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Last updated 1 December, 2005 10:40 PM IST ( explanation to question 21 added)
Q1. Which of the following signs is not suggestive of a cervical spinal cord injury ?
B) Increased rectal sphincter tone.
C) Diaphragmatic breathing.
Answer 3, As Diaphragmatic breathing is reduced significantly in cervical spinal cord injury.
In lesions of C1, C2 vital capacity is only 5-10% of normal, and cough is absent.
If C3 to C6 are injured vital capacity is 20 % of normal and weak cough is present.
Diaphragm is supplied by cervical spinal roots C3,4,5.
Clinical features of cervical spine injury
|Features of spinal shock||Features of Neurogenic Shock|
Loss of anal sphincter tone
Loss of bulbocavernosus reflex
Q2) With regard to Ketamine, all of the following are true except
A) It is a direct myocardial depressant.
B) Emergence phenomena are more likely if anticholinergic premedication is used.
C) It may induce cardiac dysarrythmias in patients receiving tricyclic antidepressants.
D) Has no effect on intracranial pressure
Answer 4, raises all iot, icranial, intra anta abdominal, (choice 1, 3 is also incorrect, but we prefer 4 also). Page number 78 Ajay Yadav.
Q3) Placement of a double lumen tube for lung surgery is best confirmed by:
a) EtCo2 ?
b) Airway pressure measurement
c) Clinically by auscultation
d) Bronchoscopy ?
Reference FRCA website (http://www.frca.co.uk/article.aspx?articleid=246 ) See summary below.
Tube position can be confirmed clinically by breath sounds heard on one side
only but Fiberoptic bronchoscopy reveals the carina and
the top edge of the blue bronchial cuff should be just visible in the intended
main stem bronchus. When a right-sided tube is used, the fibrescope should
be used to visualise the orifice of the right upper lobe bronchus.
Direct visualisation would obviously be a better choice than clinical sounds, and the question asks for BEST.. (Authors opinion)
But Ajay yaday 31, 46.
4. The most common cause of hypoxia during one lung ventilation is:
a) Malposition of the double lumen tube.
b) Increased shunt fraction
c) Collapse of one lung
d) Soiling of lung by secretions.
5. A head injured patient, who opens eyes to painful stimulus, is confused
and localizes to pain. What is his Glasgow coma Score?
Answer 3. Eye opening with pain 2, confused mentl status 4, localization of pain 5. Therefore 2+2+5 = 11
6. The outcome following resuscitation of a cardiac arrest is worsened if
during resuscitation patient is given:
a) Ringer's Lactate
c) 5% Dextrose
d) Whole blood transfusion
5 % dextrose Ajay Yadav 188. (Glucose and calcium can be detrimental to injured neurons)
7. A 5 year old child is suffering from cyanotic heart disease. He is planned
for corrective surgery. The induction agent of the choice would be:
Answer 2, Ajay Yaday 130. Ketamine is induction agent, relaxant of choice is pancrunium, reason we need system hypertension in cyanotic heart disease and same for pancruronium,
8. A 30-year-old woman with coarctation of aorta is admitted to the labour
room for elective caesarean section. Which of the following is the anaesthesia
a) Spinal anaesthesia
b) Epidural anaesthesia
c) General anaesthesia
d) Local anaesthesia with nerve blocks.
9. Which of the following is not a cardiovascular monitoring technique:
a) Transesophageal echocardiography
b) Central venous pressure monitoring
c) Pulmonary artery catheterization
Answer 4 Ajay Yadav page 46, Capnography is a respiratory monitoring technique.
10. A 6 month old child is suffering from patent ductus arteriosus (PDA) with congestive cardiac failure. Ligation of ductus arteriosus was decided for surgical management. The most appropriate inhalational anaesthetic agent of choice with minimal haemodynamic alteration for induction of anaesthesia is:
Answer1 / PDA is a left to right. So we need systemic hypotension and pulmonary hypertension during surgery.
In children choice is sevoflurane as it causes the same, and used as a preferred agent. Adults it would have been desflurane.
Isoflurane is agent of choice in all cardiac surgery except cardiac ischeamia. Page 62, 63, 130, 158 Ajay Yadav, Anaesthesia
11. A 45 year old woman, presenting with the history of diplopia and dysphagia
worsening as the day progrsses, can be diagnosed to have:
b) Myasthenia gravis
c) Muscular dystrophy
d) Brain tumor
12. The most sensitive and practical technique for detection of myocardial ischemia in the perioperative period is:
a) Magnetic Resonance Spectroscopy
b) Radio labeled lactate determination
c) Direct measurement of end diastolic pressure
d) Regional wall motion abnormality detected wth the help of 2 D transoesphagealechocardiography
Answer 4, AIIMS people have a liking for perioperative investigations!
Choice 1) Magnetic Resonance Spectroscopy is not the answer as it is impractical to do MRI while operating as MRI takes time, and MRI machine is bulky and would not fit most operation theatres..
Correct answer is Regional wall motion abnormality
The abnormalities in wall motion associated with ischemia are characterized by diminished or absent inward endocardial motion and by impaired systolic myocardial thickening. TEE is highly sensitive for the detection of acute ischemia and is therefore used extensively for real-time monitoring of regional wall motion as well as global left ventricular function.
As an example, the continuous high-quality imaging of the left ventricle afforded
by TEE during surgical procedures makes it ideally suited for the early detection
Reference : Beaupre, PN, Kremer, PF, Cahalan, MK, et al. Intraoperative detection of changes in left ventricular segmental wall motion by transesophageal two-dimensional echocardiography. Am Heart J 1984; 107:1021.
13. While introducing the Swan-ganz catheter, its placement in the pulmonary artern can be identified by the following pressure tracing:
a) Diastolic pressure is lower in PA than in RV
b) Diastolic pressure is higher in PA than in RV.
c) PA pressure tracing has diacrotic notch from closure of pulmonary valve.
d) RV pressure tracing for plateau and sharp drop in early diastole.
14. A 63 year old man presents with a triad of angina, syncope and congestive heart failure. Which of the following valvular heart lesion can be suspected?
a) Mitral stenosis
b) Tricuspid regurgitation
c) Aortic stenosis
d) Aortic regurgitation.
15. In the treatment of severe bradycardia, all of the following can be the best modality of treatment except:
Answer 4, page number 184 Ajay Yadav
16. All of the following statements about the splenic artery are true except that it:
a) Has a tortuous course
b) Is a branch of the coelic trunk
c) Has branches that anastomose freely within the spleen
d) Supplies the greater curvature of stomach.
17. All of the following statement about the vagus nerve are true except that it:
a) Supplies heart and lung
b) Carries postganglionic parasympathetic fibers.
c) Innervates right two third of transverse colon.
d) Stimulates peristalsis & relaxes sphincters.
18. All of the following structures pass through the superior aperture of throax except:
a) Right recurrent laryngeal nerve
b) Left common carotid artern
c) Left sympathetic trunk
d) Thoracic duct
19. The vertebal artery traverses all of the following except:
a) Foramen magnum
b) Subarachnoid space
c) Intervertebral foramen
d) Foramen transversarium
Answer 3?, passes thru upper six vertebrae's transverse foramen,
20. Which of the following among axillary lympth nodes is a terminal group ?
21. The distribution of random blood glucose measurements from 50 first year medical students was found to have a mean of 3.0 mmol/litre with a standard deviation of 3.0 mmol/litre. Which of the following is a correct statement about the shape of the distribution of random blood glucose in these first year medical students?
a) Since both mean and standard deviation are equal, it should be a symmetric distribution
b) The distribution is likely to be positively skewed
c) The distribution is likely to be negatively skewed.
d) Nothing can be said conclusively.
Answer 2? (to be confirmed, but we support 2 as the answer)
Regarding skew deviation of blood glucose curve
Option 4 is essentially an answer of exclusion.
Option 1 and 2 are easily ruled out.
But option 3, positive skew deviation cannot be ruled out.
Coming to think of it, it may be then best answer.
Only a positivey skewed curve can cause a sd of 3 mmol/lit when the mean is
3 mmol/lit.. The SD is so high because of few hyperglycemics have very large
values and have streched the sd to 3 mmol without having much effect on the
mean.SD tells us the dispersion of values but not the side on which the values
Explanation with thanks to : Raman Gaikwad, MIMSR Medical college Latur.
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22. In an investigation to study the effect of smoking on renal cell cancer,
it is observed that 30 of the 50 patients were smokers as compared to 10 out
of 50 control subjects. The odd ratio of renal cancer associated with smoking
23. A chest physician observed that the distribution of forced expiratory volume (FEV) in 300 smokers had a median value of 2.5 litres with the first and third quartiles being 1.5 and 4.5 litres respectively. Based on this data how many persons in the smaple are expected to have a FEV between 1.5 to 4.5 litres ?
24. If the distribution of intra-ocular pressure (IOP) seen in 100 glaucoma patients has an average 30 mm with a SD of 10 what is the lower limit to the average IOP that can be expected 95% of times?
25. A diagonstic test for a particular disease has a sensitivity of 0.90 and specificity of .90. A single test is applied to each subject in the population in which the diseased population is 10%. What is the probability that a person positive to this test, has the disease?
26. Henoch-Schonlein purpura is characterized by the depositin of the following immunoglobulin around the vessels:
a) Ig M
b) Ig G
c) Ig A
d) Ig E
27. Angiod streaks in the eyes are seen in :
a) Pseudoxanthoma elasticum
b) Tendinous xanthoma
d) Eruptive xanthoma
28. Exclamation mark hair is a feature of:
a) Telogen effluvium
b) Andogenetic alopecia
c) Alopecia areata
d) Alpecia mucinosa
29. Pautrier's micro-abscess is a histological feature of:
c) Mycosis fungoides
d) Pityriasis Lichenoides Chronica
30. Adenoma sebaceum is a feature of:
b) Tuberous sclerosis
d) Incontinentia pigmenti
31. A 25 year old male presented with pigmentation of nose and pinna. After
voiding, his urine becomes dark. His spine is most likely to show:
a) Atlantoaxial subluxation
c) Basilar invagination
d) Calcification of disc
32. A one year old child presented with multiple fractures seen in various
stages of healing. The most probable diagonis in this case is:
c) Battered baby syndrome
d) Sickle cell disease
33. A 50 year old man presented with multiple pathological fractures. His serum
calcium was 11.5mg/dl and phosphate was 2.5 mg/dl. Alkaline phosphatase was
940 I.U./dl. The most probable diagnosis is:
c) Multiple Myeloma
34. Pain and tenderness over the lateral condyle of humerous with a painful
dorsi flexion of the wrist is indicative of:
a) Golfer's Elbow
b) Tennis Elbow
c) Pitcher's Elbow
d) Cricket Elbow
35. The pain around the hip with flexion adduction & internal rotation
of lower limb in a young adult after a road traffic accident is suggestive of:
a) Intracapsular fracture of the femoral neck.
b) Extra capsular fracture of the femoral neck.
c) Posterior disclocation of hip.
d) Anterior dislocation of hip
36. The inheritance pattern of familial Retinoblastomas is:
a) Autosomal recessive
b) Autosomal dominant
c) X-linked dominant
d) X-linked recessive
37. The lymphocytic and histiocytic variant of Reed-Sternberg cell is seen
a) Follicular center lymphoma
b) Lymphocyte depleted Hodgkin's disease
c) Nodular sclerosis Hodgkin's disease
d) Lymphocyte predominant Hodgkin's disease
38. A metastatic carcinoma in the brain of an adult, most often comes from
a primary in the :
c) Oral cavity
39. Features, which are evaluated for histological grading of breast carcinoma
include all of the following except:
a) Tumour necrosis
b) Mitotic count
c) Tubule formation
d) Nuclear pleomorphism
40. Internucleosomal cleavage of DNA is characteristic
a) Reversible cell injury
b) Irreversible cell injury
41. Which of the following is not a common site for metastatic
42. On electron microscopy, amyloid characteristically exhibits:
a) B-pleated sheat
b) Hyaline globules
c) 7.5-10nm fibrils
d) 20-25 nm fibrils
43. Which of the following is not compaitible with a diagnosis
of juvenile myelemonocytic leukemia?
a) Peripharal blood monocytosis, more than 1x109/L
b) Increased of bcr/abl fusion gene
c) Presence of bcr/abl fusion gene.
d) GM-CSF hypersensitivity of myeloid progenitors in vitro.
44. A 48 year old
woman was admitted with a history of weakness for two months. On examination,
cervical lympth nodes were found enlarged and spleen was palpable
2 cm below the costal margin. Her hemoglobin was 10.5g/dl, platelet count 237
x 109/L, which included 80% mature lymphoid cells with coarse clumped chromatin.
Bone marrow revealed a nodula lymphoid infiltrate. The peripheral blood lymphoid
cells were positive for CD19, CD5, CD20 and CD23 and were negative for CD79B
What is the most likely diagnosis?
a) T-cell rich B-cell lymphoma with leukemic spill over in blood.
b) Chronic lymphocytic leukemia
c) Mantle cell lymphoma
d) A definite diagnosis cannot be made in this patient without lymph node biopsy.
All of the following are examples of a round cell tumor, except:
b) Ewing's sarcoma
c) Non Hodgkin,s Lymphoma
46. Which of the following surface glycoproteins is most often
expressed in human hematopoietic stem cell?
c) CD15 `
47. The tumor suppressor gene p53 induces cell cycle arrest at:
a) G2-M phase
b) S-G2 phase
d) G0 phase
48. During which phase of the cell cycle the cellular content of
DNA is doubled?
a) Mitotic phase
b) G1 phase
c) G2 phase
d) S phase
49. Acute diffuse proliferative glomerulonephritis will have all
of the following features, except:
a) Microscopic haematuria
b) Raised blood urea level
c) Raised serum creatinine level
50. All of the following are mediators of acute inflammation
b) Prostaglandin E2
51. A 50 year old male feels uncomfortable in using lift, being in crowded
places and traveling. The most appropriate line of treatment is:
b) Relaxation theraphy
d) Covert sensitization
Answer 3 (exposure & response prevention is TOC)
52. A 9 year old child disturbs other people is destructive,
interferes when two people are talking, does not follow instructions and cannot
wait for his
turn while playing a game. He is likely to be suffering from:
a) Emotional disorders
b) Behavioural problems
c) No disorders
d) Attention deficit hyperactivity disorder
53. Which of following statements
differentiates the obsessional ideal from delusions ?
a) The idea is not an conventional belief.
b) The idea is held inspite of contrary evidence
c) The idea is regarded as senseless by patient.
d) The idea is held on inadequate ground
54. Dementia of Alzheimer's type is
not associated with one of the following:
a) Depressive symptoms
c) Apraxia and aphasia
d) Cerebral infarcts
55. A person who laughs one minute and cries the next without
any clear stimulus is said to have:
a) Incongruent affect
c) Labile affect
d) Split personality
56. The most common facial abnormality seen in Gardener's
a) Ectodermal dysplasia
c) Multiple osteomas`
d) Dental cysts.
57. The most common retrobulbar orbital mass in adults is:
c) Cavernous haemangioma
58. The typical movement of mitra valve calcification is:
a) Upwards and downwards
b) Counterclock wise
c) Side to side
59. The most common cause of peripheral limb, ischaemia in India is:
c) Burger's disease
d) Takayasu's disease
60. Which of the following is the most common location
of intracranical neurocysticercosis?
a) Brain parenchyma
b) Subarachnoid space
c) Spinal cord
61.The chemotherapeutic agent, most commonly administered by continuous
Answer 1 (Cytarabine)
62. Which of the following carcinoma most frequently metastasizes
a) Small cell carcinoma lung
b) Prostate cancer
c) Rectal carcinoma
d) Endometrial cancer
63. For which malignancy, Intensity Modulated Radiotherapy
(IMRT) is the most suitable?
Answer 2 CMDT Page 1604 2003 edition. (remember IMRT is also used for lung)
Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy that utilizes computer-controlled x-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor.Currently, IMRT is being used to treat cancers of the prostate, head and neck, breast, thyroid and lung, as well as in gynecologic, liver and brain tumors and lymphomas and sarcomas. IMRT is also beneficial for treating pediatric malignancies.
64. In treatement of Papillary Carcinoma thyroid, Radioiodine destroys
the neoplastic cells predominantly by:
a) X rays
b) B rays
c) Y rays
d) a particles
Answer 2 X rays traces, beta particle for destructuve action, KD Tripathi 5th edition page 233
65. Which of the following chemotherapeutic drugs has selective
action on hypoxic tumor cells?
a) Mitromycin C
d) 5 Flurouracil
Answer 1 (All?)
66. The paraneoplastic syndrome associated with Hodgkin's disease
a) Nephrotic syndrome
c) Cerebellar degenerative disease
d) Acanthosis nigricans
Answer 3, Hodgkin's disease causes two paraneoplastic syndromes, One is Cerebellar degenerative disease , other is guillain barre syndrome .
67. Platelets can be stored at:
a) 20-24 Degree C for 5 days
b) 20-24 Degree C for 8 days
c) 4-8 Degree for 5 days
d) 4-8 Degree C for 8 days
Answer 1 Ajay yaday page 15. This is why platelet transfusion has increased risk of infection.
68. Which of following radioactive isotopes is not
used for brachytheraphy.
Answer 1 (used for diagnosis)
69. All of the following soft tissue sarcomas have a propensity
for lymphatic spread except:
b) Synovial sarcoma
d) Epitheloid sarcoma
70. The expression of the following oncogene is associated
with a high incidence of Medulary carcinoma of thyroid:
a) P 53
b) Her 2 neu
c) Ret proto Oncogene
d) Rb gene
71. A 30 year old patient with history of recurrent headache was
sent for fundus evaluation. He was found to be having generalized arterial
multiple cotton wool spots and flame shaped haemorrhages in both eyes. The
likely cause is:
a) Diabetic retinopathy
b) Hypertensive retinopathy
c) Central retinal artery occulusion
d) Temporal arteritis
72. A 55 year old female comes to the eye casualty with
history of severe eye pain, redness and diminution of vision. On examination
the visual acuity is
6/60, there is circumcorneal congestion, corneal oedema and a shallow anterior
chamber. Which of the following is the best drug of choice?
a) Atropine ointment
b) I.V. Mannitol
c) Cipofloxacin eye drops
d) Betamethasone eye drops
73. A 55 year old patient complains of decreased
distance vision. However, now he does not require his near glasses for near
work. The most likely cause
a) Posterior subcapsular cataract
b) Zonular cataract
c) Nuclear sclerosis
d) Anterior subcapsular cantaract
74. Which of the following drugs is contraindicated
in a patient with history of sulfa allergy presenting with an acute attack
of angle closure glaucoma?
75. A patient has a right homonymous hemianopia with saccadic
pursuit movements and defective optokinetic nystagmus. The lesion is most likely
to be in the:
a) Frontal lobe
b) Occipital lobe answer
c) Parietal lobe
d) Temporal lobe
Answer 3 (1? saccadic pursuit movements and defective optokinetic nystagmus)
76. A young tall, thin male with archnodactyly has ectopia
lentis in both eyes. The most likely diagnosis is:
a) Marfan's Syndrome
b) Marchesani's Syndrome
d) Ehler's Danloss syndrome
77. The most common systemic association of scleritis
a) Ehlers-Danlos syndrome
b) Disseminated systemic sclerosis
c) Rheumatiod arthritis
d) Giant cell arteristis
78. The following is not a method of isolation of Chlamydia
from clinical specimens.
a) Yolk sac inoculation
b) Enzyme immunoassay
c) Tissue culture using irradiated McCoy cells
d) Tissue culture using irradiated BHK cells.
79. According to WHO, blindness
is defined as a visual acuity of the better eye, less than:
d) 3/60 Answer
80. A female presented with loss of vision in both eyes and on
examination has normal papillary responses and normal fundus. Her visually
examination shows extinguished responses. The most likely diagonis is:
b) Cortical blindness
c) Optic Neuritis
d) Retinal Detachment
Answer 2 antons syndrom
81. All the following can be used to predict severe acute
a) Glasgow score 3
b) APACHE II score 9
c) CT severity score 6
d) C-reactive protein < 100
82. Regarding bile duct injuries following Cholecystectomy
which of the following statements is false:
a) The incidence following open cholecystectomy which is in the range of 0.2-0.3%
b) The incidence rate following Laparoscopic Cholecystectomy is three times higher than the rates following open cholecystectomy
c) Untreated cases may develop secondary biliary cirrhosis
d) Routine use of open technique of laparoscopic port insertion has resulted in a decline in the incidence of post laparoscopic cholecystectomy bile duct injuries
83. All of the following extraintestinal manifestations of ulcerative
colitis respond to colectomy except:
a) Primary scherosing cholangitis
b) Pyoderma gangrenosum
d) Peripheral arthralgia
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84. Solitary hypoechoic lesion of the liver without
sepate or debris is most likely to be:
a) Hydatid cyst
b) Caroli's disease
c) Liver abscess
d) Simple cyst ANSWER
85. All of the following are features of Zollinger Ellison
a) Intractable peptic ulcers
b) Severe diarrhoea
c) Beta cell tumours of the pancreas
d) Very high acid output
86. The posterior urethra is best visualized by:
a) Static cystogram
b) Retrograde urethrogram
c) Voiding cystogram
d) CT cystogram
87. Which of the following is the most effective intravesical
therapy for superficial bladder cancer?
88. The narrowest part of the ureter is at the :
a) Uretero-pelvic junction
b) Iliac vessel crossing
c) Pelvic ureter
d) Uretero-vesical junction
89. The most common histological variant of renal
cell carcinoma is:
a) Clear cell type
b) Chromophote type
c) papillary type
d) Tubular type
90. In which of the following tumors alpha fetoprotein is elevated?
c) Hepatocellular carcinoma
91. The diagnosis of congenital megacolon is confirmed by:
a) Clinical features
b) Barium enema
c) Rectal biops
92. All of the following are the markers for malignant
germ cell tumors of ovary except:
93. All of the following are indications for surgery in
gastric lymphoma except:
c) Residual disease following chemotherapy
d) Intractable pain
94. Programmed cell death is known as:
95. The most definitive method of diagnosing pulmonary
a) Pulmonary ateriography
b) Radiosotope perfusion pulmonary scintigraphy
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96. Which is the following statements is true regarding
a) Most patients with major trauma involving long bones have urinary fat globules.
b) All patients with urinary fat globules develop fat embolism.
c) Peak incidence of respiratory insufficiency for pulmonary fat embolism is around day 7 after injury.
d) Heparin as an anticoagulant decrease mortality and morbidity in fat embolism syndrome.
of the following statement is true regarding subclavian steal syndrome:
a) Reversal of blood flow in the ipsilateral vertebral artery.
b) Reversal of blood flow in the contralateral carotid artery.
c) Reversal of blood flow in the contralateral vertebral artery.
d) Bilateral reversal of blood in the vertebral arteries.
98. In patients with breast cancer,
chest wall involvement means involvement of any one of
the follwing structures
a) Serratus Anterior
b) Pectoralis Major
c) Intercostal Muscles
99. A 45 year old male presents with 4x4
cm mobile right solitary thyroid nodule
of 5 months
his management are true except:
a) Cold nodule on thyroid scan is diagnostic of malignancy.
b) FNAC is the investigation of choice
c) The patient should undergo hemithyroidectomy if FNAC report is inconclusive
d) Indirect laryngoscopoy should be done in the preoperative period to assess mobility of vocal cords.
Answer 1, only 20 % cold nodule malignant.
100. Xeroderma Pigmentosum is caused
due to a group of closely related abnormalities
a) The patient should be prescribed antibioctics and asked to come after a week
b) Colour flow Doppler will be very useful in diagnosis
c) Scrotal exploration should be done without delay if droppler is not available
d) If left testis is not viable on exploration, patient should undergo left Orchidectomy and right orchidopexy.
101. Xeroderma Pigmentosum is caused due to a group of closely related abnormalities
a) Mismatch repair
b) Base excision repair
c) Nucleotide excision repair
d) SOS repair
102. To synthesize insulin
on a large scale basis, the most suitable starting material obtained from
the beta cells of the pancreas is:
a) Genomic DNA
b) Total cellular RNA
c) cDNA of insulin
d) mRNA of insulin
103. By which of the following anticoagulants used is estimating blood
glucose, glycosis is prevented?
c) Sodium fluoride Answer)
d) Sodium citrate
104. Apart from occurring in
nucleic acids, pyrimidines are also found in:
c) Flvine mononucleotide
105. Vitamin A is stored mainly as
retinal esters in:
106. Which of the following is a component of the visual
d) Retinoic acid
107. Idiopathic nyctalopic is due to a hereditary:
a) Absence of rod function
b) Absence of cone function
c) Absence of rod and cone function
d) Decrease of cone function
108. The following disease have defect in DNA
repair mechanism except for:
a) Xeroderma Pigmentosa
b) Fanconi Syndrome
c) Huntington's disease
d) Hereditary non polyposis colon cancer
The most potent stimulator of naïve T cells is:
a) B Cell
b) Mature dendritic cells
c) Epithelial cells
110. Subsitution of which one of the
following amino acids in place of alanine would increase the absorbance of
protein at 280 nm?
111. Which of the following situation will lead
to increased viscosity of blood?
a) Fasting state
c) Multiple myeloma
112. If cellular proteins do not
fold into a specific conformation their functions are affected. Certain disorders
arise, if specific proteins are misfolded.
Which of the following disorders arises due to conformational isomerization?
a) Familial fatal insomnia
b) Hepatitis delta
c) Pernicious anemia
d) Lesch-Nyhan Syndrome
113. Side effects of a drug
arise due to the interactions of the drug of molecules other than the target.
These effects of a drugs can be minimized by its high:
114. Secretory proteins are synthesized
b) Endoplasmic Reticulum
c) First in cytoplasm and then in Endoplasmic
d) First in Endoplasmic Reticulum and then in cytoplasm
115. Tetracycline inhibits protein synthesis by:
a) Inhibiting initiation and causing misreading of mRNA
b) Binding to 30 S subunit and inhibits binding of aminoacyl tRNA
c) Inhibiting peptidyl transferease activity
d) Inhibiting translocation
At physiological pH, the carboxy-terminal of a peptide is:
a) Positively charged
b) Negatively charged
d) Infinitely charged
117. Which of the following drugs has covalent
interaction with its target?
c) Nitric oxide
118. Which of the following property of drug
will enable it to be used in low concentrations?
a) High affinity ans
b) High specificity
c) Low specificity
d) High stability
119. Several studies have shown that
85% of cases of lung Cancer are due to cigarette smoking. It is a measure
a) Incidence rate
b) Relative risk
c) Attributable risk
d) Absolute risk
120. It is probable that physician
have a higher index of suspicion for tuberculosis in children without BCG
scar than those with BCG scar. It this is so and an
association is found between Tuberculosis and not having BCG scar, the association
may be due to:
a) Selection bias
b) Interviewer bias ans
c) Surveillance bias
d) Non-response bias
121. When an intervention is
applied to community to evaluate its usefulness, it is termed as a trial
d) Effect modification
122. The drug of choice for treating
cholera in pregnant women is:
123. The most common cause of blindness
in India is:
c) Refractive errors
d) Vitamin A deficiency
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124. In a study 400 smokers
and 600 non-smokers were followed up over a period of 10 years to find out
the incidence of hypertension. The following table
summarizes the data at the end of the study:
Hypertension Yes No Total
Smoking Yes 120 280 400
No 30 570 600
Total 150 850 1000
The risk ratio in this study is:
125. In the WHO recommended EPI Cluster sampling for assessing
coverage, the age group of children to be surveyed is:
a) 0-12 months
b) 6-12 months
c) 9-12 months
d) 12-23 months
126. Of the different epidemiological study designs
available to test the association
between risk factor and disease, the best design is of :
a) Case-control study.
b) Ecological study.
c) Cohort study.
d) Cross-sectional study.
127. If the objective of the investigatior
is to asasess the incidence of tuberculosis infection in a community, the most
appropriate methodology would be to :
a) Identify all individuals with positive tuberculin test.
b) Perform sputum examination of chest symptomatics.
c) Identify new converters to Tuberculin test.
d) Screen all under-five children with Tuberculin test.
128. All of the following
statements are true about the childhood mortality rates
in India except :
a) Almost 3/5th of infant ortality rate (IMR) occurs in neonatal period.
b) Almost 3/4th of the under-five mortality occurs in the first year of life.
c) About one in ten children die before they reach the age of five years.
d) Neonatal mortality is higher among female children as compared to males.
Which of the following statements is true about the epidemiological determinants
of measles ?
a) Measles virus survives outside the human body for 5 days
b) Carriers are important sources of infection.
c) Secondary attack rate is less than that of rubella.
d) Incidence of measles is more in males than females.
130. Study the following
table carefully and answer the question :
Test result +ve 40 225
-ve 10 225
131. The usual incubation period for pertussis is :
a) 7-14 days
b) 305 days
c) 21-25 days
d) less then 3 days
132. Risk of the damage of fetus by maternal
rubella is maximum if mother gets infected in:
a) 6-12 weeks of pregnancy
b) 20-24 weeks of pregnancy
c) 24-28 weeks of pregnancy
d) 32-36 weeks of pregnancy
133. Deficit in weight
for height in a 3 year old child indicates :
a) Acute malnutrition.
b) Chronic malnutrition.
c) Concomittant acute and chronic malnutrition
d) Under weight.
134. Under Nationa Programme for Prevention of Nutritional
Blindness, a child in the age group of 6-11 months is given a mega dose of
vitamin A equal to
a) 50,000 IU
b) 1 Lakh IU
c) 1.5 Lakh IU
d) 2 Lakh IU
135. According to a joint study "Healthcare
In India : The Road Ahead" done
by CII and MekinSey and Company in 2002, India's execting bed population rates
a) 2 : 1000
b) 1.5 : 1000
c) 9 : 1000
d) 2.5 : 1000
136. 'Vagitus uterinus' is :
a) An infection of vagina
b) An infection of uterus
c) A cry of unborn baby from uterus.
d) Infection of both vagina and uterus
'Vagitus uterinus' is : Crying of the fetus while still within the uterus, occurring at times when the membranes have been ruptured and air has entered the uterine cavity.
Gunshot residue on hands can be detected by :
a) Phenolphthalein test
b) Dermal nitrate test.
c) Benzidine test
d) Hydrogen activation analysis
138. 'La facies sympathique'
is a condition seen in cases of :
c) Myocardial insufficiency
d) Railway accidents
Answer 2, This is a french word , literal meaning of this is "The facial sympathetic nerve"
139. A dead body is found
to have marks like branching of a tree on front of chest. The most likely
cause of death could be due to :
b) Lightening injury
c) Injuries due to bomb blast
d) Road traffic accident
140. A person has been
brought in casualty with history of road accident. He had lost consciousness
transiently and then gained consciousness but again
became unconscious. Most likely, he is having brain hemorrhage of :
b) Sub arachnoid
c) Sub dural
d) Extra dural
141. Pulmonary function abnormalities in interstitial
lung disease include all of the following except :
a) Reduced vital capacity
b) Reduced FEV1/FVC ratio
c) Reduced diffusion capacity
d) Reduced total lung capacity
142. Which of the
following antihypertensives is not safe in pregnancy ?
b) ACE inhibitors
143. Which of the follwing drugs is known to
cause granuloma in the liver ?
d) Methyl testosterone
Sarcoidosis is the most important noninfectious cause; liver involvement occurs in about 2/3 of patients with sarcoidosis and occasionally is the dominant clinical manifestation. Various drugs can be responsible (eg, quinidine, sulfonamides, allopurinol, phenylbutazone). Hepatic granulomas can also occur in polymyalgia rheumatica and other collagen vascular diseases; in Hodgkin's disease, sometimes without other morphologic evidence of the lymphoma; and in many other systemic conditions.
From : http://www.merck.com/mrkshared/mmanual/section4/chapter45/45a.jsp (A free online textbook : The Merck Manual )
144. Follwing liver transplantation,
recurrence of primary disease in the liver most likely occurs in :
a) Wilson's disease
b) Autoimmune hepatitis
c) Alpha-1-antitrypsin deficiency
d) Prmary biliary cirrhosis
145. A patient
presented to emergency ward with massive upper gastrointestinal bleed. On
examination, he has mild splenomegaly. In the absence of any other
information available. Which of the following is the most appropriate therapeutic
a) Intravenous propranolol
b) Intravenous vasopressin
c) Intravenous pantoprazole
d) Intravenous somatostatin
146. All of the following
are modalities of therapy for herpatocellular carcinoma except :
a) Radiofrequency ablation
b) Transarterial catheter embolization
c) Percutanoeus acetic acid
d) Nd Yag laser ablation
147. Which of the following
is the established biological theapy for Crohn's disease ?
a) Anti TNF a-antibody
b) IL-1 antagonist
c) IL-6 antagonist
d) IL-8 antagonist
148. Which of the following is the
established biological therapy for Crohn's disease ?
149. Nephrotoxicity is a side effect of one
of the following immuno-suppressives :
c) Mycophenolate mofetil
Answer 2 , TACROLIMUS NEPHROTOXICITY Tacrolimus (FK-506) can cause all of the forms of nephrotoxicity that have been associated with cyclosporine,
Page 331 Paul G Killenberg, Pierre-Alain Clavien - Medical - 2001 - 443 pages, Harrisons 16th Table number 263-2.
While Sirolimus has little or no nephrotoxicity and cuases hyperlipedemia and thrombocytopenia.
150. Minimal change glomerulopathy
may be seen in association with all of the following except :
a) Hepatits B
c) Drug-induced interstitial nephrities
d) Hodgkin's disease
151. All of the
following poisons are dialyzable except :
a) Ethylene glycol
d) Copper sulphate
152. All the following drugs may cause
hyperkalemia except :
Answer 2, Usually renal toxic drugs cause hyperkalemia, but Amphotericin is opposite/
153. Acalculous cholecystitis can be seen in all the
followign conditions except :
a) Enteric fever
b) Dengue haemorrhagic fever
154. A 30 year old lady presents with features
of malabsorption and iron deficiency anaemia. Duodebnal biopsy shows complete
villous atrophy. Which of the following
antibodies is likely to be present ?
a) Antiendomysial antibodies ]
b) Anti-goblet cell antibodies
c) Anti-Saccharomyces cervisae antibodies
d) Antineutrophil cytoplasmic antibodies.
155. A 25 year old woman presents
with recurrent abdominal pain and anemia. Peripheral blood smear shows basophilic
stippling of the red blood cells. What
is the most likely diagnosis ?
a) Coeliac disease
b) Hookworm infestation
c) Sickle cell disease
d) Lead poisoning
156. A patient presents with lower
gastrointestianal bleed. Sigmoidoscopy shows ulcers in the sigmoid. Biopsy
from this area shows ulcers in the sigmoid. Biopsy
from this area shows flaskshaped ulcers. Which of the following is the most
appropriate treatment ?
a) Intravenous ceftriaxone
b) Intravenous metronidazole
c) Intravenous steroids and sulphasalazine
d) Hydrocortisone enemas.
157. A 25-year old farmer presented with history of high grade fever for 7
days and altered sensorium for 2 days. On examination, he was comatosed and
had conjunctival he4morrhage. Urgent investigations showed a hemoglobin of
11 gm/dl, serum bilirubin 8 mg/dl and urea 78 mg/dl. Peripheral blood smear
was nagative for malarial parasite. What is the most likely diagnosis ?
b) Weil's disease
c) Acute viral hepatities
d) Q fever
158. A 50-year old lady presented with
history of pain upper abdomen, nausea and decreased appetite for 5 days.
She had undergone cholecystectomy 2 years
back. Her bilirubin was 10 mg/dl, SGOT 900 IU/I SGPT 700 IU/I and serum alkaline
phophatase was 280 IU/I. What is the most likely diagnosis ?
a) Acute pancreatitis
b) Acute cholagits
c) Acute viral hepatitis
d) Posterior penetration of peptic ulcer
159. A 70-
year old male patient presented to the emergency department with pain in
epigastrium and difficulty in breathing for 6 hours. One examination,
his heart rate was 56 per minute and the blood pressure was 106/60 mm Hg.
Chest examination was normal. The patient has been taking omeprazole for gastroesophageal
reflux disease for last 6 months. What should be the initial investigation
a) An ECG Answer Inf wall MI
b) An upper GI endoscopy
c) Urgent ultrasound of the abdomen
d) An x-ray chest
160. A 30-year old delivered a healthy baby at 37 week of gestation.
She was a known case of chronic hepatitis B infection. She was positive for
but negative for HBeAg. Which of the following is the most appropriate treatment
for the baby ?
a) Both active and passive immunization soon after birth.
b) Passive immunization soon after birth and active immunization at 1 year of age.
c) Only passive immunization soon after birth.
d) Only active immunization soon after birth
161. The blood culture from a
patient of febrile neutropenia has grown psuedomonas aeruginsa. When tested
for antimicrobial susceptibitly, it was found to be
a producer of extended spectrum beta lactamase enzyme. The best choice of
antimicrobial theapy shod be :
162. A known HIV positive patient
is admitted in an isolation ward after an abdominal surgery following an
accident. The resident doctor who changed his
dressing the next day found it to be soaked in blood. Which of the following
would be the right method of choice of discarding the dressings :
a) Pour 1% hypochlorite on the dressing material and send it for incineration in a appropriate bag.
b) Pour 5% hypochlorite on the dressing material and send it for incineration in a appropriate bag.
c) Put the dressing material directly in an appropriate bag and send for incinerzation
d) Pour 2% Lysol on the dressing material and send it for incineration in a appropriate bag
163. A 45 yerar old fenmale complains of lower abdominal pain and vaginal
discharge. On examination there is cervicitis along with a mucopurulent cervical
The gram smear of the discharge shows presence of abundant pus cells but
no bacteria. The best approach to isolate the possible causative agent would
a) Culture on chocolate agar supplemented with Heemin
b) Culture on McCoy cells
c) Culture on a bilayer human blood agar
d) Culture on vero cells lines
164. The sputum specimen of a 70 year old male
was cultured on a 5% sheep blood agar. The culture showed the presence of
a-haemolytic colonies next day. The
further processing of this organism is most likely to yield :
a) Gram positive cocci in short chains, catalase negative and bile resident.
b) Gram positive cocci in pairs, catalase negative and bile soluble.
c) Gram positive cocci in pairs, catalase positive and oxidase positive
A major step in the pathogenesis of listeriosis is :
a) The formation of antigen-antibody complexes with resultant complement activation and tissue damage.
b) The release of hyaluronidase by L. monocytogenes, which contributes to its dissemimayopm from local sites.
c) The antiphagocytic activity of the L. monocytogenes capsule.
d) The survival and multiplication of L. monocytogenes within mononuclear phagocytes and host epithelial cells.
166. In HIV infected individual Gram stain
of lung aspirate shows yeast like morphology.
All of the following are the most likely diagnosis except :
a) Candida tropicalis
b) Cryptococcus neoformans
c) Pencillium marneffi
d) Aspergillus fumigates
167. A patient of Acute lymphocytic leukemia with fever and neutropenia develops
diarrhoea after administration of amoxicillin therapy, which of the following
organism is most likely to be the causative agent ?
a) Salmonella typhi
b) Clostridium difficle
c) Clostridium perfriungens
d) Shigella flexneri
168. The following statements
are true with reference to Mycoplasma except :
a) They are the smallest prokaryotic organisms that can grow in cell free culture media.
b) They are obligate intracellular organisms.
c) They lack a cell wall.
d) They are resistant to Beta-lactam drugs
169. Which of the following strategy
has been recommended to reduce the hereditary rist for ovarian cancer in women
with BRCA I & BRCA II mutations ?
a) Use of Oral Contraceptive Pills.
b) Screening with Transvaginal Ultrasound.
c) Screening with CA-125.
d) Prophylactic oophorectomy.
170. The corneal transparency is maintained by
b) Bowman's membrane
c) Descemet's membrane
171. The most important indication
for surgical repair of a Bicornuate Uterus is :
d) Habitual abortion
172. The one measurement of fetal maturity
that is not affected by a 'bloody tap' during
amniocentesis is :
a) L/S ratio.
b) Phosphatidyl glycerol
c) a fetoprotein
d) Bilirubin as measured by AOD 450
173. Which of the following
test is the most sensitive for detection of iron depletion in
a) Serum iron
b) Serum transferrin
c) Serum ferritin
d) Serum Erythropoiethin
174. At what gestation does the switchover from fetal to adult hemoglobin
a) 30 weeks
b) 36 weeks
c) 7 days postnatal
d) 3 weeks postnatal
175. In which of the following conditions
would maternal serum a-fetoprotein values be
the highest ?
a) Down's syndrome
b) Omphalocele ANSWER
d) Spina bifida occulta
176. The drug of choice in treatment
of typhoid fever in pregnancy is :
Answer 4 The current DOC for children and pregnant women is parenteral ceftriaxone.Reference http://www.emedicine.com/oph/topic686.htm#section~treatment
177. The treatment of choice for Anaplastic
carcinoma of thyroid infiltrating trachea and
sternum will be :
a) Anaplastic carcinoma
b) Follicular carcinouma
c) Papillary carcinoma
d) Palliative/Symptomatic treatments
178. The treatment
of choice for Anaplastic carcinoma of thyroid infiltrating trachea and sternum
a) Radical excision
d) Palliative/Symptomatic treatment
Answer 3 /4 (We prefer 4 as it is broad term and encompasses pain / other care needed for a terminal patient)
179. A 10 year old
boy developed hoarseness of voice following an attack of diphtheria. On examination,
his Rt vocal cord was paralysed. The treatment
of choice for paralysed vocal cord will be:
a) Gel foam injection of right vocal cord
b) Fat injection of right vocal cord
c) Thyroplasty type I
d) Wait for spontaneous recovery of vocal cord.
180. The current treatment
of choice for a large Antro-choanal polyp in a 30 year old man is:
a) Intranasal polypectomy
b) Caldwell Luc operation
c) E.S.S. (Endoscopic sinus surgery)
d) Lateral Rhinotomy and excision
181. A 2 year old boy presents with fever
for 3 days which responded to administration of paracetamol. Three days later
he developed acute renal failure, marked acidosis
and encephalopathy. His urine showed plenty of oxalate crystals. The blood
anion gap and osmolar gap were increased. Which of the following is the most
a) Paracetomal poisoning
b) Diethyl glycol poisoning
c) Severe malaria
d) Hanta virus infection
182. What is the drug of choice to control supraventricular
183. A child presents with diarrhea and peripheral
circulatory failure. The arterial pH is 7.0 PCO2 15 mmHg, and PO2 76mm Hg.
What will be the most appropriate
a) Sodium bicarbonate infusion
b) Bolus of Ringers lactate
c) Bolus of hydroxyethyl starch
d) 5% Dextrose infusion
184. A 5 year old child is rushed to casualty reportedly
electrocuted while playing in a park. The child is apneic and is ventilated
with bag mask. There
are burns on each hand. What will be the next step in the management?
a) Check pulses
b) Start chest compressions
d) Check oxygen
185. Arterial blood gas of a 5 year old done at sea level gives
the following results: pH 7.41, PaO2 100 mmHg and PaCO240mmHg. The child
is being ventilated
with 80% oxygen. What is the (A-a) PO2?
a) 570.4 mm Hg
b) 520.4 mm Hg
c) 470.4 mm Hg
d) 420.4 mm Hg
186. Recurrent respiratory tract infections
may occur in all of the following except:
a) Ventricular sepal defect
b) Tetrology of fallot
c) Transposition of great arteries
d) Total anomalous venous return
187. A 6 month old boy weighting 3.2 kg presents
with recurrent vomiting and polyuria Investigations show blood urea 60 mg/dL
creatinine 0.7 mg/dL, calcium
12.8 mg/dL, phosphate 3 mg/dL, pH 7.45, bicarbonate 25 mEq/L and PTH 140 pg/ml
(normal<60 pg/ml). Daily urinary calcium excretion is reduced. Ultrasound
abdomen show bilateral nephrocalcinosis. The most likely diagnosis is:
a) Bartter syndrome
b) Mutation of the calcium sensing receptor.
d) Parathyroid adenoma
188. A female child has recently learned to eat with
spoon without spilling; to dress and undress hereself with supervision; and
to understand that she
is a girl. These skills are FIRST mastered between the ages of:
a) 2 & 3 years
b) 3 & 4 years
c) 4 & 5 years
d) 5 & 6 years
189. Which of the following antiepileptic
agents acts on the GABAergic system to decrease the uptake of GABA into neurons
and glial cells:
d) Tiagabine Answer
190. The Mu receptor of the opioids is
responsible for the following clinical actions except:
b) Respiratory depression
191. Which one of the following drugs does not
produce central anticholinergic syndrome:
a) Atropine sulphate
d) Tricyclic antidep
192. Heparin is the commonly used
anticoagulant in cardiac surgery. All of the following are true about heparin
a) Weakest acid found in living things
b) Most commercial preparations of heparin now utilize pig intestinal slimes
c) Act via Antithrombin activation
d) Produce thrombocytopenia
193. The new agent , useful in breast
cancer, belongs to which of the following category of drugs?
a) Antitumor antibiotic
b) Alkylating agent
c) Hormonal agent
Answer 4 (pemetrexed is anti folate agent discovered for malignant mesothelioma. Only drug proven to improve malignant mesothelioma. 2003 CMDT 1611 pg.)
194. Bradycardia is common after injection of:
b) Succinyl choline
195. According to myogenic hypothesis of
renal autoregulation, the afferent arterioles contract in response to strech
a) No release
b) Noradrenaline release
c) Opening of Ca2+ channels
d) Adenosine release
196. All of the following
transport processes follow'saturation kinetics' except:
a) Facilitated diffusion
b) Na+-Ca2+ exchanger
c) Simple diffusion
d) Na+ coupled active transport
197. An anterolateral
corodotomy relieving pain in right leg is effective because it interrupts
a) Left dorsal column
b) Left ventral spinothalmic tract
c) Left lateral spinothalmic tract
d) Right lateral spinothalmic tract
198. Fetal haemoglobin has all the following
characteristic features except:
a) Strong affinity for 2,3-DPG
b) Oxygen dissociation curve is shifted to left
c) At low fetal PO2 gives up more oxygen to tissues than adult hemoglobin.
d) Forms 80% of haemoglobin at birth
199. Beta waveforms in electroencephalogram
designate which of the following states of the patient?
a) Deep Anaesthesia
b) Surgical Anaesthesia
c) Light Anaesthesia, eyes closed, relaxed
d) Awake/alert state
200. A 24
years old primigravida wt=57 kg. Hb 11.0 gm% visits an antenatal clinic during
2nd trimester of pregnancy seeking advice on dietary intake.
She should be advised:
a) Additional intake of 300 kcal
b) Additional intake of 500 kcal
c) Additional intake of 650 kcal
d) No extra kcal
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