GENERAL MEDICINE
GENERAL MEDICINE MCQs
1. A patient with small cell lung carcinoma has symptomatic hyponatraemia (serum sodium 127 mmol/ L). The most likely etiology is:
(a) Fanconi Syndrome
(b) Cushing’s Syndrome
(c) Metabolic Syndrome
(d) Syndrome of inappropriate ADH
Ans: D
2. A patient with cirrhosis develops oliguria and worsening azotemia. Urinary sediment is normal. Urinary sodium concentration is 5 meq/ L. The most likely cause could be:
(a) Acute cortical necrosis
(b) Acute tubular necrosis
(c) Acute glomerulonephritis
(d) Hepatorenal syndrome
Ans: D
3. A 6 week old infant presents with recurrent nonbilious vomiting with some dehydration. A mass is palpable in right upper quadrant of abdomen with visible peristalsis. The most likely diagnosis is :
(a) Intussusception
(b) Congenital hypertrophic pyloric stenosis
(c) Small intestine obstruction
(d) Duodenal atresia
Ans: B
4. A 2 year old previously healthy child develops abrupt onset high grade fever, drooling of saliva and respiratory distress. He has a toxic look and becomes severely ill within few hours. What is the most likely clinical diagnosis?
(a) Acute tonsilopharyngitis
(b) Tracheo-oesophageal fistula
(c) Acute Epiglottitis
(d) Laryngeal web
Ans: C
5. A 6 year old child presents with oliguria, haematuria, puffiness of face. He has a convulsion and blood pressure is found to be 200/100 mm of Hg. Laboratory tests reveal hemoglobin: 12g/dl, total leucocyte count: 7200/mm3, platelet count: 3.1 lakhs/mm3, blood urea: 80 mg/dl and serum creatinine: 1.1 mg/dl. What is the most likely diagnosis?
(a) Haemolytic uraemic syndrome
(b) Urinary tract infection
(c) Acute glomerulonephritis with hypertensive encephalopathy
(d) Obstructive uropathy
Ans: C
6. A two year old child with acute watery diarrhea and severe dehydration presents to the emergency. Which of the following is the most appropriate initial treatment?
(a) Ringer lactate at 30ml/kg given intravenously in 30 minutes
(b) Oral rehydration solution through nasogastric tube
(c) Ringer lactate at 10ml/kg given intravenously in 2 hours
(d) Normal saline at 10ml/kg given intravenously in 2 hours
Ans: A
7. A diagnosis of steroid dependent nephrotic syndrome is made in a 5 year old male child and he is initiated on a drug. After 6 weeks of therapy, he develops nausea, vomiting, neutropenia and gross hematuria. Which of the following is the most likely drug used?
(a) Cyclophosphamide
(b) Levamisole
(c) Cyclosporine
(d) Prednisolone
Ans: A
8. Consider the following statements regarding distal renal tubular acidosis:
1. Blood biochemistry reveals normal anion gap metabolic acidosis
2. There is defective secretion of H+ in the distal tubule.
3. There may be associated muscle weakness and rickets.
4. Children may present with polydipsia and polyuria.
Which of the above statements are correct?
(a) 1 only
(b) 2 and 3 only
(c) 2 and 4 only
(d) 1, 2, 3 and 4
Ans: D
9. A one year old male child presents with poor urinary stream and dribbling of urine since birth. A mass is palpable mass just above the symphysis pubis. The most likely diagnosis is:
(a) Tumor of the urinary bladder
(b) Posterior urethral valve
(c) Ureterocele
(d) Neuroblastoma
Ans: B
10. A 4 years old child presents with rash on lower limbs, arthritis, and abdominal pain. Urine examination reveals microscopic hematuria. The most likely diagnosis is:
(a) Thrombaesthenia
(b) Idiopathic thrombocytopenic purpura
(c) Systemic lupus erythematosus
(d) Henoch Schonlein purpura
Ans: D
11. The following milestones can be achieved by a 12 month old infant except:
(a) Wave “bye bye”
(b) Speak ‘mama’, ‘baba’, ‘dada’
(c) Make a tower of 6 blocks
(d) Stand without support
Ans: C
12. Which one of the following is not a feature of severe combined immunodeficiency in children?
(a) Enlarged thymus
(b) Decreased serum immunoglobulin levels
(c) Defective T cell function
(d) Recurrent pulmonary infections
Ans: A
13. Children with an autosomal recessive condition have partial albinism, susceptibility to infections and presence of giant peroxidase positive lysosomal granules in granulocytes. What is the most probable diagnosis?
(a) Chediak Higashi syndrome
(b) Hermansky Pudlak syndrome
(c) Piebaldism
(d) Waardenburg’s syndrome
Ans: A
14. A 50 hours old full term breast – fed newborn boy weighing 3100 g presents with jaundice. Physical examination is normal. The total serum bilirubin is 11.0 mg/ dL with a direct bilirubin of 0.4 mg/ dL. The correct treatment would be to:
(a) Continue breast feeds and review after 48 hours
(b) Stop breast feeds and review after 24 hours
(c) Continue breast feeds and start blue – light phototherapy
(d) Arrange for a double volume exchange transfusion
Ans: A
15. Which one of the following pairs is not correctly matched?
(a) Vitamin B6 -------- Beriberi
(b) Vitamin B3 ---------- Pellagra
(c) Vitamin B12 -------- Subacute combined degeneration of cord.
(d) Vitamin B5 --------- Burning feet syndrome
Ans: A
16. Match List I with List II and select the correct answer using the code given below the lists:
List I (Congenital malformation syndrome) List II (Congenital heart defect)
A. Foetal alcohol syndrome 1. Bicuspid aortic valve
B. Turner’s syndrome 2. Endocardial cushion defect
C. Down syndrome 3. Pulmonary stenosis
D. Congenital rubella syndrome 4. Ventricular septal defect
Code:
A B C D
(a) A/3 B/2 C/1 D/4
(b) A/3 B/1 C/2 D/4
(c) A/4 B/2 C/1 D/3
(d) A/4 B/1 C/2 D/3
Ans: D
17. A 12 months old baby boy weighs 4.5 kg and measures 60 cm. He has marked loss of subcutaneous fat and has no edema. What form of protein energy malnutrition does the baby have?
(a) Grade III protein energy malnutrition
(b) Grade IV protein energy malnutrition with K
(c) Marasmic Kwashiorkar
(d) Marasmus
Ans: D
18. Which of the following pairs is not correctly matched?
(a) Turner’s syndrome ……. 45, X
(b) Down syndrome ……. 47, XY, +21
(c) Klinefelter’s syndrome ……. 47, XXY
(d) Marfan’s syndrome ……. 47, XYY
Ans: D
19. Which of the following is the most reliable test for screening hemophilia?
(a) Prothrombin time
(b) Clotting time
(c) Partial thromboplastin time
(d) Clot retraction
Ans: C
20. A child with poliomyelitis in acute phase can have all the following except:
(a) Painful affected extremity
(b) Sensory loss
(c) Hypotonia
(d) Depressed deep tendon reflexes
Ans: B
21. Which one of the following antibodies is most specific in children with systemic lupus erythematosus?
(a) Anti neutrophil cytoplasmic antibody
(b) Anti myeloperoxidase antibody
(c) Anti double stranded DNA antibodies
(d) Anti histone antibodies
Ans: C
22. Match List I with List II and select the correct answer using the code given below the lists:
List I (Vaccine) List II (Type of vaccine)
A. Hepatitis B vaccine 1. Live attenuated vaccine
B. Diphtheria vaccine 2. Sub unit vaccine
C. Haemophilus influenzae vaccine 3. Toxoid
D. Measles vaccine 4. Polysaccharide vaccine
Code:
A B C D
(a) A/1 B/4 C/2 D/3
(b) A/2 B/3 C/4 D/1
(c) A/4 B/1 C/2 D/3
(d) A/3 B/1 C/2 D/4
Ans: B
23:-The following are branches of Thyro cervical trunk EXCEPT
A:-Deep cervical artery
B:-Transverse cervical artery
C:-Inferior thyroid artery
D:-Supra scapular artery
Ans: A
24:-General sensations from anterior two-third of tongue is carried by
A:-Lingual nerve
B:-Glosso-pharyngeal nerve
C:-Chorda tympani nerve
D:-Lesser palatine nerve
Ans: A
25:-Following nerve is called Musician's nerve
A:-Superficial branch of radial nerve
B:-Deep branch of ulnar nerve
C:-Deep branch of radial nerve
D:-Recurrent branch of median nerve
Ans: B
26:-Which of the following immunoglobulin is responsible for secondary immune response ?
A:-IgA
B:-IgE
C:-IgG
D:-IgM
Ans: C
27:-Epinephrine is synthesized from
A:-Glycine
B:-Tyrosine
C:-Methionine
D:-Tryptophan
Ans: B
28:-The enzyme deficient in von Gierke's disease is
A:-Alpha Galactosidase
B:-Pyruvate kinase
C:-Glucose-6-Phosphatase
D:-Pyruvate dehydrogenase
Ans: C
29:-In sickle cell hemoglobin which of the following is correct ?
A:-Glutamic acid is replaced by valine in the sixth position of alpha chain
B:-Glutamine is replaced by valine in the sixth position of beta chain
C:-Glutamine is replaced by valine in the sixth position of alpha chain
D:-Glutamic acid is replaced by valine in the sixth position of beta chain
Ans: D
30:-Which receptor responds to angular acceleration ?
A:-Utricle
B:-Saccule
C:-Semicircular canals
D:-Organ of Corti
Ans: C
31:-Carotid sinus massage stops supraventricular tachycardia because
A:-It decreases sympathetic discharge to SA node
B:-It increases vagal discharge to SA node
C:-It increases refractory period of ventricular myocardium
D:-It increases vagal discharge to AV node
Ans: D
32:-In the presence of ADH, the greatest fraction of filtered water is reabsorbed in
A:-Proximal convoluted tubule
B:-Loop of henle
C:-Distal convoluted tubule
D:-Collecting duct
Ans: A
(a) Fanconi Syndrome
(b) Cushing’s Syndrome
(c) Metabolic Syndrome
(d) Syndrome of inappropriate ADH
Ans: D
2. A patient with cirrhosis develops oliguria and worsening azotemia. Urinary sediment is normal. Urinary sodium concentration is 5 meq/ L. The most likely cause could be:
(a) Acute cortical necrosis
(b) Acute tubular necrosis
(c) Acute glomerulonephritis
(d) Hepatorenal syndrome
Ans: D
3. A 6 week old infant presents with recurrent nonbilious vomiting with some dehydration. A mass is palpable in right upper quadrant of abdomen with visible peristalsis. The most likely diagnosis is :
(a) Intussusception
(b) Congenital hypertrophic pyloric stenosis
(c) Small intestine obstruction
(d) Duodenal atresia
Ans: B
4. A 2 year old previously healthy child develops abrupt onset high grade fever, drooling of saliva and respiratory distress. He has a toxic look and becomes severely ill within few hours. What is the most likely clinical diagnosis?
(a) Acute tonsilopharyngitis
(b) Tracheo-oesophageal fistula
(c) Acute Epiglottitis
(d) Laryngeal web
Ans: C
5. A 6 year old child presents with oliguria, haematuria, puffiness of face. He has a convulsion and blood pressure is found to be 200/100 mm of Hg. Laboratory tests reveal hemoglobin: 12g/dl, total leucocyte count: 7200/mm3, platelet count: 3.1 lakhs/mm3, blood urea: 80 mg/dl and serum creatinine: 1.1 mg/dl. What is the most likely diagnosis?
(a) Haemolytic uraemic syndrome
(b) Urinary tract infection
(c) Acute glomerulonephritis with hypertensive encephalopathy
(d) Obstructive uropathy
Ans: C
6. A two year old child with acute watery diarrhea and severe dehydration presents to the emergency. Which of the following is the most appropriate initial treatment?
(a) Ringer lactate at 30ml/kg given intravenously in 30 minutes
(b) Oral rehydration solution through nasogastric tube
(c) Ringer lactate at 10ml/kg given intravenously in 2 hours
(d) Normal saline at 10ml/kg given intravenously in 2 hours
Ans: A
7. A diagnosis of steroid dependent nephrotic syndrome is made in a 5 year old male child and he is initiated on a drug. After 6 weeks of therapy, he develops nausea, vomiting, neutropenia and gross hematuria. Which of the following is the most likely drug used?
(a) Cyclophosphamide
(b) Levamisole
(c) Cyclosporine
(d) Prednisolone
Ans: A
8. Consider the following statements regarding distal renal tubular acidosis:
1. Blood biochemistry reveals normal anion gap metabolic acidosis
2. There is defective secretion of H+ in the distal tubule.
3. There may be associated muscle weakness and rickets.
4. Children may present with polydipsia and polyuria.
Which of the above statements are correct?
(a) 1 only
(b) 2 and 3 only
(c) 2 and 4 only
(d) 1, 2, 3 and 4
Ans: D
9. A one year old male child presents with poor urinary stream and dribbling of urine since birth. A mass is palpable mass just above the symphysis pubis. The most likely diagnosis is:
(a) Tumor of the urinary bladder
(b) Posterior urethral valve
(c) Ureterocele
(d) Neuroblastoma
Ans: B
10. A 4 years old child presents with rash on lower limbs, arthritis, and abdominal pain. Urine examination reveals microscopic hematuria. The most likely diagnosis is:
(a) Thrombaesthenia
(b) Idiopathic thrombocytopenic purpura
(c) Systemic lupus erythematosus
(d) Henoch Schonlein purpura
Ans: D
11. The following milestones can be achieved by a 12 month old infant except:
(a) Wave “bye bye”
(b) Speak ‘mama’, ‘baba’, ‘dada’
(c) Make a tower of 6 blocks
(d) Stand without support
Ans: C
12. Which one of the following is not a feature of severe combined immunodeficiency in children?
(a) Enlarged thymus
(b) Decreased serum immunoglobulin levels
(c) Defective T cell function
(d) Recurrent pulmonary infections
Ans: A
13. Children with an autosomal recessive condition have partial albinism, susceptibility to infections and presence of giant peroxidase positive lysosomal granules in granulocytes. What is the most probable diagnosis?
(a) Chediak Higashi syndrome
(b) Hermansky Pudlak syndrome
(c) Piebaldism
(d) Waardenburg’s syndrome
Ans: A
14. A 50 hours old full term breast – fed newborn boy weighing 3100 g presents with jaundice. Physical examination is normal. The total serum bilirubin is 11.0 mg/ dL with a direct bilirubin of 0.4 mg/ dL. The correct treatment would be to:
(a) Continue breast feeds and review after 48 hours
(b) Stop breast feeds and review after 24 hours
(c) Continue breast feeds and start blue – light phototherapy
(d) Arrange for a double volume exchange transfusion
Ans: A
15. Which one of the following pairs is not correctly matched?
(a) Vitamin B6 -------- Beriberi
(b) Vitamin B3 ---------- Pellagra
(c) Vitamin B12 -------- Subacute combined degeneration of cord.
(d) Vitamin B5 --------- Burning feet syndrome
Ans: A
16. Match List I with List II and select the correct answer using the code given below the lists:
List I (Congenital malformation syndrome) List II (Congenital heart defect)
A. Foetal alcohol syndrome 1. Bicuspid aortic valve
B. Turner’s syndrome 2. Endocardial cushion defect
C. Down syndrome 3. Pulmonary stenosis
D. Congenital rubella syndrome 4. Ventricular septal defect
Code:
A B C D
(a) A/3 B/2 C/1 D/4
(b) A/3 B/1 C/2 D/4
(c) A/4 B/2 C/1 D/3
(d) A/4 B/1 C/2 D/3
Ans: D
17. A 12 months old baby boy weighs 4.5 kg and measures 60 cm. He has marked loss of subcutaneous fat and has no edema. What form of protein energy malnutrition does the baby have?
(a) Grade III protein energy malnutrition
(b) Grade IV protein energy malnutrition with K
(c) Marasmic Kwashiorkar
(d) Marasmus
Ans: D
18. Which of the following pairs is not correctly matched?
(a) Turner’s syndrome ……. 45, X
(b) Down syndrome ……. 47, XY, +21
(c) Klinefelter’s syndrome ……. 47, XXY
(d) Marfan’s syndrome ……. 47, XYY
Ans: D
19. Which of the following is the most reliable test for screening hemophilia?
(a) Prothrombin time
(b) Clotting time
(c) Partial thromboplastin time
(d) Clot retraction
Ans: C
20. A child with poliomyelitis in acute phase can have all the following except:
(a) Painful affected extremity
(b) Sensory loss
(c) Hypotonia
(d) Depressed deep tendon reflexes
Ans: B
21. Which one of the following antibodies is most specific in children with systemic lupus erythematosus?
(a) Anti neutrophil cytoplasmic antibody
(b) Anti myeloperoxidase antibody
(c) Anti double stranded DNA antibodies
(d) Anti histone antibodies
Ans: C
22. Match List I with List II and select the correct answer using the code given below the lists:
List I (Vaccine) List II (Type of vaccine)
A. Hepatitis B vaccine 1. Live attenuated vaccine
B. Diphtheria vaccine 2. Sub unit vaccine
C. Haemophilus influenzae vaccine 3. Toxoid
D. Measles vaccine 4. Polysaccharide vaccine
Code:
A B C D
(a) A/1 B/4 C/2 D/3
(b) A/2 B/3 C/4 D/1
(c) A/4 B/1 C/2 D/3
(d) A/3 B/1 C/2 D/4
Ans: B
23:-The following are branches of Thyro cervical trunk EXCEPT
A:-Deep cervical artery
B:-Transverse cervical artery
C:-Inferior thyroid artery
D:-Supra scapular artery
Ans: A
24:-General sensations from anterior two-third of tongue is carried by
A:-Lingual nerve
B:-Glosso-pharyngeal nerve
C:-Chorda tympani nerve
D:-Lesser palatine nerve
Ans: A
25:-Following nerve is called Musician's nerve
A:-Superficial branch of radial nerve
B:-Deep branch of ulnar nerve
C:-Deep branch of radial nerve
D:-Recurrent branch of median nerve
Ans: B
26:-Which of the following immunoglobulin is responsible for secondary immune response ?
A:-IgA
B:-IgE
C:-IgG
D:-IgM
Ans: C
27:-Epinephrine is synthesized from
A:-Glycine
B:-Tyrosine
C:-Methionine
D:-Tryptophan
Ans: B
28:-The enzyme deficient in von Gierke's disease is
A:-Alpha Galactosidase
B:-Pyruvate kinase
C:-Glucose-6-Phosphatase
D:-Pyruvate dehydrogenase
Ans: C
29:-In sickle cell hemoglobin which of the following is correct ?
A:-Glutamic acid is replaced by valine in the sixth position of alpha chain
B:-Glutamine is replaced by valine in the sixth position of beta chain
C:-Glutamine is replaced by valine in the sixth position of alpha chain
D:-Glutamic acid is replaced by valine in the sixth position of beta chain
Ans: D
30:-Which receptor responds to angular acceleration ?
A:-Utricle
B:-Saccule
C:-Semicircular canals
D:-Organ of Corti
Ans: C
31:-Carotid sinus massage stops supraventricular tachycardia because
A:-It decreases sympathetic discharge to SA node
B:-It increases vagal discharge to SA node
C:-It increases refractory period of ventricular myocardium
D:-It increases vagal discharge to AV node
Ans: D
32:-In the presence of ADH, the greatest fraction of filtered water is reabsorbed in
A:-Proximal convoluted tubule
B:-Loop of henle
C:-Distal convoluted tubule
D:-Collecting duct
Ans: A
33. Acute severe asthma is characterised by all EXCEPT :
(A) Resp rate> 28/mt (B) Pulse > 110/mt
(C) Pulsus paradoxus > 25 (D) Normal FEV1/FVC ratio
Ans: D
34. Which of the following patients requires Infective endocarditis prophylaxis?
(A) VSD undergoing rigid bronchoscopy
(B) Mitral stenosis before dental extraction
(C) VSD undergoing fibreoptic bronchoscopy
(D) MVP for vaginal delivery
Ans: A
35. Patients taking which of the following drugs should avoid grapefruit juice?
(A) Amoxycillin (B) Aspirin
(C) Atorvastatin (D) Sildenafil
Ans: C
36. BMI likely to be lethal in males?
(A) 11 (B) 13
(C) 16 (D) 18.5
Ans: B
37. In which stage of sleep parasomnias somnambulism and night terrors most likely to occur?
(A) Stage 1 (B) Stage 2
(C) Slow-wave sleep (D) REM sleep
Ans: C
38. All the following cause urethritis in men except :
(A) GARDENERELLA VAGINALIS (B) Mycoplasma genitalium
(C) Neisseria gonorrhoeae (D) Trichomonas vaginalis
Ans: A
39. All the following are upregulated in cardiac failure with reduced ejection fraction EXCEPT :
(A) Angiotensin 2
(B) BNP
(C) Norepinephrine
(D) Calcium uptake into sarcoplasmic reticulum
Ans: D
40. All are direct complications of short bowel syndrome EXCEPT :
(A) CHOLESTEROL GALL stoness (B) Coronary artery disease
(C) Renal calculi (D) Gastric hypersecretion
Ans: B
41. Which of the following autoantibodies is least likely to be present in a patient with SLE?
(A) Antids DNA (B) Antiphospholipid
(C) Antierythrocyte (D) Anti La
Ans: D
42. Which of the following is the most common extraarticular manifestation of ankylosing spondylitis?
(A) Anterior uveitis (B) Aortic insufficiency
(C) Inflammatory bowel disease (D) Pulmonary fibrosis
Ans: A
43. Which is not a criteria for diagnosis of Behcet’s disease?
(A) Pathergy test (B) Recurrent oral ulcers
(C) Recurrent genital ulcers (D) Large vessel vasculitis
Ans: D
44. All are consistent with diagnosis of DKA EXCEPT :
(A) Arterial pH 7.1 (B) Glucose 550
(C) Plasma ketone strongly positive (D) Plasma osmolality 380
Ans: D
45. Stem cell therapy has been found to have in vivo benefit in :
(A) Cirrhosis (B) Ischemic heart disease
(C) Spinal cord injury (D) Parkinson disease
Ans: B
46. Type of nystagmus most commonly associated with peripheral vertigo :
(A) Unidirectional horizontal (B) Downbeat
(C) Gaze- evoked (D) Rebound
Ans: A
47. Which of the following gases is NOT produced by small intestinal bacteria?
(A) Carbon dioxide (B) Hydrogen
(C) Methane (D) Nitrogen
Ans: D
48. CT imaging in a 42 yr old woman with stage 3 ovarian cancer after 6 cycles of chemo with carboplatin and paclitaxel shows 25% reduction in tumour burden. What is her response to therapy?
(A) Complete response (B) Partial response
(C) Progressive disease (D) Stable disease
Ans: D
49. 53 yr old man with a hematocrit of 59%, WBC count 18,400 with normal DC, Platelet of 5 lakhs has SpO2 95%. He has a palpable spleen. What is the recommended therapy?
(A) Hydroxyurea (B) Imatinib
(C) Phlebotomy (D) Warfarin
Ans: C
50. Organism causing pneumonia in patient on maintanence dialysis?
(A) Acinetobacter (B) MRSA
(C) MDR enterobacter (D) Pseudomonas
Ans: B
(A) Resp rate> 28/mt (B) Pulse > 110/mt
(C) Pulsus paradoxus > 25 (D) Normal FEV1/FVC ratio
Ans: D
34. Which of the following patients requires Infective endocarditis prophylaxis?
(A) VSD undergoing rigid bronchoscopy
(B) Mitral stenosis before dental extraction
(C) VSD undergoing fibreoptic bronchoscopy
(D) MVP for vaginal delivery
Ans: A
35. Patients taking which of the following drugs should avoid grapefruit juice?
(A) Amoxycillin (B) Aspirin
(C) Atorvastatin (D) Sildenafil
Ans: C
36. BMI likely to be lethal in males?
(A) 11 (B) 13
(C) 16 (D) 18.5
Ans: B
37. In which stage of sleep parasomnias somnambulism and night terrors most likely to occur?
(A) Stage 1 (B) Stage 2
(C) Slow-wave sleep (D) REM sleep
Ans: C
38. All the following cause urethritis in men except :
(A) GARDENERELLA VAGINALIS (B) Mycoplasma genitalium
(C) Neisseria gonorrhoeae (D) Trichomonas vaginalis
Ans: A
39. All the following are upregulated in cardiac failure with reduced ejection fraction EXCEPT :
(A) Angiotensin 2
(B) BNP
(C) Norepinephrine
(D) Calcium uptake into sarcoplasmic reticulum
Ans: D
40. All are direct complications of short bowel syndrome EXCEPT :
(A) CHOLESTEROL GALL stoness (B) Coronary artery disease
(C) Renal calculi (D) Gastric hypersecretion
Ans: B
41. Which of the following autoantibodies is least likely to be present in a patient with SLE?
(A) Antids DNA (B) Antiphospholipid
(C) Antierythrocyte (D) Anti La
Ans: D
42. Which of the following is the most common extraarticular manifestation of ankylosing spondylitis?
(A) Anterior uveitis (B) Aortic insufficiency
(C) Inflammatory bowel disease (D) Pulmonary fibrosis
Ans: A
43. Which is not a criteria for diagnosis of Behcet’s disease?
(A) Pathergy test (B) Recurrent oral ulcers
(C) Recurrent genital ulcers (D) Large vessel vasculitis
Ans: D
44. All are consistent with diagnosis of DKA EXCEPT :
(A) Arterial pH 7.1 (B) Glucose 550
(C) Plasma ketone strongly positive (D) Plasma osmolality 380
Ans: D
45. Stem cell therapy has been found to have in vivo benefit in :
(A) Cirrhosis (B) Ischemic heart disease
(C) Spinal cord injury (D) Parkinson disease
Ans: B
46. Type of nystagmus most commonly associated with peripheral vertigo :
(A) Unidirectional horizontal (B) Downbeat
(C) Gaze- evoked (D) Rebound
Ans: A
47. Which of the following gases is NOT produced by small intestinal bacteria?
(A) Carbon dioxide (B) Hydrogen
(C) Methane (D) Nitrogen
Ans: D
48. CT imaging in a 42 yr old woman with stage 3 ovarian cancer after 6 cycles of chemo with carboplatin and paclitaxel shows 25% reduction in tumour burden. What is her response to therapy?
(A) Complete response (B) Partial response
(C) Progressive disease (D) Stable disease
Ans: D
49. 53 yr old man with a hematocrit of 59%, WBC count 18,400 with normal DC, Platelet of 5 lakhs has SpO2 95%. He has a palpable spleen. What is the recommended therapy?
(A) Hydroxyurea (B) Imatinib
(C) Phlebotomy (D) Warfarin
Ans: C
50. Organism causing pneumonia in patient on maintanence dialysis?
(A) Acinetobacter (B) MRSA
(C) MDR enterobacter (D) Pseudomonas
Ans: B
51. 35 yr old man with AML relapse post BMT presents with neutropenic sepsis, septic shock. He has haemorragic vesicles on his skin. What is the likely causative organism?
(A) Neisseria (B) Pseudomonas
(C) Rickettsia (D) Vibrio vulnificans
Ans: B
52. Unique side effect of Abacavir among ARV treatment drugs?
(A) Severe hypersensitivity (B) Famconi’s anemia
(C) Lactic acidosis (D) Lipoatrophy
Ans: A
53. Treatment of choice in a patient with wide QRS tachycardia brought in shock?
(A) Amiodarone 150 mg IV (B) Lidocaine 1mg IV
(C) Metoprolol 10 mg IV (D) DC defibrillation
Ans: D
54. Which is true of RVOT origin VT?
(A) Abnormal MRI (B) LBBB pattern in ECG
(C) Right upper quadrant axis (D) Precipitated by vagal stimulation
Ans: B
55. All are risk factors for postpartum cardiomyopathy EXCEPT :
(A) Aged mother (B) Twin pregnancy
(C) Primiparous (D) Use of tocolytics
Ans: C
56. Which is TRUE?
(A) Degenerative arthritis is associated with morning Stiffness
(B) Pain worsening with movement indicates mechanical problem
(C) Acute onset monoarthritis is most often infection related (
D) Synovial fluid analysis has no role in acute monoarthritis
Ans: B
57. Active urinary sediment indicates renal damage in all EXCEPT :
(A) SLE (B) Vasculitis (C) Bacterial endocarditis (D) Gout
Ans: D
58. Which is unlikely in inflammatory arthritis?
(A) Locking (B) Swelling of joint (C) Morning stiffness (D) Tenderness
Ans: A
59. All are true regarding Ascaris Lumbricoides EXCEPT :
(A) May be asymptomatic (B) Fever and meningeal signs
(C) Non productive cough and pleurisy (D) Small bowel obstruction
Ans: B
60. Skin findings in reactive arthritis include all EXCEPT :
(A) Erythema chronicum migrans (B) Circinate balanitis
(C) Keratoderma blenorrhagicum (D) Psoriasiform plaques
Ans: A
61. Giant cell arteritis has all EXCEPT :
(A) Older than 50 yrs (B) Anterior ischemic optic neuritis
(C) 80% may have negative temporal artery biopsy (D) Associated with polymyalgia rheumatica
Ans: C
62. Causes of lumbar canal stenosis includes all EXCEPT :
(A) Achondroplasia (B) Paget’s (C) Fluorosis (D) Rheumatoid arthritis
Ans: D
63. Which of the following statements is TRUE?
(A) Dermatomyositis may be associated with lymphoproliferative disorders
(B) Progression to lymphoma in sjogren may be associated with disappearance of rheumatoid factor
(C) Ovarian malignancy is commonly seen in SLE
(D) Splenomegaly is a feature of malignancy in scleroderma
Ans: B
64. Which of the following associations is INCORRECT in SLE?
(A) antidsDNA with nephritis (B) Antiribosomal P with CNS manifestations
(C) Anti Ro with neonatal lupus (D) Antiphospholipid antibody with arthritis
Ans: D
65. Which of the following associations is INCORRECT?
(A) HCG- gonadal germ cell tumour (B) CD25- adult T cell lymphoma-leukemia
(C) AFP- lymphoma (D) CA125- ovarian cancer
Ans: C
66. A 55 yr old woman, is found to have a 14 cm cyst in liver with daughter cysts extending to liver edge, causing biliary dilatation. Appropriate management for the condition?
(A) Albendazole followed by surgery (B) Needle biopsy
(C) PAIR (D) Serological testing for Echinococcosis
Ans: A
67. All are true regarding lymphocytic hypophysitis EXCEPT :
(A) MRI shows a prominent pituitary mass (B) May cause permanent hypopituitarism
(C) Post partum patients present with headache or visual disturbance (D) Surgery is the treatment of choice
Ans: D
68. MEN 1 includes all EXCEPT :
(A) Hyperparathyroidism (B) Pituitary adenoma
(C) Atrial myxoma (D) Pancreatic neuroendocrine tumours
Ans: C
69. Which feature distinguishes pituitary ACTH secretion from Ectopic?
(A) Rapid onset of clinical picture in ectopic
(B) Hypokalemia more common in pituitary
(C) Overnight low dose dexa suppression test result with cortisol > 5 microg distinguishes pituitary secretion
(D) Urinary free cortisol is suppressed in ectopic
Ans: A
70. Itai-itai disease was due to contamination with :
(A) Arsenic (B) Lead (C) Cadmium (D) Mercury
Ans: C
71. Which is NOT a feature of chronic arsenic poisoning?
(A) Haemorrhagic gastroenteritis (B) Guttate hyperpigmentation (C) Mee’s lines (D) Sensory polyneuropathy
Ans: A
72. Which of the following chemotherapeutic agents causes sensory neural hearing loss?
(A) Paclitaxel (B) Doxorubicin (C) 5 fluoro uracil (D) Cisplatin
Ans: D
73. Which statin is least myotoxic?
(A) Pravastatin (B) Simvastatin (C) Atorvastatin (D) Lovastatin
Ans: A
74. A 45 yr old lady with Crohn’s disease and small intestinal fistulae develops tetany while on TPN. her investigations are as follows : Ca : 8.2 K : 3.2 Na : 135 Cl : 103 Po4 : 2.4 Alb : 2.4 pH : 7.48 HCO3 : 25 Cause of her tetany?
(A) hyperventillation (B) hypocalcemia (C) focal seizure (D) hypomagnesemia
Ans: D
75. Best management for a patient presenting to casualty with mild right sided pleuritic pain with Xray showing <1 cm free air :
(A) tube thoracostomy (B) underwaterseal drainage (C) observation (D) needle aspiration
Ans: C
76. All are true about amiodarone induced thyroid dysfunction EXCEPT :
(A) hyperthyroidism is common in iodine deficient areas
(B) hypothyroidism commoner in men
(C) amiodarone inhibits deiodinase activity (
D) amiodarone treatment is associated with decreased T4 levels initially
Ans: B
77. All are seen in cardiac tamponade EXCEPT :
(A) pulsus paradoxicus (B) diastolic RV collapse in echo
(C) electrical alternans (D) kussmaul’s sign
Ans: D
78. Which of the following causes calcified pulmonary metastasis?
(A) adenocarcinoma kidney (B) squamous cell carcinoma
(C) seminoma (D) carcinoma thyroid
Ans: D
79. Balint’s syndrome has all the following features EXCEPT :
(A) Simultagnosia (B) Oculomotor apraxia
(C) Optic ataxia (D) Riddoh phenomenon
Ans: D
80. Differentiation syndrome has all the following features EXCEPT :
(A) Low grade lymphoma transforms to high grade
(B) Promyelocytic leukemia on treatment with ATRA
(C) Characterised by fever and pleuropericarditis
(D) SIRS mediated by interleukins
Ans: A
81. Which is NOT TRUE regarding strongyliodosis?
(A) Infection is always symptomatic
(B) Immunosuppression leads to increase worm burden
(C) hyperinfection may lead to bacterial translocation
(D) Filiform larvae may be demonstrated from skin lesions
Ans: A
82. Which of the following causes swollen optic disc with sudden visual loss?
(A) Caverous sinus thrombosis (B) Glaucoma
(C) Optic neuritis (D) Retinal vein occlusion
Ans: C
83. Heberden’s nodes are:
(A) Associated with rheumatoid arthritis
(B) Affect proximal interphalangeal joints
(C) Disease of the elderly
(D) Needs to be treated with DMARDS
Ans: C
84. Rivaroxaban belongs to which category of drugs?
(A) Factor Xa inhibitor (B) Direct thrombin inhibitor
(C) Vit K antagonist (D) Low molecular weight heparin
Ans: A
85. WALLENBERG syndrome. What is not true?
(A) Ipsilateral horner’s (B) Ipsilateral loss of taste (C) Chronic loss of pain in the arm (D) Chronic atrophy of tongue
Ans: D
86. Which of the following is not a component of syndrome Z?
(A) Obstructive sleep apnoea (B) BP > 130/85 (C) Fasting triglyceride > 150 (D) LDL > 100
Ans: D
87. Most common cause of lobar haemorrhage in elderly :
(A) Hypertension (B) Vascular malformation (C) Coagulopathy (D) Amyloid angiopathy
Ans: D
88. Most common preceding infection in bone marrow failure syndrome :
(A) Parvo B19 (B) Ebstein barr virus (C) HIV (D) Hepatitis
Ans: D
89. Which of the following statements is wrong?
(A) Light chains are normally produced slightly in excess in plasma cells
(B) Qualitation of M component can be done by electrophoresis
(C) M components may be present in CML
(D) 20% myeloma proteins produce light chains
Ans: B
90. Artery that is spared in polyarteritis nodosa is :
(A) Bronchial artery (B) Renal (C) Coronary (D) Pulmonary
Ans: D
91. Generalised painless lymphadenopathy is seen in :
(A) Rocky mountain spotted fever (B) Scrub typhus (C) Epidemic typhus (D) Q fever
Ans: B
92. Protein losing enteropathy with mucosal erosion is seen in :
(A) Lymphoma (B) Coeliac disease (C) Menetrier’s disease (D) SLE
Ans: A
93. Hepatitis C infection – all are true EXCEPT :
(A) Serum transaminitis is a good predictor of degree of liver fibrosis
(B) Telaprevir is effective in management
(C) 3% risk of vertical transmission
(D) Sharing tooth brushes is a risk factor for transmission
Ans: A
94. Effects of chronic hypoxia include all EXCEPT :
(A) Elevated production of erythrocytes
(B) Reduced pulmonary artery resistance
(C) Reduced systemic arterial resistance
(D) Upregulation of vascular endothelial growth factor
Ans: B
95. Treatment of choice for a 72 year old man with asymptomatic MGUS with no organ dysfunction and <5% plasma cells in bone marrow is :
(A) Yearly serum protein electrophoresis (B) Low dose prednisolone
(C) Rituximab (D) Thalidomide
Ans: A
96. A 76 yr old smoker presents with unilateral limb oedema and elevated D-Dimer, he gives h/o past similar episode. Which of the following makes D Dimer less predictive of DVT in this patient?
(A) Smoking (B) Negative Homan sign
(C) Age > 70 yrs (D) Previous DVT
Ans: C
97. In an ECG with wide QRS tachycardia, which of the following strongly favours ventricular tachycardia?
(A) A-V dissociation
(B) RBBB pattern
(C) Irregularly irregular rhythm with varying QRS complexes
(D) QRS duration > 120 msec
Ans: A
98. Which of the following is true coma?
(A) Akinetic mutism (B) Metabolic encephalopathy
(C) Locked in state (D) Catatonia
Ans: B
(A) Neisseria (B) Pseudomonas
(C) Rickettsia (D) Vibrio vulnificans
Ans: B
52. Unique side effect of Abacavir among ARV treatment drugs?
(A) Severe hypersensitivity (B) Famconi’s anemia
(C) Lactic acidosis (D) Lipoatrophy
Ans: A
53. Treatment of choice in a patient with wide QRS tachycardia brought in shock?
(A) Amiodarone 150 mg IV (B) Lidocaine 1mg IV
(C) Metoprolol 10 mg IV (D) DC defibrillation
Ans: D
54. Which is true of RVOT origin VT?
(A) Abnormal MRI (B) LBBB pattern in ECG
(C) Right upper quadrant axis (D) Precipitated by vagal stimulation
Ans: B
55. All are risk factors for postpartum cardiomyopathy EXCEPT :
(A) Aged mother (B) Twin pregnancy
(C) Primiparous (D) Use of tocolytics
Ans: C
56. Which is TRUE?
(A) Degenerative arthritis is associated with morning Stiffness
(B) Pain worsening with movement indicates mechanical problem
(C) Acute onset monoarthritis is most often infection related (
D) Synovial fluid analysis has no role in acute monoarthritis
Ans: B
57. Active urinary sediment indicates renal damage in all EXCEPT :
(A) SLE (B) Vasculitis (C) Bacterial endocarditis (D) Gout
Ans: D
58. Which is unlikely in inflammatory arthritis?
(A) Locking (B) Swelling of joint (C) Morning stiffness (D) Tenderness
Ans: A
59. All are true regarding Ascaris Lumbricoides EXCEPT :
(A) May be asymptomatic (B) Fever and meningeal signs
(C) Non productive cough and pleurisy (D) Small bowel obstruction
Ans: B
60. Skin findings in reactive arthritis include all EXCEPT :
(A) Erythema chronicum migrans (B) Circinate balanitis
(C) Keratoderma blenorrhagicum (D) Psoriasiform plaques
Ans: A
61. Giant cell arteritis has all EXCEPT :
(A) Older than 50 yrs (B) Anterior ischemic optic neuritis
(C) 80% may have negative temporal artery biopsy (D) Associated with polymyalgia rheumatica
Ans: C
62. Causes of lumbar canal stenosis includes all EXCEPT :
(A) Achondroplasia (B) Paget’s (C) Fluorosis (D) Rheumatoid arthritis
Ans: D
63. Which of the following statements is TRUE?
(A) Dermatomyositis may be associated with lymphoproliferative disorders
(B) Progression to lymphoma in sjogren may be associated with disappearance of rheumatoid factor
(C) Ovarian malignancy is commonly seen in SLE
(D) Splenomegaly is a feature of malignancy in scleroderma
Ans: B
64. Which of the following associations is INCORRECT in SLE?
(A) antidsDNA with nephritis (B) Antiribosomal P with CNS manifestations
(C) Anti Ro with neonatal lupus (D) Antiphospholipid antibody with arthritis
Ans: D
65. Which of the following associations is INCORRECT?
(A) HCG- gonadal germ cell tumour (B) CD25- adult T cell lymphoma-leukemia
(C) AFP- lymphoma (D) CA125- ovarian cancer
Ans: C
66. A 55 yr old woman, is found to have a 14 cm cyst in liver with daughter cysts extending to liver edge, causing biliary dilatation. Appropriate management for the condition?
(A) Albendazole followed by surgery (B) Needle biopsy
(C) PAIR (D) Serological testing for Echinococcosis
Ans: A
67. All are true regarding lymphocytic hypophysitis EXCEPT :
(A) MRI shows a prominent pituitary mass (B) May cause permanent hypopituitarism
(C) Post partum patients present with headache or visual disturbance (D) Surgery is the treatment of choice
Ans: D
68. MEN 1 includes all EXCEPT :
(A) Hyperparathyroidism (B) Pituitary adenoma
(C) Atrial myxoma (D) Pancreatic neuroendocrine tumours
Ans: C
69. Which feature distinguishes pituitary ACTH secretion from Ectopic?
(A) Rapid onset of clinical picture in ectopic
(B) Hypokalemia more common in pituitary
(C) Overnight low dose dexa suppression test result with cortisol > 5 microg distinguishes pituitary secretion
(D) Urinary free cortisol is suppressed in ectopic
Ans: A
70. Itai-itai disease was due to contamination with :
(A) Arsenic (B) Lead (C) Cadmium (D) Mercury
Ans: C
71. Which is NOT a feature of chronic arsenic poisoning?
(A) Haemorrhagic gastroenteritis (B) Guttate hyperpigmentation (C) Mee’s lines (D) Sensory polyneuropathy
Ans: A
72. Which of the following chemotherapeutic agents causes sensory neural hearing loss?
(A) Paclitaxel (B) Doxorubicin (C) 5 fluoro uracil (D) Cisplatin
Ans: D
73. Which statin is least myotoxic?
(A) Pravastatin (B) Simvastatin (C) Atorvastatin (D) Lovastatin
Ans: A
74. A 45 yr old lady with Crohn’s disease and small intestinal fistulae develops tetany while on TPN. her investigations are as follows : Ca : 8.2 K : 3.2 Na : 135 Cl : 103 Po4 : 2.4 Alb : 2.4 pH : 7.48 HCO3 : 25 Cause of her tetany?
(A) hyperventillation (B) hypocalcemia (C) focal seizure (D) hypomagnesemia
Ans: D
75. Best management for a patient presenting to casualty with mild right sided pleuritic pain with Xray showing <1 cm free air :
(A) tube thoracostomy (B) underwaterseal drainage (C) observation (D) needle aspiration
Ans: C
76. All are true about amiodarone induced thyroid dysfunction EXCEPT :
(A) hyperthyroidism is common in iodine deficient areas
(B) hypothyroidism commoner in men
(C) amiodarone inhibits deiodinase activity (
D) amiodarone treatment is associated with decreased T4 levels initially
Ans: B
77. All are seen in cardiac tamponade EXCEPT :
(A) pulsus paradoxicus (B) diastolic RV collapse in echo
(C) electrical alternans (D) kussmaul’s sign
Ans: D
78. Which of the following causes calcified pulmonary metastasis?
(A) adenocarcinoma kidney (B) squamous cell carcinoma
(C) seminoma (D) carcinoma thyroid
Ans: D
79. Balint’s syndrome has all the following features EXCEPT :
(A) Simultagnosia (B) Oculomotor apraxia
(C) Optic ataxia (D) Riddoh phenomenon
Ans: D
80. Differentiation syndrome has all the following features EXCEPT :
(A) Low grade lymphoma transforms to high grade
(B) Promyelocytic leukemia on treatment with ATRA
(C) Characterised by fever and pleuropericarditis
(D) SIRS mediated by interleukins
Ans: A
81. Which is NOT TRUE regarding strongyliodosis?
(A) Infection is always symptomatic
(B) Immunosuppression leads to increase worm burden
(C) hyperinfection may lead to bacterial translocation
(D) Filiform larvae may be demonstrated from skin lesions
Ans: A
82. Which of the following causes swollen optic disc with sudden visual loss?
(A) Caverous sinus thrombosis (B) Glaucoma
(C) Optic neuritis (D) Retinal vein occlusion
Ans: C
83. Heberden’s nodes are:
(A) Associated with rheumatoid arthritis
(B) Affect proximal interphalangeal joints
(C) Disease of the elderly
(D) Needs to be treated with DMARDS
Ans: C
84. Rivaroxaban belongs to which category of drugs?
(A) Factor Xa inhibitor (B) Direct thrombin inhibitor
(C) Vit K antagonist (D) Low molecular weight heparin
Ans: A
85. WALLENBERG syndrome. What is not true?
(A) Ipsilateral horner’s (B) Ipsilateral loss of taste (C) Chronic loss of pain in the arm (D) Chronic atrophy of tongue
Ans: D
86. Which of the following is not a component of syndrome Z?
(A) Obstructive sleep apnoea (B) BP > 130/85 (C) Fasting triglyceride > 150 (D) LDL > 100
Ans: D
87. Most common cause of lobar haemorrhage in elderly :
(A) Hypertension (B) Vascular malformation (C) Coagulopathy (D) Amyloid angiopathy
Ans: D
88. Most common preceding infection in bone marrow failure syndrome :
(A) Parvo B19 (B) Ebstein barr virus (C) HIV (D) Hepatitis
Ans: D
89. Which of the following statements is wrong?
(A) Light chains are normally produced slightly in excess in plasma cells
(B) Qualitation of M component can be done by electrophoresis
(C) M components may be present in CML
(D) 20% myeloma proteins produce light chains
Ans: B
90. Artery that is spared in polyarteritis nodosa is :
(A) Bronchial artery (B) Renal (C) Coronary (D) Pulmonary
Ans: D
91. Generalised painless lymphadenopathy is seen in :
(A) Rocky mountain spotted fever (B) Scrub typhus (C) Epidemic typhus (D) Q fever
Ans: B
92. Protein losing enteropathy with mucosal erosion is seen in :
(A) Lymphoma (B) Coeliac disease (C) Menetrier’s disease (D) SLE
Ans: A
93. Hepatitis C infection – all are true EXCEPT :
(A) Serum transaminitis is a good predictor of degree of liver fibrosis
(B) Telaprevir is effective in management
(C) 3% risk of vertical transmission
(D) Sharing tooth brushes is a risk factor for transmission
Ans: A
94. Effects of chronic hypoxia include all EXCEPT :
(A) Elevated production of erythrocytes
(B) Reduced pulmonary artery resistance
(C) Reduced systemic arterial resistance
(D) Upregulation of vascular endothelial growth factor
Ans: B
95. Treatment of choice for a 72 year old man with asymptomatic MGUS with no organ dysfunction and <5% plasma cells in bone marrow is :
(A) Yearly serum protein electrophoresis (B) Low dose prednisolone
(C) Rituximab (D) Thalidomide
Ans: A
96. A 76 yr old smoker presents with unilateral limb oedema and elevated D-Dimer, he gives h/o past similar episode. Which of the following makes D Dimer less predictive of DVT in this patient?
(A) Smoking (B) Negative Homan sign
(C) Age > 70 yrs (D) Previous DVT
Ans: C
97. In an ECG with wide QRS tachycardia, which of the following strongly favours ventricular tachycardia?
(A) A-V dissociation
(B) RBBB pattern
(C) Irregularly irregular rhythm with varying QRS complexes
(D) QRS duration > 120 msec
Ans: A
98. Which of the following is true coma?
(A) Akinetic mutism (B) Metabolic encephalopathy
(C) Locked in state (D) Catatonia
Ans: B
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