PG Entrance Examination
November -2014
ANATOMY
1. Skull Photo (Color Plate 1: Foramen Ovale). Which of the following structures doesn’t pass through the area marked in the diagram:
(a) Lesser Petrosal nerve
(b) Maxillary nerve
(c) Motor root of trigeminal nerve
(d) Sensory branch of mandibular nerve
2. “Trukish Saddle” refers to
(a) Hypothalamus
(b) Pituitary gland
(c) Amygdaloid body
(d) Uncus
3. During pronation of foot, the axes of which two joints become parallel?
(a) Talocrural and subtalar
(b) Talonavicular and calcaneocuboid
(c) Talonavicular and subtalar
(d) Midtarsal and tarsometatarsal
4. Most common site of Mucosa associated lymphoid tissue
(a) Duodenum
(b) Jejunum
(c) Ileum
(d) Stomach
5. All are true about sphincter urethrae except
(a) Voluntary
(b) Supplied by Pudendal nerve
(c) Originates from the ischiopubic rami
(d) Located at bladder neck
6. Dense regular collagen is found in all except
(a) Ligament
(b) Periosteum
(c) Aponeurosis
(d) Tendon
7. Panniculus Adiposus is seen in
(a) Scrotum
(b) Orbit
(c) Eyelid
(d) Penis
8. Membrana tectoria is derived from
(a) Anterior atlanto occipital membrane
(b) Posterior atlanto occipital membrane
(c) Anterior longitudinal ligament
(d) Posterior longitudinal ligament
9. All of the following are true about cavernous sinus thrombosis except
(a) Loss of Jaw Jerk
(b) Infection can spread to cavernous sinus from danger area of ace via inferior ophthalmic vein
(c) Most common cause in ethmoidal sinusitis
(d) Loss of sensation around the eye
10. Which of the following is not carried by dorsal column?
(a) Pain
(b) Proprioception
(c) Vibration
(d) Touch
11. Which cranial nerve nucleus underlies the facial colliculus?
(a) Sixth
(b) Seventh
(c) Eighth
(d) Fifth
PHYSIOLOGY
12. Which of the following techniques is used to study the current flow across a single ion channel?
(a) Voltage clamp technique
(b) Patch clamp technique
(c) Lontophoresis
(d) Galvanometry
13. K complexs and sleep spindles area seen in which stage of sleep
(a) REM
(b) Stage 1 NREM
(c) Stage 2 NREM
(d) Stage 3 NREM
14. Free nerve endings carrying nociceptive fibres area seen in which of the followings
(a) Intestine
(b) Mesentery
(c) Spleen
(d) Liver
15. Attention and concentration are functions of which of the following brain areas:
(a) Frontal Lobe
(b) Parietal Lobe
(c) Hypohalamus
(d) Basal Ganglia
16. You are testing knee jerk reflex in a patient. The afferents in deep tendon reflexes are carried by:
(a) Nuclear bag and chain fibres
(b) Golgi tendon organ
(c) Nuclear bag and static chain fibres
(d) Dynamic Intrafusal fibres
17. Which of the following is not a component of counter current mechanism?
(a) Thick ascending limb of henle
(b) Collecting duct
(c) Descending limb of henle
(d) Vasa recta
18. The traid of bradycardia, hypertension and irregular respiration is called as:
(a) Cushings reflex
(b) Bezold Jarisch reflex
(c) Bainbridge reflex
(d) Herrings reflex
19. A short duration high frequency stimulation with 5 Hz of perforant pathway in hippocampus leads to
(a) Long term potentiation
(b) Habituation
(c) Long term depression
(d) Post titanic potentiation
BIOCHEMISTRY
20. In traumatic brain injury, changes in brain metabolism are seen. All are True except:
(a) There is shut down of pyruvate dehydrogenase activity
(b) there is accumulation of lactate in brain
(c) there is increased lactate uptake from circulation
(d) increased CSF lactate is associated with good prognosis
21. Which technique is used to study structure of molecules?
(a) X ray crystallography
(b) Electron microscopy
(c) Ion exchange chromatography
(d) Agarose gel electrophoresis
22. A child suffered from a viral illness for which he took aspirin. 3 days later the child presented to the emergency with altered sensorium and icterus. What is the underlying biochemical defect?
(a) Beta oxidation of fatty acids
(b) Glucose- 6 phosphatase deficiency
(c) Pyruvate dehydrogenase deficiency
(d) Urea cycle defect
23. All of the following amino acids are components of collagen except:
(a) Glycine
(b) Proline
(c) Lysine
(d) Desmosine
PATHOLOGY
24. Identify the disease shown in the karyotype (Color Plate 2):
(a) Bloom Syndrome
(b) Cri-du-chat syndrome
(c) PraderWilli syndrome
(d) Downs Syndrome
25. A 17 year old female underwent a fine needle aspiration cytology (FN AC) for a lump im the breast which was well defined, nontender and mobile. The diagnosis of a benign lesion can be considered by which of the following pathological features:
(a) Dyscohesive ducatal epithelial cell without cellular fragments
(b) Tightly arranged ductal epithelial cell with dyschohesive bare nuclei
(c) Stromal predominance with hyperplasia of spindle cells
(d) Polymorphism with single or arranged ductal epithelial cells
26. Which of the following is seen in Schwannoma?
(a) Storiform pattern
(b) Spindle cells
(c) Antoni A and B
(d) Target Cells
27. A 27 year old female with right sided thyroid nodule was operated. A 2 * 2 cm thyroid nodule was resected and the following histology was found. What is your diagnosis? (Color plate 3)
(a) Papillary carcinoma thyroid
(b) Adenomatous Goitre
(c) Follicular Adenoma
(d) Graves disease
28. A patient with a history of recurrent ureteric stones presented with fever. Right sided nephrectomy was done. What is your diagnosis. (Color plate 4)
(a) Adult polycytic kidney disease
(b) Renal Cell Carcinoma
(c) Cystic Dysplastic Kidney
(d) Hydronephrosis with chronic pyelonephritis
29. Which of the following induces apoptosis in a cell?
(a) Oleic acid
(b) Glucocorticoids
(c) Isoprenoids
(d) Myristic acid
30. A 65 year old chronic smoker presented with a central lung mass with distal bronchiectasis and recurrent pneumonia. A grayish white tumor was resected. Which of the following histopathological finding is most likely to be seen?
(a) Small cells with sacant cytoplasm, ill defined cell borders and hyperchromatic nuclei with nuclear moulding
(b) Derivatives of all three germ layers are seen
(c) Tall columnar cells with cytoplasmic and intra alveolar mucin
(d) Palisading or rosette-like arrangements of cells separated bhy abundant fibrovascular stroma
31. About Gastrointestinal Stromal tumour (GIST) all are true except:
(a) Most common site is stomach
(b) Originates from interstitial cells of Cajal
(c) Size plays a role in Prognosis
(d) ALK mutation is seen in most cases
32. Which of the following changes is commonly seen in cancers:
(a) Hypomethylation of Oncogenes
(b) Methylation of Tumor Suppressor genes
(c) Loss of Heterozygosity
(d) Mutation of introns
33. Molecular classification of breast cancer is based on:
(a) Gene Expression profiling
(b) Expression of hormone receptors (ER/PR)
(c) Serum hormone levels
(d) In-vitro response to chemotherapeutic agents
34. An Afroamerican boy of 6 years of age presented with abdominal pain, chronic hemolysis and abnormal RBC shape on peripheral smear. Most likely disorder responsible for this condition:
(a) Trinucleotide repeat
(b) Point mutation
(c) Antiboides against RBC membrane
(d) Genetic imprinting
35. Which of the following is incorrect regarding tumor markers?
(a) Desmin-Carcinoma
(b) Cytokeratin-Carcinoma
(c) S100-Melanoma
(d) Common leukocyte antigen-Lymphoma
36. Epigenetics deals with genetic modification that do not alter the sequence of DNA. All of the following can detect epigenetic modification except:
(a) CHIP on Chip
(b) Bisulphite method
(c) HPLC
(d) Methylation Specific PCR
37. In a 70 years old man who was working in asbestos factory for 10-15 years. On routine X-ray, a mass was seen in right apical region of the lung. Biopsy was taken from the mass. Which of the following is seen on electron microscopic examination?
(a) Numerous long, slender microvilli
(b) Melanosomes
(c) Desmosomes
(d) Neurosecretory granules in the cytoplasm
38. A patient is on treatment with penicillin he developed pallor but there was no shortness of breath, urticaria or wheezing. On investigation antibodies against penicillin were found in his blood. What is the type of hypersensitivity reaction that most likely occurred in this patient?
(a) I
(b) II
(c) III
(d) IV
PHARMACOLOGY
39. Dexmeditomedine is a :
(a) Centrally acting alpha 2 agonist
(b) Centrally acting alpha 2 antagonist
(c) Peripherally acting alpha 2 antagonist
(d) Centrally peripherally acting alpha 2 agonist and antagonist
40. PPI can cause all except
(a) Hypothyroidism
(b) Community acquired penumonia
(c) Clostridium difficile infection
(d) Osteoporosis leading to hip fracture
41. Edema is side effect of all except:
(a) Digoxin
(b) Cyclosporine
(c) Amlodipine
(d) Estrogen
42. All are true about Rituximab except:
(a) Has dose independent pharmacokinetics
(b) Most common side effect is infusion reaction
(c) First FDA drug approved for resistant lymphomas
(d) Chimeric monoclonal antibody against CD-20 B cell antigen
43. Which of the following drug is Class B: Adequate studies in pregnant women have failed to demonstrate a fetal risk?
(a) Brimonidine
(b) Latanoprost
(c) Dorzolamide
(d) Pilocarpine
44. Time dependent killing and prolonged postantibiotic effect is seen with:
(a) Fluoroquinolones
(b) Beta lactam antibiotics
(c) Clindamycin
(d) Erythromycin
45. In which of the following condition, cholinomimetics are not used?
(a) Glaucome
(b) Postsurgical ileus/atony
(c) Myasthenia gravis
(d) Bradycardia
46. Which of the following antibiotics can be used in the treatment of fungal keratomycosis?
(a) Linezolid
(b) Vancomycin
(c) Silver sulphadiazine
(d) Doxycycline
47. Which of the following third generation cephalosporin has activity against MRSA (methicillin resistant staphylococcus aureus)?
(a) Ceftobiprole
(b) Ceftraixone
(c) Cephalexin
(d) Aztreonam
48. Which of the following is not a tertiary amine derivative?
(a) Scopolamine
(b) Hyoscine
(c) Glycopyrrolate
(d) Atropine
49. A person has been consuming 200 ml alcohol per day for last 20 years. Which of the following drugs should avoided in this patient?
(a) Disulfiram
(b) Acamprosate
(c) Phenytoin
(d) Naltrexone
50. Following serum levels are suggestive of lithium toxicity:
(a) 2 mEq/L
(b) 4 mEq/L
(c) 6 mEq/L
(d) 8 mEq/L
51. Which of the following is incorrect about NSAIDs?
(a) decrease the anti-hypertensive action of Diuretics
(b) used in Neuropathic pain
(c) should be avoided in renal failure
(d) can be used topically
52. Which of the following drugs is not active against Hepatitis B?
(a) Telbivudine
(b) lamivudine
(c) Zydovudine
(d) Interferon
53. Which of the following is true about Penicillin G?
(a) It is effective orally
(b) It has a wide spectrum
(c) It is used in rat bite fever
(d) Probenecid given along with PnG decreases it duration of action
54. Which of the following is the drug of choice for antibiotic associated pseudomembranous enterocolitis?
(a) Oral Vancomycin
(b) Cephalexin
(c) Clindamycin
(d) Penicillin
55. Which is not true about Paclitaxel?
(a) It stabilizes the microtubules
(b) It is obtained from E.Coli
(c) It is used in Ca ovary, breast and Cervix
(d) It most commonly causes myelosuppression and alopecia
56. Which of the following drugs is useful against Pseudomonas?
(a) Piperacillin-tazobactam
(b) Cefotaxime
(c) Streptomycin
(d) Cephalexin
MICROBIOLOGY
57. Not used by Non typable Hib?
(a) Meningitis
(b) Otitis media
(c) Pueperal Sepsis
(d) Exacerbation of COPD
58. The role played by major histocompatibility complex 1 and 2 is to:
(a) Transduce the signal to Tcells following antigen recognition
(b) Mediate immunogenic class switching
(c) Present antigens for recognition by T cell antigen receptors
(d) Enhance secretion of cytokines
59. A cystic fibrosis patient presented with an episode of pneumonia. On sputum culture, mucoid colonies of pseudomonas were seen. What does this indicate?
(a) It formed a biofilm on bronchial walls.
(b) It underwent a mutation
(c) It is resistant to most of the antibiotics
(d) There is a mistake with the culture technique
60. A child has Neonatal Meningitis. CSF examination showed small gram positive bacilli. Which is the likely causative organism?
(a) Hemophilus
(b) Strep
(c) Neisseria
(d) Listeria
61. Enterohemorrhagic, enterotoxic and enteroinvasive are types of:
(a) E. Coli
(b) Klebsiella
(c) Shigella
(d) Streptococcus penumoniae
62. What is true regarding viral antibodies?
(a) Appear before interferon
(b) They are formed against viral surface proteins
(c) They are formed against viral nucleic acid
(d) Maximum levels are seen within 1 week
63. Regarding Amoebic liver abscess all are true except:
(a) Trophozoite in stool are essential for clinical diagnosis
(b) Mostly asymptomatic
(c) More common in male than females
(d) It rarely affects brain, eye and skin
FORENSIC
64. Harakiri is death by:
(a) stab in the neck
(b) stab in the thorax
(c) stab in the abdomen
(d) stab in the wrist plus neck
65. A case of suspected homicide comes to a doctor. He is supposed to inform to police under section…..of CRPC (Criminal penal code).
(a) 174
(b) 39
(c) 37
(d) 176
66. A female with suspected child abuse comes to the casualty with severe bleeding from perineum. What will the first step in management?
(a) Airway
(b) Blood Transfusion
(c) First inform the police
(d) Internal Iliac Artery ligation
67. Fatal Dose of Arsenic in adults:
(a) 40-60 mg
(b) 20-30 mg
(c) 60-80 mg
(d) 100-200 mg
68. Calibre is defined as:
(a) Distance between two diametrically opposite grooves
(b) Distance between two diametrically opposite lands
(c) Distance between opposite land and groove
(d) Ratio of the length and width of the barrel
69. According the Galstaun method Iliac crest fuses in fameless at the age of:
(a) 13-15 years
(b) 15-17 years
(c) 17-19 years
(d) 19-20 years
70. What is the most common cause of parasuicide?
(a) hanging
(b) drugs
(c) wrist cutting
(d) firearms
ENT
71. A child has a disc battery in the nose. What is the most important consideration in management?
(a) Refer the child to specialist for removal.
(b) The battery may leak and cause tissue damage
(c) It can lead to tetanus
(d) Instill Nasal Drops
72. Post-adenoidectomy not seen is:
(a) Velopharyngeal insufficiency
(b) Hyponsality
(c) Retropharyngeal abscess
(d) Base of skull fracture/atlanto-axial subluxation/Griesel syndrome
73. An elderly male presents with T3N0 laryngeal carcinoma. What would be the management?
(a) Neoadjuvant chemotherapy followed by radiotherapy
(b) Concurrent Chemoradiotherapy
(c) Radical radiotherapy followed by chemotherapy
(d) Radical radiotherapy without chemotherapy
74. A patient of head trauma presents with clear nasal discharge. NCCT brain was done which revealed non operable injury to frontobasal area. What is the most appropriate management?
(a) Wait and watch for 4-5 days to allow spontaneous healing
(b) Do an MRI to localise the leak and control the discharge endoscopically
(c) Put a dural catheter to control CSF leak
(d) Approach transcranially to repair the damaged frontobasal region
75. All are true about malignant otitis externa except?
(a) ESR is used for follow up after treatment
(b) Granulations are seen on superior wall of external auditory canal
(c) Severe hearing loss is the chief presenting complaint
(d) Pseudomonas is the most common cause
76. Topical steroids are not recommended in:
(a) Antrochoanal polyp
(b) Ethomoidal polyps
(c) Allergic fungal sinusitis
(d) Chronic Rhinosinusitis
77. Most common cause of vocal cord palsy:
(a) Surgical
(b) Inflammatory
(c) Trauma
(d) Malignancy
78. What is true about meniere’s disease?
(a) Semont’s smanoeuvre is used for treatment
(b) Electrocochleography is the gold standard for diagnosis
(c) surgery is the manstay of treatment
(d) V shaped audiogram is seen
OPHTHALMOLOGY
79. Gene commonly indicated in congenital cataract:
(a) CRYGS3
(b) PAX6
(c) PITX3
(d) LMX1B
80. Normal value of arden index:
(a) 1
(b) 1.5
(c) less than 185%
(d) more than 185%
81. There is a retained intraocular iron foreign body. What is the best investigation for monitoring vision?
(a) ERG
(b) Arden Index
(c) Dark adaptometry
(d) Serial Evoke Potentials
82. Which diagnostic procedure is not done in a dilated pupil?
(a) Fundus Examination
(b) Gonioscopy
(c) Laser Inferometry
(d) Electroretinography
83. Which is not feature of fungal corneal ulcer?
(a) fixed hypopyon
(b) ulcer with solughing margins
(c) symptoms are more pronounced than signs
(d) hyphae are seen on KOH mount
84. Laser Trabeculoplasty is indicated in which of the following?
(a) NeovascularGlaucoma
(b) Chronic Angle closure glaucoma
(c) Pseudoexfoliative glaucoma
(d) Uveitic Glaucoma
85. A patient presents with painless red eye with an IOP of 600 mm Hg. What is the likely diagnosis?
(a) Acute anterior uveitis
(b) Glaucomatocyclitic crisis
(c) Angle closure glaucoma
(d) Chronic Papilledema
86. A Distortion increases in both direction on wearing a lens. Which of the following is not true about this?
(a) It is a type of Aniseikonia
(b) It is called as Pin Cushion effect
(c) Seen on wearing a convex lenses
(d) Cylindrical lenses increases the distortion
87. Which is not an absolute contraindication of corneal transplantation?
(a) TB Meningitis
(b) Rabies
(c) SSPE
(d) Death due to unknown cause
88. Which of the following is used as a self tonometer?
(a) Perkins
(b) Diaton
(c) Rebound
(d) Dynamic Contour
89. Subretinal Demarcation lies (high water marks) indicate:
(a) Fresh rhegmatogenous RD
(b) Old rhegmatogneous RD
(c) Retinopathy of prematurity
(d) Retinitis Pigmentosa
90. Which is not true about rhegmatonenous RD?
(a) It is caused due to fibrous bands in the vitrous
(b) Presents as floaters
(c) Surgery is the primary treatment
(d) Can extend upto ora serrata
91. Corneal edema is due to accumulation of:
(a) Lactate
(b) Pyruvate
(c) Glycogen
(d) Carbon Dioxide
PSM
92. Population attributable risk is defined as the difference between:
(a) incidence is exposed and incidence in non exposed compared with incidence in non-exposed
(b) incidence in population and incidence in exposed compared with incidence in population
(c) incidence in population and incidence in non exposed compared with incidence in population
(d) incidence in population and incidence in exposed compared with incidence in non-exposed
93. A pandemic of H1N1 is suspected when:
(a) Cases are spread over 5 or more cities
(b) 25 or more people are affected
(c) Cases occur within 2 weeks period
(d) Atleast one or more laboratory confirmed H1N1 case
94. H5N1 Avian Influenza has not become an epidemic till now. What is the most important reason for this?
(a) Seen only in wild birds and not in domestic poultry
(b) It has avian influenza genes
(c) Human to Human transmission is rare
(d) It causes serious illness leading to death of the patient
95. School closure is recommended during an outbreak of swine flu. All of the following support this except?
(a) Closure of school will not lead to reduction in contact between children
(b) children are the most common affected population by swine flu
(c) Increased rates of transmission due to more opportunities for contact
(d) Playing together of students increases transmission
96. Which is incorrect about inertization?
(a) Relatively inexpensive
(b) It is done for pharmaceutical waste
(c) It involves mixing the waste the cement before disposal
(d) It causes water pollution
97. Which of the following is not a type of VDPV?
(a) mVDPV
(b) aVDPV
(c) iVDPV
(d) cVDPV
98. Which is Output indicator of NPCB?
(a) No of cataract surgeries leading to sight restoration
(b) Decrease in prevalence of Blindness
(c) No of school children provided glasses for refraction correction
(d) Number of Eye surgeons trained
99. Who is the chairman of District Blindness Control Society?
(a) District Collector
(b) District Health Officer
(c) District Eye Surgeon
(d) Programmer Manager
100. Which of the following is not true about cataract surgery rate?
(a) Cataract surgery rate is defined as total number of cataract surgeries performed per one million population
(b) A target cataract surgery rate of 3000 per million
(c) CSR is a true rate
(d) It is an indicator of success of blindness control programmes.
101. Which of the following is used to compare two data sets taken on two different scales of measurement?
(a) Coefficient of variation
(b) Standard deviation
(c) Standard error
(d) Variance
102. According to ICDS, supplements given to a pregnant woman are:
(a) 200 kcal and 10 g protein
(b) 250 kcal and 12 g protein
(c) 300 kcal and 15 g protein
(d) 330 kcal and 15 g protein
103. A study has been done to establish the relationship between smoking and lung cancer. It was found that the association was more in people who exercise less and less in people who exercise more. In this situation, exercise is a
(a) Confounding factor
(b) Effect modifier
(c) Colinear factor
(d) Bias
104. Most efficient larval control method to prevent transmission of urban malaria.
(a) Covering overhead tanks
(b) Cleaning of drains
(c) Filling of ditches and cesspools
(d) Uprooting of plants
105. You are doctor. You visit a village and want to make a quick estimate of the Infant population of the area. Which of the following measures can you use?
(a) No. of TT injections in last one year
(b) No. of folifer tablets consumed in one year
(c) Female population in reproductive age group
(d) Literacy Rate
106. Chandler Index is an important tool in epidemiology. Which of the following is its least likely use?
(a) Determining case severity and prognosis
(b) Impact of control programme
(c) Endemicity
(d) Load of infection in the community
107. All are true about dengue expect:
(a) Aedes Aegypti is the vector
(b) Caused by a flavivirus
(c) Malnutrition is protective
(d) Lamivudine is the drug of choice
108. In a sampling technique, every 10th unit of population is chosen. What is tthis type of sampling technique called?
(a) Systematic Random Sampling
(b) Systematic Sampling
(c) Simple random sampling
(d) Cluster Sampling
109. Which of the following is true about ESI act?
(a) Funeral benefit is upto Rs 50, 000
(b) The state government’s share of expenditure on medical care is 1/8; the ESI corporation’s share of expenditure on medical care is 7/8 of total cost
(c) Person with daily wages of Rs 70 has to contribute Rs 300 towards ESI
(d) Employee has to contribute 4.75 and employer contributes 8.75%
110. Screening under RNTCP emphasizes on :
(a) Chest X-ray
(b) Sputum Microscopy
(c) Sputum Culture
(d) PCR
111. Indicator used in RNTCP to measure the impact of the control measures is:
(a) Annual infection rate
(b) Incidence of new cases
(c) Prevalence of infection
(d) Number of people having access to DOTS
ORTHOPEDICS
112. Bone Dysplasia is invariably seen in:
(a) Hyperparathyroidism
(b) Osteosarcoma
(c) Developmental Defect
(d) Osteomalacia
113. A 10 year child presented with a mid tibial swelling which on X-ray reveled a lytic lesion with sclerotic margins. What is the most likely diagnosis?
(a) Osteoid Osteoma
(b) Eosinophilic granuloma
(c) Fibrocortical Defect
(d) Fibrous Dysplasia
114. A child is diagnosed with Osteosarcoma based on Sunray appearance seen on X-ray. This is because of:
(a) Calcification along the periosteum
(b) Calcification along the blood vessels
(c) Periosteal reaction
(d) Soft tissue invasion
115. Which of the following displacement is not seen in Colles fracture?
(a) Dorsal Displacement
(b) Supination
(c) Volar Tilt
(d) Radial Tilt
116. A person is hemiplegic and bed ridden for one year. Changes in bone mineral density are first seen in:
(a) Distal radius
(b) Lumbar spine
(c) Proximal femur
(d) Proximal humerus
117. A child is spinned around by his father holding his hand. Suddenly the child started crying and did not allow his father to touch his elbow. Which of the following is the likely diagnosis?
(a) Supracondyfar fracture
(b) Pulled Elbow
(c) Fracture Olecranon Process
(d) Radial Head dislocation
118. A 40 year old female presents with multiple lytic bone lesions, fracture calvicle, periosteal resorption of 2nd and 3rd What is the most likely diagnosis?
(a) Renal osteodystrophy
(b) Osteomalacia
(c) Hyperparathyroidism
(d) Hyperthyroidism
119. A 40 year old man presented with acute onset pain and swelling of left great toe. On X-ray, a punched out lytic lesion is seen on phalanx with sclerotic margins and overhanging bony edges. The likely diagnosis is:
(a) Gout
(b) Rheumatoid arthritis
(c) Psoriatic arthritis
(d) Reiters syndrome
MEDICINE
120. Which of the following is true about Non specific intesrstital Pneumonia?
(a) common in elderly age group
(b) good prognosis
(c) early honeycombing
(d) males are affected more commonly then females
121. True about Obstructive sleep apnea are all except:
(a) Females affected more than males
(b) Commonly associated with hypertension
(c) Day time sleepiness is seen
(d) >5 episodes of apnea per hour
122. A person starts seizing on a railway station while waiting for a train. A wrist band was found showing he is a patient of epilepsy and has a medicine in his pocket. What will you do next?
(a) Put a handkerchief in his mouth and restrain him by holding hands and legs
(b) Take him away from the train, give him medicine with small sips of water and wait for seizure to resolve
(c) Take him away from the train, give him medicine with small sips of water, raise his legs and wait for seizure to resolve
(d) Take him away from the train, make him lie down and refer to the hospital
123. High calcium uptake leads to:
(a) Milk Alkali Syndrome
(b) Osteoporosis
(c) Osteopetrosis
(d) Cardiomyopathy
124. A female in her twenties presents with complaints pain abdomen, abdominal distension and vomiting. On examination she was found to have alopecia and a crepitus in the epigastrium. What is your diagnosis?
(a) Trichobezoar
(b) Carcinoma Pyloric Antrum
(c) Intestinal Tuberculosis
(d) Rectus Sheath Hematoma
125. A 70 year old female suffered from an attack of influenza but refused to take the vaccine. She subsequently developed pneumonia and died in 5 days. What is the most common cause of post influenza pneumonia?
(a) Staphylococcus aureus
(b) CMV
(c) Measles
(d) Legionella
126. A 15 year old boy came back to this village after a vacation to his relatives. He developed severe headache and purulent nasal discharge and was diagnosed as acute bacterial meningitis. He died 5 days later. Which is the most likely etiological agent?
(a) Plasmodium falciparum
(b) Toxoplasma
(c) Naegleria fowleri
(d) Entamoeba Histolytica
127. In which of the following diseases decrease in levels of single of neurotransmitter was first indentified?
(a) Alzheimer’s disease
(b) Parkinson’s disease
(c) Huntington disease
(d) Schizophrenia
128. In which of the following chronic conditions, degenerative changes in the brain area seen which are not a part of normal ageing?
(a) Dementia
(b) Pseudodementia
(c) Amnestic Syndrome
(d) Delirium
129. Which of the following is the most effective treatment of severe malaria?
(a) Artenusate
(b) Chloroquine
(c) Primaquine
(d) Doxycycline
130. Which of the following inflammatory condition has 90% association with HLA-B27?
(a) Ankylosing Spondylitis
(b) Psoriasis
(c) Reiters
(d) Rheumatoid Arthritis
131. Which of the following is usually not seen in Rheumatic Heart Disease?
(a) PS
(b) MS
(c) TS
(d) As
132. A patient has Angina, Dyspnea and syncope. What is the most likely diagnosis?
(a) Aortic Stonosis
(b) Aortic Regurgitation
(c) ASD
(d) VSD
133. All are seen in chronic MS except:
(a) Mid Distolic Murmur
(b) Opening Snap
(c) S3
(d) Loud S1
134. Abatacept, a new drug inhibiting costimulation is used for:
(a) SLE
(b) Scleroderma
(c) Rehumatoid Arthritis
(d) Sjogren Syndrome
135. A known case of bronchial asthma presents with respiratory distress, a respiratory rate of 48/min and can barely speak 2 words. Nebulised Salbutamol was given and pt could speak a sentence but there was fall in SpO2 from 95% to 85%. What could be the possible explanation?
(a) Ventilation Perfusion mismatch because of increased dead space ventilation
(b) Intrathoracic shunting
(c) Due to salbutamol
(d) Faulty oximeter
136. Which of the following is diagnostic of Acute Hepatitis B infections?
(a) IgM Anti Hbc
(b) IgG Anti Hbc
(c) Anti HbS
(d) IgM Angi Hbe
137. A Nurse has been found to be seropositive for both HbsAg and HBeAg. She is suffering from:
(a) Concurrent Hep B and Hep E infection
(b) Acute infectious Hepatitis B
(c) Chronic Hepatitis B infection
(d) Past Hepatitis B infection
138. Inability to perform physical activity without discomfort falls under:
(a) NYHA Class 1
(b) 2
(c) 3
(d) 4
139. Which of the following is not an indicator of Chronic Congestive heart failure
(a) Brain natriuretic Peptide
(b) Troponin
(c) C-reactive protein
(d) Sirtuin
140. Which of the following pulmonary symptoms don’t have the corresponding non pulmonary association?
(a) Cyanosis-Anxiety
(b) Wheesing-CHF
(c) Tachypnoea-Acidosis
(d) Chest pain-Pericarditis
141. A 30 year old man presents to the emergency with complaints of muscle weakness, nausea, vomiting and fatigue. ECG showed tall peaked T waves, prolonged PR interval, wide QRS and absent P. Which of the following drugs is not used in management?
(a) Beta antagonist
(b) Calcium Gluconate
(c) Insulin
(d) Sodium bicarbonate
142. H-reflex is done in:
(a) L2 radiculopathy
(b) L3
(c) L4
(d) S1
143. What is the emergent management of tension pneumothorax?
(a) Chest X-ray
(b) Emergency room thoracotomy if unstable
(c) Immediate needle throacostomy in 2nd intercostals space
(d) Tube thoracostomy in 5th ICS
144. A man presented with bilateral crepitations in the base of ht lungs and signs of pneumonitis with a history of exposure to pigeon faeces. What is true about this condition?
(a) Diagnosis can be made on the basis of history
(b) CT Scan is the Investigation of choice
(c) Chest X-ray will reveal characteristic changes
(d) It is a Type 1 hypersensitivity reaction
145. Which of the following is not a components of SIRS
(a) Urine ouput < 1 kl/kg/hr
(b) Temperature >38℃
(c) RR > 24/min
(d) SBP < 90 mmhg
SURGERY
146. In case of ascites, Le Veen shunt is done between peritoneum and
(a) SVC
(b) Cisterna Chyli
(c) Gall Bladder
(d) Renal Pelvis
147. Which of the following drugs is useful for treatment of advanced prostate cancer?
(a) Ganirelix
(b) Cetrorelix
(c) Abarelix
(d) Goserelin
148. All of the following are premalignant except?
(a) Peutz Jeghers syndrome
(b) Ulcerative colitis
(c) Crohn’s disease
(d) Familial Adenomatous Polyposis
149. A 65 year man presented with an episode of syncope. He said he felt dizzy during defecation and noticed gross bleeding in the pan. Fecal occult blood test done 3 months ago as a part of routine screening for colon cancer was negative. There is no history of recent weight loss. What is the likely colonoscopic finding?
(a) Microscopic colitis
(b) Dilated mucosal and submucosal vein in colon
(c) Early colonic carcinoma
(d) Sigmoid diverticulitis
150. A 58 year old female complains of dull aching pain in right iliac fossa. On examination, gross pallor was found and a mass was palpable in the right liliac fossa. What is the most likely diagnosis?
(a) Appendiceal mass
(b) Carcinoma ascending colon
(c) Ileocaecal TB
(d) Diverticulitis
151. FNAC cannot detect which of the following?
(a) Follicular Carcinoma
(b) Colloid Goitre
(c) Papillary Carcinoma
(d) Hashimoto Thyroiditis
152. A 13 year old girl with soft painful swelling on posterior aspect of thigh. Color Doppler showed multiple venous channels without any major arterial feeder. All of the following are liquid embolizing agents except.
(a) Absolute alcohol
(b) Polyvinyl alcohol
(c) Sodiumtetradecyl sulphate
(d) Cyanoacrylate
153. You are a surgeon posted at CHC. A patient of head injury comes to you with rapidly deteriorating sensorium and progressive dilation and fixation of pupil. No neurosurgeon/CT scan is available. You decide to make a burr hole to emergently relieve the intracranial pressure. Which of the following sites will you choose:
(a) In the temporal region contralateral to the side of papillary dilatation
(b) In the midline if both pupils are equal or it is not known which side dilated first
(c) In the left temporal region if no localizing sign in found
(d) Refer to a higher centre of both pupils are equal or its is not known which side dilated first
154. A couple presents with infertility. On investigating, the husband is found to have azoospermia on semen analysis. Vas was not palpable on PerRectal examination. Semen had low volume, high viscosity and fructose was present. What will you do next?
(a) CFTR gene mutation analysis
(b) Karyotype
(c) PSA
(d) Trans Rectal Ultrasound
155. Which of the following is the ideal time for repair of cleft palate?
(a) 9-12 months
(b) 18-24 months
(c) 2-3 years
(d) 5-6 years
PEDIATRICS
156. A child with cyanosis and choking on feeding at birth was diagnosed as TEF and had underwent a corrective surgery. He comes to you with complaints of barking cough and expiratory wheeze. What is the most likely diagnosis?
(a) Bronchial Asthma
(b) Croup
(c) Tracheomalacia
(d) Subglottic stenosis
157. A child complains of fluid coming out of umbilicus on straining. What is the diagnosis?
(a) Patent Vitellointestinal duct
(b) Urachal Fistula
(c) Umbilical Hernia
(d) Gastroschisis
158. A neonate presents with respiratory distress with enlargement of left upper lobe of lung and mediastinal shift towards the right. What is the most likely diagnosis?
(a) Cong lobar emphysema
(b) Alpha 1 antitrypsin deficiency
(c) Pneumonia
(d) Cystic Fibrosis
159. A 10 month child weighing 5 kg and 65 cm presents with cough and cold. He was found to have a respiratory rate of 48 per minute with no retractions, grunting, cyanosis. There is no history of convulsions. Which is true?
(a) No pneumonia, only cough and cold
(b) Child has Pneumonia
(c) Severe Pneumonia
(d) Very Severe disease
160. A female girl child came with complaints of involuntary movements was diagnosed as a case of Sydenham chorea suggestive of a diagnosis of acute rheumatic fever. There is no complaints of carditis or arthritis. Throat culture is negative. Which of the following will most likely suggest recent streptococcal infection?
(a) Antistreptolysin S
(b) ASLO
(c) PCR for M protein
(d) Antihyaluronidase
161. A neonate at 48 hours of birth with a history of non-passage of meconium. Next step in evaluation will be?
(a) Lower GI study
(b) Manometry
(c) Sweat Chloride levels
(d) CFTR mutation analysis
162. Which of the following is not seen in adults?
(a) Kawasaki disease
(b) Henoch Schonlein Purpura
(c) Susac Syndrome
(d) Takayasu Arteritis
163. A 60 month child presents with episodes of vomiting after ingesting fruit juice. Which of following enzyme deficiency is likely?
(a) Aldolase B
(b) Fructokinase
(c) Glucose 6 phosphatase
(d) Hexokinase
164. A month child woke up in right crying with abdominal pain which got relieved on passing red stools. What is the diagnosis?
(a) Meckel’s diverticulum
(b) Intusussception
(c) Malrotation
(d) Intestinal Obstruction
165. A child presents with pellagra like dermatitis and aminoaciduria. Two siblings have the condition and it is absent in two siblings while it is absent in both parents. Which of the following condition is most likely?
(a) Hartnup’s disease
(b) Alkaptonuria
(c) Phenylketonuria
(d) Von Gierke’s disease
166. Which is not seen in tuberous sclerosis?
(a) Astrocytoma
(b) Ependymoma
(c) White matter lesions
(d) Subependymal nodules
167. Which of the following if seen on Day 10 on life, is worrisome?
(a) Conjugated hyperbilirubinemia
(b) Dolls Eye Relfex
(c) No weight gain
(d) Unconjugated hyperbilirubinemia
168. A child with Nephrotic syndrome following an episode of diarrohea presented with acute kidney injury with a creatinine of 4.5. All of the following are possible reasons except?
(a) Renal vein thrombosis
(b) Diarrohoea water depletion
(c) Frusemide
(d) Steroid induced diabetes
OBG
169. All of the following are used for screening cancers in females except:
(a) Pap Smear-Cervical Cancer
(b) Office Endometrial Aspirate-Endometrial Carcinoma
(c) Mammography-Breast Cancer
(d) CA-125-Ovary Cancer
170. All of the following are true about of agumentation of labour except:
(a) Twin pregnancy precludes the use of oxytocin
(b) Amniotomy decreases the need for oxytocin use
(c) Methods of agumentation does not increase the risk of operational management
(d) Associated with a risk of uterine hyperstimulation
171. Studies have shown that complications of prematurity, IUGR are not affected by the timing of caesarean section. What is the recommended timing of caesarean section?
(a) 37 weeks
(b) 38 weeks
(c) 39 weeks
(d) 40 weeks
172. Which of the following is not a ligation technique?
(a) Irving
(b) Parkland
(c) Pomeroy
(d) Essure
173. A girl with normal stature and minimal or absent pubertal development is seen in :
(a) Kallman syndrome
(b) Testicular feminization sundrome
(c) Turner’s syndrome
(d) Pure gonadal dysgenesis
174. Which of the following drug is not a first line treatment for an ovulatory abnormal uterine bleeding in a 13 year old?
(a) Progesterone
(b) Estrogen plus progesterone
(c) Tranexamic Acid
(d) Mefenamic Acid
175. In a patient with Anti Phospholipid antibody syndrome, what treatment is used to prevent further abortions?
(a) Aspirin + LMWH
(b) Steroids
(c) Aspirin
(d) LMWH
176. Which is not true about Expected date of delivery?
(a) less then 5% deliver on the expected date of delivery
(b) 50% deliver within 1 week
(c) 80% deliver within 2 weeks
(d) standard deviation around expected date of delivery is 3 weeks
177. All the followings factors have been shown to improve fertility except:
(a) Vegetarian diet
(b) Loss of weight
(c) Gain of weight
(d) Less exercise
SKIN
178. Itchy tense blisters are seen on normal looking sin as well as urticarial plaques, as seen in the figure. What is the diagnosis? (Color Plate 6)
(a) Bullous pemphigoid
(b) IgA pemphigus
(c) Dermatitis herpetiformis
(d) Pemphigus Vulgaris
179. A 25 year old girl presented with erythematous papules on the face as seen in the figure. The lesions were exacerbated on excessive sweating, sun exposure and emotional disturbance. What is the diagnosis? (Color plate 7)
(a) SLE
(b) Rosacea
(c) Acne Vulagris
(d) Photodermatitis
180. A patient presented with the lesion as shown in the picture. What is the next best investigation? (Color plate 8)
(a) Grattage Test
(b) KOH amount
(c) Skin Sensation testing
(d) Patch test
181. A female patient comes after a holiday with vulvovaginal discharge and dysuria. Which of the following is the most sensitive diagnostic test?
(a) Nucleic Acid Amplification Test
(b) Wet mount
(c) Gram Stain
(d) Blood Culture
182. Which of the following is not a type of Lichen Planus?
(a) Lichen planopilaris
(b) Lichen pigmentosa
(c) Lichen hypertrophica
(d) Lichen scrofulosorum
183. A 24 year old female presented with complains of acne. On examination multiple nodules. cystsand intercommunicating sinuses were seen. How will you treat her?
(a) Oral Isotretinoin
(b) Tazarotene
(c) Acitretin
(d) Doxycycline
184. A 23 year old male complains of recurrent scaly lesion on the glans penis. It always occurred at the same site and healed with slight hypergig mentation. What is the likely diagnosis?
(a) Syphilis
(b) Fixed Drug Eruption
(c) Chlamydia
(d) Gonorrhoea
ANESTHESIA
185. Which of the following agent is used in Day Care Surgery?
(a) Propofol
(b) Ketamine
(c) Diazepam
(d) Thiopentone
186. The names Bethune and Brethren are associated with which of the following monitoring devices?
(a) Plethysmography
(b) End Tidal Capnography
(c) Transesophageal echo
(d) Precordial Doppler
187. An eye surgery was performed using propofol as the intravenous anaesthetic agent and Succinylcholine as the muscle relaxant. Recovery from anaesthesia was uneventful. However the patient complains of pain in the muscles. Which of the following is the likely reason for this?
(a) Propofol
(b) Succinylcholine
(c) Muscle Infraction
(d) None of the above
188. Which of the following is a plasma expander similar to albumin, has a MW30,000 and causes less hypersensitivity reactions but should be used with caution?
(a) Dextran
(b) HES
(c) Polygeline
(d) Polypyrrrolidone
189. Which of the following is the Circuit of choice for Spontaneous Ventilation?
(a) Mapleson B
(b) Mapleson C
(c) Mapleson D
(d) Mapleson A
190. All of the followings are methods for improving oxygenation using a ventilator, except:
(a) ECMO
(b) Low Tidal Volume High PEEP
(c) Prone Ventilation
(d) High frequency ventilation
RADIO
191. A neonate presented on day 1 of life, with bilious vomiting. What investigation will you do?
(a) Ultrasound
(b) Babygram
(c) Chest Skiagram
(d) CT Scan
192. Investigation of choice for acute appendicitis in children?
(a) USG
(b) MRI
(c) CT Scan
(d) X-ray
193. A person has a injury in the forefinger with glass and it is suspected that he has retained piece of glass in this finger. Which is the first investigation you will do?
(a) Plane radiograph
(b) Ultrasound
(c) CT Scan
(d) MRI
194. What is the investigation of choice in a patient with acute head injury?
(a) Non Contrast CT
(b) CECT
(c) MRI
(d) PET
195. A 3 month old baby presented with clay coloured stools and dark yellow urine. On further investigation he was found to have direct bilirubin of 6 mg%. Which is the most sensitive investigation to diagnose the above condition?
(a) HIDA Scan
(b) USG
(c) Liver Function tests
(d) CT Abdomen
196. Investigation of choice for bronchiectasis.
(a) HRCT
(b) Chest X-ray
(c) Bronchoscopy
(d) MRI
PSYCHI
197. A patient was diagnosed with schizophrenia and was started on haloperidol 5 mg. On 3rd day he presented with uprolling of eyes. A comlete neurological examination revealed no spasticity or any other abnormalities except uprolling of eyeballs. Visual acuity was found to be normal. What is your likely diagnosis?
(a) Seizure
(b) Acute Dystonia
(c) Malingering
(d) Akathesia
198. Which of the following is not an objectives of mental health act 1987?
(a) Minimal mental health care for all
(b) Application of mental health knowledge in general health care
(c) Promote community participation
(d) Human rights for the mentally ill
199. Which of the following is the most effective treatment modality for post traumatic stress disorder?
(a) Cognitive behavioural therapy
(b) Hypnosis
(c) Rational and emotive therapy
(d) Eye movement desensitization and reprocessing
200. All are true about autism except:
(a) 2/3rd are mentally retarded
(b) Language is impaired
(c) Abnormal dermatoglyphics
(d) Poor eye contact
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