycetoma is a chronic, granulomatous disease of the skin and
subcutaneous tissue, which sometimes involves muscle, bone, and neighboring organs. [1] It is
characterized by tumefaction, abscess formation, and fistulae. It typically affects the lower extremities.
Mycetoma infection can be caused by fungi or bacteria (actinomycotic mycetoma or actinomycetoma)
Q6. False statement about Frey’s syndrome is?

A. It is caused by cross communication between parasympathetic auriculo-temporal

nerve and sympathetic middle cervical ganglion

B. Surgical trauma is one of the most common cause.

C. Presents with redness and sweating over cheek and temporal area with salivation

D. Botox injection is most common treatment now a day.

Correct Answer: A. It is caused by cross communication between parasympathetic

auriculo-temporal nerve and sympathetic middle cervical ganglion

Explanation: Correct Answer (A) It is caused by cross communication between parasympathetic

auriculo-temporal nerve and sympathetic “superior” cervical ganglion not middle cervical ganglion.
Q7. I VITROS is an acronym associated with?

A. Minimal access surgery

B. Primary survey

C. ICD insertion

D. CVP insertion

Correct Answer: A. Minimal access surgery

Explanation: Correct Answer (A) The core principles of minimal access surgery (independent of
procedure or device) can be summarized by the acronym I-VITROS: ● Insufflate/create space – to
allow surgery to take place in the minimal access setting ● Visualise – the tissues, anatomical
landmarks and the environment for the surgery to take place ● Identify – the specific structures for
surgery ● Triangulate – surgical tools (such as port placement) to optimise the efficiency of their
action, and ergonomics by minimising overlap and clashing of instruments ● Retract – and manipulate
local tissues to improve access and gain entry into the correct tissue planes ● Operate – incise,
suture, anastomose, fuse ● Seal/haemostasis.
Q8. Arrange the right sequence of hand washing?

A. A B C D

B. D C B A

C. B C A D

D. B C D A

Correct Answer: D. B C D A

Explanation: Correct Answer (D)

Q9. Drop of BP is seen when circulating volume drops by?

A. 10-20%

B. 20-30%

C. 30-40%

D. 40-50%

Correct Answer: C. 30-40%

Explanation: Correct Answer (C)

Q10. Which of the following is not a feature of superficial partial thickness
burn?

A. Blisters

B. Painful

C. Hairs can be pulled out easily

D. Heals in 7 – 14 days

Correct Answer: C. Hairs can be pulled out easily

Explanation: Correct Answer (C)

Q11. Regarding paediatric abdominal surgery which of the following is a false
statement?

A. Ladd’s operation is done for malrotation

B. Bishop Koop operation is done for meconium ileus

C. Gastroschisis is more often associated with congenital CVS malformation than

omphalocele.

D. Kasai operation give better results if done within 8 weeks

Correct Answer: C. Gastroschisis is more often associated with congenital CVS malformation
than omphalocele.

Explanation: Correct Answer (C)

Q12. All are true about Mammography except?

A. Dose of radiation is 10 rads (0.1 cGy)

B. Mammography is a low voltage and high ampere X ray

C. Triple assessment has a positive predictive value of > 99%

D. Axillary tail of breast is best seen on Cranio-Caudal view

Correct Answer: D. Axillary tail of breast is best seen on Cranio-Caudal view

Explanation: Correct Answer (D) Axillary tail is best seen in Medio-latero oblique view not craniocaudal
view
Q13. True statement about thyrotoxicosis is?

A. Post thyroidectomy Beta blockers should be continued for 1 week

B. In a scan of toxic nodular goitre, internodular tissue appear cold.

C. Drug of thyrotoxic storm is Carbimazole

D. FNAC helps is confirming the diagnosis in thyrotoxic patient

Correct Answer: C. Drug of thyrotoxic storm is Carbimazole

Explanation: Correct Answer (C) Treatment of thyroid storm consists of supportive measures like
intravenous (IV) fluids, oxygen, cooling blankets, acetaminophen, as well as specific measures to treat
hyperthyroidism. Specific Strategic Steps for Treatment 1. Therapy to control increased adrenergic
tone: Beta-blocker 2. Therapy to reduce thyroid hormone synthesis: Thionamide 3. Therapy to
reduce the release of thyroid hormone: Iodine solution 4. Therapy to block peripheral conversion of
T4 to T3: Iodinated radiocontrast agent, glucocorticoid, PTU, propranolol 5. Therapy to reduce
enterohepatic recycling of thyroid hormone: Bile acid sequestrant
Q14. True statement about Buerger’s disease is?

A. It is a segmental inflammatory pan arteritis of large vessels seen in young smokers

B. Sympathectomy is not indicated if patients come with symptom of claudication

C. ABPI < 0.5 is suggestive of critical limp ischemia

D. ABPI > 1.2 is indicates patient is on vasodilators.

Correct Answer: C. ABPI < 0.5 is suggestive of critical limp ischemia

Explanation: Correct Answer (C) • Buerger’s is a disease of medial and small sized vessels •
Sympathectomy is indicated for rest pain and ischemic ulcers not for claudication • ABPI > 1.2
indicates atherosed/ calcified vessel with poor compliance.
Q15. A 68-year-old man presents with increasing headache and "clumsiness"
on the left side over the past two months. On physical examination he has mild
left upper and lower extremity weakness (left pronator drift and 4/5 weakness in
left extremity muscles), and moderate sensory loss in the left extremities. MRI
shows a large infiltrating lesion centered in the right parietal cortex and
expanding the corpus callosum, surrounded by edema. The most likely
histologic appearance of this tumor is:

A. Nuclear pleomorphism, necrosis, multiple mitoses

B. Spindled cells arranged in sheets and whorls, no mitoses

C. Fibrillary cells with true ependymal rosettes

D. Primitive cells resembling cerebellar granular cells, numerous mitoses

Correct Answer: A. Nuclear pleomorphism, necrosis, multiple mitoses

Explanation: Correct Answer (A) • The most likely diagnosis is glioblastoma, because of the age of
the patient, the onset over two months, and the radiologic characteristics with infiltration into the corpus
callosum. Typical microscopic features of glioblastoma include nuclear pleomorphism, necrosis,
multiple mitoses. • Spindled cells in sheets and whorls with no mitoses indicate a benign tumor,
likely a meningioma. • Rosettes of various types, including true rosettes (ependymoma cells in a
circular arrangement around extracellular space) are characteristic of ependymoma. • Primitive cells
resembling cerebellar granular cells and numerous mitoses characterize medulloblastoma, which is a
malignant tumor.
Q16. Singapore Flap is used for the reconstruction of

A. Nose

B. Vagina

C. Chronic bed sores

D. Breast

Correct Answer: A. Nose

Explanation: Correct Answer (A)

Q17. The developing kidneys can sometimes fuse into a single,
horseshoe-shaped organ that will usually be found:

A. In the pelvic cavity, wrapped around a right or left common iliac artery

B. In the abdominal cavity, at the level of the inferior mesenteric artery

C. In the abdominal cavity, at the level of the superior mesenteric artery

D. In the abdominal cavity, at the level of the celiac artery

Correct Answer: B. In the abdominal cavity, at the level of the inferior mesenteric artery

Explanation: Correct Answer (B) Horseshoe Kidney fails to ascend due to inf mesenteric artery
therefore its isthmus is found at the level of L4 • The 'horseshoe kidney' is the most common renal
fusion anomaly • asymmetric horseshoe kidney, 70% of which are left dominant. • 1 in 500 in the
normal population with a male preponderance of 2:1 • Edward syndrome at approximately 67%,
Turner syndrome at 14% to 20%, and Down syndrome at about 1% • During weeks six to eight of
development, the renal ascent is coupled with a 90-degree medial rotation
Q18. Polycystic kidney disease:

A. Arises due to defects in development of the mesonephric ducts.

B. Usually results in polyhydramnios.

C. Is often associated with abnormal persistence and subsequent formation of cysts

within the allantois.

D. Can arise due to errors in apical versus basal polarization of epithelium in the kidney
tubules.

Correct Answer: D. Can arise due to errors in apical versus basal polarization of epithelium in
the kidney tubules.

Explanation: Correct Answer (D) • Autosomal dominant polycystic kidney disease affects 1 in 500 to
1,000 people • Mutations in the PKD1, PKD2 genes (Chromosome 16 and 4) Signs and symptoms •
Pain- is the most common initial complaint • Bleeding: May be confined inside the cyst or lead to
gross hematuria with passage of clots or a perinephric hematoma • UTI (eg, acute pyelonephritis,
infected cysts, perinephric abscess) • Nephrolithiasis and renal colic • Rarely, a coincidental
hypernephroma • A rise in diastolic blood pressure is the rule in ADPKD. Main treatment- Transplant
Rovsing operation is obsolete now
Q19. A “65” years old male underwent TURP for BPH. His biopsy revealed a
focus of prostatic adenocarcinoma with Gleason score 5. Further best treatment
for this patient is?

A. Further Radiotherapy

B. Further Chemotherapy

C. Hormone therapy

D. Observation

Correct Answer: D. Observation

Explanation: Correct Answer (D) This is stage T1a prostate cancer, which is managed by observation
Q20. False statement about Posterior urethral valve is?

A. This condition is only seen in boys

B. USG give key hole sign

C. Most common site in just above veru montanum

D. May be associated with bladder atony or urinary ascites

Correct Answer: C. Most common site in just above veru montanum

Explanation: Correct Answer (C)

Q21. Main role of Cheatle slit in bowel anastomosis is?

A. To minimize lumen size discrepancy

B. To minimize leaks for angle

C. To provide extra strength in single layer anastomosis

D. To invert the cut edges of bowel in anastomosis

Correct Answer: A. To minimize lumen size discrepancy

Explanation: Correct Answer (A)

Q22. Coomb sign and Target Sign on CT is seen in which abdominal condition?

A. Crohn’s disease

B. Pseudomembranous colitis

C. Acute venous thrombus

D. Mesenteric lymphoma

Correct Answer: A. Crohn’s disease

Explanation: Correct Answer (A)

Q23. Oncological outcome of HCC is described by all except?

A. MELD

B. OKUDA

C. BLCC

D. CLIP

Correct Answer: A. MELD

Explanation: Correct Answer (A) MELD is used for feasibility of liver transplant not for HCC outcome in
treatment protocol of HCC
Q24. An old female presented with dull upper abdominal pain and features of
malabsorption. CT scan showed a mass in the pancreas. CT image and gross
appearance of the lesion is given below. Which of the following is true about
this lesion?

A. Serum amylase and CEA are normal

B. Common site is head of pancreas with honey-comb appearance

C. It has high malignant potential

D. Lined by Columnar cell with high mucin content

Correct Answer: B. Common site is head of pancreas with honey-comb appearance

Explanation: Correct Answer (B) Cystic Lesions of the Pancreas Most (70% to 80%) cystic lesions of
the pancreas are nonneoplastic (either pseudocysts complicating acute or chronic pancreatitis, or,
rarely, true cysts). However, 15% of cystic lesions are neoplastic. The 4 types most frequently
encountered are • mucinous cystic neoplasm (including mucinous cystadenocarcinoma and
mucinous cystadenoma), • serous cystadenoma, • papillary cystic neoplasm, and • intraductal
papillary mucinous tumor.
Q25. A 65 year old patient presented with perforated Diverticular disease. What
is the best treatment for him?

A. Exploratory laparotomy with resection and anastomosis of diseased segment

B. Exploratory laparotomy and Hartmann’s procedure

C. Exploratory laparotomy and left hemicolectomy

D. Exploratory laparotomy, closure of perforation

Correct Answer: B. Exploratory laparotomy and Hartmann’s procedure

Explanation: Correct Answer (B) Perforated diverticulosis is Hinchey type IV which is treated by
resection and hartmann’s procedure
Q26. A patient with AIDS and a CD4 cell count of 16/mm3 comes to medical
attention because of the recent onset of motor and sensory neurologic deficits
and mental status changes. CSF examination reveals mild lymphocytosis.
Neuroimaging studies show multiple ill-defined areas of T2 changes, interpreted
as evidence of demyelination. These areas are located in the white matter of
both cerebral hemispheres and cerebellum. Which of the following is the most
likely diagnosis?

A. AIDS-dementia complex

B. Cerebral toxoplasmosis

C. CMV encephalitis

D. Progressive multifocal leukoencephalopathy

Correct Answer: Unknown

Explanation: Correct Answer (D) Progressive multifocal leukoencephalopathy Reference: Read the text
below Sol: • The history of severe HIV-related immune compromise and evidence of destruction of
myelin at multiple sites in the CNS points to a diagnosis of progressive multifocal leukoencephalopathy
(PML). PML is caused by JC virus, a papovavirus that produces asymptomatic infections in
immunocompetent hosts. Oligodendrocytes in active lesions contain characteristic intranuclear
inclusions. Usually, biopsy of the lesions is not necessary, as a presumptive diagnosis of PML can be
made on clinical grounds. PML is also seen in patients with lymphomas, or those receiving organ
transplants. • In AIDS-dementia complex , there is no focal brain lesion. Sometimes, diffuse, but
usually mild, cerebral atrophy can be identified by MRI. Patients present with progressive dementia,
often associated with incontinence and disorientation. • Cerebral toxoplasmosis typically manifests
with a round, well-circumscribed lesion that shows a peripheral rim of contrast enhancement. • CMV
encephalitis has a predilection for the periventricular gray matter and ependyma, as well as the retina.
Q27. A 29-year-old man is brought to the emergency department in a comatose
state a few hours after complaining of sudden onset of excruciating headache.
Neurologic examination reveals dilated pupils poorly responsive to light. A CT
scan of the head without contrast demonstrates hyperdensity within the
suprasellar cistern, while MRI is unremarkable. Lumbar puncture shows
hemorrhagic cerebrospinal fluid. Which of the following is the most likely
diagnosis?

A. Amyloid angiopathy-related hemorrhage

B. Cavernous sinus thrombosis

C. Hemorrhagic infarction

D. Ruptured berry aneurysm

Correct Answer: D. Ruptured berry aneurysm

Explanation: Correct Answer (D) Ruptured berry aneurysm Reference: Read the text below Sol: •
Headache of sudden onset ("thunderclap" headache), rapid deterioration of mental status and blood in
the CSF are virtually diagnostic of ruptured berry aneurysms. • Note the characteristic hyperdensity
on CT of the suprasellar cistern, indicating blood in the subarachnoid space. Rupture of a berry
aneurysm is the most common cause of subarachnoid bleeding. • Berry aneurysms develop as a
result of congenital weakness at branching points of the arteries in the circle of Willis. These
outpouchings tend to expand progressively, but in most cases they remain asymptomatic. Hypertension
facilitates development and rupture of berry aneurysm. One third of patients recover, one third die, and
one third develop re-bleeding. Rapid onset of coma is an ominous sign.
Q28. Which of the following viral infections is associated with highest risk of
progression to fulminant disease & acute liver failure:

A. HBV injection

B. HDV infection

C. HBV- HDV confection

D. HDV superinfection

Correct Answer: D. HDV superinfection

Explanation: Correct Answer (D) HDV superinfection Ref: Read the text below Sol:
Q29. In a patient with bacterial endocarditis, which of the following
echocardiographic lesions is most likely to lead to embolization?

A. 5-mm mitral valve vegetation

B. 5-mm tricuspid valve vegetation

C. 11-mm aortic valve vegetation

D. 11-mm mitral valve vegetation

Correct Answer: D. 11-mm mitral valve vegetation

Explanation: Correct Answer (D) 11-mm mitral valve vegetation Ref– Read the text below Sol: • While
any valvular vegetation can embolize, vegetations located on the mitral valve and vegetations >10 mm
are greatest risk of embolizing. However, only choice D demonstrates the risks of both size and
location. • Hematogenous infection from an embolized vegetation may involve any organ, but
particularly affects those organs with the highest blood flow. They are seen in up to 50% of patients
with endocarditis. • Tricuspid lesions will lead to pulmonary septic emboli. Common in injection drug
users. Mitral and aortic lesions can lead to embolic infections in the skin, spleen, kidneys, meninges,
and skeletal system. • A dreaded neurologic complication is mycotic aneurysm, focal dilations of
arteries at points in the arterial wall that have been weakened by infection in the vasa vasorum or septic
emboli, leading to hemorrhage.
Q30. Intracellular survival of M. Tuberculosis is due to

A. Interference with oxidative burst

B. Prevention of fusion of phagosome with lysosome

C. Inhibition of degranulation

D. Resistance to lysosomal enzymes

Correct Answer: B. Prevention of fusion of phagosome with lysosome

Explanation: Correct Answer (B) Prevention of fusion of phagosome with lysosome Ref: Read the text
below Sol: • Macrophages usually kill bacteria by fusion of the phagosome with the lysosome to form
a phagolysosome. • M. tuberculosis blocks fusion of the lysosome with the phagosome, allowing the
bacteria to proliferate unchecked within the macrophage.
Q31. Hypokalemia can be associated with the following electrocardiographic
changes EXCEPT?

A. Prolonged PR interval

B. Prolongation QT interval

C. Prominent T waves

D. Prominent U waves

Correct Answer: C. Prominent T waves

Explanation: Correct Answer (C) Prominent T waves Ref– Read the text below Sol: • Hypokalemia
leads to following ECG changes: 1. Prologed PR interval 2. Prolonged QT interval 3.
Pseudo-p-pulmonale 4. Flattened T wave 5. Prominent U wave
Q32. Keshan disease is an endemic cardiomyopathy found in deficiency of

A. Selenium

B. Manganese

C. Chromium

D. Copper

Correct Answer: A. Selenium

Explanation: Correct Answer (A) Selenium Ref: Read the text below Sol: Keshan disease - found in
children and young women residing in regions of china where dietary intake of selenium is low (< 20
µg/d) • Concomitant deficiencies of iodine and selenium may worsen the clinical manifestations of
cretinism.
Q33. Primary Receptor for HIV is

A. CD-20

B. CD-25

C. CD-4

D. CDCX-4

Correct Answer: C. CD-4

Explanation: Correct Answer (C) CD-4 Ref: Read the text below Sol: HIV is a single stranded RNA
retrovirus from the Lentivirus family. After mucosal exnosure HIV is transported to the lymph nodes via
Dendritic, CD4, T lymphocytes or Langerhans cells.
Q34. Most common cause of airborne dermatitis in India

A. Congress grass

B. Cotton fibers

C. Pollen fibers

D. Marigold

Correct Answer: A. Congress grass

Explanation: Correct Answer (A) Congress grass Ref: Read the text below Sol: • In India commonest
cause of the air born contact dermatitis by perthenium histerophorus (Congress grass) • Detergents
are most common cause of contact dermatitis in Indian women • Nickle - most common metal
involved in the dermatitis The most common presentation of contact dermatitis is hand eczema
Q35. A patient is found to have a holosystolic murmur on physical examination.
With deep inspiration, the intensity of the murmur increases. This is consistent
with which of the following?

A. Mitral Regurgitation

B. Ventricular Septal defect

C. Tricuspid Regurgitation

D. Atrial Septal Defect

Correct Answer: C. Tricuspid Regurgitation

Explanation: Correct Answer (C) Tricuspid Regurgitation Ref– Read the text below Sol: • Causes of
holosystolic murmurs include mitral regurgitation, tricuspid regurgitation, and ventricular septal defects.
• Increase of the murmur with Inspiration indicates Right sided lesion and favours diagnosis of
Tricuspid regurgitation. • Atrial septal defects cause a mid-systolic murmur at the mid to upper left
sternal border,with fixed splitting of S2. There is no change with respiration.
Q36. Syndrome of inappropriate antidiuretic hormone secretion is diagnosed by
all except:

A. Hyponatremia

B. Decreased osmolality (< 280 mosm/kg)

C. Normal blood urea nitrogen

D. Urinary Na+ > 20meq

Correct Answer: C. Normal blood urea nitrogen

Explanation: Correct Answer (C) Normal blood urea nitrogen Ref: Read the text below Sol: Syndrome
of inappropriate antidiuretic hormone secretion (SIADH) Clinical features • Hyponatremia •
Decreased osmolality (< 280 mosm/kg) with inappropriately increased urine osmolalilty > 150
mosm/kg) • Urine sodium usually over 20 mEq/L. • Low blood urea nitrogen (BUN) (< 10 mg/dL)
Q37. 34 years old male came to clinic with cough and hemoptysis. Patient has
history of passing blood in the urine a month ago. Urine analysis had revealed
dysmorphic RBC with RBC casts. He has a purpuric skin rash. What is the
probable diagnosis?

A. SLE

B. Diffuse Systemic sclerosis

C. Systemic Necrotising vasculitis

D. Microscopic Polyangitis

Correct Answer: D. Microscopic Polyangitis

Explanation: Correct Answer (D) Microscopic Polyangitis Ref: Read the text below Sol: MPA is a
ANCA – positive vasculitis affecting small vessels and presenting as Pulmonary Renal syndrome.
Q38. The following arrhythmia is associated with all of the following conditions,
except:

A. Hypokalemia

B. Hypomagnesemia

C. Hypercalcemia

D. All of the above

Correct Answer: C. Hypercalcemia

Explanation: Correct Answer (C) Hypercalcemia Ref:Read the text below Sol: • Hypocalcaemia can
be associated due to QT prolongation.
Q39. 90% association with HLA B27 is seen with –

A. Rheumatoid arthritis

B. Ankylosing spondylitis

C. Rieter’s syndrome

D. Psoriatic arthritis

Correct Answer: B. Ankylosing spondylitis

Explanation: Correct Answer (B) Ankylosing spondylitis Ref: Read the text below Sol: ANKYLOSING
SPONDYLITIS – • Ankylosing spondylitis (AS) is an inflammatory disorder of unknown cause that
primarily affects the axial skeleton; peripheral joints and extra-articular structures are also frequently
involved. • The disease usually begins in the second or third decade. • Male to female prevalence
is between 2:1 and 3:1. • AS shows a striking correlation with the histocompatibility antigen HLA-B27
and occurs worldwide roughly in proportion to the prevalence of B27. • In North American whites, the
prevalence of B27 is 7%, whereas it is 90% in patients with AS, independent of disease severity. • In
population surveys, AS is present in 1–6% of adults inheriting B27, whereas the prevalence is 10–30%
among B27+ adult first-degree relatives of AS probands. • Concordance rate in identical twins is
about 65%. • Susceptibility to AS is determined largely by genetic factors, with B27 comprising up to
one-half of the genetic component. • Other HLA-linked genes may also contribute to susceptibility to
AS. • Genome-wide single-nucleotide polymorphism (SNP) analysis has identified additional
susceptibility alleles in the genes encoding ERAP1 (chromosome 5q15) and IL-23R (chromosome
1p31.3). • The genes encoding TNFSF15, TNFSF1A, STAT3, ANTXR2, and IL1R2, and at least six
other chromosomal regions have also been implicated.
Q40. A 63-year-old female presented to the emergency room with an acute
aneurysmal subarachnoid hemorrhage (SAH) and underwent a clipping
procedure on admission. She has since been recovering in the intensive care
unit. On the tenth postoperative day, she was noted to have slurred speech,
worsening right facial droop, and right arm weakness. She was more difficult to
rouse. NCCT and four-vessel angiogram are shown shows ischemia in MCA
territory. Which of the following is the best treatment for her condition?

A. Thrombolysis by Alteplase

B. Intra-arterial Calcium channel blockers

C. Ventriculo-Peritoneal Shunt

D. Intravenous Fosphenytoin

Correct Answer: B. Intra-arterial Calcium channel blockers

Explanation: Correct Answer (B) Intra-arterial calcium channel blockers. SAH is due to blood in the
CSF. Even after treatment of the cause e.g. aneurysm as in the given case by clipping, delayed
complication can occur. The neurodeficit in SAH is due to VASOSPASM & is best treated by CCB
-Nimodipine.
Q41. Identify the phenomenon in DM and choose the correct statement/s about
it. 1. The picture shows Dawn phenomenon 2. It is due to excess night-time
dose of Insulin 3. Patient needs Increase in night-time dose of Insulin 4. The
phenomenon is physiological due to GH surge in early morning hours

A. 1 & 2 are true statements

B. 2 is the true statement

C. 3 & 4 are true statements

D. 4 is the true statement

Correct Answer: B. 2 is the true statement

Explanation: Correct Answer (B) The image shows Somogyi phenomenon which is due to excess
night-time dose of insulin.
Q42. An 18 yr old boy presents with melaena, abdominal pain, numbness of
both lower limbs and right upper limb. O/E: pulse: 88/min,BP : 170/110 mm Hg,
and all peripheral pulses palpable. Renal function is normal. Urine examination
shows proteinuria and RBC with no casts. What is the most probable
diagnosis?

A. Classical PAN

B. Microscopic polyangitis

C. HSP

D. Wegener’s granulomatosis

Correct Answer: A. Classical PAN

Explanation: Correct Answer (A) Classical PAN Ref– Read the text below Sol: • Digital gangrene is
usually associated with vasculitis of the medium sized vessels. Among the options PAN is medium
vessel vasculitis. • Mononeuritis multiplex : which is presenting as numbness of different
neuroanatomical regions: is a characteristic feature of PAN and Microscopic polyangitis (MPA,) less
characteristic of Wegner’s (WG) • No RBC casts are seen in urine and Hypertension is present: so
there is no glomerulonephritis with arteritis, PAN is arteritis with no glomerulonephritis. • MPA and
WG: renal involvement is Glomerulonephritis. Hence diagnosis is PAN.
Q43. All the following are direct actions of parathyroid hormone (PTH) except

A. Increased calcium resorption from bone

B. Increased calcium resorption from the kidney

C. Increased calcium resorption from the gastrointestinal tract

D. Increased synthesis of 1,25 dihydroxyvitamin D

Correct Answer: C. Increased calcium resorption from the gastrointestinal tract

Explanation: Correct Answer (C) Increased calcium resorption from the gastrointestinal tract Ref– Read
the text below Sol: • The four parathyroid glands are located posterior to the thyroid gland.
Parathyroid hormone is the primary regulator of calcium. • PTH acts directly on bone and the kidney
and indirectly, through the action of vitamin D, on the GI tract. • Calcium induces calcium absorption
from the kidney and bone. • It stimulates hydroxylation of 25-hydroxyvitamin D, resulting in the more
active form. • Vitamin D stimulates calcium resorption from the GI tract. Calcium and vitamin D are
part of a feedback loop that inhibits PTH release and synthesis. PTH prevents resorption of phosphate
from the kidney.
Q44. Coarse tremors in tongue are seen in all except?

A. Parkinsonism.

B. Alcohol.

C. Thyrotoxicosis.

D. General paresis.

Correct Answer: C. Thyrotoxicosis.

Explanation: Correct Answer (C) Thyrotoxicosis. Ref:Read the text below Sol: Coarse tremors is
defined as slow 4-6 per second. Causes are :- a. Parkinsonism. b. Wilson disease and other
extrapyramidal syndromes. c. Delirium tremens. d. General paresis (seen in neurosyphillis 10-30
years after primary syphilis ) e. Cerebellar tremors.
Q45. Match the following renal tubular defect with their presentation:

A. 1-B, 2-D, 3- A, 4-C

B. 1-C, 2-D, 3-A, 4-B

C. 1-B, 2-C, 3-B, 4- A

D. 1-D, 2-A, 3- C, 4-B

Correct Answer: Unknown

Explanation: Correct Answer (C)

Q46. The most common life threatening metabolic complication of squamous
cell carcinoma of lung is

A. Hyponatremia-

B. Hypercalcaemia

C. Hypokalaemia

D. Hypomagnesemia

Correct Answer: B. Hypercalcaemia

Explanation: Correct Answer (B) Hypercalcaemia Ref: Read the text below Sol: • Hypercalcemia
resulting from ectopic production of PTH related peptide is the most common c sq. cell ca of lung.
Q47. Familial hepatic diseases associated with cirrhosis include:

A. Osler-Weber-Rendu syndrome

B. Cystinosis

C. Marfan's syndrome

D. Wilson's disease

Correct Answer: D. Wilson's disease

Explanation: Correct Answer (D) Wilson's disease Ref– Read the text below Sol: Familial hepatic
diseases associated with cirrhosis include: 1. Wilson's disease 2. Haemochromatosis 3. Galactosaemia
4. Indian familial childhood cirrhosis 5. Alpha1 antitrypsin deficiency • Osler-Weber-Rendu is
associated with hereditary telangiectasia and may be associated with large GI haemorrhage. •
Marfan's is not really associated with any hepatic disease.
Q48. A patient presented with Uveatis. Which of the following conditions is
unlikely to cause such a presentation?

A. Rheumatoid arthritis

B. Ankylosing spondylosis

C. Reactive arthritis

D. Psoaritic arthropathy

Correct Answer: A. Rheumatoid arthritis

Explanation: Correct Answer (A) Rheumatoid arthritis Ref– Read the text below Sol: • Anterior uveitis
may be associated with all Spondylo-arthropaties (SpA) • RA cause Keratoconjunctivitis sicca or
Episcleritis. Never Uveatis.
Q49. Inability to work without any discomfort belongs to –

A. NYHA Class I

B. NYHA Class II

C. NYHA Class III

D. NYHA Class IV

Correct Answer: D. NYHA Class IV

Explanation: Correct Answer (D) NYHA Class IV Ref: Harrison’s ‘Principles of Internal Medicine’; 18/e,
Chap 234 Sol: NEW YORK HEART ASSOCIATION CLASSIFICATION –
Q50. A 78-year-old confused man presents to hospital after not passing stool
for 3 days. A careful history from his daughter reveals he has lost 8kg in weight
over the past 2 months and has been acting unusually over the past month or
so. Which of the following tumour markers would be expected to be raised in
this disease?

A. Carcino-embryonic antigen (CEA).

B. CA 153.

C. Alpha-fetoprotein (AFP).

D. Neurone specific enolase (NSE).

Correct Answer: A. Carcino-embryonic antigen (CEA).

Explanation: Correct Answer (A) Carcino-embryonic antigen (CEA). Ref– Read the text below Sol: •
CEA may be raised in gastrointestinal cancers, especially colorectal carcinoma. • As with all tumour
markers it can be raised in a variety of cases, notably pancreatitis, cirrhosis and smoking,and must be
interpreted within the clinical context. • Tumour markers should never be used as a diagnostic tool;
the use of markers is to add weight to an already strong clinical index of suspicion and to help guide
investigation of possible sites of neoplasm. • CA19-9 is also associated with colorectal cancer,
however, it may also be raised in pancreatic cancer. • AFP is most specific for hepatocellular
carcinoma but also may rise in germ cell tumours as well as other liver disorders. • NSE is specific for
small cell carcinoma of the lung • CA 153 is raised most commonly in breast disorders including
cancer and benign breast disease.
Q51. Identify the correct option regarding contribution of different pioneers in
public health:

A. William budd - Transmission of cholera

B. Joseph goldberger- Scurvy trial

C. Edwin chadwick- Enactment of public health act

D. Alphonso Laveran - Life cycle of plasmodium within Anopheles

Correct Answer: C. Edwin chadwick- Enactment of public health act

Explanation: Correct Answer (C) • William budd - Transmission of typhoid • Joseph goldberger-
Trial on pellagra • Edwin chadwick- Enactment of public health act • Alphonso Laveran - Life cycle
of plasmodium within man
Q52. Which of the following is wrongly matched :

A. Incidence - Rate

B. Relative risk- Rate

C. Prevalence - Proportion

D. Couple protection rate – Proportion

Correct Answer: B. Relative risk- Rate

Explanation: Correct Answer (B) • Incidence - Rate • Relative risk- Rate • Prevalence -
Proportion • Couple protection rate – Proportion
Q53. Which of the following statements are correct as per standardisation : 1:
Age standardised death rates are used to compare mortality data between two
populations 2: In direct standardisation: Age specific death rates of study
population are applied on standard population 3: We can calculate
standardised mortality ratio from indirect standardisation

A. 1 only

B. 1,2 Only

C. 1,2,3

D. None of these

Correct Answer: C. 1,2,3

Explanation: Correct Answer (C) • Age standardised death rates are used to compare mortality data
between two populations • In direct standardisation: Age specific death rates of study population are
applied on standard population • We can calculate standardised mortality ratio from indirect
standardisation • In Indirect standardisation: Age specific death rates of standard population are
applied on study population
Q54. Study of distribution and determinants of disease is:

A. Epidemiology

B. Sociology

C. Health sciences

D. Public health

Correct Answer: A. Epidemiology

Explanation: Correct Answer (A) Study of distribution and determinants of disease is:Epidemiology
Epidemiology is the branch of medical science that investigates all the factors that determine the
presence or absence of diseases and disorders. Epidemiological research helps us to understand how
many people have a disease or disorder, if those numbers are changing, and how the disorder affects
our society and our economy.
Q55. Which of the following is/are true statements : 1) Continuos scrutiny for
action is : Evaluation 2) Serial interval is an indirect estimate for : Incubation
period 3) An estimate to express communicability of a disease: Secondary
attack rate

A. 1,2,3

B. 1,2 only

C. 2,3 only

D. 1 only

Correct Answer: C. 2,3 only

Explanation: Correct Answer (C) • Continuos scrutiny for action is : Surveillance • To check the
acheievemnt of outcome : Evaluation • Serial interval is an indirect estimate for : Incubation period •
An estimate to express communicability of a disease: Secondary attack rate
Q56. Which of the following is/are true statements : 1: Under NIS - 1st dose of
Pentavalent vaccine can be given till (Max limit ) : 2 year 2: Onset of
dessiminated BCG infection after BCG is seen between (Time interval) : 1 month
to 12 months 3: Vaccine associated paralytic polio is seen after how many days
of recieving OPV: between 4 to 30 days

A. 1,2,3

B. 1,2 only

C. 2,3 only

D. 1 only

Correct Answer: C. 2,3 only

Explanation: Correct Answer (C) • Under NIS - 1st dose of Pentavalent vaccine can be given till (Max
limit ) : 2 year • Onset of dessiminated BCG infection after BCG is seen between (Time interval) : 1
month to 12 months • Vaccine associated paralytic polio is seen after how many days of recieving
OPV: between 4 to 30 days
Q57. Which of the following is/are true statements : 1.Unit of analysis is "
Group / population " : Ecological study 2: The proportion of individuals with
disease at one point of time can be estimated from : Cross sectional study 3:
Recall bias is seen in : Case control study

A. 1,2,3

B. 1,2 only

C. 2,3 only

D. 1 only

Correct Answer: A. 1,2,3

Explanation: Correct Answer (A) • Unit of analysis is " Group / population " : Ecological study • The
proportion of individuals with disease at one point of time can be estimated from : Cross sectional study
. Used to estimate point prevalence • Recall bias is seen in : Case control study . Can be eliminated
by prospective study
Q58. Which of the following is true regarding cross sectional study :

A. Temporal association is proved

B. Used to assess incidence

C. Can be used to assess burden of a disease

D. Attrition bias can be seen

Correct Answer: C. Can be used to assess burden of a disease

Explanation: Correct Answer (C) Cross sectional study : • Temporal association is not proved •
Used to assess prevalence • Can be used to assess burden of a disease • Attrition bias cannot be
seen Note : • Attrition bias can be seen in follow up studies • Temporal association is proved in
cohort study
Q59. Which of the following is a true statement:

A. Chicken pox rash : heals by 10-14 days

B. Mumps : Isolation is done till the onset of parotid swelling

C. Measles : Period of communicability - 4 days before and after rash

D. Diptheria : Carriers are not seen

Correct Answer: C. Measles : Period of communicability - 4 days before and after rash

Explanation: Correct Answer (C) • Chicken pox rash : heals by 4-7 days • Mumps : Isolation is done
till swelling subsides • Measles : Period of communicability - 4 days before and after rash •
Diptheria : Carriers are seen
Q60. Which of the following is a true statement :

A. Last case of polio in India : 2013

B. c-VDPVs are the rarest among VDPVs

C. OPV SWITCH: from bivalent OPV to monovalent OPV

D. None of these

Correct Answer: D. None of these

Explanation: Correct Answer (D) • Last case of polio : 2011 (West bengal ) • c-VDPVs are most
common VDPVs due to mutation in Type 2 component of OPV • OPV SWITCH: from trivalent OPV
to bivalent OPV
Q61. Which of the following is/are true statements : 1: 1 TB unit in urban areas
is per : 1.5 to 2.5 lakh 2: Investigation to rule out TB in HIV patients : Chest
x-ray 3: Treatment regimen for previously treated TB patients : 2HRZE + 4HRE

A. 1,2,3

B. 1,3 only

C. 2,3 only

D. 1 only

Correct Answer: B. 1,3 only

Explanation: Correct Answer (B) • 1 TB unit in urban areas is per : 1.5 to 2.5 lakh • Investigation to
rule out TB in HIV patients : CBNAAT • Treatment regimen for both new and previously treated TB
patients : - 6 months : 2HRZE + 4HRE - Daily regimen - Number of tabs per day : Based on body
weight
Q62. Which of the following is/are true statements : 1) ASHA will give 5 home
visits under Home based care of young child 2) Newborn stabilisation units
are established at district hospitals under FBNC 3) The target of INAP is to
bring down NMR to single digit by 2025

A. 1,2,3

B. 1,2 only

C. 2,3 only

D. 1 only

Correct Answer: D. 1 only

Explanation: Correct Answer (D) • ASHA will give 5 home visits under Home based care of young
child (HBYC) • Newborn stabilisation units are established at CHCs/FRUs under FBNC • Sick
newborn care units are established at district hospitals/Sub district hospitals under FBNC • The
target of INAP is to bring down NMR to single digit by 2030
Q63. Which of the following is/are true statements : 1:The ability of a test to
detect true negatives is : Specificity 2: The probability of having a disease after
a positive test is expressed by : NPV 3: If sensitivity is 80% , False negatives
will be : 20%

A. 1,2,3

B. 1,2 only

C. 1,3 only

D. 1 only

Correct Answer: C. 1,3 only

Explanation: Correct Answer (C) • The ability of a test to detect true negatives is : Specificity • The
ability of a test to detect true positives is : Sensitivity • The probability of having a disease after a
positive test is expressed by : PPV • The probability of not having a disease after a negative test is
expressed by : NPV • If sensitivity is 80% , False negatives will be : 20%
Q64. PPV is affected mainly by :

A. Sensitivity

B. Specificity

C. Prevalence

D. Post test probability

Correct Answer: D. Post test probability

Explanation: Correct Answer (D) Pre-test probability (~ prevalence) : This is the proportion of people in
the population at risk who have the disease at a specific time or time interval, i.e. the point prevalence
or the period prevalence of the disease. In other words, it is the probability − before the diagnostic test
is performed − that a patient has the disease. Post-test probability : This is the proportion of patients
testing positive who truly have the disease. It is similar to the positive predictive value but apart from
the test performance also includes a patient-based probability of having disease. It depends on
sensitivity , specificity , prevalence of disease . Mainly influenced by prevalence.
Q65. Which of the following is/are true statements for the image shown below :
1: This is known as ogive curve 2: Median of this data is 30 cm 3: Interquartile
range is : 10

A. 1,2,3

B. 1,2 only

C. 2,3 only

D. 1 only

Correct Answer: B. 1,2 only

Explanation: Correct Answer (B) • This is known as ogive curve • Used to plot cumulative
frequency • Median of this data is 30 cm • Interquartile range is : 33-28 = 5
Q66. A 1 day old infant is noted to be cyanotic. Physical examination reveals a
grade 2-3/6 systolic murmur and a single loud 2nd heart sound. The chest
radiograph reveals a normal-sized heart and decreased pulmonary vascular
markings. The ECG reveals left ventricular dominance. The next step in the
management of this neonate is to administer:

A. Sodium bicarbonate

B. Morphine

C. Prostaglandin E1

D. Digoxin

Correct Answer: C. Prostaglandin E1

Explanation: Correct Answer (C) Prostaglandin E1. If echocardiography is not immediately available,
the clinician caring for a newborn with possible cyanotic heart disease should not hesitate to start a
prostaglandin infusion (for a possible ductal-dependent lesion). Because of the risk of hypoventilation
associated with prostaglandins, a practitioner skilled in neonatal endotracheal intubation must be
available.
Q67. A 2 yr old girl presents with high, remittent fever of 9 days' duration
associated with marked irritability, nonpurulent conjunctival injection, red
cracked lips, swollen and erythematous hands and feet, and a maculopapular
erythematous rash on the trunk and extremities. Laboratory testing at
presentation would most likely show evidence of:

A. Aseptic meningitis

B. Thrombocytosis

C. Hyponatremia

D. Lymphocytosis

Correct Answer: A. Aseptic meningitis

Explanation: Correct Answer (A) Aseptic meningitis. Associated symptoms other than the clinical
criteria are common in the 10 days prior to diagnosis of KD. Gastrointestinal symptoms (vomiting,
diarrhea, or abdominal pain) occur in almost 65% of patients, and respiratory symptoms (interstitial
infiltrates, effusions) occur in 30%. Other clinical findings include significant irritability that is especially
prominent in infants and likely due to aseptic meningitis, mild hepatitis, hydrops of the gall bladder,
urethritis and meatitis with sterile pyuria, and arthritis.
Q68. IVIG-resistant KD occurs in approximately ..... of patients and is defined by
persistent or recrudescent fever 36 hr after completion of the initial IVIG
infusion.

A. 15

B. 25

C. 35

D. 45

Correct Answer: A. 15

Explanation: Correct Answer (A) 15. IVIG-resistant KD occurs in approximately 15% of patients and is
defined by persistent or recrudescent fever 36 hr after completion of the initial IVIG infusion. Patients
with IVIG resistance are at increased risk for CAA. Typically, another dose of IVIG at 2 g/kg is
administered to patients with IVIG resistance.
Q69. A 6-year-old, fully immunized boy is brought to the emergency room with a
3-hour history of fever to 39.5°C (103.1°F) and sore throat. The child appears
alert, but anxious and toxic. He has mild inspiratory stridor and is drooling. He
is sitting on the examination table leaning forward with his neck extended. A
lateral radiograph of his neck is shown below. Which of the following is the
most appropriate immediate management of this patient?

A. Examine the throat and obtain a culture.

B. Obtain an arterial blood gas and start an IV line.

C. Administer a dose of nebulized epinephrine.

D. Prepare to establish an airway in the operating room.

Correct Answer: D. Prepare to establish an airway in the operating room.

Explanation: Correct Answer (D) In the past, epiglottitis was most commonly caused by invasive H
influenzae type B. Due to the widespread use of the Hib vaccine, this condition is now more commonly
caused by group A β-hemolytic streptococcus, Moraxella catarrhalis, or S pneumoniae. The
radiography shows the typical “thumb” sign of a swollen epiglottis. Epiglottitis is a life-threatening form
of infection-produced upper airway obstruction. The course of the illness is brief and prodromal
symptoms are lacking. The patient experiences a sudden onset of sore throat, high fever, and
prostration that is out of proportion to the duration of the illness. Drooling and difficulty in swallowing, a
muffled voice, and preference for a characteristic sitting posture with the neck hyperextended may be
noted. Radiography of the neck, which may delay definitive treatment, is often avoided.
Q70. Most common cause of Epiglottitis is

A. Streptococcus

B. H influenza type B

C. Parainfluenza

D. S Pneumoniae

Correct Answer: A. Streptococcus

Explanation: Correct Answer (A) Streptococcus

Q71. All of the following are gastrointestinal manifestations of cystic fibrosis
EXCEPT:

A. Intussusception

B. Appendicitis

C. Colonic mucosal thickening

D. Gastric outlet obstruction

Correct Answer: D. Gastric outlet obstruction

Explanation: Correct Answer (D) Gastric outlet obstruction

Q72. A 12 yr old child with confirmed cystic fibrosis has experienced cramping
abdominal pain intermittently for the past 8 days. The pain is diffuse and
unrelated to eating and is not attended by guarding or rebound. The patient
denies emesis or diarrhea. The most likely cause of the abdominal pain is:

A. Intussusception

B. Peritonitis

C. Pancreatitis

D. Distal intestinal obstruction syndrome (DIOS)

Correct Answer: D. Distal intestinal obstruction syndrome (DIOS)

Explanation: Correct Answer (D) Distal intestinal obstruction syndrome (DIOS) Ileal obstruction with
fecal material (distal intestinal obstruction syndrome [DIOS]) occurs in older patients, causing cramping
abdominal pain and abdominal distention. Complete or incomplete intestinal obstruction by viscid faecal
material in the terminal ileum and proximal colon - distal intestinal obstruction syndrome (DIOS) - is a
common complication in cystic fibrosis. Estimates of prevalence range from 5 to 12 episodes per 1000
patients per year in children, with higher rates reported in adults. DIOS is mainly seen in patients with
pancreatic insufficiency, positive history of meconium ileus and previous episodes of DIOS. DIOS is
being described with increasing frequency following organ transplantation. Diagnosis is based on
suggestive symptoms with a right lower quadrant mass confirmed on X-ray. The main differential is
chronic constipation. Treatment consists of rehydration combined with stool softening laxatives or gut
lavage with balanced electrolyte solutions. Rapid fluid shifts have been described following osmotic
agents. Avoiding dehydration and optimizing pancreatic enzyme dosage may reduce the chance of
further episodes. Prophylactic laxative therapy is widely used, but is not evidence-based.
Q73. Which of the following statement is false about cystic fibrosis treatment?

A. Lumacaftor is an investigational CFTR corrector that has been shown in vitro to

correct p.Phe508del CFTR misprocessing and increase the amount of cell
surface–localized protein.

B. Ivacaftor is an approved CFTR potentiator that increases the open probability of

CFTR channels (i.e., the fraction of time that the channels are open) in vitro and
improves clinical outcomes in patients 6 years of age or older who have cystic fibrosis
and at least one copy of most class III (gating) mutations.

C. Recent data show that lumacaftor in combination with ivacaftor provided a benefit
for patients with cystic fibrosis homozygous for the Phe508del CFTR mutation.

D. In the TRAFFIC and TRANSPORT studies, lumacaftor in combination with ivacaftor

did not improve the FEV1 and increased the rate of pulmonary exacerbations in
patients with cystic fibrosis who were homozygous for the Phe508del CFTR mutation.

Correct Answer: D. In the TRAFFIC and TRANSPORT studies, lumacaftor in combination with
ivacaftor did not improve the FEV1 and increased the rate of pulmonary exacerbations in
patients with cystic fibrosis who were homozygous for the Phe508del CFTR mutation.

Explanation: Correct Answer (D) In conclusion, in the TRAFFIC and TRANSPORT studies, lumacaftor
in combination with ivacaftor improved FEV1 and reduced the rate of pulmonary exacerbations in
patients with cystic fibrosis who were homozygous for the Phe508del CFTR mutation.
Lumacaftor–ivacaftor therapy generally had an acceptable side-effect profile, with more than 93% of
patients completing the assigned therapy regimen. These data show that the combination of a CFTR
corrector and potentiator, designed to address the underlying cause of cystic fibrosis by targeting
CFTR, can benefit patients who are homozygous for the Phe508del CFTR mutation and represents a
treatment milestone for the 45% of patients with cystic fibrosis who are homozygous for this mutation.
Q74. This is about a 12 yr old boy. His problems typically started in early
adolescence with jerks in the morning, often causing to drop things;
generalized tonic–clonic or clonic–tonic–clonic seizures upon awakening. Sleep
deprivation and photic stimulation acted like precipitants. Following is his EEG.
What is your diagnosis?

A. Absence seizures

B. JME

C. West syndrome

D. Focal seizures

Correct Answer: B. JME

Explanation: Correct Answer (B) JME Juvenile myoclonic epilepsy (Janz syndrome) is the most
common generalized epilepsy in young adults, accounting for 5% of all epilepsies. It has been linked to
mutations in many genes including CACNB4; CLNC2; EJM2, 3, 4, 5, 6, 7, 9; GABRA1; GABRD; and
Myoclonin1/EFHC1. Typically, it starts in early adolescence with 1 or more of the following
manifestations: myoclonic jerks in the morning, often causing the patient to drop things; generalized
tonic– clonic or clonic–tonic–clonic seizures upon awakening; and juvenile absences. Sleep
deprivation, alcohol (in older patients), and photic stimulation, or, rarely, certain cognitive activities can
act as precipitants. The EEG usually shows generalized 4-5 Hz polyspike–and–slow wave discharges.
Q75. This 4 months old child has abnormal movements particularly in
drowsiness and arousal. The following is his EEG. What is your diagnosis?

A. Absence seizures

B. JME

C. West syndrome

D. Focal seizures

Correct Answer: C. West syndrome

Explanation: Correct Answer (C) West syndrome starts between the ages of 2 and 12 mo and consists
of a triad of infantile epileptic spasms that usually occur in clusters (particularly in drowsiness or upon
arousal), developmental regression, and a typical EEG picture called hypsarrhythmia. Hypsarrhythmia
is a high-voltage, slow, chaotic background with multifocal spikes. Patients with cryptogenic
(sometimes called idiopathic, now referred to as unknown etiology) West syndrome have normal
development before onset, while patients with symptomatic West syndrome have preceding
developmental delay owing to perinatal encephalopathies, malformations, underlying metabolic
disorders, or other etiologies.
Q76. Which cervical vertebra does not have a body?

A. C1

B. C2

C. C3

D. C4

Correct Answer: A. C1

Explanation: Correct Answer (A) C1 Ref.: Read the text below Sol : C1 vertebra does not have a body
which is detached from it and attached to C2 as Dens .
Q77. Spinal part of accessory nerve supplies :

A. Pectoralis major

B. Pectoralis minor

C. Sternocleidomastoid

D. Deltoid

Correct Answer: C. Sternocleidomastoid

Explanation: Correct Answer (C) Sternocleidomastoid Ref: Sol : • Accessory nerve eleventh cranial
nerve; origin, by cranial roots from the side of the medulla oblongata, and by spinal roots from the side
of the spinal cord (from the upper three or more cervical segments); the roots unite to form the trunk of
the accessory nerve, which divides into an internal branch (cranial portion) and an external branch
(spinal portion); distribution, the internal branch to the vagus and thereby to the palate, pharynx, larynx,
and thoracic viscera; the external branch branches to the sternocleidomastoid and trapezius muscles;
modality, parasympathetic and motor.
Q78. Internal arcuate fibers of medulla comes from:

A. Dorsal nucleus of vagus

B. Hyposglossal nucleus

C. Nucleus of tractus solitaries

D. Nucleus gracilis and cuneatus

Correct Answer: D. Nucleus gracilis and cuneatus

Explanation: Correct Answer (D) Nucleus gracilis and cuneatus Ref: Read the text below Sol : a. The
nucleus gracilis and cuneatus give rise to the internal arcuate fibres in the upper medulla. b. These
fibres cross to the opposite side to continue as the medial lemniscus. c. Internal arcuate fibers are
part of the second-order neurons of the dorsal column-medial lemniscus system which relay the
sensations like pressure, fine touch, conscious proprioception to the thalamus.
Q79. Parasympathetic supply is present to which muscles?

A. Inferior oblique

B. Ciliary muscle

C. Tarsal muscle

D. Muller muscle

Correct Answer: B. Ciliary muscle

Explanation: Correct Answer (B) Ciliary muscle Ref: Read the text below Sol : Ciliary muscle and
sphincter papillae muscles are supplied by Parasympathetic supply
Q80. Which is not a branch from first part of maxillary artery ?

A. Deep temporal

B. Deep auricular

C. Inferior alveolar

D. Anterior tympanic

Correct Answer: A. Deep temporal

Explanation: Correct Answer (A) Deep temporal Ref: Read the text below Sol : Deep temporal is a
branch from 2nd part of maxillary artery.
Q81. Which of the following is a false statement concerning nitrous oxide
cylinders?

A. They are colour-coded blue

B. The cylinder pressure is directly proportional to the quantity of N20 it contains

C. Rapid emptying of a cylinder will cause its temperature to fall

D. Pressure regulators must be used to reduce the pressure of the gas supplied from
the cylinder before it enters the patient circuit

Correct Answer: B. The cylinder pressure is directly proportional to the quantity of N20 it
contains

Explanation: Correct Answer (B) Option A: • colour coding is meant for easy identification of cylinder,
and it helps in preventing wrong cylinder attachment in the machine. • Nitrous oxide cylinder is blue in
colour. Option B: • nitrous oxide has a low boiling point of 36.5-degree Celsius and under pressure it
gets converted into liquid form. • Because the gas is stored in a liquid form, the pressure of the
cylinder depends on the weight of the cylinder till all the liquid is not converted into the gas and later
depends on quantity of gas present. • Until nitrous oxide is in liquid form the pressure in the cylinder
will be constant at 750 psi. Option C: • Because energy is consumed in the conversion of a liquid to a
gas (the latent heat of vaporization), the liquid nitrous oxide cools. The drop in temperature results in a
lower vapor pressure and lower cylinder pressure. The cooling is so pronounced at high flow rates that
there is often frost on the tank, and pressure regulators may freeze. Option D: • cylinder is a part of
high-pressure system and gas supply at such high pressures can damage the machine as well as
cause barotrauma to the patient as well. therefore pressure regulators are used to reduce the pressure
of the cylinders to intermediate pressure which is the working pressure of the machine.
Q82. Which of the following statements about lumbar puncture is true except?

A. Ideal level in neonates is below L3 spinal vertebrae

B. Quinke type of needle increases the risk of pdph

C. Early mobilization following lumbar puncture increases the risk of pdph

D. Contraindicated in patients with raised icp

Correct Answer: C. Early mobilization following lumbar puncture increases the risk of pdph

Explanation: Correct Answer (C) Factors which increase the risk of pdph 1) young age 2) Female
gender 3) Pregnancy intrabdominal mass 4) Multiple puncture 5) Needle: large size small gauge
dura cutting Infact early mobilization following lumbar puncture is known to decrease the incidence of
pdph
Q83. Component(s) of advanced cardiovascular life support (ACLS) according
to AHA 2015 guidelines is?

A. Rate of chest compression 100-120/min

B. One breath every 10 seconds

C. Vasopressin preferred over epinephrine

D. Capnography no longer followed to confirm ET tube placement

Correct Answer: A. Rate of chest compression 100-120/min

Explanation: Correct Answer (A) Explanation: ACLS algorithm for adult cardiac arrest-2015 as given by
AHA:
Q84. Venous air embolism can most frequently occur with following position?

A. Prone

B. Lateral decubitus

C. Reverse Trendelenburg

D. Sitting

Correct Answer: D. Sitting

Explanation: Correct Answer (D) Posterior fossa surgeries in sitting position are most common position
for venous air embolism
Q85. The capnogram waveform above represents which of the following
situations?

A. Kinked endotracheal tube

B. Bronchospasm

C. Incompetent inspiratory valve

D. Exhausted co2 absorber

Correct Answer: D. Exhausted co2 absorber

Explanation: Correct Answer (D) • The capnogram is useful in: a) verification of exhaled CO2 after
tracheal intubation b) estimation of the differences in Paco2 and Petco2 c) abnormalities of ventilation
d) hypercapnia or hypocapnia. • The four phases of the capnogram are: a) inspiratory baseline b)
expiratory upstroke c) expiratory plateau, d) inspiratory downstroke. • The shape of the capnogram
can be used to recognize and diagnose a variety of potentially adverse circumstances. • Under
normal conditions, the inspiratory baseline should be 0, indicating that there is no rebreathing of CO2
with a normal functioning circle breathing system. • If the inspiratory baseline is elevated above 0,
there is rebreathing of CO2. • If this occurs, the differential diagnosis should include an incompetent
expiratory valve, exhausted CO2 absorbent, or gas channelling through the CO2 absorbent. • Partial
obstruction may be the result of an obstruction in the breathing system (e.g., by a kinked endotracheal
tube) or in the patient’s airway (e.g., chronic obstructive pulmonary disease or acute bronchospasm).
• This may cause a prolonged increase in the slope of the expiratory plateau, which may continue
rising until the next inspiratory downstroke begins. • The inspiratory downstroke is caused by the
rapid influx of fresh gas, which washes the CO2 away from the CO2 sensing or sampling site. •
Under normal conditions, the inspiratory downstroke is very steep. • The causes of a slanted or
blunted inspiratory downstroke include an incompetent inspiratory valve, slow mechanical inspiration,
slow gas sampling, and partial CO2 rebreathing
Q86. A 10 year old boy presented with abdominal pain, muscle weakness and
fatigue. On investigations , serum lead levels were found increased in blood .
Activity of which of the following enzyme in the liver is increased :

A. ALA synthase

B. Ferrochelatase

C. PGB deaminase

D. Heme oxygenase

Correct Answer: A. ALA synthase

Explanation: Correct Answer (A) ALA synthase Lead poisoning results in reduced heme synthesis.
Heme is responsible for repression of ALA synthase gene. In lack of heme synthesis due to lead
poisoning the gene is de-repressed. Due to de-repression of ALA synthase gene, more of the ALA
synthase enzyme is synthesized.
Q87. Enzyme which is active in well fed state is:

A. Carnitine palmitoy1 transferase 1

B. Pyruvate carboxylase

C. Acety1 CoA carboxylase

D. HMG lyase

Correct Answer: C. Acety1 CoA carboxylase

Explanation: Correct Answer (C) Acety1 CoA carboxylase Explanation: • Acety1 Co-A carboxylase is
the rate- limiting step of fatty acid synthesis. Fatty acid synthesis occurs during well fed state. Insulin is
the predominant hormone during well-fed state. • Pyruvate carboxylase is the first step during
gluconeogenesis. Gluconeogenesis is favoured by glucagon, the predominant hormone of the fasting
state. • Carnitine palmitoyl transferase1 is the regulatory step for fatty acid oxidation, which occurs
during fasting.
Q88. If the tRNA has the sequence 5’-CAC-3’, what codon would it recognize
(ignore wobble base pairing)?

A. 3’-UAC-5’

B. 3’-AUG-5’

C. 5’-AUC-3’

D. 5’-GUG-3’

Correct Answer: D. 5’-GUG-3’

Explanation: Correct Answer (D) 5’-GUG-3’

Q89. Vitamin B12 deficiency results in folate trap. This is due to:

A. Methionine metabolism is decreased

B. Conversion of glutamyl CoA to Succinyl CoA

C. Conversion of methyl CoA to succinyl CoA

D. Blocking conversion of N5-methyl THFA to THFA

Correct Answer: A. Methionine metabolism is decreased

Explanation: Correct Answer (A) Blocking conversion of N5-methyl THFA to THFA Due to deficiency of
Vitamin B12 homocysteine methyl transferase enzyme is not functioning. This leads to trapping of
THFA in the form of N5 Methyl THFA. This condition is called as folate trap.
Q90. Which of the following statement is true regarding “Cyanide” ?

A. Only minimally inhibits the ETC because cytochrome oxidase is the terminal
component of the chain

B. Inhibits mitochondrial respiration but energy production is unaffected

C. Also binds the copper of cytochrome oxidase

D. Bind to Fe+++ of cytochrome a3

Correct Answer: D. Bind to Fe+++ of cytochrome a3

Explanation: Correct Answer (D) Bind to Fe+++ of cytochrome a3 • That is why methaemoglobin is an
effective antidote since it also has Fe+++. • Respiration and energy production is the coupled
process, so inhibition of one inhibits the other as well. • Cu is an important part of cytochrome
oxidase, but cyanide does not bind it.
Q91. A moving vehicle hits a person walking on the road. There are multiple
injuries on his body. The injury shown in the picture is most likely to develop
during?

A. Primary impact

B. Secondary impact

C. Tertiary impact

D. While defending the impact

Correct Answer: C. Tertiary impact

Explanation: Correct Answer (C) Grazed abrasions are common injuries in road traffic accident. The
most common scenario for their development is when the body is sliding on the rough road. The sliding
of the body happens during tertiary impact (also called as secondary injuries)
Q92. Prosecution witness Mr A, during his direct examination gives statement
contrary to what he had earlier told police during initial investigation.
Prosecution lawyer asks him- you are lying because you have been paid
money? The correct option is?

A. Leading questions are not allowed in cross examination.

B. Prosecution witness can change his evidence during direct examination.

C. Prosecution Lawyer can ask leading question to Prosecution witness during

Re-direct examination.

D. Leading questions permitted during direct examination to prove hostility of the

witness.

Correct Answer: D. Leading questions permitted during direct examination to prove hostility of
the witness.

Explanation: Correct Answer (D) The lawyer of the opposite side can ask leading questions to a witness
during cross-xamination. But if a witness turns hostile then his own lawyer can ask him leading
questions during direct examination.
Q93. A dead body is found to have multiple bullet wounds. During autopsy all
are correct statements except?

A. Multiple wounds can be combination of entry and exit wounds.

B. X-ray examination should not be done before autopsy.

C. All bullets recovered from the body are to be preserved separately.

D. It is mandatory to preserve clothing present over the body.

Correct Answer: B. X-ray examination should not be done before autopsy.

Explanation: Correct Answer (B) Multiple bullet wounds in a body means the person would have been
shot by more than one bullet. Many of the wounds thus would be entry and many would be exit. Thus it
is important that X-ray of the body be done before autopsy to determine the number/location of bullets
still present inside the body. Each bullet recovered form the body is labeled and preserved separately.
Q94. A person dies after consuming certain substance. His family gives history
that he suddenly developed chest pain, breathlessness. His pupils were
alternately dilating and contracting before death. The active principle
responsible for his death is?

A. Aconitine

B. Bhilawanol

C. Abrin

D. Calotropin

Correct Answer: A. Aconitine

Explanation: Correct Answer (A) Alternating constriction and dilation of pupils (Hippus) is a classical
sign in Aconite (Wolf’s bane) poisoning. The active principle is Aconitine.
Q95. A couple comes for Artificial Insemination. The doctor takes the consent of
the father and performs the procedure. Conception happens. All statements are
false except?

A. The procedure can be done on wife’s consent only.

B. The couple gets to choose the Race of the inseminated semen.

C. The born child is illegitimate although consent of father is there.

D. The donor of the semen has the right to know where insemination will be done.

Correct Answer: C. The born child is illegitimate although consent of father is there.

Explanation: Correct Answer (C) The child born after artificial insemination remains illegitimate to the
father. To make the child heir of the property, the father has to adopt the child after birth.
Q96. In which layer is this sign located in

A. Nerve fibre layer.

B. Ganglion cell layer

C. Inner plexiform layer.

D. Inner nuclear layer

Correct Answer: A. Nerve fibre layer.

Explanation: Correct Answer (A) Cotton wool spots Nerve fiber Layer It is due to infarction of nerve fibre
layer
Q97. All of the following are associated with this condition except:

A. Marfans syndrome

B. Sulphite oxidase deficiency

C. Diabetes mellitus

D. Hyperlysinemia

Correct Answer: C. Diabetes mellitus

Explanation: Correct Answer (C) Ectopia lentis is associated with: • Familial ectopia lentis • Marfan
syndrome • Weill-Marchesani • Homocystinuria • Hyperlysinaemia • Sulphite oxidase deficiency •
Stickler syndrome syndrome • Aniridia
Q98. Diplopia increasing on levoversion and downgaze is seen in?

A. Right SO palsy

B. Left SO palsy

C. Right IR palsy

D. Left SR palsy

Correct Answer: A. Right SO palsy

Explanation: Correct Answer (A) Diplopia in right superior oblique palsy increases on looking down and
levoversion In paralysis of the superior oblique muscle (trochlear nerve palsy), maximum diplopia is
experienced when the patient looks down. This is especially important when the patient tries to climb
downstairs and when trying to read a book.
Q99. The predominant cell forms seen in the figure are

A. Lymphocytes

B. Epithelioid cells

C. Polymorphonuclear leukocytes

D. Macrophages

Correct Answer: D. Macrophages

Explanation: Correct Answer (D) “ Granulomatous “ keratic precipitates ( KPs ) may have a
characteristic greasy , mutton –fat appearance , without actually being granulomas themselves.
Macrophages are responsible for the clinical appearance.
Q100. Features of Horner’s syndrome caused by post-superior ganglion lesion
are all the following except:

A. Miosis

B. Ptosis

C. Anhydrosis

D. Loss of ciliospinal reflex

Correct Answer: C. Anhydrosis

Explanation: Correct Answer (C) Anhydrosis Horner’s Syndrome Clinical features: • Miosis • Ptosis,
inverse ptosis • Apparent Enophthalmos • Heterochromia iridis • Anhidrosis (if lesion is before superior
cervical ganglion), loss of ciliospinal reflex
Q101. An 18 year old boy comes to the eye casuality with history of injury with a
tennis ball. On examination there is no perforation but there is hyphaema. What
is the sign shown in the picture

A. Iridodialysis

B. Cyclodialysis

C. Iris sphincter rupture

D. Vossius ring

Correct Answer: A. Iridodialysis

Explanation: Correct Answer (A) It is a localized separation or tearing away of the iris from its
attachment to the ciliary body- causing a D shaped pupil Cyclodialysis- separation of ciliary body from
scleral spur Iris sphincter rupture- rupture of sphincter pupillae muscle causes dilatation at that area of
pupil Vossius ring- pigments of iris on lens capsule
Q102. Evisceration of eye is not done in

A. Intraocular Malignancy

B. Panophthalmitis

C. Severe globe trauma

D. Expulsive hemorrhage

Correct Answer: A. Intraocular Malignancy

Explanation: Correct Answer (A) Eviseration is taking out intraocular contents leaving behind sclera. Its
contraindicated in intraocular tumours
Q103. Which tonometer is a based on dynamic contour principle?

A. Goldmann

B. Pascal

C. Perkins

D. Tonopen

Correct Answer: B. Pascal

Explanation: Correct Answer (B) Goldmann and Perkin are based on applanation Tonopen is based on
applanation plus indentation
Q104. Which bony structures are broken during dacryocystorhinostomy?

A. Lacrimal, ethmoid

B. Maxillary, ethmoid

C. Nasal, lacrimal

D. Lacrimal, maxillary

Correct Answer: D. Lacrimal, maxillary

Explanation: Correct Answer (D) Medial orbital bones maxillary and lacrimal are broken in DCR and
opening is made in middle meatus of nose
Q105. Diagnosis?

A. Horner syndrome

B. Homes-Adie pupil

C. Argyll-Roberston Pupil

D. Marcus Gunn pupil

Correct Answer: B. Homes-Adie pupil

Explanation: Correct Answer (B) Anisocoria is more in light condition, so dilated pupil is the affected
eye There is light near dissociation as well Adies pupil causes this ARP is a miotic pupil
Q106. Which of the following is not true about kleine levin syndrome?

A. Periodic hypersomnia followed by hyperphagia

B. Voracious eating

C. Self limiting in nature

D. Onset in 3rd decade of life

Correct Answer: D. Onset in 3rd decade of life

Explanation: Correct Answer (D) Onset in 3rd decade of life Clinical features of kleine Levin syndrome
Periodic episodes of hypersomnia followed by hyperphagia Episodes lasts for several weeks 1st attack
between 10 -21 years of age Self limiting Intervening periods of normal sleep and waking Other
symptoms during hypersomnic episodes Social withdrawal Apathy Irritability Confusion Voracious
eating Delusions/ hallucinations Incoherent speech
Q107. The “P300” evoked potential abnormalities are reported in which of the
following disease?

A. Herpes encephalitis

B. Creutzfeld Jacob disease

C. Schizophrenia

D. Depression

Correct Answer: C. Schizophrenia

Explanation: Correct Answer (C) Schizophrenia • A large number of abnormalities in evoked potential
among patients with schizophrenia has been described. • The P300 has been most studied and is
defined as a large, positive evoked-potential wave that occurs about 300 milliseconds after a sensory
stimulus is detected. • The major source of the P300 wave may be located in the limbic system
structures of the medial temporal lobes. • In patients with schizophrenia, the P300 has been reported
to be statistically smaller than in comparison groups. • Abnormalities in the P300 wave have also
been reported to be more common in children who, because they have affected parents, are at high
risk for schizophrenia.
Q108. What is the second most common cause of DEMENTIA in elderly?

A. Vascular dementia

B. Frontotemporal dementia

C. Dementia due to Lewy body disease

D. Dementia due to use of alcohol

Correct Answer: C. Dementia due to Lewy body disease

Explanation: Correct Answer (C) Dementia due to Lewy body disease (Ref : ICD 11) Dementia due to
Lewy body disease is the second most common form of dementia in the elderly after Alzheimer
disease. The precise etiology is unknown but involves abnormal alpha-synuclein protein folding and
aggregation with Lewy body formation primarily in the cortex and brainstem. Onset is insidious with
attentional and executive functioning deficits typically reported as the initial presenting complaint.
These cognitive deficits are often accompanied by visual hallucinations and symptoms of REM sleep
behaviour disorder. Hallucinations in other sensory modalities, depressive symptoms, and delusions
may also be present. The symptom presentation usually varies significantly over the course of days
necessitating longitudinal assessment and differentiation from Delirium. Spontaneous onset of
Parkinsonism within approximately 1 year of the onset of cognitive symptoms is characteristic of the
disease.
Q109. Acc to jean piaget, cognitive developmental theory, concepts like "out of
sight is out of mind" and "here and now" are seen in which of the following
stage:

A. Sensorimotor stage

B. Preoperational stage

C. Concrete operational

D. Stage of formal operations

Correct Answer: A. Sensorimotor stage

Explanation: Correct Answer (A) Sensorimotor stage

Q110. Over a 5-week period, a previously healthy 55-year-old female has
developed headaches, progressively severe word-finding difficulty, and
confusion. She speaks incoherently and is unable to follow commands, repeat
phrases, or name objects. What is the most likely site of the lesion?

A. Frontal lobe

B. Temporal lobe

C. Occipital lobe

D. Occipital lobe

Correct Answer: B. Temporal lobe

Explanation: Correct Answer (B) Temporal lobe is associated with language, memory, and emotional
expression.
Q111. A 25 years old man is involved in an automobile accident and slams his
head into a concrete wall of a bridge. His CT scan is shown to you. Blood
leaking the ruptured artery enters which of the following spaces?

A. Subarachnoid space

B. Subdural space

C. Epidural space

D. Subpial space

Correct Answer: C. Epidural space

Explanation: Correct Answer (C) Note the typical EDH with biconvex shape and limited by skull sutures.
Q112. Iridium-192 is characterized by the following EXCEPT:

A. It is a widely used radionuclide for brachytherapy procedures.

B. It has a small source size.

C. It is used for permanent implants.

D. The lower photon energy makes radiation protection easier than radium or cesium.

Correct Answer: C. It is used for permanent implants.

Explanation: Correct Answer (C) It is used for permanent implants. Iridium-192 is a used radionuclide
in part because of its convenience, due to its small size, its low photon energy simplifying radiation
protection and its ability to be used in remote afterloaders. It is used for temporary implants and not
used for permanent implants
Q113. Linear accelerator for

A. Electrons and xrays

B. Gamma and protons

C. Electrons and protons

D. Set 3Neutrons and xray

Correct Answer: A. Electrons and xrays

Explanation: Correct Answer (A) Electrons and Xrays Linear accelerator (LINAC) is the device used for
external beam radiation treatments for patients with cancer. It delivers high-energy x-rays or electrons
to the region of the patient's tumor.
Q114. FDG PET negative tumor

A. Atypical carcinoid

B. Typical carcinoid

C. Small cell carcinoma

D. Large cell neuroendocrine carcinoma

Correct Answer: B. Typical carcinoid

Explanation: Correct Answer (B) Typical carcinoid Typical carcinoids and bronchoalveolar carcinoma
are classical low metabolic rate tumour and are usually negative on FDG PET.
Q115. Identify the structure marked by arrow

A. Ascending aorta

B. Descending aorta

C. SVC

D. Pulmonary artery

Correct Answer: A. Ascending aorta

Explanation: Correct Answer (A) Ascending aorta

Q116. A young Marathon runner complaining of pain on walking and running in
anterior and medial aspect of tibia. The X-rays findings are normal. Further
bone scan was advised. What is your diagnosis?

A. Nutcracker fracture

B. Shin splints

C. Jones fracture

D. Lisfranc fracture

Correct Answer: B. Shin splints

Explanation: Correct Answer (B)

Q117. The given below instrument is used for:

A. Plate holding

B. Bone nibbler

C. Controlled traction of the fracture segment

D. Cutting the K-WIRE

Correct Answer: A. Plate holding

Explanation: Correct Answer (A)

Q118. A middle-aged female present with lytic lesion in lower 1/3 of femur.
Biopsy showed grooved nuclei and giant cells. No periosteal reaction seen.
What is the confirmatory investigation for this case:

A. Serum PTH

B. Serum Calcitonin

C. Cd1a and Langerin IHC

D. MRI

Correct Answer: C. Cd1a and Langerin IHC

Explanation: Correct Answer (C)

Q119. A male brought to the casualty after he met with an accident. He was
having comminuted fracture in the lower end of femur. His distal pulses were
not palpable so a vascular surgeon decided to explore. So the resident did the
following procedure given below the picture. What is the name of the fixator?

A. K nail

B. Interlocking nail

C. Rail fixator

D. Ilizarov fixator

Correct Answer: C. Rail fixator

Explanation: Correct Answer (C)

Q120. Match the following:

A. a-2, b-3, c-5, d-1

B. a-4, b-3, c-2, d-1

C. a-1, b-2, c-4, d-3

D. a-4, b-5, c-3, d-1

Correct Answer: D. a-4, b-5, c-3, d-1

Explanation: Correct Answer (D)

Q121. Scaly lesions are all except:

A. Discoid lupus erythematosus

B. Lichen planus

C. Pityriasis rosea

D. Tinea

Correct Answer: B. Lichen planus

Explanation: Correct Answer (B)

Q122. A patient presents to with target lesions. The likely causes are all except:

A. Tick bite

B. Drugs

C. Mycoplasma

D. HPV

Correct Answer: D. HPV

Explanation: Correct Answer (D)

Q123. Pick the incorrect histology:

A. Spongiosis- eczema

B. Microabscess- Dermatitis herpetiformis

C. Interface dermatitis- Psoriasis

D. Epidermotropism- Lymphoma

Correct Answer: C. Interface dermatitis- Psoriasis

Explanation: Correct Answer (C)

Q124. A patient presents with lesions for which the microscopy is as shown as
shown. The diagnosis is :

A. Chromoblastomycosis

B. Wart

C. Sporotrichosis

D. Molluscum

Correct Answer: D. Molluscum

Explanation: Correct Answer (D)

Q125. All the following tests are useful in diagnosis of blisters except:

A. Bulla spread sign

B. Nikolsky sign

C. Tzanck smear

D. Grattage test

Correct Answer: D. Grattage test

Explanation: Correct Answer (D)

Q126. An equipment shown in the image is used to sterilize catgut and the
method is named as cold sterilization. Name the quality control agent used for
this equipment.

A. Geobacillus stearothermophilus

B. Bacillus atropheus

C. Bacillus pumilus

D. Clostridium tetani – Non toxic spores

Correct Answer: C. Bacillus pumilus

Explanation: Correct Answer (C) Bacillus pumilus • Image shown here is an equipment which
generates Gamma rays. • Sterilization by Gamma radiation is otherwise called cold sterilization. •
Used for disposable plastic syringes. • QC agent is B. pumilus
Q127. The image shown here depicts Elek’s gel precipitation test which shown
positive reaction for C. diphtheriae. Choose the correct name for this procedure

A. Oudin

B. Oakley Thorpe

C. Mancini

D. Ouchterlony

Correct Answer: D. Ouchterlony

Explanation: Correct Answer (D) Ouchterlony Image shown here is double diffusion in two dimension.
Single diffusion in one dimension- Oudin procedure Single diffusion in Two dimension –Rad ial
immunodiffusion/Mancini procedure Double diffusion in one dimension - Oakley–Fulthrope procedure
Double diffusion in two dimension- Ouchterlony procedure
Q128. A 28-year-old PLHIV man presents to the ophthalmologist complaining of
worsening vision for the past two weeks and seeing new flashes and floaters in
his right eye. He reports no pain in his right eye nor is there any redness. On
ophthalmoscopic examination finding shown in the image. Choose the best test
to diagnose this disease

A. Paul Bunnell test

B. PP65 antigen ELISA

C. Tzanck smear

D. Egg Yolk inoculation

Correct Answer: D. Egg Yolk inoculation

Explanation: Correct Answer (D) • This PLHIV male is experiencing CMV retinitis caused by the
cytomegalovirus (CMV) which is a linear, dsDNA enveloped virus. • CMV, or human herpes virus
type 5, is a linear, dsDNA, enveloped virus that is transmitted via the following routes: congenital, blood
transfusion, sex, saliva, urine, and transplantation. Once CMV has established its initial infection, it
establishes a latent infection within mononuclear cells. CMV causes mononucleosis in
immunocompentent individuals. In infants. • It causes cytomegalic inclusion disease resulting in
neonatal jaundice, hepatosplenomegaly, thrombocytic purpura, hearing loss, and seizures. In the
immunocompromised (e.g. individuals with AIDS or transplant patients taking immunosuppressive
medications), it causes retinitis and pneumonia. • Lab diagnosis : 1. PP65 antigen detection,
RTPCR. Biopsy shows owl eye appearance.
Q129. A 22-year-old man was admitted with a provisional diagnosis of
hydrophobia. He had the history of category 3 dog bite 2 months ago and
denied vaccinations. Choose the best clinical specimen that can confirm the
diagnosis is

A. Saliva for viral culture

B. Serum for anti-rabies IgG antibody by ELISA

C. Corneal impression smear for immunofluorescence stain

D. Demonstration of Negri bodies

Correct Answer: C. Corneal impression smear for immunofluorescence stain

Explanation: Correct Answer (C) • For the antemortem diagnosis of rabies, viral antigens can be
demonstrated in the corneal smear, skin biopsy from the face or neck or saliva. • RTPCR, ELISA
based tests and Immunofluorescent are used. • Hydrophobia is 100% fatal. • Vaccine can prevent
hydrophobia.
Q130. A patient, presents with fever and hemoglobinuria. The lab reports that
the CBC is remarkable for a parasite as shown in the image. He had a history of
recent blood transfusion. If the pathogen transmitted via blood transfusion,
Which stage of the lifecycle of the pathogen is absent?

A. Erythrocytic cycle

B. Pre erythrocytic cycle

C. Exoerythrocytic cycle

D. Gametogony

Correct Answer: B. Pre erythrocytic cycle

Explanation: Correct Answer (B) It’s a case of transfusion transmitted malaria infection. Caused by P.
falciparum. Infective stage is Trophozoites and Merozoites. The pre erythrocytic cycle in Liver is absent
in this case.
Q131. A 38-year-old PLHIV has a persistent cough and has shown progressive
behavioral changes in the past few weeks after eating an undercooked
hamburger. His CD4 count is 168/cmm. On examination, few skin lesions are
present in the arm and face. Cerebrospinal fluid (CSF) Stained with a specific
stain as shown in the image revealed the diagnosis. Choose the correct stain
used in the identification of this microbe.

A. India ink

B. Nigrosin

C. Mucicarmine

D. Calcofluor white

Correct Answer: C. Mucicarmine

Explanation: Correct Answer (C) • It’s a case of Cryptococcal meningitis caused by Cryptococcus
neoformans – an opportunistic fungal infection. • Laboratory diagnosis of cryptococcal infection is
made by demonstration of the yeast in CSF, sputum, pus, and brain biopsy tissue by smear and
culture. • Ideal stain for this fungi is mucicarmine stain. • Capsule can be demonstrated by India
ink/ Nigrosin stains.
Q132. A 23-year-old woman returns from a week swimming at the beach and
presents to her physician with a complaint of pain in her right ear. Physical
examination reveals an area of redness extending from her right ear toward her
right mandible that is warm to the touch. The patient's oropharynx is without
exudates or erythema. What may be the selective medium for this pathogen?

A. Filde’s agar

B. Cetrimide agar

C. Ludlam agar

D. Chocolate agar

Correct Answer: B. Cetrimide agar

Explanation: Correct Answer (B) • The patient has otitis externa, which often occurs after swimming.
• Otitis externa typically presents with ear pain, pruritis, discharge and pain on manipulation of the
pinna. Periauricular cellulitis and fever are signs of more serious infection. • As opposed to otitis
media, there is typically no evidence of middle ear fluid. Pseudomonas aeruginosa is the most common
cause of otitis externa, followed by Staphylococcus epidermidis . • Selective medium for P.
aeruginosa is Cetrimide agar.
Q133. A jaundiced 7-year-old boy, with a history of playing in a pond in a
rat-infested area, has a urine specimen submitted for a direct dark-field
microscopy examination. DFM revealed the pathogen as shown in the image.
Which medium should be inoculated to isolate the suspected organism?

A. MGTTTA

B. PPLO agar

C. Fletcher medium

D. PEMBA

Correct Answer: C. Fletcher medium

Explanation: Correct Answer (C) • DFM image shown here confirms the suspected diagnosis as
leptospirosis. • The selective medium is Fletcher’s semi solid agar. Another medium is EMJH medium
• PEMBA for B. cereus, MGTTTA for V. cholerae and PPLO for Mycoplasma.
Q134. A 24-year-old student presents to the causality with sudden onset of
abdominal pain, vomiting, and non-bloody diarrhea. A couple of hours earlier,
he had eaten fried rice and beef which had been left on the counter by his
roommate after being reheated in the microwave. Choose the colony
morphology of the pathogen in the selective medium.

A. Oil paint colonies

B. Oil drop colonies

C. Opalescent colonies

D. Molar tooth colonies

Correct Answer: C. Opalescent colonies

Explanation: Correct Answer (C) • Motile, lacks capsule, causes food poisoning – After consumption
of starch rich food and Meat – Fried rice is Bacillus cereus. • Selective media- MYPA (Mannitol, Egg
Yolk, Phenol Red, Polymyxin Agar) and PEMBA medium. • It has lecithinase, so in the egg containing
selective media, it produces opalescent colonies.
Q135. What is the infective stage in the lifecycle shown in the image?

A. Cysticercus cellulose

B. Cercariae

C. Metacercariae

D. Cysticercus bovis

Correct Answer: D. Cysticercus bovis

Explanation: Correct Answer (D) The image shown here is the life cycle of Taenia saginata Def host –
human Intermediate host – Cattle Diagnostic stage – Hexacanth egg from stool specimen Infective
stage – Cysticercus bovis in undercooked / raw beef. Treatment – Praziquantel.
Q136. Regarding flumazenil find out the false statements A. Flumazenil
antagonizes effects of β-carbolines B. Given as single IV bolus injection C. t
1/2 of about 12- 20 hrs D. causes seizures, when used for TCA poisoning

A. A only

B. A & C

C. B, C & D

D. B & C

Correct Answer: D. B & C

Explanation: Correct Answer (D) Flumazenil antagonizes both the electrophysiological and behavioural
effects of agonist and inverse-agonist benzodiazepines and β-carbolines Flumazenil is available only
for intravenous administration. Administration of a series of small injections is preferred to a single
bolus injection. A total of 1 mg flumazenil given over 1–3 min usually is sufficient to abolish the effects
of therapeutic doses of benzodiazepines. Additional courses of treatment with flumazenil may be
needed within 20–30 min should sedation reappear. Flumazenil associated with the onset of seizures,
especially in patients poisoned with tricyclic antidepressants. t 1/2 of about 1 h.
Q137. Find out the drugs which increases ocular pressure A. Topiramate B.
Echothiophate C. Imipramine D. Ripasudil

A. A & B

B. B & C

C. C & D

D. A & C

Correct Answer: D. A & C

Explanation: Correct Answer (D) topiramate can cause choroidal effusions leading to angle-closure
glaucoma. Other adverse effects of topiramate includes somnolence, fatigue, weight loss, and
nervousness, renal calculi (kidney stones), probably due to inhibition of carbonic anhydrase.
Echothiophate is Anticholinesterase useful for treatment of glaucoma, causes adverse effects of Retinal
detachment, miosis, cataract, pupillary block, iris cysts, brow ache, punctal stenosis Imipramine (TCA),
having anticholinergic property, may aggravates glaucoma Rripasudil - It is a selective rho-associated
coiled-coil-containing protein kinase 1 (ROCK1) inhibitor, useful in glaucoma
Q138. Match the following Regarding anticancer drugs and its adverse effects

A. 1. C, 2. D, 3. B, 4. A

B. 1. D, 2. C, 3. B, 4. A

C. 1. D, 2. C, 3. A, 4. B

D. 1. B, 2. D, 3. A, 4. C

Correct Answer: B. 1. D, 2. C, 3. B, 4. A

Explanation: Correct Answer (B) BLEOMYCIN Most serious: pulmonary toxicity • Cutaneous toxicity
(erythema, ulcerations, ( flagellated pigmentation on skin )) • Less myelosuppression than other
cytotoxics Capecitabine hand and foot syndrome consists of erythema, desquamation, pain, and
sensitivity to touch of the palms and soles, Capecitabine causes a similar spectrum of toxicities as 5FU
(diarrhea, myelosuppression), but the hand-foot syndrome occurs more frequently and may require
dose reduction or cessation of therapy Dactinomycin ; dermatological manifestations include alopecia,
as well as erythema, desquamation, and increased inflammation and pigmentation in areas previously
or concomitantly subjected to X-ray Busulfan prolonged (up to years) pancytopenia; suppression of
stem cells; seizures; ↑ clearance of phenytoin; hepatic VOD
Q139. Drug causing angioedema includes A. Omapatrliat B. Enalaprilat C.
Ecalantide D. Lugols iodine

A. B only

B. A. B & C

C. B, C & D

D. A, B & D

Correct Answer: D. A, B & D

Explanation: Correct Answer (D) Ecalantide -is a synthetic plasma kallikrein inhibitor approved for the
treatment of acute attacks of hereditary angioedema in patients 12 years and older The selective B2
receptor antagonist icatibant has been approved in the E.U. and recently in the U.S. for treatment of
acute episodes of swelling in patients more than 18 years of age with hereditary angioedema. Lugol
solution- Angioedema is the prominent symptom, and laryngeal edema may lead to suffocation. chronic
intoxication with iodide is known as Iodism- unpleasant brassy taste and burning in the mouth and
throat as well as soreness of the teeth and gums. Increased salivation, coryza, sneezing, and irritation
of the eyes with swelling of the eyelids commonly occur. Mild iodism simulates a “head cold.” Excess
transudation into the bronchial tree may lead to pulmonary edema.
Q140. Regarding omalizumab find out the false statement

A. It blocks the binding of IgE to high-affinity IgE receptors

B. It reduces levels of circulating IgE.

C. Administered by subcutaneous injection

D. Major side effect is severe headache

Correct Answer: D. Major side effect is severe headache

Explanation: Correct Answer (D) Omalizumab is a humanized monoclonal antibody that blocks the
binding of IgE to high-affinity IgE receptors (FcεR1) on mast cells and thus prevents their activation by
allergens. It also blocks binding on IgE to low-affinity IgE receptors on other inflammatory cells,
including T and B lymphocytes, macrophages, and possibly eosinophils, to inhibit chronic
inflammation. Omalizumab also reduces levels of circulating IgE. The antibody is administered by
subcutaneous injection every 2–4 weeks, and the dose is determined by the titer of circulating total IgE.
The major side effect of omalizumab is an anaphylactic response, which is uncommon
Q141. All of the following drugs cause memory loss except

A. Isoniazid

B. Propranolol

C. Donepezil

D. Omeprazole

Correct Answer: C. Donepezil

Explanation: Correct Answer (C) Donepezil- Acetylcholinesterase Inhibitors useful for Mild, moderate,
severe AD dementia, causing adverse effects of GI symptoms: main dose-limiting side effect,
Bradycardia/syncope less common. Other anticholinesterase inhibitor useful for Alzheimer’s disease
includes rivastigmine, galantamine Isoniazid, propranolol and omeprazole reported to cause
dementia(memory loss)
Q142. Which one of the following is the false statement?

A. Pantoprazole safe in pregnancy

B. Lafutidine has ulcer protective action

C. Bismuth has anti H. pylori activity

D. Sucralfate for better efficacy given with rabeprazole

Correct Answer: D. Sucralfate for better efficacy given with rabeprazole

Explanation: Correct Answer (D) Pantoprazole, omeprazole and lansoprazole are safer PPI in
pregnancy Lafutidine is H2 blocker, reduces acid secretion, promotes ulcer healing and has ulcer
protective property Bismuth is the ulcer protective agent also having anti H. pylori activity Sucralfate is
the ulcer protective agents acts only in acid pH, so should not be given with antacid, H3 blocker and
PPIs
Q143. From the given table and from the options Find out the correct
combinations of mechanism of action and indications for the given drugs 1.
A- Q-V 2. B- P-X 3. C-S-W 4. D- R- X

A. 1,2,3 are correct

B. 2,3,4 are correct

C. 1,2,4 are correct

D. 1,3,4 are correct

Correct Answer: A. 1,2,3 are correct

Explanation: Correct Answer (A)

Q144. Regarding Remdesivir find out the false statement

A. Acts by inhibiting RNA dependent RNA polymerase inhibition

B. Causes hepatotoxicity

C. Not recommended in renal impairment patients

D. Not approved for children of less than 12yrs

Correct Answer: D. Not approved for children of less than 12yrs

Explanation: Correct Answer (D) Remdesivir is an intravenous nucleotide prodrug of an adenosine

analog. Remdesivir binds to the viral RNA-dependent RNA polymerase and inhibits viral replication
through premature termination of RNA transcription. Liver function tests and prothrombin time should
be obtained in all patients before remdesivir is administered and during treatment as clinically indicated.
Renal function should be monitored before and during remdesivir treatment as clinically indicated.
Remdesivir is not recommended for patients with an eGFR <30 mL/min due to lack of data Remdesivir
is available through an FDA EUA for the treatment of COVID-19 in hospitalized pediatric patients
weighing 3.5 kg to <40 kg or aged <12 years and weighing ≥3.5 kg.
Q145. Match the following

A. 1. C, 2. D, 3. B, 4. A

B. 1. B, 2. D, 3. A, 4. C

C. 1. B, 2. A, 3. D, 4. C

D. 1. C, 2. A, 3. D, 4. B

Correct Answer: C. 1. B, 2. A, 3. D, 4. C

Explanation: Correct Answer (C) Injectable drug for type 1 DM- pramlintide Associated with
risk of urinary bladder cancer- Pioglitazone Associated with risk of medullary cancer of thyroid-
Liraglutide Associated with risk of megaloblastic anaemia- Metformin
Q146. Identification of sphenoethmoidal (Onodi) air cells is made by the
presence of:

A. Pneumatization of the anterior clinoid processes

B. Large sphenoid sinuses pneumatized posterior to the sella turcica

C. A transverse bony septum within the sphenoid with separation of superior and
inferior airspaces

D. A deviated or absent intersinus septum

Correct Answer: C. A transverse bony septum within the sphenoid with separation of superior
and inferior airspaces

Explanation: Correct Answer (C) A transverse bony septum within the sphenoid with separation of
superior and inferior airspaces Ref: Read the text below Sol: SPHENOETHMOIDAL (ONODI) CELLS
• If unrecognized, the potential for undertreatment is increased, especially if not utilizing intraoperative
CT navigation. • Also, if not recognized, there is increased risk of anterior skull base penetration. To
identify the presence of sphenoethmoidal (Onodi) cells, the coronal images of the CT data set should
be used. • If there is a transverse bony septum within the sphenoid, the airspaces above this septum
represent the ethmoid air cells that have pneumatized into the sphenoid.
Q147. A six-month-old child born with bilateral bony atresia is seen for an
audiological evaluation and treatment recommendation. Radiological evidence
indicates the probable presence of an intact middle ear and cochlea.Of the
following, the most appropriate course of action for this child at this time would
be to:

A. a

B. b

C. c

D. d

Correct Answer: B. b

Explanation: Correct Answer (B) Ref: Read the text below Sol: • BAHA- bone anchored hearing aid
will be given to hearing impaired individuals where conventional hearing aids can not be given like in
bilateral Anotia, EAC atresia, discharging ear, EAC stenosis. • Its a specialized device which is
surgically fitted partly on to mastoid bone. it transmits sound directly to cochlea through the bone
conduction using the principle of osseointegration
Q148. Identify the structures:

A. 1-Tensor veli palatini muscle insertion on the soft palate/2-Torus tubarius/3-Opening

of the Eustachian tube.

B. 3-Tensor veli palatini muscle insertion on the soft palate/1-Torus tubarius/2-Opening

of the Eustachian tube.

C. 3-Tensor veli palatini muscle insertion on the soft palate/2-Torus tubarius/1-Opening

of the Eustachian tube.

D. 1-Tensor veli palatini muscle insertion on the soft palate/3-Torus tubarius/2-Opening

of the Eustachian tube.

Correct Answer: D. 1-Tensor veli palatini muscle insertion on the soft palate/3-Torus
tubarius/2-Opening of the Eustachian tube.

Explanation: Correct Answer (D) 1-Tensor veli palatini muscle insertion on the soft palate/3-Torus
tubarius/2-Opening of the Eustachian tube Ref: Read the text below Sol: Midsagittal section of a
cadaver showing the nasopharynx region and antoamical landmarks surrounding the Eustachian tube.
1. Tensor veli palatini muscle insertion on the soft palate. 2. Opening of the Eustachian tube. 3. Torus
tubarius.
Q149. Which cancer has maximum propensity to spread to cervical lymph
nodes –

A. Nasopharyngeal carcinoma

B. Carcinoma of hard palate

C. Carcinoma of soft palate

D. Carcinoma of mandible

Correct Answer: A. Nasopharyngeal carcinoma

Explanation: Correct Answer (A) Nasopharyngeal carcinoma Reference: Read the text below Sol: •
“Nasopharynx is a centrally located structure with extensive submucosal capillary lymphatic plexus. •
Partly due to this extensive lymphatic existence, NPC has a propensity of lymph node involvement in
its early stages. • Clinical evident cervical lymph adenopathy is seen in more than 86% of the
patients with nasopharyngeal carcinoma”
Q150. On performing a tuning fork exam, a positive Rinne (air greater than bone
conduction) is seen at 1024 Hz, but negative Rinne (bone greater than air
conduction)at 512 and 256 Hz. Which of the following degrees of hearing loss is
suggested by this?

A. 15 to 30 dB HL

B. 30 to 45 dB HL

C. 45 to 60 dB HL

D. 60 to 85 dB HL

Correct Answer: B. 30 to 45 dB HL

Explanation: Correct Answer (B) 30 to 45 dB HL Ref: Read the text below Sol:
Q151. Which of the following best describes the boundaries of Prussak space?

A. Neck of the malleus medially, pars flaccida laterally, scutum superiorly, and lateral
process of malleus inferiorly

B. Anterior and posterior malleolar folds medially and tympanic membrane laterally

C. Facial nerve medially, tympanic annulus and chorda tympani laterally, and incus
buttress superiorly

D. Posterior semicircular canal medially; pyramidal eminence, stapedius muscle, and

facial nerve laterally; ponticulus superiorly; and subiculum inferiorly

Correct Answer: A. Neck of the malleus medially, pars flaccida laterally, scutum superiorly, and
lateral process of malleus inferiorly

Explanation: Correct Answer (A) Neck of the malleus medially, pars flaccida laterally, scutum
superiorly, and lateral process of malleus inferiorly Ref: Read the text below. Sol:- • Prussak space
resides in the lateral epitympanum, medial to the pars flaccida and lateral to the neck of the malleus.
Q152. A patient with autophony has a hypermobile tympanic membrane. what is
the most possible diagnosis?

A. Serous otitis media

B. Palatal myoclonus

C. Patulous Eustachian tube

D. Tympanosclerosis

Correct Answer: C. Patulous Eustachian tube

Explanation: Correct Answer (C) Patulous Eustachian tube Ref: Read the text below Sol: • Patulous
Eustachian tube, also known as patent Eustachian tube, is the name of a physical disorder where the
Eustachian tube, which is normally closed, instead stays intermittently open. • When this occurs, the
patient experiences autophony, the hearing of self-generated sounds. • These sounds, such as one's
own breathing, voice, and heartbeat, vibrate directly onto the ear drum and can create a "bucket on the
head" effect.
Q153. Choose the appropriate statements regarding the structure shown in the
given image: a. The palatine aponeurosis is formed by the expanded tendons
of levator palati muscles. b. Tensor palati turns through 90 degrees around
the pterygoid hamulus. c. Contains mucous glands, lymphoid tissue and
taste buds. d. Is lined by squamous epithelium on its superior surface. e.
Main blood supply comes from the greater palatine artery.

A. Only A and B

B. A and C

C. B and C

D. A,B and C

Correct Answer: C. B and C

Explanation: Correct Answer (C) ( B and C) Ref: Read the text below. Sol:- • Formed by the
expanded tendons of tensor palati muscles, which meet in a midline raphe. This is the functional basis
of the soft palate. All other muscles except musculus uvulae insert into it. • Tensor palati turns
through 90 degrees around the pterygoid hamulus. • Contains mucous glands, lymphoid tissue and
taste buds. • Upper (nasopharyngeal) surface is lined by respiratory epithelium, lower by
non-keratinizing stratified squamous. • The main blood supply is from the palatine branch of the
ascending pharyngeal. The greater palatine artery supplies primarily the hard palate, it runs forward
from the greater palatine foramen to the incisive canal.
Q154. A congenitally deaf child on radiological evaluation of cochlea and brain
with MRI has been found to having absent cochlea. What is the best method of
hearing rehabilitation in this case.

A. Unilateral cochlear implant surgery

B. Bilateral cochlear implant surgery

C. Auditory brain stem implant surgery

D. Bone anchored hearing aids

Correct Answer: C. Auditory brain stem implant surgery

Explanation: Correct Answer (C) Auditory brain stem implant surgery Ref: Read the text below Sol: •
Brain stem implant is placed on lateral recess of 4th ventricle near cochlear nucleus for stimulation. •
The indications are- NF-2 cases with bilateral acoustic neuromas, congenital absence of VIII nerve,
cochlear aplasia(Michel’s)
Q155. All of the following statements are true regarding the pathology shown in
given image except :

A. Superficial layer of the lamina propria is involved.

B. Hypothyroidism may be associated.

C. Increased risk of laryngeal cancer

D. Antireflux medications should be given trial.

Correct Answer: C. Increased risk of laryngeal cancer

Explanation: Correct Answer (C) Increased risk of laryngeal cancer Sol Reinke’s Space Edema
(Polypoid Degeneration) Reinke’s space: superficial layer of the lamina propria, loose connective tissue
(susceptible to fluid accumulation) Risks: GERD, smoking, hypothyroidism, vocal abuse, chronic throat
clearing, chronic cough Not associated with increased risk of laryngeal cancer Dx: indirect mirror exam,
flexible nasopharyngoscopy, endoscopy, videostroboscopy Rx • Evaluate and manage for
hypothyroidism and GERD (antireflux medications) • Voice rest, smoking cessation • Consider
microlaryngoscopy and excision with removal of gelatinous material in Reinke’s space
Q156. The vacutainer used for measuring ESR and it’s ratio of anticoagulant
with blood is

A. Black 1:9

B. Blue 1:9

C. Black 1:4

D. Blue 4:1

Correct Answer: C. Black 1:4

Explanation: Correct Answer (C) Black 1:4. Contains sodium citrate 1;4 ratio has to be taken for ESR
and for coagulation it is 1:9 in Sky blue tube.
Q157. A 28 year old multi-gravid woman is having severe anemia and is
currently at 38 weeks of gestation. The obstetrician decides to transfuse 3 units
of blood over next 2 days. The blood bank did not have component separation
facility thus they issued whole blood. She was transfused three units of blood
each 8 hrs apart. 1 hour into the third unit of transfusion the patient develops
breathlessness. Pulse is 100 per minute, respiratory rate is 24/min, BP 135/85,
temperature 98 F, oxygen saturation is at 90. Which of the following is the likely
diagnosis?

A. Transfusion associated GVHD

B. Transfusion Associated circulatory overload

C. Transfusion associated acute Lung injury

D. Transfusion associated anaphylaxis.

Correct Answer: B. Transfusion Associated circulatory overload

Explanation: Correct Answer (B) Patient is having hypoxia and BP is increased which is very
characteristic of TACO.
Q158. A 3-year-old child is noted to have small pinpoint hemorrhages on the
skin, appearing over the past 3 days. On examination the child's vital signs are
normal. There are petechae over skin of extremities and trunk. A CBC shows
Hgb 14.3 g/dL, Hct 43%, MCV 90 fL, platelet count 19,300/microliter, and WBC
count 9370/microliter. This condition resolves over the next month without
treatment. Which of the following is the most likely antecedent event for this
child's illness?

A. Sulfonamide ingestion

B. Respiratory syncytial virus infection

C. Aspirin ingestion

D. History of trauma

Correct Answer: B. Respiratory syncytial virus infection

Explanation: Correct Answer (B) This is acute immune thrombocytopenia in a child. It is usually
self-limited. In most cases the predisposing event is a viral infection that sets off an immune response
directed specifically at platelet production
Q159. A 43-year-old man has complained of mild burning substernal pain
following meals for the past 3 years. Upper GI endoscopy is performed and
biopsies are taken of an erythematous area of the lower esophageal mucosa 3
cm above the gastroesophageal junction. There is no mass lesion, no
ulceration, and no hemorrhage noted. The biopsies show the presence of
columnar epithelium with goblet cells. Which of the following mucosal
alterations is most likely represented by these findings?

A. Dysplasia

B. Neoplasia

C. Anaplasia

D. Metaplasia

Correct Answer: D. Metaplasia

Explanation: Correct Answer (D) Metaplasia is the substitution of one tissue normally found at a site for
another. The esophageal stratified squamous epithelium undergoes metaplasia in response to the
ongoing inflammation from reflux of gastric contents. This is common in the lower esophagus with
gastroesophageal reflux disease (GERD).
Q160. A 55 year hypertensive atherosclerotic patient presents with severe chest
pain radiating to left shoulder. The pain is not related to exertion or any
emotional stress and is present at rest. The pain disappears immediately after
sublingual sorbitrate. Which of the following mediators is responsible for such
an episode?

A. Prostaglandin E2

B. IL-1

C. Thromboxane A2

D. Complement 3a

Correct Answer: C. Thromboxane A2

Explanation: Correct Answer (C) Clinically it appears to be unstable angina which is due to rupture of
atherosclerotic plaque, which leads to release of TXA2 (due to platelet adhesion) which causes
vasospasm leading to angina.
Q161. A 38 year old lady presents with easy fatigue, peripheral blood
examination shows Hb 8 g/dl, MCH 27, MCV 80 fl, RBC count 2.9 millions, retic
count 0.5%. Which of the following is likely a diagnosis in this

A. Paraoxysmal nocturnal hemoglobinuria

B. Auto immune haemolytic anemia

C. Iron deficiency anemia

D. Aplastic anemia

Correct Answer: D. Aplastic anemia

Explanation: Correct Answer (D) Normocytic normochromic anemia with reticulocytopenia (1%) makes
diagnosis of Aplastic in this patient.
Q162. A 45 year old male presents with spontaneous mucosal bleeding and
gum hypertrophy. Blood examination reveals Hb 10 g/dl, Platelet count 20,000,
and 30% blasts. Coagulation studies are as follows PT 20 Sec, APTT 65 Sec.
Fibrinogen levels are low. The blasts are more likely to show?

A. T (9;22)

B. T(8;21)

C. T(16;16)

D. T(15;17)

Correct Answer: D. T(15;17)

Explanation: Correct Answer (D) This is a patient of leukaemia (30% blasts ) with DIC, which is
commonly seen with AML M3, which has t(15;17 ) commonly associated with it.
Q163. A 35 year healthy man had a snake bite, based on his description the
doctor was confused between two most venomous snakes, following which he
was administered polyvalent anti Snake Venom (ASV)and was discharged from
the hospital after a week. Three days after discharge he develops high grade
fever, arthralgia, lymphadenopathy, facial swelling and erythema in hands and
feet. Which of the following explains the manifestations?

A. Immune complex deposition

B. Delayed effects of snake venom

C. Anaphylaxis due to ASV

D. Hospital acquired infection

Correct Answer: A. Immune complex deposition

Explanation: Correct Answer (A) Immune complex deposition. This is a classical presentation of serum
sickness disease (SSD) which is type III HSR following antibody injection. The ASV will contain animal
antibodies which will be recognised as non self by the patient and mounts an immune response, the
antibodies form immune complexed and deposit in multiple locations leading to generalised disease.
SSD can occur after injections anti thymocyte immunoglobulin and even after monoclonal antibodies
Q164. A routine H&E; histologic section from an irregular white area within the
anterior wall of the heart of a 71-year-old male who died secondary to ischemic
heart disease reveals the myocytes to be replaced by diffuse red material. This
material stains blue with a trichrome stain. Which one of the listed statements
correctly describes this material?

A. A misfolded normal protein

B. A protein derived from leakage of blood vessels

C. A protein from dead cells

D. A protein produced by fibroblasts.

Correct Answer: D. A protein produced by fibroblasts.

Explanation: Correct Answer (D) Red or pink material can be collagen, amyloid or fibrin, if it stains blue
with trichrome it confirms collagen
Q165. A 23-year-old female presents with progressive bilateral loss of central
vision. You obtain a detailed family history from this patient and produce the
associated pedigree. Which of the following transmission patterns is most
consistent with this patient’s family history?

A. Autosomal dominant

B. X-linked recessive

C. X-linked dominant

D. Mitochondrial

Correct Answer: D. Mitochondrial

Explanation: Correct Answer (D) Mitochondrial. There is mother to child transmission of 100% while no
transmission from father to child thus mitochondrial inheritance.
Q166. A 2 year child presents with failure to thrive and repeated episides of
fever. Abdominal examination shows a mass in the left flank. A biopsy from the
mass is as shown below. What is the likely diagnosis?

A. Neuroblastoma

B. Nephroblastoma

C. Multicystic dysplastic kidney

D. Hepatoblastoma

Correct Answer: A. Neuroblastoma

Explanation: Correct Answer (A) Neuroblastoma. The image shows typical Homer Wright rosettes
which are seen in Neuroblastomas.
Q167. A 10 year child presents with bleeding per rectum. Colonoscopy shows 2
polyps and histological examination is as below. What is the most likely
diagnosis?

A. Juvenile polyp

B. Peutz Jaghers Polyp

C. Villous adenoma

D. Tubular adenoma

Correct Answer: B. Peutz Jaghers Polyp

Explanation: Correct Answer (B) Peutz Jaghers Polyp. Age is 20 years and the histology shows
arborizing pattern of glands and smoothmuscle which is diagnostic of Peutz Zaghers polyp.
Q168. Most characteristic cell seen in pathology of Rheumatic carditis is ?

A. Achoff cell

B. Plasma cell

C. Giant cell

D. Anitschkow cell

Correct Answer: D. Anitschkow cell

Explanation: Correct Answer (D) Anitschkow cell. Aschoff Nodules (not cell) are pathognomonic of
Rheumatic carditis which consist of macrophages known as Anitschkow cells ( caterpillar cells),
lymphocytes plasma cells and giant cells (Aschoff cells). Anitschkow cells are most characteristic cells
of Aschoff Nodule.
Q169. A 20 year girl presents with a lump in the breast, which is soft and mobile.
An excision was done and the histology is as shown below. What is the most
probable origin of this mass?

A. Luminal cell

B. Ductal cell

C. Intralobular stroma

D. Interlobular stroma

Correct Answer: C. Intralobular stroma

Explanation: Correct Answer (C) Intralobular stroma. The clinical description and histology (
compressed ducts with stromal proliferation) confirms the diagnosis of fibroadenoma, which along with
phyloides tumor arise from intralobular stroma. Whicle sarcomas of breast arise frominterlobular
stroma.
Q170. A 60-year-old woman with rheumatoid arthritis presents to her doctor
with a 2-month history of progressive fatigue. She also reports feeling “wobbly”
lately. Physical examination reveals a decreased light touch and vibration sense
on her lower extremities. Laboratory studies show a Hb 9 MCV 104, MCH 32. A
peripheral blood smear for the patient is shown in the image. On further
analysis, methylmalonic acid levels and homocysteine levels are elevated. This
patient’s anemia most likely results from which of the following factors?

A. Drug induced B12 deficiency

B. Drug induced Folate deficiency

C. Antibodies to parietal cells

D. Drug induced iron deficiency

Correct Answer: C. Antibodies to parietal cells

Explanation: Correct Answer (C) Antibodies to Parietal cells. The patient is having a megaloblastic
anemia because MCV is high and blood smear shows hypersegmented neutrophils. Additionally the
patient is having neurological symptoms suggesting a Vitamin B12 deficiency (not Folic acid deficiency)
and a patient with a history of autoimmune disease having B12 deficiency is most likely suggestive of
pernicious anemia. It is not A and C because methotrextate a drug used in treatment of RA causes folic
acid deficiency not Vitamin B12
Q171. A 40-year-old man develops a brain tumour that impinges on the
supraoptic nucleus in the hypothalamus. As a result, the secretion of which of
the following hormones is mainly affected?

A. ACTH

B. ADH

C. FSH

D. Oxytocin

Correct Answer: B. ADH

Explanation: Correct Answer (B) ADH 5/6th of ADH is synthesized in the supraoptic nucleus and 1/6th
in the paraventricular nucleus of hypothalamus.
Q172. A patient with renal failure develops symptoms caused by the loss of a
hormone produced by the kidney. Which of the following is the most likely
diagnosis?

A. Edema

B. Hypertension

C. Anemia

D. Uremia

Correct Answer: C. Anemia

Explanation: Correct Answer (C) Anemia The anemia associated with renal failure results from a
decrease in synthesis of erythropoietin by the kidney. Often, the first sign of renal failure is the fatigue
produced by anemia.
Q173. A 53-year-old woman who has been dieting for several weeks breaks
down and eats three sugar coated doughnuts. Insulin secretion following a
carbohydrate- rich meal is stimulated by which of the following?

A. Gastrin

B. CCK

C. Serotonin

D. GLP-1

Correct Answer: D. GLP-1

Explanation: Correct Answer (D) GLP-1 GLP-1 (also called physiologic β cell stimulating hormone of GI
tract) secreted by the L cells in the small intestine is a potent stimulator of insulin secretion.
Q174. A medical student is waiting to be called for her first MBBS Anatomy
university exam viva. She becomes very anxious and increases her rate of
alveolar ventilation. If her rate of CO2 production is constant, which of the
following will decrease?

A. pH

B. PaO 2

C. PaCO 2

D. V/Q ratio

Correct Answer: C. PaCO 2

Explanation: Correct Answer (C) PaCO 2 PACO 2 and PaCO 2 level is inverse to the alveolar
ventilation. Increasing the alveolar ventilation at a constant rate of carbon dioxide production will lower
the PACO 2 and PaCO 2 levels. Hyperventilation will increase the PAO 2 and PaO 2 , with no change
in the alveolar-arterial Po 2 difference. The V/Q ratio will be normal or increased.
Q175. Which of the following is the most similar in the systemic and pulmonary
circulations?

A. Preload

B. Afterload

C. Peak systolic pressure

D. Stroke work

Correct Answer: A. Preload

Explanation: Correct Answer (A) Preload Although the right and left preloads are not identical, they are
nearly the same. The resistance of systemic vasculature is much higher than the pulmonary
vasculature. Thus, the afterload and stroke work is higher on the left side than on the right side. Peak
systolic pressure is also higher on the left side (120 mm Hg) than on the right side (25 mm Hg).
Q176. A 22-year-old G3P2 undergoes a normal spontaneous vaginal delivery
without complications. The placenta is spontaneously delivered and appears
intact. The patient is later transferred to the postpartum floor where she starts
to bleed profusely. Physical examination reveals a boggy uterus and a bedside
sonogram indicates the presence of placental tissue. Match the descriptions
with the appropriate placenta type.

A. Vasa previa

B. Succenturiate placenta

C. Placenta previa

D. Placenta accrete

Correct Answer: B. Succenturiate placenta

Explanation: Correct Answer (B)

Q177. Component of active management of third stage of labor include all of the
following , except :

A. Controlled cord traction

B. Early cord clamping

C. Inj methergine (Ergometrine)

D. Uterine massage

Correct Answer: B. Early cord clamping

Explanation: Correct Answer (B) Early cord clamping

Q178. A woman delivers a infant with a midline episiotomy and suffers a
third-degree tear. Inspection shows that which of the following structures is
intact ?

A. Anal sphincter

B. Perineal body

C. Fascia

D. Rectal mucosa

Correct Answer: D. Rectal mucosa

Explanation: Correct Answer (D) Rectal mucosa

Q179. Which one of the following is not true regarding oxytocic in pregnancy?

A. Oxytocin is shorter acting than carbetocin

B. Ergometrine contracts lower uterine segment more

C. Carboprost is the most potent uterotonic used in prevention of PPH

D. Misoprostol is also used in MTP of first and second trimester

Correct Answer: C. Carboprost is the most potent uterotonic used in prevention of PPH

Explanation: Correct Answer (C) Carboprost is the most potent uterotonic used in prevention of PPH
Carboprost is PGF2a derivative. It is strongest uterotonic agent as well as bronchospastic agent. It is
used in the treatment of PPH however it is not approved for the prevention of PPH.
Q180. Which one of the following is not included in simplified Bishop’s score?

A. Cervical dilatation

B. Cervical length

C. Cervical effacement

D. Station of the fetus

Correct Answer: B. Cervical length

Explanation: Correct Answer (B) Cervical length Cervical length is not a component of simplified
BISHOP’s score. It is a component of Modified BISHOP’s score.
Q181. An intern conducting delivery observes mother developing
breathlessness, hypotension tachycardia and is collapsing. Shock is out of
proportion to bleeding what is the cause

A. PPH

B. Uterine inversion

C. Amniotic fluid embolism

D. DIC

Correct Answer: C. Amniotic fluid embolism

Explanation: Correct Answer (C)

Q182. Which one of the following cardiovascular finding will warrant further
evaluation to rule out any cardiorespiratory pathology?

A. Systolic murmur

B. Right axis deviation on ECG

C. Loud S3 heart sound

D. Increase in cardiac output during and after delivery

Correct Answer: B. Right axis deviation on ECG

Explanation: Correct Answer (B) Right axis deviation on ECG There is left axis deviation during
pregnancy due to rotation of heart upward and laterally on the left side caused by pressure of growing
uterus on the diaphragm. Right axis deviation will be abnormal finding seen in pulmonary hypertension
especially due to mitral stenosis which is very common heart disease in pregnancy.
Q183. A 23 year old patient with previous LSCS is in labour for VBAC. Which of
the following conditions is specifically seen in uterine rupture?

A. Maternal tachycardia

B. Supra pubic tenderness

C. Hematuria

D. Loss of fetal station on PV examination

Correct Answer: D. Loss of fetal station on PV examination

Explanation: Correct Answer (D)

Q184. Arrange the ultrasounds done in obstetrics in proper sequence: 1. NT
scan 2. TIFFA 3. Growth scan 4. Dating scan

A. 1, 2, 4, 3

B. 4, 2, 1, 3

C. 4, 1, 3, 2

D. 4, 1, 2, 3

Correct Answer: D. 4, 1, 2, 3

Explanation: Correct Answer (D) 4, 1, 2, 3 Dating scan in done during 7-9 weeks for assessment of
gestational age with the help of CRL. NT scan is done at 11-13+6 weeks for screening out trisomy.
TIFFA is targeted imaging for fetal anomalies. It is done between 18-22 weeks. Growth scan is done in
third trimester if there is discrepancy between gestational age and the size of uterus.
Q185. Which one of the following is true regarding fetal assessment? 1. NST
reactive would mean that there is no acute distress 2. Biophysical profile has
fetal breathing, fetal tone, amniotic fluid index, NST and gross body movements
3. Sinusoidal decelerations are seen due to uteroplacental insufficiency 4.
Modified biophysical profile consists of NST and umbilical artery doppler

A. 1, 2 are true

B. 1, 2 and 3 are true

C. 1, 2 and 4 are true

D. Only 1 is true

Correct Answer: A. 1, 2 are true

Explanation: Correct Answer (A) Only 1 is true NST is a marker of acute distress. BPP has SDP and
not AFI. Sinusoidal deceleration is due to fetal anemia. Modified BPP has NST and AFI.
Q186. A 3800 g male infant is delivered vaginally. A shoulder dystocia was
encountered. If a neonatal injury is suspected, what is the likely finding in the
infant?

A. Arm that is fixed and flexed and hypertonic

B. Arm that is at its side and internally rotated

C. Clavicle fracture

D. Depressed skull fracture

Correct Answer: B. Arm that is at its side and internally rotated

Explanation: Correct Answer (B) An Erb palsy is the most common injury of the neonate in a shoulder
dystocia. The arm is typically limp and at its side with the arm internally rotated. If the palsy is severe,
then the infant may not be able to move its fingers. Eighty percent of the time, brachial plexus injuries
will improve with physical therapy. However, if the nerve roots are avulsed rather than simply injured,
the neuropathy usually will not resolve
Q187. Which of the following is not true regarding multifetal gestation?

A. Monozygotic twins are more common than dizygotic in IVF cycles

B. Superfecundation is a kind of dizygotic twinning

C. There is AV malformation in monozygotic twins which leads to twin-twin transfusion

syndrome

D. TRAP sequence is seen in monochorionic twins

Correct Answer: A. Monozygotic twins are more common than dizygotic in IVF cycles

Explanation: Correct Answer (A) Monozygotic twins are more common than dizygotic in IVF cycles In
IVF cycles, multiple zygotes are transferred during D3/5 embryo transfer stage. It leads to dizygotic
twins. Superfecundation is when two eggs are released in same cycle but fertilized by different acts of
intercourse. TTTS is due to abnormal AV anastomosis in monochorionic twins. TRAP sequence is due
to AA malformation in monochorionic twins with death of one baby.
Q188. Which one of the following is a sign of fetal demise?

A. Stallworthy sign

B. Piskacek sign

C. Kustner’s sign

D. Ball sign

Correct Answer: D. Ball sign

Explanation: Correct Answer (D) Ball sign Ball sign is seen due to hyperflexion of spine and
overcrowding of ribs. It is a sign of dead, macerated baby. Stallworthy sign is of placenta previa,
Piskacek sign is asymmetric uterus due to lateral implantation. Kustner sign is a sign of placental
separation.
Q189. Which one of the following does not present as ambiguous genitalia?

A. Congenital adrenal hyperplasia

B. Reifenstein syndrome

C. Swyer’s syndrome

D. 46XY and 45XO mosaic

Correct Answer: C. Swyer’s syndrome

Explanation: Correct Answer (C) Swyer’s syndrome SWYER syndrome is SRY gene defect which leads
to gonadal dysgenesis. The testicular formation is absent and there are bilateral streak gonads. There
is no AMH and no androgenic formation. The baby is phenotypically female. It is never with ambiguous
genitalia. The most common cause of ambiguous genitalia at birth is CAH. Reifeienstein syndrome is a
partial AIS. It may present as ambiguous genitalia. Mixed gonadal dysgenesis is 46 XY and 45 XO.
There will be ambiguous genitalia with testis on one side and streak ovary on the other side.
Q190. A 32-year-old G1P0 woman at 24 weeks’ gestation is seen by her
obstetrician for painful vesicles on the vulva. PCR is performed and returns as
H SV-2. The obstetrician counsels the patient about the possibility of needing
cesarean when she goes into labor. Which of the following is an indication for
cesarean section due to maternal H SV?

A. Vesicular lesions noted on the cervix

B. History of lesions noted on the vagina 1 month previously, now not visible

C. Lesions noted on the posterior thigh

D. Tingling of the chest wall with lesions consistent with herpes zoster

Correct Answer: A. Vesicular lesions noted on the cervix

Explanation: Correct Answer (A) The presence of prodromal symptoms or lesions along the genital
tract (ie, cervix) suspicious for H SV is sufficient to warrant a cesarean delivery to prevent neonatal
infection. When there are no lesions or prodromal symptoms, the patient should be counseled that she
is at low risk for viral shedding and has an unknown risk of neonatal herpes infection; typically, the
patient will opt for vaginal delivery. The posterior thigh is unlikely to inoculate the baby during delivery,
and is not an indication for cesarean delivery. Lesions on the chest wall consistent with herpes zoster
would not necessitate cesarean delivery; however, the baby should still not come in contact with these
lesions, and breast feeding should be avoided. Herpes zoster infection in a neonate can have fatal
consequences.
Q191. Which one of the following is done for urinary incontinence?

A. Colpoperineorrhaphy

B. Colpocleisis

C. Colposuspension

D. Colporrhaphy

Correct Answer: C. Colposuspension

Explanation: Correct Answer (C) Colposuspension COLPOSUSPENSION is an abdominal surgery

which is done by lifting the vagina for correction of stress urinary incontinence. The surgery is called as
BURCH colposuspension. The most common surgery for SUI is TOT i.e. trans obturator tape.
Q192. WHICH OF THE FOLLOWING SONOGRAPHICAL FINDINGS ARE
SUGGESTIVE OF MALIGNANT OVARIAN ETIOLOGY?

A. UNILOCULATED CYST

B. PAPILLARY PROJECTIONS

C. HIGH RESISTANCE IN DOPPLER USG

D. ALL OF THE ABOVE

Correct Answer: B. PAPILLARY PROJECTIONS

Explanation: Correct Answer (B) PAPILLARY PROJECTIONS

Q193. WHICH OF THE FOLLOWING IS TRUE REGARDING THE TUMOUR
REPRESENTED IN THIS PHOTOMICROGRAPH

A. INHIBIN B IS OFTEN ELEVATED

B. THE TUMOUR CAN OFTEN EXCEED 10 CM IN SIZE

C. NEEDS ENDOMETRIAL ASSESSMENT

D. ALL THE ABOVE

Correct Answer: D. ALL THE ABOVE

Explanation: Correct Answer (D) ALL THE ABOVE

Q194. Which one of the following is not an indication to pulsatile GnRH
therapy?

A. Kallmann’s syndrome

B. Sheehan’s syndrome

C. Savage syndrome

D. B and C

Correct Answer: D. B and C

Explanation: Correct Answer (D) Kallmann’s syndrome KALLMANN SYNDROME is GnRH deficiency
with anosmia. It is to be treated by EPRT but if the patient desires pregnancy then pulsative GnRH
therapy is used. SHEEHAN syndrome is pituitary stalk necrosis due to PPH. It cannot be treated by
pulsatile GnRH therapy since pituitary is not responsive. Savage is resistant ovary syndrome where
ovary stops working.
Q195. In which of the following cases HRT is not indicated?

A. Menopause in a 35 years old patient

B. Hot flushes in a 57 years old patient

C. Vaginal dryness with dyspareunia in a 53 years old patient

D. Prevention of cardiovascular disease prevention in a 50 years old patient

Correct Answer: D. Prevention of cardiovascular disease prevention in a 50 years old patient

Explanation: Correct Answer (D) Prevention of cardiovascular disease prevention in a 50 years old
patient HRT is indicated in premature menopause, vasomotor symptoms like hot flushes and urogenital
atrophy. It is not indicated in prevention of cardiovascular disease.
Q196. In a patient with recurrent pregnancy losses, which of the following is not
included in the list of investigations required for this case?

A. USG pelvis

B. aPTT

C. ACLA

D. Fetal karyotype

Correct Answer: D. Fetal karyotype

Explanation: Correct Answer (D) Fetal karyotype Recurrent pregnancy losses are due to autoimmune
disorder e.g. APLA syndrome where aPTT may be prolonged (marker of lupus anticoagulant). It may be
due to anatomical defects like Mullerian anomalies or submucous fibroids for which USG is needed.
ACLA is another autoimmune antibody for APLA syndrome. Karyotype of fetus is not necessary
however karyotype of patient and partner is done to rule out any genetic cause of RPL e.g. balanced
translocation.
Q197. One of the following is not a NON CONTRACEPTIVE USE OF COC pills:

A. Reduced risk of endometrial cancer

B. Treatment of hirsutism

C. Protection from functional ovarian cyst

D. Reduced risk of cervical cancer

Correct Answer: D. Reduced risk of cervical cancer

Explanation: Correct Answer (D) Reduced risk of cervical cancer

Q198. Which one of the following is considered as bad prognostic marker in
gestational choriocarcinoma?

A. Previous pregnancy – full term delivery

B. Interval of <4 months between previous pregnancy and cancer

C. Lung metastasis

D. A and C

Correct Answer: A. Previous pregnancy – full term delivery

Explanation: Correct Answer (A) Previous pregnancy – full term delivery

Q199. Which of the following is not a contraindication of an Cu- intrauterine
device?

A. Acute PID

B. Nulliparous patient

C. Wilson’s disease

D. Bicornuate uterus

Correct Answer: B. Nulliparous patient

Explanation: Correct Answer (B) Nulliparous patient

Q200. According to MTP act (amendment 2020, passed in 2021 which came into
effect from 24th September 2021, MTP for contraceptive failure is allowed till?

A. 20 weeks and 1 doctor is needed

B. 24 weeks and 2 doctors are needed

C. 24 weeks and 1 doctor is needed

D. 20 weeks and 2 doctors are needed

Correct Answer: A. 20 weeks and 1 doctor is needed

Explanation: Correct Answer (A) 20 weeks and 1 doctor is needed