JIPMER Medical PG Entrance November 2014 Question Paper With Answer Key

JIPMER PG Medical Entrance Examination

November-2014

ANATOMY

1. Myelination begins at

(a)   20 weeks

(b)   25 weeks

(c)   30 weeks

(d)   35 weeks

Ans: (a)

2. Pressure on hook of hamate when hand is hyperextended will damage

(a)   Ulnar nerve

(b)   Superficial branch of ulnar nerve

(c)   Median nerve

(d)   Musculoctuaneous nerve

Ans: (a)

3. Wrist is more adducted than to be abducted because

(a)   Ulnar styloind process extends far more distally

(b)   Radial styloid process extends far more distally

(c)   Radial styloid process is bulky and prevents muscle action

(d)   Ulnar styloid process is thin and moves more medially

Ans: (b)

4. Major branches of popliateal artery are

(a)   Genicular, anterior tibial and deep femoral arteries

(b)   Genicular artery only

(c)   Genicular, anterior and posterior tibial artery

(d)   Genicular and circumbflex tibial artery

Ans: (c)

5. Cruciate ligament of knee prevents

(a)   Gliding of femur on tibia during flexion

(b)   Locking of knee

(c)   Extension of knee joint

(d)   Rotational movements of knee joint

Ans: (a)

6. A patient with recurrent chest infections presents to the emergency department. He was ordered for an X ray. The patient says that he has an “azygos lobe” diagnosed few years back. What is the location of azygos lobe?

(a)   Right upper lobe

(b)   Left upper lobe

(c)   Right lower lobe

(d)   Left lower lobe

Ans: (a)

7. A patient present with hematemesis. On oesophago-gastroduodenoscopy, bleeding in lesser curvature was noted. The artery of bleed is

(a)   Right gastric artery

(b)   Left gastro omental artery

(c)   Anterior gastric artery

(d)   Posterior gastric artery

Ans: (a)

8. Not a tributary of portal vein

(a)   Inferior phrenic vein

(b)   Splenic vein

(c)   Cystic vein

(d)   Superior mesenteric vein

Ans: (a)

9. The major support for the liver to be held in position is

(a)   Peritoneal ligaments

(b)   Pressure exerted by the abdominal muscles and their tone

(c)   Attachment of hepatic vein to inferior vena cava

(d)   Suction force given by the diaphragm

Ans: (c > b)

10. True regarding biliary anatomy

(a)   Normal diameter of common bile duct is 10 mm.

(b)   Gall bladder is innervated sympathetic nerve

(c)   1-2 litres of bile is secreted by the liver daily and it is 10 fold concentrated by bladder

(d)   Right and left hepatic ducts join to form common bile duct

Ans: (b)

11. Root of mesentery crosses all except

(a)   Second part of duodenum

(b)   IVC

(c)   Abdominal aorta

(d)   Right ureter

Ans: (a)

12. Pleura that continues into the necks as cervical pleura is

(a)   Costal pleura

(b)   Diaphragmatic pleura

(c)   Visceral pleura

(d)   Mediastinal pleura

Ans: (a)

13. Deep inguinal ring is a defect in

(a)   Fascia transversalis

(b)   Rectus sheath

(c)   External oblique aponeurosis

(d)   Pelvic fascia

Ans: (a)

14. The ligament that maintains the stability of atlanto axial joint is

(a)   Alar ligament

(b)   Apical ligament

(c)   Transverse ligament

(d)   Tectorial ligament

Ans: (c)

15. Gray rami communicans appears gray because

(a)   Post ganglionic sympathetic fibers are nonmyelinated

(b)   Pre gnaglionic sympathetic fibers are nonmyelinated

(c)   Post ganglionic sympathetic fibers are myelinated

(d)   Post ganglionic parasympathetic fibers are nonmyelinated

Ans: (a)

PHYSIOLOGY

16. Action of nor adrenaline in sympathetic nerve endings are terminated by

(a)   Oxidative deamination by monoamine oxidase

(b)   Reuptake by axonal terminals

(c)   Enzymatic inactivation by catecholamine-O Methyl transferase

(d)   Removal by circulation of blood

Ans: (b)

17. Lateral spinothalamic tract of spinal cord

(a)   Transmits contralateral light touch

(b)   Crosses to opposite side in medial lemniscus

(c)   Carries pain sensation from same side

(d)   Crosses from the thalamus to the contralateral  parietal lobe

Ans: (d)

18. Not a component of electrical cardiac conduction pathway

(a)   SA node

(b)   Bundle of His

(c)   Purkinje Fibres

(d)   Sarcomere

Ans: (d)

19. According to Starling’s law of heart, the force of contraction of ventricle is proportional to

(a)   Afterload

(b)   End systolic volume

(c)   End diastolic volume

(d)   Heart rate

Ans: (c)

20. Following is a lecture on cardiovascular physiology, you consultant asks you during a ward rounds to calculate how much blood (in ml) Mr. X’s ventricle ejects every time his heart beats. He gives you the following values; Age of X : 42 years, BP: 136/90 mmHg. Cardiac Output-5L/min, Heart rate- 72 /min, Urine output-5 ml/kg/hr.

(a)   70 ml

(b)   20 ml

(c)   50 ml

(d)   130 ml

Ans: (a)

21. Measurable index of preload and afterload is

(a)   End systolic pressure – volume relation ship

(b)   Ejection fraction

(c)   Stroke volume

(d)   Cardiac output

Ans: (b)

22. A patient met with motor vehicle accident is shifted in an ambulance to the emergency department. Primary survey reveals open fracture of right femur with bleeding profusely in cardiovascular physiological terms, the most likely response to blood loss is

(a)   Stroke volume decreases due to hypovolemia

(b)   Total peripheral resistance increases due to decreased sympathetic output.

(c)   Increased cardiac output due to increased stroke volume and decreased heart rate

(d)   Heart rate increases due to increased vagal stimulation

Ans: (a)

23. Feature seen immediately after lying down

(a)   Increased cerebral blood flow

(b)   Immediate increase in venous return to the heart

(c)   Decrease in blood flow to the lung apex

(d)   No change in heart rate

Ans: (b)

24. Fenestrated capillaries are seen in

(a)   Skeletal muscle

(b)   CNS

(c)   Skin

(d)   Small intestine

Ans: (d)

25. The carbohydrate determining the blood group substance is

(a)   Xylose

(b)   Xylulose

(c)   Fucose

(d)   Arabinose

Ans: (c)

26. Pulmonary vascular system differs from systemic circulation in that the pulmonary system has

(a)   Low pressure, low flow rate

(b)   Low pressure, high flow rate, high compliance vessels

(c)   High pressure, high flow rate, high compliance vessels

(d)   Low pressure, high flow rate, high compliance vessels

Ans: (d)

27. In an acclimatized individuals,

(a)   Periodic breathing occurs

(b)   Increase in mean corpuscular haemoglobin concentration

(c)   Increased airway resistance

(d)   Increased pulmonary artery pressure

Ans: (d)

28. A 30 year old male presents with indigestion for past 4 months. Five years back, he had duodenal ulcer. Fasting gastric values are- 120p mol/L. (NORMAL LEVELS 10-20 pmol/L). True regarding gastrin is

(a)   Produced by parietal cells of stomach

(b)   Produced by alpha cells of pancreas

(c)   Inhibits bicarbonate secretion in a phased manner

(d)   Release is stimulated by presence of gastric  luminal peptides.

Ans: (d)

29. Enterohepatic circulation occurs in

(a)   Rectosigmoid junction

(b)   Terminal ileum

(c)   Jejunum

(d)   Pancreas

Ans: (b)

30. Oxygen requiring metabolic reactions occur in which cells of liver

(a)   Zone-1 cells

(b)   Zone-2 cells

(c)   Zone-3 cells

(d)   Kupffer cells

Ans: (a)

31. True regarding GLP-1

(a)   Acts t the satiety centre

(b)   Inhibits glucose induced insulin secretion

(c)   Secreted by alpha cells of pancreas

(d)   Release is inhibited by the presence of fatty acids

Ans: (a)

32. Insulin independent glucose uptake occurs in

(a)   Liver

(b)   Skeletal muscle

(c)   Heart

(d)   Adipose tissue

Ans: (a)

BIOCHEMISTRY

33. A patient have acquired syndrome associated with defective breakdown and disposal of intracellular fatty acids. Which intra cellular organelle is concerned with this mechanism?

(a)   Mitochondria

(b)   Peroxisomes

(c)   Lysosomes

(d)   Smooth endoplasmic reticulum

Ans: (b)

34. Function of golgi apparatus

(a)   Packs and sorts proteins

(b)   Synthesis of ATPs

(c)   Steroid synthesis

(d)   DNA replication

Ans: (a)

35. Pyridoxine is a co enzyme of

(a)   Carboxylation

(b)   Transamination

(c)   Oxidation

(d)   Reduction

Ans: (b)

36. The vitamin whose RDA is related to protein intake is

(a)   Pantothenate

(b)   Niacin

(c)   Pyriodxine

(d)   Thiamine

Ans: (b)

37. 55 year old presents with bleeding gums. He is an alcoholic, has petechia. The vitamin deficiency associated with this condition is

(a)   Vitamin B1

(b)   Vitamin B 12

(c)   Vitamin C

(d)   Vitamin E

Ans: (c)

38. The common polymorphism in the gene for methylene-tetrahydro folate reductase appears to influence the sensitivity of homocysteine levels to deficiency of

(a)   Vitamin B12

(b)   Folic acid

(c)   Vitamin A & D

(d)   Vitamin B6

Ans: (b)

39. True regarding metabolic acidosis

(a)   Body shunts more glutamine from liver to kidneys

(b)   Less ammonia is excreted in urine

(c)   Urea synthesis is increased

(d)   Liver glutaminase activity increases

Ans: (a)

40. True regarding gamma glutamyl transferase

(a)   Synthesized only in liver.

(b)   Levels are increased in fatty acid

(c)   Better indicator of infectious hepatitis than for cholestasis

(d)   Isolated increase of GGT in patients with prostatic carcinoma indicates hepatic metastasis.

Ans: (b)

41. Impaired glucose tolerance is seen in deficiency of

(a)   Selenium

(b)   Chromium

(c)   Manganese

(d)   Molybdenum

Ans: (b)

42. Divalent zinc ion is essential for

(a)   Catalase

(b)   Pancreatic lipase

(c)   Alkaline phosphatase

(d)   Salivary amylase

Ans: (c)

43. Mucopolysaccharide not containing uronic acid is

(a)   Heparin

(b)   Heparan sulphate

(c)   Keratan sulphate

(d)   Chondroitin sulphate

Ans: (c)

44. Enzyme involved in the synthesis of both cholesterol as well as ketone bodies is

(a)   HMG CoA reductase

(b)   HMG CoA synthase

(c)   HMG CoA lyase

(d)   Acetyl CoA synthetase

Ans: (b)

45. Enzyme action increased in fed state

(a)   Carbomyl phosphate-I transferase

(b)   Pyruvate carboxylase

(c)   HMG coA lyase

(d)   Acetyl COA carboxylase

Ans: (d)

46. Lipoprotein-A is in structural homology to

(a)   Albumin

(b)   Prothrombin

(c)   Collagen

(d)   Plasminogen

Ans: (d)

47. Injections of heparin releases

(a)   Lipoprotein lipase

(b)   Insulin

(c)   Alkaline phosphatase

(d)   Nitric oxide

Ans: (a)

48. The rate limiting enzyme of de novo purine biosynthesis pathway

(a)   Phosphoribosylpyrophosphate synthetase

(b)   Phosphoribosylpyrophosphate amidotransferase

(c)   Adenylosuccinate lyase

(d)   Formyltransferase

Ans: (b)

49. Function of pseudouridine arm of tRNA is

(a)   Terminates translation

(b)   Binding of tRNA to ribosomes

(c)   Recognition of specific tRNA to add with specific amino acid

(d)   Recognition of specific amino acid to be attached to the amino acid arm.

Ans: (b)

50. Polymerase chain reaction is used to amplify a small fragments of DNA for further analysis. To do this, DNA double helix must be split. This is done by

(a)   DNA polymerase

(b)   Centrifuge

(c)   Alkali

(d)   Heating around 100℃

Ans: (d)

51. Northern blot detects

(a)   RNA

(b)   DNA

(c)   Protein

(d)   Antigens

Ans: (a)

PHARMACOLOGY

52. A new drug is being studied to find the most appropriate dose in dose response study. Small does results in linear increase in serum drug concentration. At high doses there is exponential increase in serum levels. This is called as

(a)   Saturations kinetics

(b)   First passes effect

(c)   Zero order kinetics

(d)   First order kinetics

Ans: (d)

53. 72 years old male patient presents with fast atrial fibrillation on treatment with digoxin. Inadequate dosage was suspected. Blood sample was drawn after 6 hours of last dose of digoxin to estimate the plasma concentration of digoxin. Why to wait for 6 hours after the last dose of digoxin?

(a)   Rate of elimination

(b)   Rate of clearance

(c)   Rate of absorption

(d)   Rate of distribution

Ans: (d)

54. Smooth endoplasmic reticulum in liver cell is increased in people using lipid soluble drugs, because

(a)   SER packs drugs away from the cells

(b)   Produces protein against the drug

(c)   Detoxify the drug

(d)   Converts lipid soluble drugs to proteins

Ans: (c)

55. True regarding leukotrienes

(a)   Synthesised from COX pathway

(b)   Increases mucus secretion

(c)   Synthesised by fibroblasts

(d)   LT D4 is Slow Reactive Substance-A which causes bronchial wall smooth muscle relaxation

Ans: (b)

56. Bradycardia is most common in

(a)   Midazolam

(b)   Succinyl choline

(c)   Isoprenaline

(d)   Dopamine

Ans: (b)

57. N-Acetyl Cysteine replenish

(a)   Glutathione

(b)   Cytochrome p450

(c)   Glucuronyl transferase

(d)   Sulfatase

Ans: (a)

58. Am 85 year old female presents with bilateral osteoarthritis. There was no history of any gastro intestinal symptoms. The most appropriate drug that can be recommended is

(a)   Dihydrocodeine

(b)   Celecoxib

(c)   Naproxen

(d)   Paracetamol

Ans: (c)

59. The most potent anti-emetic agent in pre-operative period is

(a)   Ondansetron

(b)   Metochlopramide

(c)   Perchlorperazine

(d)   Chlorpromazine

Ans: (a)

60. A patient was on lithium therapy for bipolar disorder. Initiation of hydrochlorothiazide for hypertension can cause

(a)   Failure of hydrochlorothiazide therapy

(b)   Increased hepatic clearance of lithium

(c)   Increased renal clearance of lithium

(d)   Increase in serum lithium levels

Ans: (d)

61. Drugs decreasing mortality in ischemic heart disease are all except

(a)   Statins

(b)   ACE inhibitors

(c)   Nitrates

(d)   Aspirin

Ans: (c)

62. A 70 years old female presents with H/O pancreatitis, persistent diarrhea and osteoporosis. DVT is present. Drug least effective if given after she takes cholestyramine to relieve the intolerable itching is

(a)   Warfarin

(b)   Thiamine

(c)   Vitamin-D

(d)   Aspirin

Ans: (a)

63. True regarding insulin is

(a)   Interacts with nuclear membrane

(b)   Increases glucose – protein transport in ER

(c)   Has similar mechanism of action of steroid receptors

(d)   Not detected in lymph

Ans: (b)

64. A 35 year old female with 2+ glycosuria with a body mass index of 35, fasting blood sugar-132mgs/dl. The best measure to decrease the insulin resistance is

(a)   Repaglinide therapy

(b)   Insulin therapy

(c)   Metformin therapy

(d)   Weight loss and exercise

Ans: (d)

65. 82 years ld female presents with history of fall on the ground and diagnosed as Colle’s Fracture. She was started with alendronate. The mechanism of action of alendronate in this condition is that it

(a)   Inhibits the osteoblastic activity

(b)   Inhibits the osteoclastic activity

(c)   Increases the osteoblastic activity

(d)   Increased bone turn over

Ans: (b)

66. You are developing a new long acting antagonist for the treatment of SIADH. Where will this drug act?

(a)   Aquaporin-1 channels

(b)   V1 receptors

(c)   Aquaporin-2 channels

(d)   V2 receptors

Ans: (d)

67. The first drug increases the pharmacological action of the second drug, when given concomitantly is

(a)   Erythromycin: theophylline

(b)   Ranitidine: corticosteroids

(c)   Phenytoin: ethinyl estradiol

(d)   Rifampicin: warfarin

Ans: (a)

68. True for poisoning or overdose

(a)   Clomethiazole- causes hypertension and hyperthermia

(b)   Aspirin-causes acidosis due to hypoventilation

(c)   Methanol causes metabolic acidosis with increased anion gap

(d)   Phenobarbitone causes metabolic acidosis.

Ans: (c)

69. Not a cause of drug induced hepatitis

(a)   Isoniazid

(b)   Ethambutol

(c)   Pyrazinamide

(d)   Methyldopa

Ans: (b)

70. Mechanism of action of gentamicin when given synergistically with benzyl penicillin in the treatment of infective endocarditis of streptococcus viridians is

(a)   Interfere with DNA replication

(b)   Inhibit protein synthesis (translocation)

(c)   Inhibit protein synthesis (transcription)

(d)   Cell wall inhibition

Ans: (b)

71. The anti-retroviral drug which acts as a function inhibitor

(a)   Atazanavir

(b)   Emtricitabine

(c)   Enfuvirtide

(d)   Elvitegravir

Ans: (c)

72. A 16 year old male presents with recurrent acne not responding to oral antibiotics. To start with oral isotretinoin, which of the following investigations has to be done before and during the oral administration of isotretinoin?

(a)   Liver function test with fasting lipid profile

(b)   Electrolytes with fasting lipid profile

(c)   Liver function test with Electrolytes

(d)   Liver function test with platelet count

Ans: (a)

73. A 30 years old male is on methotrexate 7.5 mg weekly. His wife is fit and well and is not on any medication except for oral contraceptive pills. They are keen to start family and want to know about continued contraception and whether to stop methotrexate. The appropriate advice is

(a)   Should continue adequate contraception atleast 3 months after stopping methotrexate.

(b)   Should continue adequate contraception atleast for 4 weeks after stopping methotrexate.

(c)   Should continue adequate contraception atleast for 1 year after stopping methotrexate.

(d)   Dispense with contraception now but husband should stop methotrexate.

Ans: (a)

74. Lenalidomide increases the risk of thromboembolic events when combined with

(a)   Barbiturates

(b)   Anti-psychotics

(c)   Alcohol

(d)   Glucocorticoids

Ans: (d)

MICROBIOLOGY

75. Which of the following is not a feature of exotoxin?

(a)   High antigenicity

(b)   Neutralised by antibodies

(c)   Heat stable

(d)   Protein in nature

Ans: (c)

76. Mechanism of development of resistance to penicillin in Streptococcus pneumonia is

(a)   Production of Beta lactamase

(b)   Mutations in the penicillin binding proteins on the bacterial surface

(c)   Changes in the membrane permeability to penicillin

(d)   Production of an alternative penicillin binding protein

Ans: (b)

77. A new agent was developed to increase the recognition of foreign antigens by Antigen presenting cells. True regarding the physiological aspects of APC’s

(a)   Antigen is presented via MCH-I complexes

(b)   APC’s are required before a response to viruses are generated

(c)   Direct antibody stimulation still requires APC’s

(d)   Antigen processed by APC are recognised by CD4+ T cells

Ans: (d)

78. True regarding thymus is

(a)   Mature thymocytes express CD 4 and CD 8

(b)   Thymocytes whose T cell receptor binds with high affinity to self-antigens and MHC complexes are clonally detected

(c)   Mature thymocytes express surface IgM & IgD

(d)   CD 4 & CD 8 double positive cells are eliminated by a process of negative selection

Ans: (d)

79. A 16 years old male patient presents with head ache, fever and neck stiffness for the past 24 h ours. Similar history was present one year back. CSF analysis shows WBC’s-400/ml, with 90% neutrophils. Gram staining shows gram negative diplococcic. The immune system affected in t his condition is

(a)   B lymphocytes

(b)   T lymphocytes

(c)   Immunoglobulins

(d)   Complement system

Ans: (d)

80. All the following are true about Staphylococcus aureus except

(a)   Coagulase positive

(b)   Catalase negative

(c)   DNAse positive

(d)   Indole negative

Ans: (b)

81. There was a sudden outbreak of MRSA infection in generall ward. The best method for reducing the MRSA outbreak in the ward and to reduce the transmission is

(a)   Encourage regular hand wash

(b)   Clean the walls and floors with chlorhexidine

(c)   Screen the ward staff using nasal swabs and exclude those with positive culture for MRSA

(d)   Close the ward for 1 month

Ans: (a)

82. 37 year old person, poorly controlled case to type-1 DM presents with painful, red, swollen middle finger with redness extending to metacarpophalangeal joint. A diagnosis of cellulitis is made and rerated with antibiotics. What is the organism causing this condition?

(a)   Pseudomonas aeruginosa

(b)   Klebsiella penumoniae

(c)   MRSA

(d)   Streptococcus pyogenes

Ans: (d)

83. 19 years old male patient comes to the emergency department with complaints of urthral discharge, 1 week after having unprotected sex. Gram staining reveals numerous neutrophils, some gram negative intracellular diplococcic. He was treated with ceftriaxone 250 mg i.m. 5 days later he returns with the same complaints. What is the diagnosis?

(a)   Chlamydia trachomatis

(b)   Penicillin resistant Neisseria gonorrhoeae

(c)   Reinfection with Neisseria gonorrhoeae

(d)   Ureaplasma urealyticum

Ans: (c)

84. A strain of E.coli isolated from urine is resistant to third generation cephalosporins. The mechanism of development of resistance is

(a)   Extended spectrum β-Lactamases

(b)   Decrased permeability

(c)   Active efflux of β-Lactam agents

(d)   Alteration of PBPs

Ans: (a)

85. Infection that can be acquired in laboratories

(a)   Brucellosis

(b)   Tuberculosis

(c)   Pertusssis

(d)   Melioidosis

Ans: (a)

86. A child presents with tuberculosis. Steroids are not indicated in

(a)   Tuberculoma

(b)   Endobronchial tuberculosis

(c)   Pleural effusion

(d)   Progressive primary pulmonary disease

Ans: (d)

87. Agent used in interferon gamma release assay for diagnosing latent tuberculosis is

(a)   MPT 64

(b)   Mycolic acid

(c)   Lipoarabinomannan

(d)   ESAT-6

Ans: (d)

88. 45 years old female patient presents with duodenal ulcer. The most sensitive test for the detection of H.Pylori is

(a)   Urea breath test

(b)   Serology

(c)   Biopsy & Culture

(d)   Stool antigen test

Ans: (a)

89. Channel activated by cholera toxin

(a)   Adenylate cyclase

(b)   Guanyl cyclase

(c)   ABC transport channel

(d)   Ion transport channel

Ans: (a)

90. A 25 years old male presents with 2 months history of loose stools and weight loss. Laboratory diagnostic tests are positive for HIV. Presence of which of the following disease is most likely in diagnosing HIV/AIDS?

(a)   Lyme disease

(b)   Glandular fever

(c)   Orpharyngeal candidiasis

(d)   Pulmonary TB

Ans: (c)

91. Parotid enlargement in a HIV infected child is characterised in which stage of AIDS according to WHO?

(a)   Stage 1

(b)   Stage 2

(c)   Stage 3

(d)   Stage 4

Ans: (b)

92. Indication for varicella immunoglobulin is

(a)   A pregnant woman non-immune to Varicella Zoster, exposed to a child with chicken pox 12 days ago

(b)   A pregnant woman non-immune to Varicella Zoster, exposed to mother with shingles

(c)   A pregnant woman with no history of chicken pox develops shingles

(d)   A pregnant woman previously treated with varicella immunoglobulin 10 days ago, but re-exposed to a case of chicken pox

Ans: (b)

93. Negri bodies are pathological inclusions seen in some pathological conditions. They are seen in all the following areas except

(a)   Pyramidal neurons of hippocampus

(b)   Subcortical white matter

(c)   Basal ganglia

(d)   Purkinje cells of cerebellum

Ans: (b)

94. Modality not employed in the diagnosis of respiratory viruses in laboratory

(a)   ELISA

(b)   Immunofluorescence

(c)   Single Radial hemolysis (SRH)

(d)   Hemagglutination

Ans: (none)

95. Morphological appearance of Pneumocystis jeroveci infection of lung is best characterized by

(a)   Hemorrhagic and necrotizing pneumonia

(b)   ARDS with wide spread hyaline membrane formation

(c)   Interstitial pneumonitis with foamy intra alveolar exudates

(d)   Broncho pulmonary absecess formation

Ans: (c)

PATHLOGY

96.Apoptosis in initiated by

(a)   Caspases

(b)   DNA

(c)   Antibodies

(d)   MAP kinase

Ans: (a)

97. All the following inflammatory mediators are derived from the cells except

(a)   Kinins

(b)   Cytokines

(c)   Histamine

(d)   Leukotrienes

Ans: (a)

98. 17 years old pregnant woman h as scattered small, raised lesions on trunk and axillary freckles. The mode of inheritance of this condition

(a)   Autosomal dominant

(b)   Autosomal recessive

(c)   X-linked dominant   

(d)   X-linked recessive

Ans: (a)

99. The following condition is not a single gene disorder

(a)   Arrhythmogenic right ventricular cadiomyopathy

(b)   Hypertorphic cardiomyopathy

(c)   Dilated cardiomyopathy

(d)   Mitral valve prolapsed

Ans: (c)

100. A 17 y ear old female with von Willebrand disease presents for dental extraction. She had history of simi9lar dental extraction 2 years back with increased bleeding and two units of plasma was transfused. Now appropriate prior line of management includes

(a)   Cryoprecipitate

(b)   FFP

(c)   Recombinant factor VIII

(d)   Desmopressin (DDAVP)

Ans: (d)

101. Most accurate statement regarding DIC is

(a)   Removal of the underlying cause leads to complete resolution.

(b)   Associated with increased serum fibrinogen levels

(c)   Normal clotting parameters excludes DIC

(d)   DIC is associated with increased levels of D-dimer

Ans: (d)

102. 42 years old female presents with tiredness. There was no H/O smoking, drug abuse or alcohol consumption. Hb 78 g/L, MCV-72 fL, WBC – 7 × 109/μL, platelet count 3, 50, 000/μ Serum ferritin levels – 8 μg/L (15-300 μg/L). She was started on oral iron therapy and her Hb condition during review was 80 g/L. The cause for failure of treatment is

(a)   Acquired sideroblastic anemia

(b)   Inadequate iron dosage

(c)   Poor compliance to oral iron

(d)   Folate deficiency

Ans: (c)

103. True regarding abnormal hemoglobins are

(a)   HbS is caused by single base mutation

(b)   In thalassemia, persistence of HbF indicates bad prognosis

(c)   Alpha thalassemia is due to deficiency of Bea chain production

(d)   Genes for alpha & beta chains are present in the same chromosome

Ans: (a)

104. Severe Hereditary spherocytosis is seen due to the defect of the following protein

(a)   Spectrin

(b)   Ankyrin

(c)   Band 3

(d)   Band 4.2

Ans: (a)

105. Reagent used in A:t test

(a)   Sodium hydroxide

(b)   Sodium chloride

(c)   Sodium acetate

(d)   Sodium bicarbonate

Ans: (a)

106. A 65 years old smoker presents with chronic cough, hemoptysis and loss of weight. X ray chest shows cavitatory lesion. The most appropriate diagnosis is

(a)   Unidifferentiated large cell carcinoma

(b)   Small cell carcinoma

(c)   Adeno carcinoma

(d)   Squamous cell carcinoma

Ans: (d)

107. Carcinoid tumors of lung arises from

(a)   Type-II pneumocytes

(b)   Kulchitsky (K) cells

(c)   Mucus (goblet) cells

(d)   Clara cells

Ans: (b)

108. True in a child with post streptococcal glomerulonephritis is

(a)   Microscopic haematuria decreases within 4 weeks

(b)   Serum triglyceride levels increase

(c)   Severe renal dysfunction is an indication for biopsy

(d)   Serum C3 levels are normal

Ans: (c)

109. A 50 years old male patient develops cardiogenic shock following acute myocardial infarction. The urine output decreases in next few days. Urea levels – 90 mg/dl, creatinine. 4.5 mg/dl. Urine analysis reveals no glycosuria or proteinuria, traces of blood present and numerous hyaline casts is present. Later he develops polyuria and the urea and creatinine levels fall. The pathological finding coinciding with the above situation is

(a)   patchy tubular necrosis

(b)   Glomerular crescents

(c)   Mesangial immune complex deposition

(d)   Hyperlastic arteriosclerosis

Ans: (a)

110. Mutation of STK II/LKB I gene results in

(a)   Peutz Jegher’s syndrome

(b)   Cowden syndrome

(c)   Familial adnomatous polyposis

(d)   Herediatary non-polyposis colorectal cancer

Ans: (a)

FORENSIC MEDICINE

111. First internal sing of putrefaction is seen in

(a)   Under surface of liver

(b)   Under surface of spleen

(c)   Over the region of Caecum

(d)   Over the region of pancreas

Ans: (a)

112. Magistrate inquest in India is conducted for all the following conditions except

(a)   Exhumation

(b)   Custody death

(c)   Homicide

(d)   Dowry death

Ans: (c)

113. Not a characteristic feature of male hip bone

(a)   Preauricular sulcus

(b)   Broad and round pelvic cavity

(c)   Wide and shallow geater sciatic notch

(d)   Everted ischial tuberosity

Ans: (a)

114. A pedestrian was hit by fast moving vehicle on leg and thrown away. He hit the road divider and fell down on the road and sustained head injuries. He was run over by a car moving on the opposite direction. The head injuries sustained by the patient are example of

(a)   Primary impact injuries

(b)   Primary injuries

(c)   Secondary impact injuries

(d)   Secondary injuries

Ans: (d)

115. A child sustained burns in front and back of both thighs and buttocks, face and scalp with singeing of hair. Calculate the percentage of burns

(a)   27

(b)   32

(c)   34

(d)   45

Ans: (b)

116. Dribbling of saliva is common in

(a)   Post-mortem hanging

(b)   Ante mortem hanging

(c)   Homicidal hanging

(d)   Suicidal hanging

Ans: (a)

117. Hanging injuries

(a)   Trachea

(b)   Oesophagus

(c)   Vertebral artery

(d)   Carotid artery

Ans: (d)

118. Identify the true pair in the management of poisoning

(a)   N-acetyl cysteine- Paraquat

(b)   Methylene blue – Cyanide

(c)   Ethanol – Isopropyl alcohol

(d)   Pralidoxime – Sarin (nerve gas)

Ans: (d)

119. A farmer with H/O depression is admitted for treatment with over dosage. He has bradycardia, hypotension, disorientation, hypersalivation and small pupils. The causative substance is

(a)   Organophosphates

(b)   Paracetamol

(c)   Tricyclic anti-depressants

(d)   Cyanide

Ans: (a)

120. According to MTP act, medial termination of pregnancy can be done upto

(a)   28 weeks

(b)   22 weeks

(c)   20 weeks

(d)   Before period of viability

Ans: (c)

ENT

121. A 6 year old boy was referred by his school teacher for a suspected hearing loss. On examination, a middle ear effusion (MEE) was diagnosed. The usual range of hearing loss associated with MEE is

(a)   10-20 dB

(b)   21-30 dB

(c)   31-40 dB

(d)   41-50 dB

Ans: (b)

122. Diplopia on looking to left side in a cased of bilateral CSOM is due to

(a)   Right lateral sinus thrmbophlebitis with cerebellar abscess

(b)   Left lateral sinus thrombophlebitis with cerebellar abscess

(c)   Right petrositis affecting abducent nerve

(d)   Left petrositis affecting abducent nerve

Ans: (d)

123. A child with adenoidal hypertrophy with persistent ET dysfunction can develop into

(a)   Primary acquired cholesteatoma

(b)   Secondary acquired cholesteatoma

(c)   Osteitis and granulation tissue

(d)   Microcholesteatoma

Ans: (a)

124. A case of Meniere’s disease has failed all medical treatment. But still has a serviceable hearing. All can be done except

(a)   Intratympanic gentamicin

(b)   Endolymphatic sac decompression

(c)   Vestibular neurectomy

(d)   Labyrinthectomy

Ans: (d)

125. 8 years old child presents with a preauricular sinus, not associated with any discharge. The sinus opening is visualized clearly. The mother has same H/O preauricular sinus and was operated 30 years b ack. Now, next line of management is

(a)   HRCT of temporal bone

(b)   Sinogram with a radio-opaque dye

(c)   Regular follow up

(d)   MRI to exclude cyst

Ans: (b)

126. A case of Lower motor neuron facial palsy with intact lacrimation on Schirmer’s test and loss of taste sensation in anterior 2/3rd The level of lesion

(a)   At the level of stylomastoid foramen

(b)   At the level of geniculate ganglion

(c)   At the internal acoustic canal

(d)   At the horizontal tympanic canal

Ans: (d)

127. Deep and lower voice in males is due to

(a)   Inferior placement of larynx

(b)   Longer vocal cord

(c)   More vocal vibration due to flaccidity

(d)   Larger arytenoids cartilage

Ans: (b)

128. A school teacher complains of easy fatiguability of voice following upper respiratory tract infection. Indirect laryngoscopy shows key hole appearance of glottis. The next line of management is

(a)   There is weakness of thyroarytenoid and interarytenoid, can  be cured by type-I thyroplasty and arrytenoid adduction

(b)   There is weakness of thyroarytenoid and interarytenoid, can be cured by vocal hygiene and voice rest

(c)   There is weakness of thyroarytenoid and interarytenoid, can be cured by type-I thyroplasty

(d)   Thee is early vocal nodule, can be cured by voice rest and microlaryngeal surgery

Ans: (b)

OPHTHALMOLOGY

129. The ideal rehabi9ilitation for aphakia is

(a)   ACIOL

(b)   PCIOL

(c)   Spectacle

(d)   Contact lens

Ans: (b)

130. Pathognomonic retinal change is seen in

(a)   Wilson disease

(b)   Infective endocarditis

(c)   Polycythemia rubra vera

(d)   Sickle cell anemia

Ans: (d)

131. A 52 year old male on regular diclofenac medication for back pain presents with deteriorating vision. His BP is 142/82 mmGh, PR-72/min, regular respiration. There is bilateral loss of visual acuity and colour vision. There were no other abnormal neurological findings. Diagnosis

(a)   Cataract

(b)   Optic neuritis

(c)   Primary open angle glaucoma

(d)   Primary angle closure glaucoma

Ans: (b)

132. 22 year sold female with one month hisotry of episodic, brief visual loss in the right eye. There was H/O weight gain for last 1 year. Now BMI is 35. Fundus examination shows bilateral optic disc swelling more on right with small retinal Diagnosis

(a)   Optic neuritis

(b)   Craniopharyngioma

(c)   Sagittal sinus thrombosis

(d)   Idiopahtic intracranial hypertension

Ans: (d)

133. 28 years old female presents with complains of her right pupil larger than left after developing Shingles. On examination right pupil is larger than the left, reacts poorly to light, normal near reflex. Diagnosis is

(a)   Third nerve palsy

(b)   Holme-Adie’s pupil

(c)   Argyll Robertson pupil

(d)   Horner syndrome

Ans: (b)

PREVENTIVE & SOCIAL MEDICINE

134. The appropriate level of prevention for preventing childhood obesity

(a)   Primordial prevention

(b)   Primary prevention

(c)   Secondary prevention

(d)   Rehabilitation

Ans: (a)

135. Meta-zoonosis among the following is

(a)   Rabies

(b)   Brucellosis

(c)   Plaque

(d)   Taeniasis

Ans: (c)

136. A new publisher devices a test for tuberculosis. You want to know that proportion of patients with tuberculosis would be confidently identified this test. Which measure will you use?

(a)   Sensitivity

(b)   Specificity

(c)   Negative predictive value

(d)   Positive predictive value

Ans: (a)

137. The fifth millennium development goals for 2015aims at bringing down the MMR by

(a)   0.25

(b)   0.5

(c)   0.75

(d)   1

Ans: (d)

138. The colour code for the bag for collecting waste sharps

(a)   Blue/White

(b)   Black

(c)   Red

(d)   Yellow

Ans: (a)

139. In a study of correlation between serum insulin levels (μU/ml) and waist circumference (cm), 100 patients were recruited. They found that the correlation coefficient was 0.5. The true statement is

(a)   Change in unit of insulin will change the correlation coefficient

(b)   Correlation is weak

(c)   For every cm increase in waist circumference, insulin levels increased by 0.3 μU/mL

(d)   95% confident interval should be considered for correlation coefficient.

Ans: (d)

140. Not a feature of systematic review

(a)   Meta-analysis always performed

(b)   Search for literature is compulsory using explicit search strategy

(c)   Critical appraisal is always criterion based

(d)   Research question is always focused

Ans: (a)

141. True about meta-analysis is all except

(a)   A statistical technique for combining the findings from several independent studies on a specific topic

(b)   Its purpose is not to identify risk factors

(c)   Its purpose is o increase statistical power by increasing the sample size

(d)   The validity does not depend on the quality of thee systematic review

Ans: (d)

MEDICINE

142. Right sided heart sound that decreases in intensity during inspiration is

(a)   Systolic murmur of tricuspid regurgitation

(b)   Systolic murmur of pulmonary stenosis

(c)   Right ventricular S3

(d)   Pulmonary ejection sound

Ans: (d)

143. Treatment of choice in ST segment elevated myocardial ischemia is

(a)   Thrombolysis with streptokinase

(b)   Thrombolysis with alteplase

(c)   Primary percutaneous coronary intervention

(d)   Aspirin with low molecular weight heparin

Ans: (c)

144. Test to detect reversible Myocardial ischemia

(a)   Resting echo

(b)   Multi gated acquisition (MUGA) scan

(c)   Thallium scan

(d)   Cornoary angiogram

Ans: (c)

145. A 41 year old male presents with infective endocarditis. Condition associated with best prognosis is

(a)   Streptococcus viridans

(b)   IV drug abusers

(c)   Prosthetic valve infections

(d)   Staphylococcus aureus infections

Ans: (a)

146. True regarding the diagnosis of infective endocarditis is

(a)   Failure to detect vegetations does not exclude the diagnosis.

(b)   Sensitivity of transthoracic echocardiogram is 95%

(c)   Transthoracic echo is as good as transesophageal echo

(d)   Transthoracic echo can detect vegetations less than 2 mm.

Ans: (a)

147. A staff nurse of cardiology unit measures the blood pressure of a 61 years old male and records as 183/100 on sitting and 190/105 mmHg on standing. The heart rate is 81/min. irregularly irregular. On auscultation, no mumurs but there was bilateral basilar crackles, the most appropriate differential diagnosis is

(a)   Left atrial myxoma

(b)   Mitral regurgitation

(c)   Cor pulmonale

(d)   Left ventricular hypertrophy

Ans: (c)

148. A 24 years old female patient in operation theatre for excision of sebaceous cyst has a pulse rate of 220/min, BP- 70/50 mmHg, Respiratory rate- 32/min. Patient is wake, alert, oriented but feel dizzy. ECG shows a regular rhythm with a QRS width of 0.11 secs. The immediate line of management is

(a)   Adenosine 6mg/6mg/12mg

(b)   Amiodarone 300 mg

(c)   Direct current cardioversion

(d)   Atenolol 50mg

Ans: (a)

149. 18 years old female presents to the emergency department with cyanosis. There are no other notable clinical signs or symptoms. The presence of cyanosis was known to her from her neighbours. The most appropriate cause for her cyanosis would be

(a)   Lead poisoning

(b)   Severe anemia

(c)   Drinking water contaminated with nitrates

(d)   Carbon monoxide poisoning

Ans: (c)

150. Right internal carotid artery stenosis is associated with all except

(a)   Dysphasia

(b)   Drop attacks

(c)   Contralateral hemi sensory loss

(d)   Contralalteral hemiplegia

Ans: (b)

151. 66 years old male presents to the emergency department with ataxia, vomiting, head ache with increasing drowsiness. The most appropriate diagnosis is

(a)   Herpes Simplex Encephalitis

(b)   Acute subdural haemorrhage

(c)   Acute cerebellar haemorrhage

(d)   Transient ischemic attack

Ans: (c)

152. A 73 years old male patient presents with abrupt onset of double vision with left leg weakness, right facial weakness affecting upper and lower parts of face with left hemipareiss. All these clinical features can occur, if the lesion is at the level of

(a)   Left frontal lobe

(b)   Right mid brain

(c)   Left lateral medulla

(d)   Right pons

Ans: (d)

153. An 18 year old male presents with history of head ache for past 6 months in the frontal area, occasionally associated with nausea. He is on paracetamol 3g/day, Aspirin 300 mgtds, Codeine 40 mg tds. It provides only temporary relief. He had a history of depression 2 years back and was on treatment with paroxetine. No abnormalities were detected on clinical examination. The exact diagnosis is

(a)   Medication overuse head ache

(b)   Migraine

(c)   Cluster head ache

(d)   Head ache due to depression

Ans: (a)

154. A 22 years old female presents with distress, shortness of breath with respiratory rate 35/min, pulse rate-120/min, BP- 110/70 mmHg, Oxygen saturation of 90% and peak expiratory flow less than 50%. Salbutamol 5 mg was given twice and face mask O2 was given, the next line of management is

(a)   Prednisolone 40 mg

(b)   Intensive care referral

(c)   Arterial blood gas analysis

(d)   Salbutamol 5 mg + ipratropium bromide 0.5 mg

Ans: (a)

155. 80 years old coal miner who stopped working 16 years back develops dyspnoea. FEV1- 1.4 L(predicted value – 2.5 L), FVC – 2.8L(Predicated value – 3.0 L) Diagnosis

(a)   Silicosis

(b)   Idiopathic pulmonary fibrosis

(c)   COPD

(d)   Hypersensitive pneumonitis.

Ans: (c)

156. A 26 years old patient was brought to the emergency department with severe shortness of breath with BP 80/50 mmHG, tachypnea. On examination he is apyrexial. The oxygen saturation is 74%. ON clinical examination JVP was increased, trachea was shifted to left side. The next step in management include

(a)   Insert a large bore needle in the right side

(b)   Insert a large bore needle in the left side

(c)   Order for an urgent portable Chest X ray and administer high levels of  oxygen

(d)   Aspirate the left side of chest with wide bore cannula

Ans: (a)

157. A patient posted for surgery for squamous cell carcinoma of lung. He suddenly develops. Left hemothroax. The next line of management is

(a)   Tranexamic acid

(b)   Bronchial embolization

(c)   Throacostomy tube

(d)   Radiotherapy

Ans: (c)

158. 18 years old female presents with a red tender lump on shin and arthralgia. Chest X rays shows bilateral hilar lymphadenopathy with clear lung fields. She is diagnosed to be having sarcoidosis. The most appropriate management plan is

(a)   24 hours urinary calcium levels measurement

(b)   Follow up with chest X ray after 3 months

(c)   Mediastinoscopy with lymph node biopsy

(d)   Thoracic CT-scan

Ans: (c)

159. Cavitatory lesion on chest X ray is seen in

(a)   Klebsiella pneumonia

(b)   Pneumococcal pneumonia

(c)   Sarcoidosis

(d)   Leginnaire’s disease

Ans: (a)

160. Conglomerate nodules in chest X ray is seen in

(a)   Silicosis

(b)   Sarcoidosis

(c)   Lobar pneumonia

(d)   Hypersensitive pneumonitis

Ans: (a)

161. Identify the true association

(a)   Broncho pulmonary aspergillosis + wheezing

(b)   Pulmonary embolism + LBBB

(c)   Lung carcinoid + pulmonary embolism

(d)   Pneumoconiosis + clubbing

Ans: (a)

162. 40 years old male patient presents with pulmonary embolism to the emergency department. A ventilation perfusion san is ordered. All the following are true regarding V/P scan except

(a)   Contraindicated in pregnancy

(b)   a normal perfusion scan excludes the diagnosis of clinically significant pulmonary embolism

(c)   An abnormal ventilation with perfusion defects points towards a diagnosis other than pulmonary embolism

(d)   Two or more segmental perfusion defects in the presence of normal ventilation indicates high probability of pulmonary embolism

Ans: (a)

163. A 29 years old female with 30 weeks of pregnancy is receiving subcutaneous low molecular weight heparin for pulmonary embolism. Now she is developing bruises. BP in left lateral position is 125/75 mmHg. Next immediate step is

(a)   Platelet count

(b)   Factor X-a levels

(c)   Aptt

(d)   Serum albumin levels

Ans: (b)

164. 35 years old female with history of 2 previous episodes of DVT now presents with further DVT. Lupus anti-coagulant is positive. The treatment is

(a)   LMW heparin

(b)   Aspirin and warfarin

(c)   Warfarin life long

(d)   Warfarin for 6 months.

Ans: (c)

165. A 30 years primi with no previous significant medical history has a sister suffering from deep vein thrombosis in her second pregnancy. Thrombophilia screening shows she is heterozygous for factor-V (Leiden) The appropriate next line of management is

(a)   Treat her with 75 mg aspirin daily

(b)   Advise her to come for treatment if she develops calf swelling or pain

(c)   Give warfarin

(d)   Start her on prophylactic LMWH

Ans: (d)

166. 30 years old male patient develops heamturia in operation table 15 minutes following blood transfusion. His pulse rate is 120/min, BP- 70/40 mmgHG. Identify the cause

(a)   DIC

(b)   Anaphylaxis to anaesthetic agents

(c)   ABO incompatibility

(d)   Graft versus host disease

Ans: (c)

167. Even after screening of blood before transfusion, post transfusion hepatitis is common because

(a)   Most cases of post transfusion hepatitis are caused by hepatitis C virus

(b)   Most hepatitis B carriers do not have detectable HbS antigen in serum

(c)   Available tests are not sensitive to detect HbS antigen

(d)   Most cases of post transfusion hepatitis are cause by CMV

Ans: (b)

168. Number connection test is done in

(a)   Alzheimer’s disease

(b)   Parkinson’s disease

(c)   Dementia

(d)   Hepatic encephalopathy

Ans: (d)

169. True regarding spontaneous bacterial peritonitis is

(a)   Occurs due to intestinal perforation

(b)   Diagnosed by culture of ascetic fluid

(c)   Treatment of choice is gentamicin

(d)   Usually caused by aerobic bacteria

Ans: (d)

170. A 65 years old female presents with one month history of malaise, weight loss and right sided pain around the eye with head ache. Intermittent diplopia was present. She underwent mastectomy for breast carcinoma five years back. Temperature now is 37.5 C. Tenderness of scalp on right forehead and temple was present. Some minor weakness of abduction of right eye was present, ESR is 55 mm/hr. Diagnosis

(a)   Meningeal metastatic disease

(b)   Giant cell arteritis

(c)   Frontal sinusitis

(d)   Posterior cerebral artery aneurysm

Ans: (b)

171. 53 years old male presents with polyuria, polydipsia and weight loss for 3 months. Presence of one of the following in this patient is diagnostic of Diabetes mellitus

(a)   Urine dipstick test 3+ glucose

(b)   Fasting plasma glucose 135 mgs/dl

(c)   Fasting plasma glucose 117 mgs/dl

(d)   Two-hour plasma glucose 180 mgs during an oral glucose tolerance test

Ans: (b)

172. Feature of hereditary hemorrhagic telangiectasia is

(a)   Cerebral arterio venous malformations

(b)   Responds to oestrogen      

(c)   Telangiectasia of mucus membranes and not skin

(d)   Gastrointestinal haemorrhage is usually starts in the prepubertal age group

Ans: (a)

173. 56 years old male patient in septic shock, fully ventilated is on veno-venous hemofiltration on Noradrenaline, vancomycin and ciprofloxacin, Mean arterial pressure is 60 mmHg, not improving after changing on or adrenaline to adrenaline. No myocardial dysfunction. Next step in the management is

(a)   ACTH stimulation test

(b)   Hydrocortisone

(c)   Activated protein C

(d)   Change of inotropes

Ans: (b)

174. Hallmark of uncompensated shock in a child is imbalance between O2 delivery and O2 consumption. This is manifested by all except

(a)   High anion gap metabolic acidosis

(b)   Increased lactic acid production

(c)   Decreased oxygen extraction in the tissues

(d)   Low mixed venous oxygen saturation

Ans: (a)

175. 42 years old female presents with diazepam and alcohol overdose. Patient is unconscious, temperature 34.5℃, BP 100/80 mmHg, creatinine 242 μmol/L, AST 500 U/L, Gamma glutamyl transferase 35 IU, urine analysis is unremarkable, urine dipstick test shows 3+ blood. USG abdomen was normal. Identify the cause

(a)   Hypothermia

(b)   Dehydration

(c)   Rhabdomyolysis

(d)   Associated paracetamol over dosage

Ans: (c)

176. An 11 year child with failure to thrive, metabolic acidosis with increased anion gap. Not true regarding the differential diagnosis

(a)   Insulin dependent diabetes mellitus

(b)   Chronic renal failure

(c)   Renal tubular acidosis

(d)   Inborn errors of metabolism

Ans: (c)

177. Not an indication to administer anti-snake venom to a child at early morning 4 am is

(a)   Local swelling with fang marks

(b)   Severe abdominal pain without fang marks

(c)   Gum bleeding or prolonged 20 minutes whole blood clotting time (WBCT)

(d)   External ophthalmoplegia with inability to lift the head.

Ans: (a)

178. 45 year old male presents with facial swelling, breathlessness to the emergency department. Urgent chest X-ray shows paral tracheal lymphadenopathy. The most appropriate statement favouring SVC obstruction is

(a)   Most common cause is squamous cell carcinoma of lung

(b)   Associated with hoarseness of voice

(c)   Associated with Kussmaul’s sign

(d)   Commonest symptom is stridor

Ans: (b)

SURGERY

179. Most common organ involved in blunt trauma in children

(a)   Spleen

(b)   Kidney

(c)   Liver

(d)   Small intestine

Ans: (a)

180. IN case of abdominal trauma, if the patient is hemodynamically unstable, investigation of choice is

(a)   Chest X ray erect

(b)   Barium Meal

(c)   FAST (Focussed Abdominal Sonar for Trauma)

(d)   Diagnostic peritoneal lavage

Ans: (c)

181. True regarding reflux of gastric contents into oesophagus

(a)   Neutralised by the bicarbonate secretion by oesophageal mucosa

(b)   Condition can be improved by eradication of H. Pylori

(c)   Diagnosis is excluded by normal appearing oesophagus at endoscopy

(d)   Occurs during transient relaxation of Lower oesophageal sphincter

Ans: (d)

182. 55 years old male presents with dysphagia is diagnosed to be a case of achalasia cardia. Management of choice is

(a)   Nifedipine

(b)   Buscopan

(c)   Omeprazole

(d)   Surgical cardiomyotomy

Ans: (d)

183. A coin is loaded in the oesophagus of an asymptomatic 3 years female child. Treatment is

(a)   Endoscopic removal within 24 hours

(b)   Immediate endoscopic removal

(c)   Wait for 48 hours

(d)   Dislodge the coin to the stomach

Ans: (a)

184. A child with upper gastro intestinal bleed due to varices. Line of management is

(a)   Octreotide is reserved for situations where immediate endoscopy is not available

(b)   Sengstaken Blackmore tube is preferred than pharamcotherapy

(c)   Lavage is given in room temperature

(d)   Target of haemoglobin for blood transfusion is 10g/dl

Ans: (c)

185. 52 years old male presents with heamtemesis and melena. icterus, confusion and flapping tremors. He is a case of chronic liver disease with a pulse rate 110/min and a BP of 100/70 mmHg. Ascites present. Endoscopy reveals small esophageal varcies without evidence of bleeding and an oozing portal hypertensive gastropathy. Treatment is evidence of bleeding an an oozing portal gastropathy. Treatment is

(a)   IV Terlipressin

(b)   Endoscopic injection of ethanolamine

(c)   IV vitamin K

(d)   Endoscopic banding

Ans: (a)

186. Invertogram in a new born with imperforate anus is done

(a)   After 2 hours

(b)   After 4 hours

(c)   After 6 hours

(d)   Immediately

Ans: (c)

187. Intussusception is caused by

(a)   Submucous lipoma

(b)   Subfascial lipoma

(c)   Subserous lipoma

(d)   Intramural lipoma

Ans: (a)

188. A 29 years old male presents with anemia, bleeding, diarrhea, abdominal pain. ON examination, mass is felt in right lower quadrant with skin tags. The most appropriate diagnosis is

(a)   Ulcerative colitis

(b)   Crohn’s disease

(c)   Intestinal lymphoma

(d)   Coeliac disease

Ans: (b)

189. Commonest cause of symptomatic ischemia of gastro intestinal tract

(a)   Superior mesenteric artery thrombosis

(b)   Inferior mesenteric artery thrombosis

(c)   Hepatic artery thrombosis

(d)   Coeliac artery thrombosis

Ans: (a)

190. All the following are features of acute pancreatitis except

(a)   Increased amylase

(b)   Hypocalcemia

(c)   Hypoglycemia

(d)   Leucocytosis

Ans: (c)

191. Nerve affected in sentinel node biopsy in breast cancer

(a)   Intercostobrachial nerve

(b)   Long thoracic nerve

(c)   Nerve to Latissimus dorsi

(d)   Lateral pectroal nerve

Ans: (a)

192. Thyrotoxicosis is characterised by all except

(a)   Palpitation

(b)   Hair loss

(c)   Diarrhea

(d)   Hyper activity

Ans: (c)

193. In an asthma clinic, a 30 years female complains of appearance of a mole. Suspicion for development of malignant melanoma should arise if

(a)   Size of lesion > 6 mm

(b)   Lesion in face

(c)   Lesion with regular outline

(d)   Deeply pigmented lesions

Ans: (a)

PEDIATRICS

194. The normal gain in length in a full term baby, at first 6 months of life is

(a)   6 cm

(b)   9 cm

(c)   15 cm

(d)   24 cm

Ans: (c)

195. Bed wetting is normal upto what age in girls and boys respectively?

(a)   3 years and 4 years

(b)   4 years and 5 years

(c)   5 years and 5 years

(d)   5 years and 6  years

Ans: (c)

196. Molar ratio of Sodium & Glucose in WHO ORS is

(a)   1:1

(b)   1:2

(c)   1:4

(d)   2:1

Ans: (a)

197. According to WHO, severe acute malnutrition in children is defined as

(a)   Weight for height Z score < −3

(b)   Weight for height Z score < −2

(c)   Weight for height Z score < −1

(d)   Weight for height Z score between −2 and −3

Ans: (a)

198. To prevent acute rheumatic fever, acute pharyngitis due to group A streptococci should be treated with antibiotics before

(a)   7 days of illness

(b)   8 days of illness

(c)   9 days of illness

(d)   10 days of illness

Ans: (c)

199. Not a typical localizing sign indicative of involvement of intrathoracic extra pulmonary site in children with respiratory infections

(a)   Stridor

(b)   Wheezing

(c)   Tachypnoea

(d)   Chest retraction

Ans: (b)

200. Neonatal liver failure is uncommonly associated with

(a)   Hereditary fructose intolerance

(b)   Congenital hepatic fibrosis

(c)   Galactosemia

(d)   Hemophagocytic lympho histiocytosis

Ans: (b)

201. Phenylketonuria – true statement

(a)   Urine phenyl alanine metabolites are increased

(b)   Deficiency of tyrosine hydroxylase

(c)   Serum tyrosine levels are decreased

(d)   Mental retardation does not occur if patient is advised to have phenyl alanine free diet

Ans: (d)

202. Component of initial impression in Pediatric Advanced Life Support(PALS)-2010 are all except

(a)   Airway

(b)   Breathing

(c)   Color

(d)   Consciousness

Ans: (a)

OBSTETRICS

203. USG is 18-20 weeks is done to

(a)   Detect maturity

(b)   Detect anomalies

(c)   Detect the sex of the fetus

(d)   Estimate the liquor

Ans: (b)

204. Diabetes mellitus in 32 y ears old female with 16 weeks pregnancy. BMI is 22. On oral glucose tolerance test with 75 mg glucose reveals, 0 hour-108, 2 hours-225 mgs/dl. The next step in the management of this case is

(a)   Repeat Oral glucose tolerance test after 4 weeks

(b)   Low calorie diet with exercise

(c)   Insulin therapy

(d)   Metformin therapy

Ans: (c)

205. Medical termination for a 11 weeks of unwanted pregnancy is done by

(a)   Menstrual regulation

(b)   Manual evacuation

(c)   Misoprostol + Mifepristone

(d)   Dilatation and curettage

Ans: (d)

206. The drug of choice for preventing pre-term labor is

(a)   Ritodrine

(b)   Progesterone

(c)   Nifedipine

(d)   Oestrogen

Ans: (c)

207. Cardiac condition which does not increases the risk during pregnancy

(a)   Pulmonary hypertension

(b)   Cyanotic heart disease

(c)   Ebstein’s anomaly

(d)   Marfan’s syndrome

Ans: (c)

208. A 30 year old female with 12 weeks of pregnancy is diagnosed to be a case of systemic lupus erythematosus. With reference to SLE in pregnancy, true statement is

(a)   Risk of pulmonary embolism is same that of general population

(b)   Stop hydroxychloroquine during breast feeding

(c)   Azathioprine is contraindicated in pregnancy

(d)   In anti-Ro and Anti-la are negative, there is increased risk of congenital heart block.

Ans: (a)

209. Drug of choice for a pregnant woman with Chlamydia trachomatis infection is

(a)   Amoxicillin

(b)   Doxycycline

(c)   Cefazolin

(d)   Azithromycin

Ans: (a)

GYNECOLOGY

210. 17 years old female patient presents with 3 days history of vaginal discharge associated with pruritis. Recently she received treatment for UTI. Identify the causative organism.

(a)   Gradenella vaginalis

(b)   Candida albicans

(c)   Chlamydia trachomatis

(d)   Trichomonas vaginalis.

Ans: (d)

211. An 18 years old female patient with H/o irregular period was diagnosed as polycystic ovaries and started Metformin therapy. The mechanism of action of metoforming in this condition is

(a)   Increases the levels of LH

(b)   Increased peripheral glucose uptake

(c)   Increases estradiol level

(d)   Increases the insulin level.

Ans: (b)

212. A 22-year-old woman consults you for treatment of hirsutism. She is obese and has facial acne and hirsutism on her face and periareolar regions and a male escutcheon. Serum LH level is 35 mIU/mL and FSH is 9 mIU/L. Androstenedione and testosterone levels are mildly elevated, but serum DHEAS is normal .The patient does not wish to conceive at this time. Which of the following single agents is the most appropriate treatment of her condition?

(a)   Oral contraceptives

(b)   Corticosteroids

(c)   GnRH

(d)   Wedge resection

Ans: (a)

213. 23 years old female patient comes to gynaecological OPD with H/O irregular cycles for the past two years and is anxious to conceive. Her BMI is 29. There are features of hirsutism. On USG, her ovarian volumes were high. You have to educate her regarding her life style modification as she is more prone for the risk of developing which of the following carcinoma?

(a)   Cervical Ca

(b)   Endometrial Ca

(c)   Breast Ca

(d)   Ovarian Ca

Ans: (b)

214. 40 years old multiparous woman shows CIN-2 on Pap smear. Next line of management

(a)   Hysterectomy

(b)   Conisation

(c)   Colposcopy

(d)   Cryotherapy

Ans: (c)

ORTHOPEDICS

215. Light bulb sign in anteroposterior view of X ray shoulder is due to

(a)   Fracture humerus with dislocation of glenohumeral joint

(b)   Fracture scapula

(c)   Anterior dislocation of shoulder

(d)   Posterior dislocation of shoulder

Ans: (d)

216. Pointing index in a case of supracondylar fracture humerus in children occurs due to involvement of

(a)   Radial nerve

(b)   Anterior interosseous nerve

(c)   Musculo cutaneous nerve

(d)   Ulnar nerve

Ans: (b)

217. The most appropriate term in bone growth is

(a)   Apposition

(b)   Enlargement

(c)   Hypertrophy

(d)   Hyperplasia

Ans: (a)

218. Features of hemophilic knee joint are all except

(a)   Squaring of patella

(b)   Widening of intercondylar notch

(c)   Sub chondral cyst formation

(d)   Juxta articular osteosclerosis.

Ans: (d)

219. History of twisting strain and locking of knee joint occurs due to

(a)   Tear of Anterior cruciate ligament

(b)   Tear of Medial cruciate ligament

(c)   Meniscal tear

(d)   Patellar fractures

Ans: (c)

220. Conditions requiring open reduction in children is

(a)   Intercondylar fracture femur

(b)   Fracture both bones of forearm

(c)   Lateral condylar fracture of humerus

(d)   Epiphyseal separation of tibia

Ans: (c)

221. Recognizing feature of achondroplasia

(a)   AR inheritance

(b)   Diagnosed radiologically at birth

(c)   Increased liability for fractures

(d)   Short spine

Ans: (d)

222. 58 years old female patient presents with one year history of anterior knee pain on climbing stairs. On examination crepitus was present. There was severe restriction of movements beyond 110 degrees. Examination of hip and back was normal. Diagnosis is

(a)   Osteoarthritis

(b)   Psoriatic arthritis

(c)   Osteonecrosis

(d)   Gout

Ans: (a)

223. Degree of angulation acceptable after reducing tibial fracture is

(a)   5

(b)   10

(c)   15

(d)   20

Ans: (a)

224. Open fracture is best treated by

(a)   Internal fixation

(b)   External fixation

(c)   Debridement

(d)   Tourniquet

Ans: (c)

225. Treatment of club foot in a new born is

(a)   Manipulation and corrective splint

(b)   Corrective splint

(c)   Manipulation alone

(d)   Observe till 6 months of age

Ans: (a)

ANESTHESIA

226. Delivery of high concentration of oxygen (more than 90%) is delivered via

(a)   Partial rebreathing mask

(b)   Nasal cannula with oxygen flow at 5 L/min

(c)   Simple face mask

(d)   Non rebreathing face mask with oxygen reservoir

Ans: (d)

227. A patient on epidural anesthesia with 15 ml of 1.5% lignocaine with adrenaline for hernia surgery develops hypotension and respiratory depression three minutes. Most common cause for this clinical condition is

(a)   Systemic toxicity of anesthetic agents

(b)   Drug allergy

(c)   Vaso vagal shock

(d)   Drug entering into sub archnoid space

Ans: (d)

228. A 20 year old male patient met with motor vehicle accident and sustained head injuries. BP- 90/60 mmHg, Pulse rate – 150/min. All the following anesthetic agents are avoided for induction except

(a)   Thiopentone

(b)   Halothane

(c)   Succinylcholine

(d)   Ketamine

Ans: (a)

229. A child with intestinal obstruction and deranged LFT. Anesthetic agent of choice is

(a)   Halothane

(b)   Enflurane

(c)   Isoflurane

(d)   Sevoflurane

Ans: (d)

230. A 25 years old primi with mitral stenosis and mitral regurgitation wants a normal delivery. The appropriate analgesia is

(a)   Inhalational analgesia

(b)   Spinal anesthesia

(c)   Neuro axial block analgesia

(d)   IV opioids

Ans: (c)

231. True regarding hypothermia during anesthesia

(a)   Body may lose heat by conduction

(b)   Beneficial to patients in some conditions

(c)   Always occur irrespective of the type of anaesthesia

(d)   Prevented by given warm fluids

Ans: (b)

RADIODIAGNOSIS & RADIOTHERAPY

  1. Principle used in radiotherapy

(a)   Double-stranded breaks of nuclear DNA

(b)   Inhibition of protein synthesis

(c)   Inhibition of peroxisomes

(d)   Activation of caspases

Ans: (a)

233. Gamma camera is used in radiotherapy to

(a)   Monitor surface contamination

(b)   Measures radioactivity

(c)   Organ imaging

(d)   Radio immune assay

Ans: (b)

234. A patient presents with a tumor of 4 cms in his left parietal lobe. Patient underwent surgery and radiotherapy. After 2 months, he develops headache and vomiting. The investigation of choice for this condition is

(a)   99m-Tc  hexamethylpropylene amine oxide- SPECT scan

(b)   Digital Subtraction Angiography with dual source CT

(c)   Gadolinium enhanced MRI

(d)   18-FDG PET scan

Ans: (d)

235. A patient with Hodgkin’s disease undergoes mantle field radio therapy. Several months later he complains that on flexion or extension of neck, an electric shock phenomenon is felt down the back and limbs. This is called as

(a)   Uthoff’s sign

(b)   Cervical arthritis

(c)   Malignant spinal cord compression

(d)   Lhermitte’s sign

Ans: (d)

236. Bone scan in multiple myeloma shows

(a)   Cold nodule

(b)   Hot nodule

(c)   Diffusely increased uptake

(d)   Diffusely decreased uptake

Ans: (a)

237. Stereo tactic radio surgery is form of

(a)   Cryotherapy

(b)   Radiotherapy

(c)   Robotic therapy

(d)   Radio iodine Therapy

Ans: (b)

238. 68 years old male patient referred by a general practitioner with detoriated hypertension and renal function. His serum creatanine is 4.5, mild proteinuria +. Renal USG shows left kidney 9 cm and right kidney 7 cm in length (normal length 10 cm). There was no obstruction. Investigation is

(a)   MR angiography

(b)   Isotope renogram

(c)   Intravenous renography

(d)   Retrograde pyelography

Ans: (b)

239. Radiological features indicating increased pulmonary blood flow are all except

(a)   Kerley B lines

(b)   Pulmonary artery diameter more than 6mm

(c)   Diameter of two peripheral arteries greater than accompanying bronchi

(d)   More than 6 blood vessels in outer 1/3rd

Ans: (c)

DERMATOLOGY

240. The peculiar hue of Mongolian spots in new born is due to dermal location of melanin containing melanocytes that are presumably arrested in their migration from neural crest to epidermis. The arrest occurs at the level of

(a)   Neural crest to melanocytosis

(b)   Low dermal melanocytosis

(c)   High dermal melanocytosis

(d)   Mid dermal melanocytosis

Ans: (b)

241. Syndromic management of urethral discharge includes the treatment of

(a)   Syphilis and chancroid

(b)   Neisseria gonorrhea and herpes geniatalis

(c)   Nesseria gonorrhea and chlaymdia trachomatis

(d)   Chlamydia trachomatis and herpes genitalis

Ans: (c)

242. A 16 year old male in dermatology OPD presents with a history of hair loss on scalp. His past medical history includes atopic eczema and he has a number of depigmented areas on the hands. Diagnosis is

(a)   Hypothyrodism

(b)   SLE

(c)   Seborrheic dermatitis

(d)   Alpecia areata

Ans: (d)

PSYCHIATRY

243. Perception in the absence of external stimulus is called as

(a)   Illusion

(b)   Delusion

(c)   Hallucination

(d)   Malingering

Ans: (c)

244. Intentional production of symptoms by a patient for obvious and tangible goals is seen in

(a)   Malingering

(b)   Conversion disorder

(c)   Adjustment disorder

(d)   Factitious disorder

Ans: (a)

245. True regarding pathological grief reaction is

(a)   No psychiatric treatment is required

(b)   Normal response to los of loved ones

(c)   Universal phenomenon

(d)   Lasts more than six months

Ans: (d)

246. True regarding puerperal psychosis

(a)   Begins 2nd week of postpartum

(b)   Recurrence in subsequent pregnancies

(c)   Good prognosis

(d)   Insidious onset

Ans: (b)

247. Strong urge to u se a drug in a person with substance misuse disorder is

(a)   Tolerance

(b)   Salience

(c)   Craving

(d)   Impulse

Ans: (c)

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