PG-DIAMS NEET Mock Test Title

PG-DIAMS NEET Mock Test
1. What is the most common entrance point for contagions to cause septic cavernous sinus thrombosis?
A. Gums (gum disease)
B. Ear
C. Upper lip
D. Parotid region of the cheek
Ans-C: Upper Lip
The cavernous sinus lies on surrounds the body of the sphenoid bone and receives blood from the facial veins
(via the superior and inferior ophthalmic veins) as well as the sphenoid and middle cerebral veins. Infections of
the face including the nose, tonsils, and orbits can spread easily by this route.
2. In regards to the coronary arteries, which of the following is correct:
A. The posterior interventricular artery is a branch of the circumflex artery
B. There is a lot of cross over circulation between the right and left coronary arteries
C. The anterior interventricular artery arises above the left posterior aortic cusp
D. The anterior interventricular artery predominantly supplies the left ventricle
Ans-D: The anterior interventericular artery predominantly supplies the left ventricle
3. Regarding the spinal cord, which of the following is true:
A. The spinal cord commonly terminates at the disc space between L1 and L2, although it can extend to L3 in some
B. The spinal cord occupies the full length of the dural sac at birth
C. The dural sac in the adult extends through the whole length of the sacral canal
D. The average spinal cord length is 14 inches (36 cm)
Ans-A: The spinal cord commoly terminates at the disc space between L1 and L2, although it can extend to L3 in
some
The spinal cord adults is 18 inches (45 cm) in length. In the newborn it terminates at L3. The extradural space
contains fat and vertebral veins.
4. Which muscle is associated with ulnar neuropathy?
A. Adductor pollicis
B. opponens pollicis
C. Lateral lumbricals
D. Flexor pollicis brevis
Ans-A ; Adductor pollicis
The ulnar nerve supplies the hypothenar muscles (opponens digiti minimi, abductor digiti minimi, flexor digiti
minimi), dorsal interossei, the lateral lumbrical muscles, palmar interossei and the adductor pollicis.
5. Where would you find the azygous lobe on an antero posterior chest X ray?
A. Right lower zone
B. Left middle zone
C. Left upper zone
D. Right upper zone
Ans-D) Right upper zone
The azygos lobe is a rare congenital malformation that would be found at the right upper zone. It is of little
clinical significance.
6. A patient with gallstones develops pain on the tip of his right shoulder. Which nerve is responsible for the pain?
A. Right phrenic nerve
B. Right vagus
C. Axillary nerve
D. C7 root
Ans-A) Right phrenic nerve
The phrenic nerve suuplies the diaphragm but its irritation results in referred pain to the shoulder. This is
because the supraclavicular nerves, which cover the shoulder, have the same nerve origins (C3,4,5).
7. When would parenteral feeding be utilised over enteral feeding?
A. High risk of aspiration
B. Dysphagia
C. High risk of refeeding syndrome
D. Dysfunctional small bowel
ANS-D) Dysfunctional small bowel
All of these options do not preclude the use of enteral feeding except small bowel dysfunction. If the small
bowel is dysfunctional then TPN should be utilised
8. In obesity, which of the following is the most likely to lead to increased mortality?
A. Cardiovascular disease
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B. Diabetes
C. Depression
D. Metabolic syndrome
ANS-A) Cardiovascular disease
Explanation:Cardiovascular disease is greatly increased in obesity and is one of the biggest causes of mortality.
9. Which of the following is not a common feature of acute salicylate poisoning?
A. Hepatic dysfunction
B. Hyperventilation
C. Tinnitus
D. Nausea and vomiting
E. Deafness
ANS-A) Hepatic dysfunction
Hepatic dysfunction is a rare feature of acute poisoning is more often seen in chronic overdose.
10. Which of the following autoantibodies is found in type 1 diabetes mellitus?
A. Rheumatoid factor
B. Anti GAD
C. Anti alpha cells
D. Antiendomysial antibodies
ANS-B) Anti GAD
GAD autoantibodies which are directed against islet cells can occur in type 1 diabetes mellitus.
11. Which of the following is most indicative of type 1 diabetes mellitus rather than type 2 diabetes mellitus?
A. Peripheral neuropathy
B. Weight loss
C. Family history
D. Onset in early 20s
ANS-B) Weight loss
Weight loss is more suggestive of type 1. Type 2 diabetes mellitus due to rising rates of obesity unfortunately is
occurring in young patients also. Retinopathy and peripheral neuropathy occur in both and bot have a genetic link.
12. Which of the following pairs shows the correct enzyme as the rate limiting step for the reaction?
A. Glycogen synthase : glycogenolysis
B. Carnitine acyl transferase : fatty acid oxidation
C. Glycogen phosphorylase : glycogenesis
D. HMG CoA reductase : Glycolysis
E. Phosphofructokinase 1 : cholesterol synthesis
ANS-B) Carnitine acyl transferase : fatty acid oxidation
Carnitine acyl transferase is the rate limiting step for fatty acid beta oxidation. The rate limiting step for
glycogenesis is glycogen synthase and for glycogenolysis is glycogen phosphorylase. The rate limiting step for
cholesterol synthesis is HMG CoA reductase.
13. Which biochemical test is most helpful in differentiating chronic from acute renal failure?
A. Calcium
B. Potassium
C. Sodium
D. Bicarbonate
ANS-A) Calcium
In chronic renal failure there is reduced synthesis of calcitriol as there is reduced 1 hydroxylation. This occurs over some
time and is not observed in acute renal failure.
14. Which of the following is consistent with the diagnosis of Gilberts syndrome?
A. Increased conjugated bilirubin, reduced unconjugated bilirubin, raised urinary urobilinogen
B. Increased conjugated bilirubin, reduced unconjugated bilirubin, low urinary urobilinogen
C. Increased unconjugated bilirubin, reduced conjugated bilirubin, raised urinary urobilinogen.
D. Increased unconjugated bilirubin, reduced conjugated bilirubin, low urinary urobilinogen
ANS-D) Increased unconjugated bilirubin, reduced conjugated bilirubin, low urinary urobilinogen
Gilberts syndrome leads to an unconjugated hyperbilirubinaemia. This therefore leads to a high levels of unconjugated
bilirubin, low conjugated and reduced levels of urobilinogen in the urine as unconjugated bilirubin is water insoluble
15. Which pair is correct in regards to the type of porphyria and the correct deficiency?
A. Acute intermittent porphyria : Porphobilinogen
B. Porphyria cutanea tarda : coproporphyrinogen
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C. Hereditary coproporphyria : Uroporphyrinogen decarboxylase

D. Variegate Porphyria : ferrochelatase
ANS-A) Acute intermittent porphyria : Porphobilinogen
Acute intermittent porphyria is due to porphobilinogen deficiency and is autosomal dominant. Porphyria cutanea tarda
is due to deficiency of protoporphyrinogen decarboxylase, hereditary coproporphyria due to Coproporphyrinogen
oxidase deficiency and variegate porphyria due to deficiency of protoporphyrinogen oxidase.
16. Which is true of low density lipoproteins?
A. They contain a lower proportion of cholesterol compared to VLDL
B. Hepatic LDL receptor levels decrease with statins
C. Apolipoprotein B100 acts as a ligand for LDL receptors
D. Insulin promotes LDL formation
ANS-C) Apolipoprotein B100 acts as a ligand for LDL receptors
A LDL molecule contains a apolipoprotein B100 at its core which acts as a ligand for LDL receptors. LDL contains a
higher proportion of cholesterol than VLDL. When a statin is taken and cholesterol levels drop, hepatic LDL receptor
levels increase in an attempt to absorb more cholesterol. HDL transports cholesterol from peripheral cells to the
liver
17. What is the best treatment for familial dysbetalipoproteinaemia?
A. Statin
B. Nicotinic acid
C. Fibrate
D. Ezetimibe
ANS-C)| Fibrate
Fibrates are effective against high cholesterol and hyperlipidaemia. Bile acid sequestrants only act against
cholesterol and may actually increase triglyceride levels. Ezetimibe and statins act to lower only cholesterol.
Nicotinic acid would lower lipids and cholesterol but are poorly tolerated.
18. Which is an acute porphyria?
A. Porphyria cutanea tarda
B. Hereditary coproporphyria
C. Erythropoietic protoporphyria
D. None of the others
ANS-D) None of the others
The acute porphyrias are acute intermittent porphyria and variegate porphyria and both are due to abnormal haem
metabolism. Both are autosomal dominant and cause a variety of symptoms including abdominal pain, bowel change,
weakness, seizures and neurological disturbance. Variegate porphyria additionally causes photosensitivity.
19. Half of aldosterone is bound to which of the following?
A. Albumin
B. Chylomicron
C. Sex hormone binding globulin
D. Corticosteroid binding globulin
ANS-D) Corticosteroid binding globulin
Approximately half of aldosterone is free and half is bound to albumin.
20. Which of the following molecules in pulmonary surfactant is mainly responsible for reducing surface tension?
A. DPPC
B. SP-A
C. DMPC
D. Phosphatidylcholine
ANS-A) DPPC
DPPC (dipalmitoylphosphatidylcholine) comprises the largest proportion of pulmonary surfactant. It is a phospholipid
and is the main molecule for reducing surface tension. Other phospholipids such as DMPC and phosphatidylcholine also
play a role. Surface associated proteins (SP-A, B, C and D) account for 10%.
21. Which of the following is found with familial hypercholesterolaemia?
A. Xanthelasma palpebrarum
B. Arcus senilis
C. Digital xanthomata
D. Palmar xanthomata
ANS-A) Xanthelasma palpebrarum
Xanthelasma palpebrarum is indicative of familial hypercholesterolaemia.
22. Which GLUT transporter plays a role in glucose sensing?
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A. GLUT 2
B. GLUT 1
C. GLUT 4
D. GLUT 5
ANS-A) GLUT 2
GLUT 2 is found on beta cells and transports glucose into these cells and thus is important in glucose sensing
23. What is the target of rheumatoid factor?
A. Chondrocytes
B. Constant region of IgM
C. Constant region of IgG
D. Variable region of immunoglobulins
ANS-C) Constant region of IgG
Rheumatoid factor is directed at the constant region of IgG.
24. In a patient with symptomatic acute iron poisoning who presents 4 hours post ingestion, how should they be managed?
A. Gastric Lavage
B. Activated Charcoal
C. Desferrioxamine
D. Whole bowel irrigation
ANS-C) Desferrioxamine
Desferrioxamine is a chelating agent and should be utilised in symptomatic or severe ingestion. Activated charcoal is
not shown to be helpful. Gastric lavage is only useful if the patient presents less than one hour after ingestion.
Whole bowel irrigation can be useful if there is still undissolved tablets and this can be checked via an xray.
25. Which is true of Crigler Najjar syndrome?
A. Autosomal recessive disease with severe conjugated hyperbilirubinaemia
B. Autosomal recessive disease with mild unconjugated hyperbilirubinaemia
C. Autosomal recessive disease with mild conjugated hyperbilirubinaemia
D. Autosomal recessive disease with severe unconjugated hyperbilirubinaemia
ANS-D) Autosomal recessive disease with severe unconjugated hyperbilirubinaemia
Crigler Najjar syndrome is a rare autosomal recessive condition that results in severe unconjugated
hyperbilirubinaemia due to a lack of glucuronyl transferase.
26. A patient presents with acute renal failure secondary to rhabdomyolysis. Which other biochemical abnormalities may be
seen?
A. Hypokalaemia and metabolic acidosis
B. Hyperkalaemia and metabolic acidosis
C. Hyperkalaemia and metabolic alkalosis
D. Hypokalaemia and metabolic alkalosis
ANS-B) Hyperkalaemia and metabolic acidosis
In rhabdomyolysis there is breakdown of muscle fibres and leakage of intracellular substances. Potassium in the main
intracellular ion and thus rhabdomyolysis can lead to hyperkalaemia and metabolic acidosis.
27. A patient presents with enlargement of his hands, feet and tongue. What investigation would you order?
A. Fasting glucose test, GH and IGF1 levels
B. Hourly growth hormone levels
C. Glucose tolerance test, GH and IGF1 levels
D. ACTH levels
ANS-C) Glucose tolerance test, GH and IGF1 levels
Acromegaly is the likely diagnosis and is caused by high levels of growth hormone. Growth hormone fluctuates throughout
the day and cannot be diagnosed with hourly growth hormone levels alone. A glucose tolerance test, in which 75g of glucose
is given and blood GH levels are subsequently measured, would demonstrate suppressed GH levels in a normal patient. IGF1
is also an accurate test and some argument that this alone is enough for diagnosis.
28. At what time of the day should the cortisol level be at its lowest?
A. 9 am
B. Midnight
C. Midday
D. 6 pm
ANS-A)
Cortisol is at its lowest level at midnight. It shows a circadian rhythm being highest in the morning
29. A patient with known alcohol excess presents with confusion, ataxia and nystagmus. Which vitamin deficiency is likely to
have leads to these symptoms?
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A. Vitamin B12
B. Vitamin B1
C. Vitamin E
D. Folate
ANS-B) Vitamin B1
This is the classical triad of Wernicke Korsakoff syndrome which is due to thiamine deficiency.
30. Which of the following if taken at toxic levels would lead to a respiratory alkalosis?
A. Benzodiazipines
B. Monoamine oxidase inhibitors
C. Paracetamol
D. Salicylate
ANS-D) Salicylate
Hyperventilation occurs secondary to salicylate poisoning and none of the other options thus t us the most likely to lead
to a respiratory alkalosis.
31. Which of the following suggests a poor prognosis at the first episode of schizophrenia?
A. ADHD diagnosis
B. A family history of depression
C. Low intelligence
D. A recent bereavement
Ans-C) Low intelligence
32. Which of the following herbal medicines cannot be taken with antidepressants?
A. Grape seed extract
B. Royal Jelly
C. St Johns wort
D. Chondroitin sulfate
Ans-C) St Johns wort
33. A patient is discovered to have autosomal dominant polycystic kidney disease. Who should be screened and what method
should be utilised?
A. Genetic testing for first degree relatives
B. Ultrasound for first degree relatives
C. Ultrasound and genetic testing of first degree relatives
D. Regular urine dipstick of first degree relatives
Ans-B) Ultrasound for first degree relatives
34. Which of the following ocular signs would you find in acne rosacea?
A. Uveitis
B. Swollen optic disc
C. Keratitis
D. Cataract
Ans-C) Keratitis
35. How is the majority of cortisol metabolised and excreted from the body?
A. Metabolised in liver and excreted in the urine as cortisol
B. Metabolised in liver and excreted in bile acids as conjugated metabolites
C. Metabolised in liver and excreted in bile acids as free cortisol
D. Metabolised in liver, metabolites conjugated and excreted in the urine
Ans-D) Metabolised in liver, metabolites conjugated and excreted in the urine
36. Where is B type natriuretic peptide secreted from?
A. Right atrium
B. Ventricles
C. Left atrium
D. Carotid body
Ans-B) Ventricles
37. A 32 year old male who has rheumatoid arthritis is wishing to start a family with his partner. However there has been
difficulty in conceiving and further investigation reveals a low sperm count. Which of the following drugs is the most likely
cause?
A. Azathioprine
B. Hydroxychloroquine
C. Methotrexate
D. Sulfasalazine
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Ans-D) Sulfasalazine
38. Which one of the following atypical antipsychotics is most likely to cause weight gain?
A. Risperidone
B. Quetiapine
C. Olanzapine
D. Aripiprazole
Ans-C) Olanzapine
39. In angina, which of the following accounts for some of the therapeutic effect of beta blockers?
A. Increased heart rate
B. Peripheral vasodilatation
C. Decreased heart rate
D. Peripheral vasoconstriction
Ans-C) Decreased heart rate
40. In a patient with a HB of 19 g/dL and a haematocrit of 0.45, what test should be ordered to confirm this is a true
polycythaemia?
A. EPO level
B. Bone Marrow Biopsy
C. Platelet count
D. Red cell volume
Ans-D) Red cell volume
41. What is not true regarding Aldesleukin therapy?
A. Interleukin 6 analogue
B. Interleukin 2 analogue
C. Given as slow IV infusion
D. Can lead to hypotension
Ans-A) Interleukin 6 analogue
42. A patient with von Willebrands disease is requiring surgery. How should you manage this patient?
A. Platelet transfusion
B. DDAVP and tranexamic acid
C. Fresh frozen plasma
D. Cryoprecipitate
Ans-B) DDAVP and tranexamic acid
43. A patient post operatively is found to have a prolonged APTT, high normal PT, prolonged TT and normal reptilase. What does
this indicate?
A. DIC
B. Liver disease
C. Dysfibrinogenaemia
D. Contamination of sample with heparin
Ans-D) Contamination of sample with heparin
44. What is the most likely complication of aplastic anaemia?
A. Thromboses
B. Infections
C. GI haemorrhage
D. Splenic infarct
Ans-B) Infections
45. Which of the following genetic mutations is associated with the worst prognosis in acute lymphoblastic leukaemia?
A. t(12;21)
B. t(4;11)
C. t(9;22)
D. inv 16
Ans-C) t(9;22)
46. All trans retinoic acid is utilised in the management of promyelocytic leukaemia. What is its mechanism of action?
A. Promotes differentiation of blast cells into mature cells
B. Prevents division of blasts cells
C. Promotes differentiation of mature cells into blast cells
D. Acts as a granulocyte colony stimulating factor
Ans-A) Promotes differentiation of blast cells into mature cells
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47. A 32 year old man is found to have a cerebellar haemangioblastoma. His history reveals that his father had a kidney cancer
and his brother is undergoing surgery to remove a pheochromocytoma. What is the diagnosis?
A. Polycystic kidney disease
B. Multiple endocrine neoplasia type 1
C. Multiple endocrine neoplasia type 2A
D. Von Hippel Lindau disease
Ans-A) Polycystic kidney disease
48. Which of the following provides a definitive diagnosis of myotonic dystrophy?
A. Muscle biopsy
B. Nerve conduction studies
C. Genetic testing
D. MRI
Ans-C) Genetic testing
49. A blood film shows Heinz bodies. What is the likely underlying condition?
A. Glucose 6 phosphate dehydrogenase deficiency
B. Sickle Cell Anaemia
C. Autoimmune haemolytic anaemia
D. Hereditary spherocytosis
Ans-A) Glucose 6 phosphate dehydrogenase deficiency
50. In a patient with renal artery stenosis what is the imaging modality of choice?
A. Radionuclide scans
B. CT angiography
C. CT abdomen
D. Magnetic resonance angiography
Ans-D) Magnetic resonance angiography
51. There is evidence of a paraprotein band in a patients blood results. How do you differentiate between a myeloma or MGUS?
A. Levels of different immunoglobulins
B. Bence Jones Protein
C. Hypercalcaemia
D. Beta 2 glycoprotein
Ans-B) Bence Jones Protein
52. Which of the following is involved in in a tuberculin skin reaction?
A. NK Cells
B. Immune Complex Deposition
C. Interferon Gamma
D. Interleukin 10
Ans-C) Interferon Gamma
53. A 56 year old with recently diagnoses COPD presents with shortness of breath and wheeze. Blood gases reveal a PO2 of 8.6
kPa, PCO2 of 6.8 kPa, Ph of 7.25 and a bicarbonate of 24. What do these gases indicate?
A. Respiratory acidosis with metabolic compensation
B. Acute respiratory acidosis
C. Acute on chronic respiratory acidosis
D. Metabolic acidosis
Ans-B) Acute respiratory acidosis
54. Which of the following organisms is associated with a cavitating upper lobe pneumonia?
A. Pneumocystis jiroveci
B. Staphylococcus Aureus
C. Mycoplasma pneumoniae
D. Klebsiella pneumoniae
Ans-D) Klebsiella pneumoniae
55. In some cases of familial primary pulmonary hypertension, mutation of bone morphogenic protein receptor 2 on
chromosome 2q33 is thought to be responsible. What does this gene encode?
A. TNF alpha
B. TGF beta
C. Interleukin 6
D. Interleukin 10
Ans-B) TGF beta
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56. A patient with HIV presents with fever, malaise, dyspneoa, diarrhoea, generalised lynphadenopathy and significant weight
loss. His CD4 count is 20. There is evidence of tender hepatosplenomegaly. What is the most likely causative agent?
A. Histoplasmosis
B. Toxoplasmosis
C. Mycobacterium avium complex
D. Cryptococcus
Ans-C) Mycobacterium avium complex
57. What is the role of primaquine in treatment of plasmodium vivax?
A. Clears hypnozoites in liver
B. Prevents digestion of haemoglobin in erythrocytic stage of parasite
C. Clears sporozoites
D. Prevents schizonts from rupturing cell membrane
Ans-A) Clears hypnozoites in liver
58. What is the most common gastrointestinal complication seen in SLE?
A. Lymphogranuloma venereum
B. Primary Sclerosing Cholangitis
C. Mouth ulcers
D. Hepatitis
Ans-C) Mouth ulcers
59. A 33 year old female presents with symmetrical polyarthritis, affecting predominantly her PIPs and her wrists. It takes about
3 hours for her joints to loosen off in the morning. She is found to have a very positive rheumatoid factor. What would you
expect to see on an x-ray of her hands?
A. Widened joint space
B. Juxta-articular sclerosis
C. Osteophyte formation
D. Juxta-articular osteopaenia
Ans-D) Juxta-articular osteopaenia
60. What HLA type is associated with rheumatoid arthritis?
A. HLA DQ2
B. HLA DR4
C. HLA B27
D. HLA B51
Ans-B) HLA DR4
61. What provides the best description of a crossover trial?
A. Longitudinal study where subjects receive a sequence of some treatments
B. Longitudinal study where patient receives treatment followed by placebo
C. Longitudinal study where subjects receive a sequence of all treatments
D. Studies side effects
Ans-C) Longitudinal study where subjects receive a sequence of all treatments
62. Which of the following bias are meta analysis most susceptible to?
A. Publication bias
B. Methodological bias
C. Statistical analysis
D. Volunteer bias
Ans-A) Publication bias
63. A research team believe that 5 genes can be used to predict the length of time someone will have the common cold for. 500
patients with colds are studied to measure the length of time they had their cold. How should you analyse the results?
A. Chi square testing
B. Paired t test
C. Linear regression
D. F test
Ans-C) Linear regression
64. A researcher believes that night shift work raises stomach cancer incidence. Which study would be the most suitable to look
into this relationship?
A. Randomised control trial
B. Retrospective case control study
C. Prospective cohort study
D. Randomised cross over trial
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Ans-B) Retrospective case control study

65. A trial is performed to study the effect of fish oil on post operative infection rates. The relative risk of infection compared to
those on placebo is 0.8 with a 95% confidence interval of 0.6 to 1. Which of the following is true?
A. There was no statistically significant difference in infection rate when fish oil was used
B. There was an 80% decrease in infections
C. 80% of patients didnt have an infection
D. The standard deviation was 0.2
Ans-A) There was no statistically significant difference in infection rate when fish oil was used
66. How does lactulose work?
A. Increased motility
B. Bulk forming laxative
C. Softens faecal matter
D. Increased faecal pH
Ans-C) Softens faecal matter
67. Which of the following contributes the most to weight loss in colorectal cancer?
A. TNF a
B. Diarrhoea
C. Anorexia
D. Chemotherapy
Ans-C) Anorexia
68. The C282Y mutation on chromosome 6 is associated with which disease?
A. HNPCC
B. Haemochromatosis
C. Gilberts syndrome
D. FAP
Ans-B) Haemochromatosis
69. In ulcerative colitis, which of the following is not an indication for the use of Azathioprine?
A. Disease relapses within 6 weeks of stopping steroids
B. Disease relapses after reducing steroids
C. Intolerant to steroids
D. As first line with mesalazine
Ans-D) As first line with mesalazine
70. Which of the following would score 3 on the Child Pugh classification?
A. Albumin less than 28
B. PT of 2.0
C. Encephalopathy grade I
D. Mild ascites
Ans-A) Albumin less than 28
71. What is indicative of a parietal lesion?
A. Superior homonymous Quadrantanopia
B. Visual inattention
C. Hallucinations
D. Personality Change
Ans-B) Visual inattention
72. A patient with long standing Rheumatoid arthritis presents with features of mononeuritis multiplex. There is also evidence of
nail fold infarcts. Bloods reveal an elevated ESR and positive pANCA. Which of the following is the most likely cause of these
clinical findings?
A. Rheumatoid Vasculitis
B. Wegener's Granulomatosis
C. AA amyloidosis
D. AL Amyloidosis
Ans-A) Rheumatoid Vasculitis
73. A 50 year old female has noticed loss of taste, facial weakness and hypersensitivity to sound. On examination there is a left
facial nerve palsy including the forehead and reduced sensation on the left side of the face. What structure is likely to be
involved?
A. Parotid gland
B. Auditory canal
C. Cerebellopontine angle
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D. Left Facial nerve

Ans-C) Cerebellopontine angle
74. A 48 year old female is complaining of repeatedly burning her right hand as she is unaware of the temperature. She also has
occipital headaches which are worsened by sneezing and coughing. Which of the following is the likely diagnosis?
A. Space Occupying lesion
B. Syringomyelia
C. Peripheral Neuropathy
D. Cervical Disc Prolapse
Ans-B) Syringomyelia
75. In motor neurone disease, where is the site of the lesion?
A. Corticospinal tract
B. White matter of spinal cord
C. Motor axons
D. Anterior horn cells of spinal cord
Ans-D) Anterior horn cells of spinal cord
76. Which of the following can differentiate between cranial diabetes insipidus and nephrogenic diabetes insipidus?
A. Increased plasma osmolality during water deprivation test
B. Desmopressin leads to more concentrated urine
C. Desmopressin does not lead to more concentrated urine
D. Dilute urine despite water deprivation
Ans-B) Desmopressin leads to more concentrated urine
77. What is the mechanism of action of bisphosphonates?
A. Inhibits farnesyl pyrophosphate synthase, inhibiting osteoclasts activity
B. Inhibits farnesyl pyrophosphate synthase, stimulating osteoblasts activity
C. Inhibits farnesyl pyrophosphate synthase, stimulating osteoclasts activity
D. None
Ans-A) Inhibits farnesyl pyrophosphate synthase, inhibiting osteoclasts activity
78. A 24 year old nurse is brought to A+E. She has collapsed. She had told people prior to this she was feeling nauseous, anxious,
sweaty and having a headache. Her BM is 1.2 mmol/L. How would you differentiate this being self administration of insulin
rather than an insulinoma?
A. Bruising of skin suggesting injection
B. High insulin level
C. C peptide level high
D. C peptide level normal
Ans-D) C peptide level normal
79. Rheumatoid factor is most commonly which immunoglobulin class?
A. A.IgM
B. B.IgG
C. C.IgA
D. D.IgE
Answer is A: IgM
The most common immunoglobulin class of RA is IgM but they can also be a of the IgA and IgG class.
80. In a patient with a oculomotor nerve palsy, which of the following would distinguish between a medical (ischaemic) and
surgical (compressive) lesion?
A. B.Hyperhydrosis of the affected side
B. A.Pupil involvement
C. C.Facial paralysis
D. D.Inability to abduct the eye
Answer is B: Pupil involvement
The oculomotor nerve carries motor nerves and parasympathetic fibres which both arise from different parts of the
brain. An ischaemic lesion will only effect the nucleus of motor fibres, sparing the oculomotor nerves and therefore the
pupil.
81. What would be found on fundoscopy if a patient has maculopathy?
A. B.Macular oedema, ischaemia and cotton wool spots
B. C.Flame haemorrhage and cotton wool spots
C. A.Macular oedema, ischaemia and hard exudates
D. Neovascularisation
Answer is C : Macular oedema, ischaemia and hard exudates
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Maculopathy is characterised by macular oedema, ischaemia and hard exudates. The exudates may be arranged in a
circle surrounding leaking vessel.
82. Which of the following drugs is not associated with increased risk of lithium toxicity?
A. A.Erythromycin
B. B.Losartan
C. C.Diclofenac
D. D.Furosemide
Answer is A: Erythromycin
Diuretics that promote renal sodium loss can lead to increased toxicity. ACE inhibitors reduce glomerular filtration rate
and enhance tubular reabsorption of lithium thus increasing toxicity risk. NSAIDs also affect glomerular filtration rate
and change prostaglandin synthesis in the kidneys thus increasing its toxicity.
83. Which of the following is the most appropriate treatment of renal osteodystrophy?
A. Ergocalciferol and calcium supplementation
B. Colecalciferol and calcium supplementation
C. Calcium supplementation
D. Alfacalcidol and calcium supplement
Answer is D: Alfacalcidol and calcium supplement
In renal osteodystrophy there is hypocalcaemia secondary to reduced vitamin D hydroxylation. There is also increased
PTH. Alfacalcidol should be utilised rather than the other vitamin D analogues as there is reduced action of 1
hydroxylase in the kidneys. Alfacalcidol is 1 alpha hydroxy vitamin D and does not require hydroxylation by the kidneys
to be active whilst the others contain cholecalciferol which require renal hydroxylation before they are active. Calcium
aids in binding the excess phosphate which occurs due to failure of its excretion.
84. What happens to the pulmonary vasculature in a patient with pneumonia?
A. Vasodilatation of vessels in area of lung with pneumonia and vasoconstriction in normal lung
B. Vasoconstriction of vessels in area of lung with pneumonia and vasodilatation in normal lung
C. Vasoconstriction of vessels in area of lung with pneumonia and vasoconstriction in normal lung
D. No change
Answer is B: Vasoconstriction of vessels in area of lung with pneumonia and
vasodilatation in normal lung.
When a pneumonia is present, shunting occurs where there is vasoconstriction to the lung tissue affected by the
pneumonia and vasodilatation occurs in the unaffected areas to reduce the blood supply to poorly oxygenated areas.
85. Which of the following ABGs results is due to an error in the analysis?
A. pH 7.39; pO2 11.1 kPa; pCO2 3.7 kPa; bicarbonate 18mmol/l
B. pH 7.38; pO2 11.8 kPa; pCO2 5.6 kPa; bicarbonate 26 mmol/
C. pH 7.25; pO2 11.1 kPa; pCO2 2.8 kPa; bicarbonate 26 mmol/
D. pH 7.38; pO2 10.6 kPa; pCO2 6.5 kPa; bicarbonate 34 mmol/l
Answer is C: pH 7.25; pO2 11.1 kPa; pCO2 2.8 kPa; bicarbonate 26 mmol/
This result reveals a pH which is low suggesting an acidosis despite a low CO2 and normal bicarbonate which
suggests there is a respiratory alkalosis. The rest are feasible blood gases.
86. A 40 year old with brittle asthma presents with left hip and groin pain. It is very painful to weight bear. An x-ray reveals no
evidence of a fracture. What investigation will give the definitive diagnosis?
A. MRI of the left hip
B. X-ray of left knee
C. Arthroscope of left knee
D. Autoantibodies
Ans-A) MRI of the left hip
The most likely diagnosis given the clinical findings and history of brittle asthma is avascular necrosis of the femoral
head. Steroid use is a major risk factor as is use of long term heparin, sickle cell disease and alcohol excess. MRI is
useful if it is suspected and x-ray is normal.
87. What is the most common finding in blood testing for those with SLE?
A. ANA
B. Low complement levels
C. Anti double-stranded DNA
D. Anticardiolipin antibody
Ans-B) Low complement levels
Due to SLE being an autoimmune disease and immune complex formation, complement levels are reduced. Anti dsDNA
is specific but only seen in about a third of patients. RF is evident in about 30 to 50 per cent. Anticardiolipin can be
evident and evidences the presence of antiphospholipid syndrome.
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88. Which of the following is a feature on Xray of Rheumatoid Arthritis?

A. Loosers Zones
B. Osteophytes
C. Periarticular osteopenia
D. Lytic lesions
Ans-C) Periarticular osteopenia
Periarticular osteopenia is a characteristic Xray feature. Loosers zones are seen in osteomalacia. Osteophytes are seen in
osteoarthritis.
89. Rheumatoid factor is most commonly which immunoglobulin class?
A. IgM
B. IgG
C. IgA
D. IgE
Ans-A) IgM
The most common immunoglobulin class of RA is IgM but they can also be a of the IgA and IgG class
90. Which of the following carries the highest risk of developing SLE?
A. Monozygotic twin
B. Dizygotic twin
C. 2 times first degree relative
D. HLA
Ans-A) Monozygotic twin
The greatest risk is with monozygotic twins. HLA B27 is associated with seronegative spondylarthropathies.
91. A 14 year old runner presents with knee pain. There is no history of trauma. There is nil of note on examination and an x-ray
is normal. What is the most likely diagnosis?
A. Osteochondritis dissecans
B. Suprapatellar bursitis
C. ACL rupture
D. Osgood
Ans-D) "Osgood
92. A 25 year old female complains of chest pain. She is known to have a history of SLE. Examination reveals no abnormality.
There is evidence of diffuse ST elevation on an ECG. What due to you think is the likely cause of her chest pain?
A. Libman
B. Myocarditis
C. Pericarditis
D. Cardiac Tamponade
Ans-C) Pericarditis
Pericarditis is the most common process in SLE and would explain the widespread ST elevation. Myocarditis is less
common. STEMI is very unlikely. Libman-Sacks Syndrome is a non-infective endocarditis occurring in SLE. You would
expect to hear a murmur. It is rare.
93. A 39 year old presents with malaise, myalgia and weight loss. She has had a cough and recurrent haemoptysis. She has also
noticed a rash. On examination there is evidence of palpable purpura. ANCA PR3 and ANCA MPO are positive and an
eosinophil count is normal. What is the most likely diagnosis?
A. Wegeners granulomatosis
B. Churg Strauss syndrome
C. Polyarteritis Nodosa
D. Microscopic polyangiitis
Ans-D) Microscopic polyangiitis
Microscopic polyangiitis given the history and the positivity of ANCA-PR3 and ANCA-MPO. These autoantibodies are also
observed in Churg-Strauss but there is also an associated eosinophilia. These autoantibodies are less common in
Wegeners granulomatosis. Goodpastures anti GBM is found and the history is not indicative of PAN.
94. What tissue is the most commonly involved in Wegeners Granulomatosis?
A. Renal
B. Lungs
C. Nervous
D. Skin
Ans-B) Lungs
Wegeners granulomatosis affects the upper respiratory tract and lungs in 90% of cases as it most commonly presents as
rhinorrhoea then nasal mucosal ulceration and cough, haemoptysis and pleuritic pain. Renal tissue is affected in 80% of
12 | P a g e
cases, musculoskeletal system in 60%, gastrointestinal tract in about half of cases and the skin is less commonly involved
with only 40% affected.
95. What is the most common respiratory complication in SLE?
A. Pleural effusion
B. Restrictive Lung Disease
C. LRTI
D. Pneumonitis
Ans-A) Pleural effusion
The most common respiratory complication of SLE is pleural effusions. Pneumonitis and atelectasis can also occur.
Restrictive lung disease then develops. Obstructive lung disease is not seen.
96. What clinical finding is most commonly found in the hands of a patient with rheumatoid arthritis?
A. Boutonni
B. Swan-neck deformity
C. Ulnar deviation of the MCPs
D. Bouchards Nodes
Ans-C) Ulnar deviation of the MCPs
The most common deformity is ulnar deviation of the MCPs and palmar subluxation.
97. A 19 year old male is complaining of back pain. It is stiff in the morning and the pain and stiffness eases with exercise. What
are you likely to find on clinical examination?
A. Positive straight leg raising
B. Tenderness over the sacroiliac joint
C. Tenderness over the thoracic spine
D. Nil specific
Ans-B) Tenderness over the sacroiliac joint
The likely diagnosis is ankylosing spondylitis which leads to sacroiliitis thus the clinical finding of tenderness over the
sacroiliac joint. The other options are not indicative of ankylosing spondylitis.
98. ll is true for about foreign body impaction in ear except ?
A. Syringing is used for removal of vegetable foreign body
B. Object located medial to isthmus of canal is diffuclt to remove
C. GA is preffered in children to remove foreign bodies
D. Blunt hook is used to remove rounded foreign body
Ans: A Syringing is used for removal of vegetable foreign body
Syringing is contraindicated for living vegetable foreign body
99. True about Secretory otitis media except?
A. Flat tympanogram is present
B. Presence of cleft palate reduces its chance
C. Type C tympanogram may be seen in early stage of otitis media with effusion
D. Most common cause is Eustachian tube dysfunction
Ans: B) Presence of cleft palate reduces its chance
Impedance audiometry show a flat curve with a shift in compliance to the negative side.
100. Which of these is true of obstructive sleep apnea syndrome?
A. Snoring and day time sleepiness is the most common presentation
B. Polysomnography is the only investigation that will decide the treatment
C. Any cessation of breathing for more than 10 seconds is called apnea
D. All of the above
Ans A) Snoring and day time sleepiness is the most common presentation
101. Singh shown in photograph occure due to injury of?
A. Radial nerve
B. Median nerve
C. Ulnar nerve
D. Axillary nerve
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Ans-C) Ulnar nerve

102. Structure shown in photograph comprise of?
A. Association fibers
B. Projection fibers
C. Commissural fibers
D. None of the above
Ans-C) Commissural fibers
103. Length of fibromuscular shown in photograph is?
A. 3-5 cm
B. 5-10 cm
C. 10-15 cm
D. 15-20 cm
Ans-D) 15-20 cm
104. Joint shown in photograph is a type of?
A. Gomphosis
B. Syndesmosis
C. Symphysis
D. Schindylesis
Ans-D) Schindylesis
105. Photograph shown depicts pressure recordings from….&…..?
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A. LV & aorta in aortic regurgitation

B. LV & aorta in normal person
C. RV & pulmonary artery in normal person
D. LV & aorta in aortic stenosis
Ans-B) LV & aorta in normal person
106. Identify the cell type layer shown in photograph of cerebellar cortex?
A. Molecular layer
B. Purkinje cell layer
C. Granular cell layer
D. Climbing fibers
Ans-B) Purkinje cell layer
107. Identify phase 1 as shown in the photograph of cardiac muscle action potential?
A. Rapid depolarization
B. Rapid repolarisation
C. Slow repolarisation
D. Complete repolarisation
Ans-B) Rapid repolarisation
108. Michaelis Menten curve below characterizes an allosteric enzyme system.true statement is?
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A. Modifier at the allosteric site can affect the catalytic site too
B. Substrate to enzyme is concentration independent
C. Allosteric modifier is non-competitive
D. Allosteric modifier doesn’t affect the velocity of the reaction
Ans-A) Modifier at the allosteric site can affect the catalytic site too
109. Test shown in the photograph is positive for?
A. Bilirubin in urine
B. Sugar in urine
C. Protein in urine
D. Ketone bodies in urine
Ans-D) Ketone bodies in urine
110. Intermediate of glycolysis shown in photograph occure in?
A. RBCs
B. Liver
C. Kidney
D. Brain
Ans-A) RBCs
111. Identify the method shown in the photograph
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A. Chromosome banding
B. Karyotyping
C. PCR
D. DNA Fingerprinting
Ans-B) Karyotyping
112. Glucose in transported in organ(box)shown in photograph via?
A. GLUT-1
B. GLUT-2
C. GLUT-3
D. GLUT-4
Ans-B) GLUT-2
113. Identify the Instrument shown in the photograph?
A. Glucometer
B. pH meter
C. Spectrophotometer
D. Serum bilirubin meter
Ans-B) pH meter
114. Identify the Disaccharide shown in the photograph?
A. Maltose
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B. Isomaltose
C. Sucrose
D. Lactose
Ans-A) Maltose
115. Sheets are produced by type of molecule shown in photograph?
A. 1
B. 2
C. 4
D. 6
Ans-C) 4
116. Transport shown in the photograph is done by…..amino acid?
A. Lysine
B. Arginine
C. Alanine
D. Glutamate
Ans-C) Alanine
117. Anaemia shown in photograph of smear is found in deficiency of?
A. Vitamin A
B. Vitamin B6
C. Vitamin B12
D. Vitamin C
Ans-C) Vitamin B12
118. Disease shown in the photograph is a disorder of?
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A. Purine
B. Pyrimidine
C. Glycogen
D. Fatty acid oxidation
Ans-A) Purine
119. Condition shown in photograph is due to deficiency of?
A. Niacin
B. Iron
C. Zinc
D. Selenium
Ans-C) Zinc
120. Rule shown in photograph was given by
A. Watson & Crick

B. Chargaff
C. H.Khorana
D. Lederberg & tatum
Ans-B) Chargaff
121. In cell-death, body shown in photograph is derived from?
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A. Nucleus
B. Cell membrane
C. Cytoplasm
D. Mitochondria
Ans-B) Cell membrane
122. Process shown in photograph was discovered by?
A. Virchow
B. Celsus
C. Cohnhein
D. Metchnikoff
Ans-D) Metchnikoff
Endocytosis is the process.
123. Identify the type of haemorrhage shown in photograph?
A. Petechiae
B. Purpura
C. Ecchymosis
D. Thrombosis
Ans-C) Ecchymosis
124. Amyloidosis shown in cardiac muscle is mainly due to …fibril
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A. AL
B. AA
C. ATTR
D. AANF
Ans-C) ATTR
125. Typical appearance of RBCs as shown in the photograph is found in
A. AML
B. Multiple myeloma
C. Hemolytic anaemia
D. Sideroblastic anaemia
Ans-B) Multiple myeloma
this is due to Rouleaux formation.
126. False regarding fluid portion of human blood shown in photograph is
A. Supplies major coagulation factors

B. ABO match not required
C. Should be used in replacement of factors in DIC/trauma
D. Use withing 30-minutes of trauma
Ans-D) Use withing 30-minutes of trauma
127. Peripheral smear of G6PD deficiency show…bodies in photograph
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A. Cabot rings
B. Heinz bodies
C. Howell jolly bodies
D. Dohle bodies
Ans-B) Heinz bodies
128. In photograph depicting Kinetics of Enzyme reaction,5 depicts
A. Enzyme induction
B. Enzyme stimulation
C. Competitive inhibition
D. Non- Competitive inhibition
Ans-D) Non- Competitive inhibition
129. In dose-response curve of the same drug shown in photograph,Therapeutic index would be?
A. A-B
B. A+B
C. A/B
D. B/A
Ans-D) B/A
130. Muscle relaxant of choice for use for instrument shown in photograph
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A. Pancuronium
B. Roxacuronium
C. Succinylcholine
D. Atracurium
Ans-C) Succinylcholine
131. Identify the route of drug administration shown in the photograph
A. Pellet implant
B. Transdermal delivery
C. Topical application
D. Dermojet
Ans-D) Dermojet
132. Condition shown in photograph is due to ?
A. Ancylostoma braziliensis
B. Wuchereria bancrofti
C. Brugia malayi
D. Dracunculus medinensis
Ans-A) Ancylostoma braziliensis
133. Identify the fungus variety shown in the photograph
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A. Histoplasma
B. Penicillium
C. Candida
D. Rhizopus
Ans-D Rhizopus
134. p24 antigen in HIV infection is represented by?
A. 1
B. 2
C. 3
D. None
Ans-C) 3
135. Punishment for Act shown in photograph is dealt with under section?
A. 376 A IPC
B. 497 IPC
C. 498 A IPC
D. 302 IPC
Ans-B) 497 IPC
Expl;this is adultery.
136. Peculiar effect of firearm upon impact shown in the photograph is ?
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A. Yawning bullet
B. Frangible bullet
C. Tumbling bullet
D. Ricochet bullet
Ans-B) Frangible bullet
137. Sexual perversion shown in the photograph is known as
A. Buggery
B. Bestiality
C. Eonism
D. Tribadism
Ans-D) Tribadism
138. Injury on the left anterior chest in the given photograph is?
A. Lacerated wound
B. Chop wound
C. Abrasion
D. Incised wound
Ans-A) Lacerated wound
139. Identify change 4 in photograph showing changes after death?
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A. Cooling
B. Rigor
C. Decomposition
D. Lividity
Ans-D) Lividity
140. Mode of injury shown in photograph is?
A. Telefono
B. Garroting
C. Falanga
D. Mugging
Ans-C) Falanga
141. Identify the distribution shown?
A. Normal distribution
B. Uniform distribution
C. Poisson’s distribution
D. Dirichlet distribution
Ans-A) Normal distribution
142. Identify the statistical diagram shown?
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A. Frequency polygon
B. Histogram
C. Frequency curve
D. OGIVE
Ans-C) Frequency curve
143. False about contraceptive shown
A. Non-steroidal contraceptive
B. Developed by CDRI,Lucknow
C. Pearl index 0.1-0.2 per HWY
D. Once a week pill
Ans-C) Pearl index 0.1-0.2 per HWY
144. Identify the diagram shown
A. Stem and leaf plot

B. Pie chart
C. Venn diagram
D. Flow chart
Ans-C) Venn diagram
145. Identify parameter represented by’Green arrow’
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A. Mean
B. Median
C. Mode
D. Range
Ans-B) Median
146. Identify the symbol
A. Systemic reviews
B. Meta-analysis
C. Evidence based medicine
D. Clinical medicine
Ans-C) Evidence based medicine
147. Diagnose the underlying condition based on tracing in cardiotocograph
A. Head compression
B. Early cord compression
C. Fetal anaemia
D. Fetal distress
Ans-B) Early cord compression
148. Cell cleavage type in embryo shown in photograph is
28 | P a g e
A. Fertilized egg
B. Morula
C. Blastocyst
D. Gastrula
Ans-C) Blastocyst
149. Clinical sign shown in the photograph is known as
A. Chadwick’s sign
B. Osiander’ sign
C. Palmer’ sign
D. Hegar’ sign
Ans-D) Hegar’ sign
150. Foetal scan shown in photograph is useful for prediction of
A. Diabetes
B. Twin pregnancy
C. Down’s syndrome
D. Congenital dislocation of hip
29 | P a g e
Ans-C) Down’s syndrome

151. Maneuver shown in the photograph is known as
A. Fundus palpation
B. Lateral palpation
C. Deep pelvic palpation
D. Pawlik’s grip
Ans-D) Pawlik’s grip
152. Cell types is seen in vagina of a case of
A. HSV
B. Candidiasis
C. Bacterial vaginosis
D. Trichomonas vaginitis
Ans-C) Bacterial vaginosis
153. Ovulation is seen after change shown in photograph
A. 0-6 hours
B. 6-12 hours
C. 12-24 hours
30 | P a g e
D. 24-36 hours
Ans-D) 24-36 hours
154. Identify 1 in the hormonal level depicted in a Menstrual cycle
A. LH
B. FHS
C. Estradiol
D. Progesterone
Ans-B) FHS
155. PID generally occurs after….device insertion
A. 3 weeks
B. 5 weeks
C. 7 weeks
D. 12 weeks
Ans-A) 3 weeks
156. Milestone shown in photograph appears at age of…
A. 6 months
B. 9 months
C. 12 months
D. 18 months
Ans-A) 6 months
157. Identify the instrument as in figure
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A. Rotahaler
B. Metered dose inhaler with spacer
C. Ambu bag
D. Laryngeal mask airway
Ans-B) Metered dose inhaler with spacer
158. Diagnose the skin disorder as shown in figure
A. Tinea capitis
B. Seborrhoeic dermatitis
C. Lichen planus
D. Kerion
Ans-A) Tinea capitis
159. Identify the morphology of skin lesion shown in figure
A. Wheal
B. Scale
C. Plaque
D. Blister
Ans-C) Plaque
160. Typical pattern on direct immune-fluorescene is seen in
32 | P a g e
A. Lichen planus
B. SSSS
C. Pemphigus
D. Leprosy
Ans-C) Pemphigus
161. A 45 year old man presents with acute, profuse, watery diarrhoea some after returning from a holiday in Namibia. Which
one of the following is the most appropriate treatment?
A. Metronidazole
B. Ciprofloxacin
C. Vancomycin
D. Cefuroxime
Ans- B: Ciprofloxacin
Expl; The most likely cause of travellers diarrhoea is E. coli. Ciprofloxacin would cover for this as well as shigella,
salmonella and campylobacter. However, if giardiasis was cultured in the stool then metronidazole is recommended.
162. Which one of the following is a feature of VIPoma syndrome?
A. Hypoglycaemia
B. Hypokalaemia
C. Induction of VIP release by somatostatin
D. Increased gastric acid seceretion
Answer: B- Hypokalaemia
Expl; Features of VIP syndrome include watery diarrhea (100%), hypochlorhydria (70% in adults), hyperglycemia (20-50%
in adults), hypercalcemia (20-50% in adults), flushing (20% in adults) and hypokalaemia due to diarrhoea
163. A 50 year old man has diabetes. He has the following results: Alanine aminotransferase 35 U/L ,Aspartate aminotransferase
40 U/L ,Fasting plasma glucose 7.4 ,Ferritin 500 ug/L, (15-300) ,Which one of the following is an appropriate investigation?
A. Transferrin saturation
B. Serum electrophoresis
C. Serum transferrin receptors
D. Liver biopsy
Answer: A- Transferrin saturation
Exp; In hemochromatosis, the serum Fe is elevated (> 300 mg/dL). The serumtransferrin saturation is a sensitive
parameter of increased Fe and merits evaluation when > 50%. The serum ferritin is increased. Urinary Fe excretion is
markedly increased (> 2 mg/24 h) by the chelating drug deferoxamine (500 to 1000 mg IM based on the size of the
patient), and this has been used as a diagnostic test.
In addition, when the Fe content in the liver is significantly increased, an MRI may reflect this change. Liver biopsy had
been the gold standard in diagnosis; it now serves only to provide evidence of fibrosis (cirrhosis). Gene assay
(Homozygosity C282y mutations) is also an excellent diagnostic test.
164. A 65 year old woman presents with dysphagia and intermittent vomiting. Endoscopy shows a tight lower oesophageal
sphincter suggestive of achalasia. Which of the following medical therapies is most effective?
A. Diltiazem
B. Bismuth
C. Glyceryl trinitrate
D. Botulinum toxin
33 | P a g e
Answer: D- Botulinum toxin

Expl; Botulinum injections are most effective of all the options for relieving a lower oesophageal sphincter restriction
which leads to achalasia. Nifedipine, nitrates or sildenafil can also be used, but are less effective.
165. Which of the following factors decreases large intestinal motility?
A. Parasympathetic activity
B. CCKPZ
C. Gastric Distension
D. Anticholinergic agents
Answer: D- Anticholinergic agents
Expl; Anticholinergic agents, e.g. atropine, reduce intestinal motility. All the other agents increase intestinal motility.
166. Which of the following is a recognised feature of irritable bowel syndrome?
A. Lactase deficiency
B. Bloating
C. A past history of dysentery
D. Diarrhoea but not constipation
Answer: B- Bloating
Expl; Abdominal pain relieved by defecation, bloating, as well as alternating bowel habits is common.
167. Which of the following is the most sensitive test in detecting ongoing infection with Helicobacter pylori?
A. The (13C) urea breath test
B. The urease test on a gastric biopsy
C. A gastric fundal biopsy culture
D. Helicobacter pylori serology
Answer: A- The (13C) urea breath test
Expl; The urea breath test is expensive but has up to 98% sensitivity. The gastric biopsy culture has high specificity but
sensitivity of 90%. Histology of gastric biopsy (not listed above) has both high sensitivity and specificity.
168. A 28 year old intravenous drug user complains about severe epigastric pains, nausea and vomiting. He has upper GI
endoscopy which shows small areas of ulceration and white plaques. Which of the following is the best treatment option?
A. Metronidazole
B. Amoxycillin
C. Ranitidine
D. Fluconazole
Answer: D- Fluconazole
Expl; This is a patient with possible HIV who has oesophageal candidiasis. Fluconazole, ketoconazole and itraconazole
can be used.
169. Which one of the following is an X-ray change which suggests Ulcerative Colitis?
A. Cobblestones
B. Skip lesions
C. Loss of haustral pattern
D. Strictures
Answer: D- Strictures
Expl; Loss of haustral pattern, lead pipe, and shortened colon on the X ray, suggests ulcerative colitis.
In Crohn's disease, transmural inflammation with formation of fissures, ulcers and granulomata, and cobblestone
appearance are seen.
170. Which one of the following drugs is likely to cause cholestatic jaundice?
A. Chlorpromazine
B. Paracetamol
C. Ibuprofen
D. Allopurinol
Answer: A- Chlorpromazine
Expl; Chlorpromazine, tricyclic antidepressants, azathioprine, augmentin and erythromycin cause cholestatic jaundice
and also associated hepatitis.
171. Which of the following would support a diagnosis of a VIPoma?
A. Hypoglycaemia
B. Raised Insulin levels
C. Pellagra
D. Achlorhydria
Answer: D- Achlorhydria
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Expl; Achlorhydria (lack of acidity from the stomach) is classically associated with VIPoma. It can be diagnosed by
measuring acid output from nasogastric contents (NG tube). Features of VIP syndrome include watery diarrhea,
hypochlorhydria, hyperglycemia, hypercalcemia and flushing. Migratory erythema associated with glucagonoma
172. Which of the following findings would make a diagnosis of Budd Chiari syndrome likely?
A. Encephalopathy
B. Tender hepatomegaly
C. Ascites fluid protein of 42 g/L
D. Alanine aminotransferase of 150 U/L
Answer: B- Tender hepatomegaly
Budd-Chiari syndrome is an uncommon condition induced by thrombotic or nonthrombotic obstruction to hepatic
venous outflow . The classic triad of abdominal pain, ascites, and hepatomegaly is observed in the vast majority of
patients but is nonspecific. Tender hepatomegaly on examination is one of the hallmark signs.
173. A 70 year old man presents with bony swellings of the DIP joints on both hands. They were painful a year ago but are now
painless.The most likely diagnosis is:
A. Heberden's nodes
B. Bouchard's nodes
C. Osler's nodes
D. Gouty tophi
Answer: A- Heberden's nodes
The most likely diagnosis is osteoarthritis. At the DIP joints, swelling are known as Heberden's nodes and at the PIP
joints, they are known as Bouchard's nodes.
174. Which one of the following tests has greatest specificity for Wegener'sgranulomatosis?
A. Anti glomerular basement antibody
B. pANCA positive antibodies proteinase 3
C. pANCA positive antibodies myeloperoxidase
D. cANCA positive antibodies proteinase 3
Answer: D- CANCA positive antibodies proteinase 3
On immunofluoresecnce, if ANCA are present, the staining pattern may be cytoplasmic (cANCA) or perinuclear (pANCA).
Typical antigen specificity includes c ANCA proteinase 3 which is more common in Wegener's granulomatosis. p ANCA
myeloperoxidase is more common in polyarteritis nodosa.
175. A 35 year old woman presents with red scaly plaques on her cheeks and her forehead. On closer examination, there was
plugging of some hair follicles and atrophy of the skin. What is the likely diagnosis?
A. Drug induced lupus
B. Psoriasis
C. Discoid lupus
D. Sarcoidosis
Answer: C- Discoid lupus
The diagnosis is discoid lupus erythematosus.Lesions are discrete plaques, often erythematous, scaly, with
extension into hair follicles. These lesions can occur on the face, scalp, in the pinnae, behind the ears or on the neck.
There can also be active indurated erythema and central atrophic scarring.
176. Which of the following X ray changes suggests rheumatoid arthritis instead of a seronegative arthropathy?
A. Osteosclerosis
B. Osteophytes
C. Osteoporotic changes
D. Periarticular erosions
Answer: D- Periarticular erosions
Osteophytes and loss of joint space are commonly found in osteoarthritis, although they can also be found in
rheumatoid arthritis.Periarticular erosions are most suggestive of rheumatoid arthritis.
177. A 45 year old patient presents with proximal muscle weakness, particularly in the lower limbs. She has a heliotropic rash
around the eyes and also Gottron's papules. Which one of the following antibodies is most strongly associated?
A. La
B. Ro
C. Jo-1
D. SCL-70
Answer: C- Jo-1
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The diagnosis is dermatomyositis. Anti Jo-1 antibody is associated with acute onset myositis, particularly
dermatomyositis. The limb girdle or proximal muscles are most severely affected in both polymyositis and
dermatomyositis.
178. Which one of the following is a risk factor for rheumatoid arthritis?
A. Pneumococcal infection
B. HLA-DR4
C. SLE
D. HIV
Answer: B- HLA-DR4
Risk factors for rheumatoid arthritis are :
 HLA-DR4
 EBV
 parvovirus B19 and rubella infections
 blood transfusion
 smoking (induces RF production)
 stress
 obesity
 Pregnancy and OCP are protective
179. A 75 year old patient with osteoarthritis of the knee has been taking codeine 30mg qds and also paracetamol regularly. He
continues to have knee pains.What is the next best treatment?
A. Diclofenac
B. Morphine
C. Ibuprofen gel
D. Oral hydrocortisone
Answer: C- Ibuprofen gel
NSAIDS tend to be better for pain control in osteoarthritis, but have significant side effects. Local NSAID application
should be considered as well as intraarticular steroid injections.
180. A 40 year old athlete has pain on abduction of her arm, particularly when resisted.Which tendon pathology is affected?
A. Biceps tendonitis
B. Supraspinatus tendonitis
C. Teres minor tendonitis
D. Infraspinatus tendinitis
Answer: B- Supraspinatus tendonitis
Pain in abduction up to 90 degrees is due to supraspinatus tendonitis.
181. A 60 year old lady has polyarthropathy due to Rheumatoid Arthtitis.Which one of the following molecules plays a central role
in its pathogenesis?
A. IFN gamma
B. Interleukin 8
C. TNF alpha
D. Endotoxin
Answer: C- TNF alpha
In the context of rheumatoid arthritis, TNF α has involvement in cytokine regulation, cell recruitment, angiogenesis, and
tissue destruction. Hence anti TNF alpha antibodies such as infliximab are used in therapy.
182. An 18 year old girl developed pulmonary haemorrhage and subsequent acute renal failure requiring dialysis. A renal biopsy
shows crescentic glomerulonephritis.Which one of the following antibodies is likely to be present?
A. Anti mitochondrial
B. Anti centromere
C. Anti nuclear
D. Anti myeloperoxidase
Answer: D- Anti myeloperoxidase
This patient manifests a pulmonary renal syndrome which is commonly due to an ANCA positive vasculitis. P ANCA
which correlates with antimyeloperoxidase (MPO) antibodies, is highly sensitive and specific tow ards rapidly
progressive glomerulonephritis and haemorrhagic alveolar capillaritis. Less commonly this could be due to
Goodpasture's syndrome (anti GBM antibodies).
183. Which of the following is a typical late complication of CREST syndrome?
A. Renal hypertensive crisis
B. Lung malignancy
C. Pulmonary hypertension
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D. Myositis
Answer: C- Pulmonary hypertension
Renal hypertensive crisis is more common in diffuse systemic sclerosis and pulmonary hypertension is more common in
limited cutaneous scleroderma.
184. A man presents with symptoms suggestive of a pneumonia. The CXR confirms this. Which of the following features suggests
poor prognosis?
A. Respiratory rate of 20
B. Temperature 38°C
C. Age 60
D. Urea of 10
Answer: D- Urea of 10
The CURB-65 score for poor prognosis in pneumonia are :
 confusion (defined as an AMT of 8 or less)
 urea greater than 7 mmol/l
 respiratory rate of 30 breaths per minute or greater
 blood pressure less than 90 systolic or diastolic blood pressure 60 or less
 age 65 or older.
185. Which one of the following is an indication for a chest drain?
A. High protein
B. Low glucose
C. Low LDH
D. PH <7.2
Answer: D- PH <7.2
Although a high protein also points tow ards an exudates, a low pH is the best marker of infection in an effusion
requiring chest drain insertion.
186. A 40 year old man has emphysema.He is found to have the SS phenotype.What is his alpha 1 antitrypsin level likely to be?
A. 10%
B. 15%
C. 25%
D. 50%
Answer: D- 50%
The normal genotype is MM and levels of enzyme is (100%). The relevant enzyme levels are MS (75%), MZ (55%), SS
(50%) ZZ (15%.)
187. A 55 year old gentleman has pickwickian syndrome. He has poor exercise tolerance of 50 yards and often feels lethargic at
work.Which of the following is the best investigation?
A. Echocardiography to assess cor pulmonale
B. CT scan of the chest
C. Sleep study
D. Exercise tolerance test
Answer: C- Sleep study
The diagnosis of obstructive sleep apnoea can be made with a sleep study (polysomnography). In sleep apnoea, there is
gross obesity and airways obstruction, occasionally leading to type II respiratory failure. During the sleep study, > 10
episodes of apneic episodes (pauses in breathing) satisfies the criteria for obstructive sleep apnoea.
188. A 60 year old man smoker of 35 pack years presents with a 6 month history of shortness of breath. His past medical history
includes diabetes and cervical spondylosis.Spirometry shows FEV1 of 1 litre - 65% predicted,FVC 1.03 litres - 57%
predicted,FEV1/FVC ratio of 95. How would you interpret the spirometry results?
A. Normal
B. Mixed defect
C. Obstructive defect
D. Restrictive defect
Answer: D- Restrictive defect
Reduced FEV1 and FVC with normal FEV1 ratio is compatible with restrictive defect.
Causes of restrictive lung defect are:
 neurogenic or psychogenic causes
 abnormalities of the thoracic wall
 stiff parenchyma (pulmonary fibrosis)
 loss of lung tissue, e.g. pneumonectomy
 displacement
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189. A 65 year old man has been diagnosed with chronic obstructive pulmonary disease (COPD). Spirometry confirms severe
COPD with a FEV1 of less than 25% predicted. In the last year he has been admitted to hospital on 6 occasions with COPD
exacerbation.Which one of the following can help to reduce hospital admissions?
A. Tiotropium
B. Monteleukast
C. Oral theophyllines
D. Salmeterol
Answer: A- Tiotropium
Severe COPD is diagnosed if the FEV1 is less or equal to 30% predicted. Studies have shown that patients treated with
long acting anticholinergic (e.g. tiotropium) have few er exacerbations per year.
190. A 13 year old male has recent onset breathlessness. He has a history of wheezing particularly during the summer when the
pollen count is high.Which of these tests would help to confirm the diagnosis?
A. Trial of inhaled corticosteroids
B. Trial of anticholinergics
C. Serial peak flow measurements
D. Lung function tests
Answer: C- Serial peak flow measurements
The history of wheezing during pollen exposure suggests asthma. The best diagnostic test for asthma would be
demonstration of variable airways obstruction with serial peak flow measurements. Asthmatic patients with
exacerbation will demonstrate peak flows lower than their predicted peak flow, and also a morning dip. There is also
reversibility if a bronchodilator (e.g. salbutamol) is administered.
191. A 20 year old male presents with breathlessness and wheezing. Which of the following is most likely to suggest asthma?
A. Increased serum IgE
B. Obstructive picture in the lung function tests
C. Response to prednisolone
D. Diurnal PEFR variation > 20%
Answer: D- Diurnal PEFR variation > 20%
In asthma, diurnal PEFR variability is due to various degrees of bronchial hyperreactivity. This is the best indicator of
likely asthma. A raised IgE indicates atopy but is not diagnostic of asthma.
192. A 70 year old man has a diagnosis of non small cell lung tumour, and has completed a set of investigations. Which one of the
following is a contraindication to lung surgery?
A. FEV1 of 1.7 L (50% predicted)
B. Horner's syndrome
C. History of myocardial infarction
D. Hypercalcaemia
Answer: B- Horner's syndrome
An FEV1 of < 1.1 L is a contraindication for most cardiothoracic surgical procedures. A malignant pleural effusion, distant
metastases, contralateral mediastinal lymph node spread, vocal cord paralysis, phrenic nerve paralysis, Horner's
syndrome, and SVC syndrome are contraindications to surgery in lung cancer.
193. A breathless 35 year old woman has the following lung function tests:FEV1 1.2 L (65%),FVC 1.4 L (60%),FEV1/FVC ratio =
82%predicted,TLC = 65% predicted,RV = 60% predictedTLCO = 57% predicted,KCO = 105% predicted.What is the most likely
diagnosis?
A. COPD
B. Bronchiectasis
C. Cystic fibrosis
D. Scoliosis
Answer: D- Scoliosis
The lung function tests show a significant restrictive defect. Only kyphoscoliosis or a pneumonitis may fit this picture but
given the normal/high KCO (i.e. after correcting for alveolar volumes), the most likely answer is kyphoscoliosis as the gas
exchange after correcting for the alveolar volume is high.
194. A 16 year girl with know n cystic fibrosis presents with cough and fevers. Chest X ray shows right lower zone consolidation.
What antibiotic should be commenced?
A. Amoxycillin
B. Metronidazole
C. Ceftazidime
D. Gentamicin
Answer: C- Ceftazidime
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Patients with cystic fibrosis often have pseudomonas as a pathogenic infection. Ceftazidime and ciprofloxacin would
cover the organism, and sometimes gentamicin or meropenem may be required due to resistance.
195. A 70 year old man with chronic obstructive lung disease presents with a cough, fevers and green sputum. What is the
antibiotic of choice?
A. Teichoplanin
B. Cefotaxime
C. Erythromycin
D. Amoxicillin
Answer: D- Amoxicillin
In COPD, the 3 bacterial species account for most isolates are : Haemophilus influenzae, Streptococcus pneumoniae and
Moraxella cattarhalis. First line treatment should be with amoxicillin, but if the patient is allergic, a tetracycline should
be used.
196. Which one of the following positive auscultatory signs is diagnostic of bronchial breathing?
A. Rhonchi
B. Increased vocal resonance
C. Aegophony
D. Whispering pectoriloquy
Answer: D- Whispering pectoriloquy
Whispering pectoriloquy is a diagnostic sign for bronchial breathing.
197. Which one of the following supports a diagnosis of small cell lung cancer?
A. Disseminated intravascular coagulation
B. Hypertrophic pulmonary osteoarthropathy (HPOA)
C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
D. Hypercalcaemia
Answer: C- Syndrome of inappropriate antidiuretic hormone secretion (SIADH) SIADH is most comonly seen with small
cell carcinoma rather than non-small cell carcinoma. HPOA, hypercalcaemia without bone metastasis is more common in
squamous cell carcinoma. DIC and thrombocytosis are more common with adenocarcinoma.
198. Which of the following investigations is the most useful to assess the severity of his airways obstruction?
A. Flow volume loop
B. Forced expiratory volume
C. Forced vital capacity
D. Peak expiratory flow rate
Answer: A- Flow volume loop
The flow volume loop is the best method of assessing extent of obstruction associated with a retrosternal mass.
199. When is LTOT indicated?
A. pO2 <7.2 kPa
B. pO2 <7.8 kPa
C. pO2 <8 kPa
D. pO2 <8.5 kPa
Answer: A- PO2 <7.2 kPa
When there is polycythaemia or pulmonary hypertension, Long Term Oxygen Therapy is indicated when pO2 < 8kPa. In
uncomplicated COPD, it is indicated when pO2 < 7.2kPa.
200. Which one of the following is the commonest cause of nephrotic syndrome in adults?
A. Minimal change glomerulonephritis
B. Post streptoccoccal glomerulonephritis
C. Membrano proliferative glomerulonephritis
D. Membranous nephropathy
Answer: D- Membranous nephropathy
Membranous nephropathy is the commonest cause of the nephrotic syndrome in adults, whilst in children it is minimal
change disease. The renal biopsy with membranous nephropathy shows a thickened glomerular basement membrane
and granular IgG + C3 on immunostaining.
201. Which of the following indicates chronic (rather than acute) renal failure?
A. Hyperkalaemia
B. heavy proteinuria
C. Urine osmolality of 300 m osmol/kg
D. Anaemia
Answer: D- Anaemia
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Anaemia (inadequate erythropoietin), renal osteodystrophy, small scarred kidneys suggest chronic rather than acute
renal failure.
202. Which one of the following features is an indication for stenting in renal artery stenosis?
A. Flash pulmonary oedema
B. Abdominal bruit
C. Heavy proteinuria
D. Unilateral small kidney
Answer: A- Flash pulmonary oedema
Revascularization is considered when the presence of hemodynamically significant renal artery stenosis is judged to
be contributing to poorly controlled hypertension or progressive renal impairment. Other less common but equally
important clinical indications for RAS revascularization include episodic pulmonary edema, congestive cardiac
failure, and unstable angina.
203. A 45 year old patient is admitted with decreased conscious level. She is oliguric and hyperventilating. Her investigations
show: sodium 125, potassium 6.0, chloride 92 (95-107), Urea 15 mmol/l, creatinine 220 micromol/L, arterial blood gas pH
7.2, bicarbonate 16 mmol/l.What is the anion gap?
A. 14
B. 16
C. 18
D. 23
Answer: D- 23
The anion gap is calculated with the formula (Na+K)-(Cl+HCO3). In this case it is 125 + 6 - 92 - 16 = 23.
204. Which one of the following can be effectively removed by haemodialysis?
A. Amiodarone
B. Digoxin
C. Phenytoin
D. Lithium
Answer: D- Lithium
Drugs with a large volume of distribution are poorly dialysed. Haemodialysis is effective in lithium poisoning.
205. A 25 year male diagnosed type I diabetes.What are his chances of progressing towards End Stage Renal Disease (ESRD)?
A. 10%
B. 25%
C. 50%
D. 75%
Answer: C- 50%
In type I diabetes, there is a 50% chance of progressing tow ards ESRD. In type II diabetics, there is a 15% chance of
doing so.
206. Which one of the following is a feature of X-linked hypophosphataemic vitamin D -resistant rickets?
A. High serum phosphate
B. High urinary phosphate
C. High parathyroid hormone (PTH) levels
D. Hypercalcaemia
Answer: B- High urinary phosphate
In X-linked hypophosphataemic Vit D resistant rickets, serum phosphate is low and urine phosphate is high due to
inappropriate renal phosphate wasting. Serum parathyroid levels are usually normal or slightly elevated. Clinically, the
most obvious of these aspects is the effect on bone formation and growth that causes very severe rickets, especially in
affected males. Treatment is with oral phosphate (difficult to tolerate) and high dose activated Vitamin D.
207. In which one of the following situations, might peritoneal dialysis be preferable to hemodialysis?
A. In hypercatabolic patients
B. In patients bordering on respiratory failure
C. In diabetic patients
D. When there is a need to conserve plasma protein levels
Answer: C- In diabetic patients
Peritoneal dialysis can be useful for intraperitoneal insulin administration.
Hemodialysis is preferable in hypercatabolic patients for rapid urea clearance. Stress is placed on the abdominal w ound
healing by PD, and on the diaphragm in respiratory failure. There is a loss of protein by diffusion in PD, hence less useful
when protein needs to be conserved.
208. Which of the following most strongly suggests post streptococcal glomerulonephritis?
A. History of previous attacks
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B. Papilloedema
C. Sore throat 10 days ago
D. Complete anuria
Answer: C- Sore throat 10 days ago
Post streptococcal glomerulonephritis is caused by Group A beta haemolytic streptococci. A second episode is
unusual in those who have previously had the disease because there is good immunity to the cell wall proteins of
Group A strep. Although features of hypertension with papilloedema, complete anuria and nephrotic syndrome can
occur, the strongest predictor is the clinical history of sore throat suggesting infection with streptococci leading to
nephritic syndrome.
209. Which of the following features is most usefulin determining whether the renal failure is acute or chronic?
A. Renal size of 7.5 and 8 cm
B. Hb of 12 g/dl
C. Blood pressure of 160/90
D. PTH level of 8 pmol/l
Answer: A- Renal size of 7.5 and 8 cm
Out of all the options small renal size is the best feature suggesting chronic renal failure.
210. A 25 year old woman is in the third semester of pregnancy. She has several investigations for proteinuria.Which one of the
following results is significant?
A. GFR 140 ml/min
B. Urea 2 mmol/l
C. Uric acid 1.5 mmol/l
D. Creatinine 60 μmol/l
Answer: C- Uric acid 1.5 mmol/l
Normal uric acid level is < 0.4 mmol/l. A high uric acid level may indicate pre-eclampsia.
211. Which of the following is likely to be associated polycystic kidney disease?
A. Polycythaemia
B. Nail pitting
C. Hypermobility
D. Mitral stenosis
Answer: A- Polycythaemia
Polycystic kidney disease is associated with increased levels of EPO which lead to polycythaemia. Aneurysms of
cerebral arteries (berry aneurysms) have been reported in 10-50% of patients. A variety of cardiac and aortic
abnormalities have been associated with APKD, including aortic root dilatation, aortic regurgitation, bicuspid aortic
valves, coarctation of the aorta, mitral regurgitation and abdominal aortic aneurysm.
212. Which of the following suggests that the patient should be considered for CAPD rather than haemodialysis?
A. Hypertension
B. Severe congestive cardiac failure
C. Recent inguinal surgery
D. COPD
Answer: B- Severe congestive cardiac failure
Severe cardiac failure often leads to circulatory compromise (hypotension) during haemodialysis, hence such a
patient would be better dialysed by CAPD.
213. Which one of the following is a side effect of erythropoietin therapy?
A. Hypokalaemia
B. Anaemia
C. Seizures
D. Iron overload
Answer: C- Seizures
EPO therapy may lead to hypertension and seizures. Other side effects of treatment with erythropoietin include
hyperkalaemia in uraemic patients, increased PCV, thrombocythaemia, shunt thrombosis, iron deficiency and
urticaria.
214. A 55 year old man who has been on haemodialysis for 20 years has progressive dementia.Which one of the following is most
likely to have caused this?
A. Small vessel ischaemia
B. Aluminium toxicity
C. Amyloidosis
D. Alzheimer's disease
Answer: B- Aluminium toxicity
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Aluminium has been implicated in 'dialysis dementia'. Dialysis dementia may be part of a multisystem disorder
which includes vitamin D resistant osteomalacia, proximal myopathy, and non-iron deficient, microcytic,
hypochromic anaemia. The use of aluminium free dialysate may arrest, or even improve, the established case.
Desferrioxamine infusions (aluminium chelator) are the mainstay of treatment of dialysis dementia, improving up to
70% of patients, sometimes to normal.
215. A 35 year old lady with SLE presents with significant proteinuria and hypoalbuminaemia. A renal biopsy confirms diffuse
proliferative glomeronephritis (WHO Class IV).Which of the following treatment regimes is recommended?
A. Prednisolone alone
B. Azathioprine alone
C. Azathioprine & Methotrexate
D. Prednisolone & intravenous Cyclophosphamide
Answer: D- Prednisolone & intravenous Cyclophosphamide
Diffuse proliferative glomerulonephritis is the commonest glomerulonephritis in SLE. There is mesangial and
endothelial cell proliferation, polymorphonuclear cell infiltrate and granular subepithelial deposits of C3. It also
carries the worst prognosis with progression towards renal failure.
The currently recommended therapy is pulse intravenous corticosteroids in combination with pulse
cyclophosphamide continued for at least 12 months after remission. Newer regimes include combinations of
prednisolone and mycophenolate.
216. Which one of the following is an absolute contraindication to choosing continuous ambulatory peritoneal dialysis?
A. Colostomy
B. Polycystic kidneys
C. Heart failure
D. Previous ovarian surgery
Answer: A- Colostomy
Recent or prospective abdominal surgery is a contraindication to CAPD
217. High urinary levels of the following substances predispose to urinary tract stone formation,EXCEPT FOR:
A. Cystine
B. Citrate
C. Calcium
D. Oxalate
Answer: B- Citrate
Calcium, oxalate, cystine and urate are all stone-forming substances, so high urinary levels promote stone
formation. Low urinary citrate levels promote stone formation.
218. Which of the following is typical of diabetic nephropathy?
A. Hyaline thrombus formation
B. Mesangial hypercellularity
C. Congo red staining causing green birefringence
D. Basement membrane thickening and mesangial widening
Answer: D- Basement membrane thickening and mesangial widening
The earliest morphologic abnormality in diabetic nephropathy is the thickening of the expansion of the
mesangium due to accumulation of extracellular matrix. Light microscopy findings show an increase in the solid
spaces of the tuft, material (diffuse diabetic glomerulopathy).
Large acellular accumulations also may be observed within these areas. These are circular on section and are known
as the Kimmelstiel-Wilson lesions/nodules.Immunofluorescence microscopy may reveal deposition of
immunoglobulin G along the GBM in a linear pattern, but this is not diagnostic. In advanced disease, the mesangial
regions occupy a large proportion of the tuft, with prominent matrix content. Further, the basement membrane in
the capillary walls (ie, the peripheral basement membrane) is thicker than normal.
219. Which one of the following findings is suggestive of amyloidosis?
A. Abnormal liver function tests
B. Cryoglobulinaemia
C. Benign monoclonal gammopathy without myeloma
D. Large numbers of granular casts, fat bodies and red cells in the urine
Answer: C- Benign monoclonal gammopathy without myeloma
Light chains in the urine suggest deposition causing amyloidosis (may be either myeloma or benign monoclonal
gammopathy).
Deposits occur in the tongue, nerves or heart. Cryoglobulinaemia is suggestive of lymphoma or myeloma. Granular
casts, red cell casts and selective proteinuria suggest glomerulonephritis
220. A 15 year old girl has nephrotic syndrome due to minimal change glomerulonephritis. What is the likely long term outcome?
42 | P a g e
A. Long term remission

B. Recurrent relapses
C. Chronic renal impairment
D. Persistent proteinuria
Answer: A- Long term remission
Minimal change disease usually responds well to medical treatment, with response to corticosteroids usually within
the first month. 90% of patients with minimal change disease in the younger age group achieve remission after 8
weeks of steroids
221. Which of the following predicts a good response to corticosteroid therapy in nephrotic syndrome?
A. Hypertension
B. Haematuria
C. Proteinuria
D. The onset is within the first month of life
Answer: C- Proteinuria
Proteinuria is highly selective, occuring in 75% of patients with minimal change, which is responsive to
steroids.There is poor response to steroids in membranous, membranoproliferative, focal segmental
glomerulonephritis.Hypertension is aggravated by steroids.Haematuria indicates that more sinister causes such as
streptococcal infection may have occurred. Early onset nephritic syndrome is correlated with severity, peak onset
age is 2-4 yrs.
222. A man has developed foot drop and has lost sensation to the dorsal part of the foot. Which nerve is most likely to have been
involved?
A. Tibial
B. Sciatic
C. Common peroneal
D. Femoral
Answer: C- Common peroneal
The common peroneal nerve controls foot eversion and dorsiflexion. Sensation is supplied to the antero-lateral part
of the leg and the dorsum of the foot.
223. A patient presents with weakness of knee extension and ankle inversion.
Which of the Following nerve roots could be damaged?
A. L2
B. L3
C. L4
D. L5
Answer: C- L4
L4 is involved in knee extension and ankle inversion. The tibial nerve carries L4 & L5 roots.
224. A 60 year old woman with headache and nausea is suspected of having posterior cerebral artery thrombosis. Which of the
Following is a recognised feature of this occurrence?
A. Cerebellar ataxia
B. Hemiparesis
C. Homonymous hemianopia
D. Third nerve palsy
Answer: C- Homonymous hemianopia
The posterior cerebral artery supplies the occipital lobe and occlusion causes damage to the visual cortex, resulting
in homonymous hemianopia.
225. A 32 year old woman has known migraine. She gets periodic episodes of headaches with associated visual symptoms. Which
one of the Following drugs should be used first in a migraine attack?
A. Ibuprofen
B. Methysergide
C. Subcutaneous sumatriptan
D. Oral sumatriptan
Answer: A- Ibuprofen
In acute migraine attack, the first line treatments are simple analgesics such as aspirin, ibuprofen or paracetamol.
Second line treatment in acute migraine are the triptans (e.g sumatriptan) which work by selectively stimulating 5-
hydroxytriptamine 1 (5HT1) receptors.
226. A 25 year old man is known to have epilepsy. He had a generalized tonic clonic seizures for 15 minutes. What drug should be
given?
A. IV phenytoin
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B. IV sodium valproate
C. IV lamotrigine
D. IV lorazepam
Answer: D- IV lorazepam
Current consensus is that a benzodiazepine, notably lorazepam (Ativan), is the initial class of drug for the treatment
of status epilepticus. A phenytoin, phenytoin sodium or fosphenytoin is the next drug to be administered.
227. A 40 year old patient has presented with a generalised tonic clonic seizure for the first time. This lasted for 10 minutes. What
advice should be given regarding driving a car?
A. No driving for 1 month
B. No driving for 6 months
C. No driving for 1 year
D. Driving is allowed if EEG is normal
Answer: C- No driving for 1 year
For a single seizure, driving is not permitted for 1 year. Also, a medical review is required before one is to do so and
it is a requirement for the patient to inform the Driver and Vehicle Licensing Authority.
228. What form of antibody is found in Eaton Lambert syndrome?
A. Anticholinesterase
B. Neuromuscular junction
C. Potassium channels
D. Voltage gated calcium channels
Answer: D- Voltage gated calcium channels
Eaton Lambert syndrome is frequently associated with a malignancy e.g. bronchial. The disorder is associated with
antibodies against voltage gated calcium channels.
229. How long is a patient required to avoid driving a car following recovery from a single transient ischaemic attack?
A. 6 weeks
B. 1 month
C. 3 months
D. 6 months
Answer: B- 1 month
Following a TIA, a patient should not drive for 1 month. If there were recurrent TIAs, then the patient should be
symptom free for 3 months before driving.
Following a seizure with altered conscious level, a patient should not drive for 1 year. All cases should be reported
to the Driver Vehicle Licensing Agency (DVLA).
230. What test will confirm that his muscle weakness is due to Myasthenia Gravis rather than Lambert Eaton myasthenic
syndrome?
A. Tensilon test
B. Trial of pyridostigmine
C. Trial of prednisolone
D. EMG
Answer: D- EMG
The main differential is myasthenia gravis and LEMS. Myasthenia gravis can be differentiated from Eaton Lambert
myasthenic syndrome by electromyography. Repetitive stimulation in myasthenia gravis leads to a decrement of
evoked muscle action potentials, whilst in myasthenic syndrome the condition improves by repetitive stimulation.
231. What is the risk of allergy to a cephalosporin antibiotic in someone with a penicillin allergy?
A. 1 in 10000
B. 1 in 1000
C. 1 in 100
D. 1 in 10
Answer: D- 1 in 10
The risk of allergy is usually 5-10%.
232. A 78 year old presents with confusion associated with a chest infection. 4 days later she developed green, then bloody
diarrhoea. Which of following organisms is likely to cause the diarrhoea?
A. Methicillin resistant Staphylococcus aureus
B. Salmonella
C. Clostridium difficile
D. Escherichia coli 0157
Answer: C- Clostridium difficile
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This is a clinical scenario of Clostridium infection causing pseudomembranous colitis predisposed to by prior
treatment broad spectrum antibiotics such as cefuroxime or augmentin.
233. Which one of the following cytokines is commonly secreted by the T helper 2 cell?
A. IL-1
B. IL-4
C. IL-2
D. TNF alpha
Answer: B- IL-4
TH1 cells commonly secrete IFN gamma and IL2, leading to B cell, natural killer and macrophage activation. TH2 cells
secrete IL3, 4,5 and 6, leading to mast cells and eosinophil activation.
234. Which one of the following tests should be sent for making a diagnosis of legionella infection?
A. Serum immunofluorescent antibody
B. Sputum immunofluorescent antibody
C. Urinary antigen
D. Blood cultures
Answer: C- Urinary antigen
The urine antigen test (a radioimmunoassay) is a rapid, relatively inexpensive, and practical test for the detection of
L pneumophila antigen excreted in the urine or present in pleural fluid.
235. A 31 year old patient who is HIV positive has a CD4 count of 200 cells /mm3. He has a viral load of 220,000 cells/ml. He is
feeling well at present. What should be the next management step?
A. Start antiretroviral therapy now
B. Start antiretroviral therapy when viral load is > 300,000 cells/ml
C. Start antiretroviral therapy when CD4 count is < 100
D. Start antiretroviral therapy when CD4 count is < 150
Answer: A- Start antiretroviral therapy now
The general recommendation for considering HAART and best prognosis is to they start when patients' CD4 count is
<200 cells/mm3 or viral load is >10,000 cells/Ml.
236. Which one of the following form has the best prognosis?
A. Nodular sclerosing
B. Lymphocyte predominant
C. Lymphocyte depleted
D. Mixed cellularity
Answer: B- Lymphocyte predominant
Hodgkin's lymphoma is rare in children. Nodular sclerosing is the commonest and lymphocyte depleted is the rarest
form. The lymphocyte predominant form has the best prognosis, whilst the lymphocyte depleted form has the
worst.
237. Which one of the following indicates the poorest prognosis in Hodgkin's lymphoma?
A. Mediastinal, inguinal lymphadenopathy and fever
B. Mediastinal lymphadenopathy and night sweats
C. Abdominal and inguinal lymphadenopathy, and night sweats
D. Cervical and mediastinal lymphadenopathy
Answer: A- Mediastinal, inguinal lymphadenopathy and fever
Stage III disease occurs when lymph nodes are present across both sides of diaphragm, hence worse prognosis than
when lymph nodes are localised to the same side of the diaphragm. Presence of B symptoms - night sweats and
fevers also worsen prognosis.
238. A 20 year old man complains of intermittent dark urine and abdominal pains. He is found to have a haemoglobin of 9.7 g/dl,
but the rest of the full blood count is normal. What is the most likely diagnosis?
A. Autoimmune haemolytic anaemia
B. G6PD deficiency
C. Paroxysmal nocturnal haemoglobinuria
D. Paroxysmal cold hemoglobinuria
Answer: C- Paroxysmal nocturnal haemoglobinuria
Paroxysmal nocturnal haemoglobinuria is caused by a defect in the formation of a red cell surface protein anchor,
called GP1. As a result of the lack of this surface protein anchor, the red blood cells are more sensitive to
complement lysis. Patients have intravascular haemolysis, leading to haemoglobinuria, and increased risk of
thrombosis, often occurring in the mesenteric vessels and the portal vein. Treatment is supportive or with bone
marrow transplantation.
239. Which of the following statements is true of idiopathic thrombocytopenic purpura?
45 | P a g e
A. The patient should be given a platelet transfusion

B. The patient should be treated with Anti-D
C. The patient should be treated with intravenous immunoglobulin
D. The patient should be commenced on steroids
Answer: D- The patient should be commenced on steroids
In younger patients with ITP, the disease usually remits spontaneously within several weeks and no treatment is
usually required unless there is significant bleeding.
240. A patient has had a splenectomy because of hereditary spherocytosis. How long should penicillin prophylaxis be used?
A. 1 year
B. 10 years
C. 15 years
D. Life long.
Answer: D- Life long
Following splenectomy, patients should receive lifelong penicillin prophylaxis. The major complication of
splenectomy is overw helming sepsis with encapsulated bacteria (eg, S pneumoniae, H influenzae, N meningitidis).
The overall risk of sepsis in asplenic patients is approximately 2% but varies depending on the age and underlying
diseases.
241. A 56 year old man was diagnosed with myelofibrosis. Which of the following is the most common presentation of the
disease?
A. Bleeding
B. Hyperuricaemia
C. Fatigue
D. Bone pain
Answer: C- Fatigue
Clinical features of myelofibrosis include usually develops in adults over age 50 patients commonly present with
fatigue and weakness spleen is often massively enlarged hepatomegaly occurs in over half of cases.
242. A patient presents with acute promyelocytic leukaemia. What is the likely mechanism underlying leukaemogenesis?
A. Aberrant fusion of 2 genes
B. Posttranslational modification
C. Over expression of cellular oncogene
D. Impaired degradation of protein
Answer: A- Aberrant fusion of 2 genes
Acute promyelocytic leukaemia is frequently due to chromosomal translocation t (15; 17).
243. Which one of the following is the best management option in mild von Willebrand's disease prior to surgery?
A. DDAVP
B. Factor VIII concentrate
C. Fresh frozen plasma
D. Factor IX concentrate
Answer: A- DDAVP
Out of all the choices, DDAVP is the most pragmatic option. Fresh frozen plasma or von Willebrand factor can be
used in cases of severe bleeding but should not be used in mild case.
244. Long term complications of radioactive iodine?
A. Hyperthyroidism
B. Hypoparathyroidism
C. Hypothyroidism
D. Thyroid malignancy
Answer: C- Hypothyroidism
Radioactive iodine generally has few side effects, is permanent, and very effective. It cannot be used during
pregnancy due to risks of teratogenicity. It can often be performed as an outpatient or with a short hospital stay.
The long-term risk is hypothyroidism, because thyroid function is reduced so effectively that thyroid replacement
may be required.
245. HbA1c is 10.5%. What average plasma glucose concentration is this HbA1c value equivalent to?
A. 7 mmol/l
B. 10 mmol/l
C. 12.5 mmol/l
D. 16 mmol/l
Answer: D- 16 mmol/l
46 | P a g e
A HbA1c of 7% would translate into an average glucose concentration of 9.5 mmol/l, and a HbA1c of 10% into 15.5
mmol/l.
246. Which one of following is the best investigation to confirm the diagnosis acromegaly?
A. Insulin like growth factor 1 (IGF1)
B. Growth hormone releasing hormone test
C. 9 am growth hormone concentrations
D. Glucose tolerance test with growth hormone concentration
Answer: D- Glucose tolerance test with growth hormone concentration
The diagnosis of acromegaly is confirmed by inadequate suppression of Growth Hormone concentrations below 2
mU/l in an oral glucose tolerance test.
247. A 35 year old woman with thyrotoxicosis is commenced on carbimazole. Which one of the following is the first blood test to
improve?
A. Thyroid stimulating hormone
B. Free T3
C. Total T4
D. Thyroglobulin
Answer: C- Total T4
Thyroxine (T4) is formed by coupling of iodinated tyrosine residues within thyroglobulin (TG).
Carbimazole acts by blocking the iodination of tyrosine residues, hence reducing levels of T4.
248. Which one of the following is the commonest presentation of a prolactinoma in males?
A. Galactorrhoea
B. Impotence
C. Gynaecomastia
D. Obesity
Answer: B- Impotence
In men with prolactinoma the commonest of the features mentioned above is impotence. Because men have no
reliable indicator such as menstruation, many men delay seeking medical advice until they have headaches or visual
problems caused by the enlarged pituitary. There may also be a gradual loss of sexual function or libido.
249. What dose of prednisolone is equivalent in its glucocorticoid potency to 100 mg of hydrocortisone?
A. 5 mg
B. 25 mg
C. 50 mg
D. 75 mg
Answer: B- 25 mg
Prednisolone is 4 x more potent than hydrocortisone, and dexamethasone is between 40 x more potent than
hydrocortisone.
250. A 40 year old man with hypertension was also found to be significantly hypokalemic. Which of the following investigation is
most appropriate?
A. Renal arteriography
B. Renin: Aldosterone Ratio
C. Plasma ACTH
D. Plasma cortisol level
Answer: B- Renin: Aldosterone Ratio
Conn's syndrome should be considered in a patient who is not on diuretics who has the following features:
hypertension, hypokalaemia and alkalosis. Investigation of choice is plasma renin and aldosterone - low renin and
high aldosterone (raised aldosterone: renin ratio) suggests primary hyperaldosteronism.
251. Which of the following is a side effect which would be most likely to occur with the progesterone only pill rather than the
combined oral contraceptive pill?
A. Irregular periods
B. DVT
C. Migraine
D. Breast tenderness
Ans-A) Irregular periods
Irregular periods often occur when taking the progesterone only pill compared with the combined oral
contraceptive which is useful in the management of dysmenorrhoea. DVTs are seen in combined oral contraceptive.
252. Low molecular weight heparins do not normally require to be monitored. However if required how can LMWH be
monitored?
A. PT
47 | P a g e
B. APTT
C. anti factor Xa assay
D. INR
Ans-C) anti factor Xa assay
Anti factor Xa assay can be utilised if required for monitoring. LMWH binds to antithrombin forming a complex with
Xa. The residual factor Xa gives an indication of dosing.
253. What advice would you give to a patient on the oral contraceptive pill, who is being treated with antibiotics?
A. Extra precautions whilst on antibiotic
B. Extra precautions whilst on antibiotic and for 28 days after
C. Extra precautions whilst on antibiotic and for 14 days after
D. Extra precautions whilst on antibiotic and for 7 days after
Ans-D) Extra precautions whilst on antibiotic and for 7 days after
Traditionally extra precautions were advised whilst on antibiotics and for 7 days after stopping however
recently it has been shown that there is no evidence to suggest reduced effectiveness with antibiotics and this
may not be required
254. Which of the following medications does not reduce the effectiveness of the oral contraceptive pill?
A. St Johns Wort
B. Fluoxetine
C. Carbamazepine
D. Phenytoin
Ans-B) Fluoxetine
All of the drugs can lead to a reduction in the effectiveness of the oral contraceptive pill except fluoxetine
255. Before commencing Infliximab, a history if which of the following should be excluded?
A. Tuberculosis
B. COPD
C. Recurrent UTIs
D. Ischaemic Heart disease
Ans-A) Tuberculosis
Infliximab due to its anti TNF alpha properties can lead to reactivation of old TB and thus this should be excluded
before starting therapy.
256. Which of the following drugs is not associated with gingival hypertrophy
A. Phenytoin
B. Atenolol
C. Ciclosporin
D. Nifedipine
Ans-B) Atenolol
Gingival hypertrophy is a well known side effect of all of these drugs except atenolol
257. After how many hours post dose should lithium levels be taken?
A. 12 hours
B. 10 hours
C. 6 hours
D. 14 hours
Ans-A) 12 hours
Post dose levels should be taken after 12 hours.
258. A patient with a past history of a psychiatric disorder presents with nausea, vomiting, tremor and ataxia. An ECG shows
flattened t waves. What is the most likely diagnosis?
A. Serotonin syndrome
B. Tardive dyskinesia
C. Tricyclic antidepressants overdose
D. Lithium toxicity
Ans-D) Lithium toxicity
These features are suggestive of lithium toxicity. Ataxia is a clue to this being the underlying diagnosis as it is not
observed in the other causes.
259. What is the mechanism of action of bendroflumethiazide?
A. Acts on proximal tubule and leads to increased sodium, chloride and water excretion
B. Acts on early distal tubule and leads to increased sodium, chloride and water excretion
C. Acts on early distal tubule and leads to increased sodium, chloride and water reabsorption
D. Acts on loop of henle and leads to increased sodium, chloride and water excretion
48 | P a g e
Ans-B) Acts on early distal tubule and leads to increased sodium, chloride and water excretion
Bendroflumethiazide inhibits active chloride reabsorption and sodium reabsorption in the distal convoluted
tubule thus leading to increased water and sodium excretion.
260. Which of the following is not a feature of digoxin toxicity?
A. Acute renal failure
B. Yellow discolouration of vision
C. Palpitations
D. Blurred vision
Ans-A) Acute renal failure
Although the dose of digoxin should be altered if there is evidence of renal impairment as it is renally excreted, it
does not directly lead to renal toxicity.
261. A 65 year old male has recently been discharged from hospital following a myocardial infaction. He had been commenced on
atorvastatin 40mg during his admission. He has been feeling very well since his discharge. He presents for his routine bloods.
His AST and ALT are found to be 100, having previously been normal. Which of the following action should be taken?
A. Reduce to 20mg atorvastatin and monitor LFTs
B. Maintain current dose of atorvastatin and monitor LFTs
C. Switch atorvastatin to simvastatin 40mg
D. Switch atorvastatin to simvastatin 80mg
Ans-B) Maintain current dose of atorvastatin and monitor LFTs
This patient is feeling well and is not complaining of any symptoms. The AST and ALT levels are only approximately
2x the normal value. Statins should be stopped if there is symptoms of muscle pain or if AST and ALT remain at
greater 3x the normal value.
262. A 35 year old female had been admitted following a paracetamol overdose and had been treated with N Acetyl cysteine. On
day 3 she is found to be in acute renal failure with a creatinine of 500. Which of the following is the best managment of the
acute renal failure?
A. Further course of N-acetyl cysteine
B. Haemofiltration
C. Haemodialysis
D. IV fluids
Ans-C) Haemodialysis
Paracetamol is metabolised to a toxic metabolite, N-acetyl-p-benzoquinone imine (NABQI). This is toxic to the
hepatocytes and to renal tubular cells which leads to acute tubular necrosis. NABQI is inactivated by glutathione
which is used up in paracetamol overdose. ARF is normally observed on and after day 3 and if the creatinine is
greater than 400 then haemodialysis is the best management
263. What is the mechanism of action of Ciclosporin?
A. Inhibits calcineurin increasing Interleukin-2 levels
B. Inhibits calcineurin reducing Interleukin-2 levels
C. Inhibits calcineurin reducing Interleukin-10 levels
D. Binds to T cell receptor
Ans-B) Inhibits calcineurin reducing Interleukin-2 levels
Ciclosporin binds to cyclophilin which results in inhibition of calcineurin. Calcineurin is important for the activating
the transcription of IL-2 and T cell signalling transduction and thus ciclosporin and leads to a reduction in IL-2.
264. A 58 year old gentleman with type 2 diabetes mellitus has tirofiban administered before undergoing primary coronary
intervention. Which of the following best describes the mechanism of action of tirofiban?
A. GP IIb/IIIa Inhibitor
B. Factor Xa inhibitor
C. ADP receptor Inhibitor
D. Activation of antithrombin III
Ans-A) GP IIb/IIIa Inhibitor
Tirofiban reversibly inhibits the binding of fibrinogen to the GP IIb/IIIa platelet receptors.
265. Which of the following is a contraindication to the use of a bisphosphonate?
A. eGFR <30
B. Corrected Calcium of 2.5
C. Patients with previous gastric surgery
D. BMI 19
Ans-A) eGFR <30
Contraindications to the use of bisphosphonates include eGFR of <30, hypocalcaemia, pregnancy and osteomalacia.
A low BMI is not a contraindication as long as calcium and vitamin D levels are normal. It should be used in caution
49 | P a g e
in patients with previous history of gastric disease. Oral bisphosphonates should be avoided in severe oesophagitis
or gastritis.
266. A 22 year old female is admitted to A+E. Her friends think she has "taken something". She appears euphoric and can't sit still.
She is being sexually inappropriate. You note her pupils are dilated. Which of the following is the most likely culprit?
A. Morphine Sulphate
B. Cocaine
C. Heroin
D. Diazepam
Ans-B) Cocaine
The combination of increased energy levels, euphoria, sexually inappropriate behaviour and dilated pupils makes
the most likely cause cocaine. Alcohol does not affect pupils. Benzodiazepines can cause dilation however her
behaviour is not inkeeping with this. Heroin and MST both lead to constriction of pupils.
267. Which of the following is a side effect of sildenafil use?
A. Blue tint to vision
B. Yellow halo around objects
C. Difficulty discriminating red/greem
D. Bodily secretions turn pink
Ans-A) Blue tint to vision
Some patients report a blue tint to their vision and difficulty with blue/green discrimination.
268. Which of the following does not require alteration in renal failure?
A. Clindamycin
B. Co amoxiclav
C. Clarithromycin
D. Amoxicillin
Ans-A) Clindamycin
Clindamycin is minimally renally excreted and dose adjustment is not required in renal failure.
269. Which of the following drug is not associated with a survival benefit in congestive cardiac failure?
A. Carvedilol
B. Ramipril
C. Digoxin
D. Spironolactone
Ans-C) Digoxin
All drugs except digoxin have been shown to have a survival benefit in CCF.
270. A patient is found to have a broad complex tachycardia. Which of the following is contraindicated?
A. DC Cardioversion
B. Adenosine
C. Verapamil
D. Amiodarone
Ans-C) Verapamil
Verapamil can lead to the development of VF or haemodynamic collapse in those with VT
271. What is the mechanism of action of sumatriptan?
A. 5-HT1D receptor agonist
B. 5-HT1D receptor antagonist
C. 5-HT2D receptor agonist
D. 5-HT2D receptor antagonist
Ans-A) 5-HT1D receptor agonist
Sumatriptan is a selective 5-HT1D receptor agonist.
272. Gastrin leads to hydrochloric acid secretion from parietal cells both directly and indirectly. Which of the following is the best
description of the indirect mechanism?
A. Binds to gastrin receptor on ECL cells which then secrete prostaglandins
B. Binds to gastrin receptor on ECL cells which then hydrogen ions
C. Binds to gastrin receptors on parietal cell
D. Binds to gastrin receptors on ECL cells which then release histamine
Ans-D) Binds to gastrin receptors on ECL cells which then release histamine
Gastrin can stimulate hydrogen ion secretion directly via gastrin receptors on the parietal cells or indirectly by
stimulating gastrin receptors on ECL cells which secrete histamine in response which then stimulate parietal cells via
histamine receptors.
273. Which of the following should be avoided if a patient is taking simvastatin?
50 | P a g e
A. Cranberry juice
B. Orange Juice
C. Amoxicillin
D. Grapefruit Juice
Ans-D) Grapefruit Juice
Grapefruit are broken down by the same cytochrome systems as statins and therefore can lead to accumulation of
metabolites and lead to increased risk of hepatic dysfunction and rhabdomyolysis.
274. The relation of the fetal parts to one another determines:
A. Presentation of the fetus.
B. Lie of the fetus.
C. Attitude of the fetus.
D. Position of the fetus.
Ans-D) Position of the fetus.
275. Electronic fetal monitoring:
A. Has high specificity but low sensitivity.
B. Has low specificity but high sensitivity.
C. Has low specificity & sensitivity.
D. Has high specificity & sensitivity.
Ans-B) Has low specificity but high sensitivity.
276. The following are major indicators of fetal asphyxia:
A. Old meconium at the time of induction of labor.
B. Loss of acceleration.
C. Deep type I deceleration in the 2ND stage of labor.
D. Type II (late) decelerations with tachycardia.
Ans-D) Type II (late) decelerations with tachycardia.
277. The bishop score is used to predict :
A. The state of the fetus at the time of delivery.
B. The success rate of the induction of the labor.
C. The fetal condition in the uterus.
D. The maternal well being in labor.
Ans-B) The success rate of the induction of the labor.
278. Which of the following fetal scalp pH results should prompt immediate delivery:
A. 7.30.
B. 7.22.
C. 7.18.
D. 7.26.
Ans-C) 7.18.
279. Ovarian Dysgenesis is associated with the elevation of which of the following hormones.
A. Pituitary Gonadotropins.
B. Estradiol.
C. Estriol.
D. Pregnandiol.
Ans-A) Pituitary Gonadotropins.
280. Which of the following is suggestive of ovulation:
A. Basal body temperature drop at least 0.5C in the second half of the cycle
B. Day 21 estrogen level is elevated
C. Progesterone level on day ten of the cycle is elevated
D. Regular cycle with dysmenorrhea
Ans-D) Regular cycle with dysmenorrhea
281. Which of the following is the best method to predict the occurrence of ovulation:
A. Thermogenic shift in basal body temperature.
B. LH surge.
C. Endometrial decidulaization.
D. Profuse, thin, acellular cervical mucous.
Ans-B) LH surge.
282. Inadequate luteal phase is associated with all of the following EXCEPT:
A. Insufficient secretion on FSH in the antecedent follicular phase.
B. Induction of ovulation with Clomiphene citrate.
51 | P a g e
C. Induction of ovulation with human menopausal gonadotropins.

D. Administration of progesterone in the luteal phase.
Ans-A) Insufficient secretion on FSH in the antecedent follicular phase.
283. The following are presumptive skin signs of pregnancy except:
A. Chloasma
B. Maculo-papular rash
C. Stretch Marks
D. Spider Telangiectases
Ans-B) Maculo-papular rash
284. The resting pulse in pregnancy is:
A. Decreased by 20 bpm.
B. Decreased by 10 to 15bpm.
C. Unchanged.
D. Increased by 10 to 15 bpm.
Ans-D) Increased by 10 to 15 bpm.
285. Select the most correct statement about fetal & neonatal IgM:
A. It is almost entirely maternal in origin.
B. It is approximately 75% maternal & 25% fetal in origin.
C. It is 50% maternal, 50% fetal in origin.
D. It is almost entirely fetal in origin
Ans-D) It is almost entirely fetal in origin
286. Regarding placental anatomy:
A. The decidua capsularis forms part of the placenta.
B. The fetal side of the placenta is divided into 30-40 cotyledons.
C. The intervillous space contains fetal blood.
D. Fetal blood vessels develop in the mesenchymal core of the chorionic villi.
Ans-D) Fetal blood vessels develop in the mesenchymal core of the chorionic villi.
287. The followings are considered normal symptoms of pregnancy EXCEPT:
A. Backache due to an increased lumbar lordosis.
B. Lower abdominal pain and groin pain due to stretch of round ligaments.
C. Visual disturbance.
D. Calf pain due to muscle spasm.
Ans-C) Visual disturbance.
288. All are true for Hairy cell leukemia except ?
A. Lymphadenopathy
B. Splenomegaly
C. Pancytopenia
D. Hepatomegaly
Ans: A ) Lymphadenopathy
Most common physical finding is splenomegaly.Leucocytosis is there not lymphadenopathy.
289. In Marfan’syndrome,aortic aneurysm occurs in ?
A. Ascending aorta
B. Descending aorta
C. Arch of aorta
D. Abdominal aorta
Ans: A ) Ascending aorta
290. This pattern is found in ?
52 | P a g e
A. Paraganglioma
B. Pheochromocytoma
C. Acoustic neuroma
D. Renal cell carcinoma
Ans: B: Pheochromocytoma
Pheochromocytoma is microscopically composed of polygonal to spindle-shaped chromaffin cells and their
supporting cells,compartmentalized into small nets,or ZELLBALLEN’ BY A rich vascular network.
291. Which of the following cell types is not a target for initiation & maintenance of HIV infection ?
A. CD4T-cell
B. Dendritic cell
C. Macrophage
D. Neutrophill
Ans D: Neutrophill
The two major targets of HIV infection are the immune system and the CNS. The profound immunodeficiency is
hallmark of AIDS. The viral envelop gp 120 interacts with CD4 molecule. The commonly affected CD 4 cells in the
human body include helper T cells (worst affected), monocyte – macrophages and dendritic cells. Defective CCRS
receptors lead to protective effect of providing resistance to the development of AIDS.
292. Specific marker of synovial sarcoma?
A. T(X,18)
B. T(9,22)
C. T(11,14)
D. T(17-9)
Ans: A) T(X,18)
Most synovial sarcoma show a characteristic translocation T(X,18) producing SYT-SSX1/SSX2 fusion gene.
293. Marker of Paget’s disease of breast is?
A. HMB-45
B. Synaptophysin
C. CEA
D. 5-100
Ans: C) CEA
“CEA is elevated in adenocarcinoma of colon, pancreas, lung, BREAST and ovary” 5-100 protein is present in virtual
primary and metastatic melanomas, including the amelanotic variety. However 5-100 positivity is also found in
tumors of neuro endocrinal origin ( e.g. small cell lung cancer, carcinoid, neuro- epithelioma); a more specific
marker melanoma is the HMB45 (human melanoma black 45) antigen”
Synaptophysin is the marker of neuroendocrine tumors.
294. .Milnacipran is used in the treatment of depression and ?
A. Multiple sclerosis
B. MND
C. Fibromyalgia
D. Shy dragger syndrome
Ans: C) Fibromyalgia
it is a Serotonin-norepinephrine reuptake inhibitor.
295. A 35 years female has lived in a state psychiatric hospital for the past 10 years. she spends most of her day rocking,muttering
softly to herself,or looking her reflection in a small mirror.she needs help with dressing and showering,and she often giggles
and laughs for no apparent reason.which of the following diagnoses is the most likely in this pt?
A. Schizoaffective disorder
B. Schizophrenia,residual type
C. Schizophrenia,disorganized type
D. Schizophrenia,paranoid type
Ans: C) Schizophrenia,disorganized type
296. All are true about dementia except?
A. Global impairement of intellect is the essential features
B. Delirium is present
C. Other mental functions may often be affected
D. None of the above
Ans: B) Delirium is present
297. All are charachteristic features of superior semicircular canal dehiscence except?
A. Third window phenomenon
53 | P a g e
B. Sensorineural hearing loss on audiometry

C. Tullio’s phenomenon
D. VEMP is a useful investigation
Ans: B) Sensorineural hearing loss on audiometry
Expl;In Third window phenomenon which may be seen in superior,lateral or posterior canal dehiscence.In this there
is CONDUCTIVE HEARING LOSS.
298. Identify this instrument?
A. Negus knot tyer

B. Tracheal dilator
C. Eves’tonsil snare
D. Tracheal hook
Ans: D) Tracheal hook
299. Cortical mastoidectomy is indicated in all except?
A. Acute coalescent mastoiditis
B. Masked mastoiditis
C. Incomplete resolution of otitis media
D. Malignant disease of middle ear
Ans: D) Malignant disease of middle ear
Cortical mastoidectomy is also known as simple or complete mastoidectomy Schwartze operation: in this operation
complete exenteration of all the accessible mastoid air cells done converting them into a single and the middle ear
structure are not touched. It is indicated in the following situation.
a) Acute coalescent mastoiditis.
b) Masked mastoiditis
c) Incomplete resolution of otitis media.
d) Initial step in endolymphatic sac surgery, decompression of facial nerve, trans- labyrinthine or retro –
labyrinthine procedures for acoustic neuroma.
300. True in menetrier’s disease are all EXCEPT:
A. Rugosities fold hypertrophy
B. Foveolar hyperplasia
C. Protein losing gastrophy
D. Hypergastrinemia
Answer is D: Hypergastrinemia
54 | P a g e

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C. Hereditary coproporphyria : Uroporphyrinogen decarboxylase

Ans-B) Retrospective case control study

D. Left Facial nerve

88. Which of the following is a feature on Xray of Rheumatoid Arthritis?

Ans-C) Ulnar nerve

A. LV & aorta in aortic regurgitation

A. Watson & Crick

A. Supplies major coagulation factors

A. Stem and leaf plot

Ans-C) Down’s syndrome

Answer: D- Botulinum toxin

A. Long term remission

A. The patient should be given a platelet transfusion

C. Induction of ovulation with human menopausal gonadotropins.

B. Sensorineural hearing loss on audiometry

A. Negus knot tyer

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