Comed K Paper-2012

Q.1      Energy requirement in most post surgical adult patients can be met by administration of :
a. 30 K cal / Kg / day    b. 40 K cal / Kg / day
c. 50 K cal / Kg / day    d. 60 K cal / Kg / day

Q.2      Object constancy is a major cognitive milestone that is usually achieved at ?
a. 6 months                 b. 9 months
c. 12 months               d. 15 months

Q.3      A 54 year old chronic smoker [ smoking index- 50 pack year ] presents with oral lesion suggestive of oral leukopalkia. Which  of the following intervention  can cause regression of the lesion ?
a. alph – tocopherol     b. Isoretinoin
c. Beta- carotene         d. Selenium

Q.4      Cystatin C is a novel marker of :
a. Fatty liver                 b. glomerular filtration
c. vitamin K status       d. cholestasis

Q.5      The following statements regarding phenytoin  are true EXCEPT:
a. It is highly bound to plasma protein
b. It is a prodrug and requires activation in the liver
c. It induces drug metabolizing enzyme
d. At high concentration , it follows zero order kinetics

Q.6      Universal antidote contains the following, EXCEPT :
a. Powdered charcoal   b. Tannic acid
c. Ground mustard       d. Magnesium oxide

Q.7      Comparing   economic benefits of a program with the cost of the program, it is called :
a. Cost – accounting Analysis  
b. Input – output Analysis
c. Cost- effective Analysis
d. Cost – benefit analysis

Q.8      Following statement are true in Leptospirosis :
a. It is a zoonosis
b. Presents with fever, petechiae , jaundice and renal failure.
c. Doxycycline , penicillin and macrolides are used in treatment
d. Demonstrated by phase contrast microscopy

Q.9      Risk of ureteric injury during abdominal hysterectomy in increased in the following condition except :
a. Endometriosis
b. Pelvic inflammatory disease
c. Adenomosis
d. Broad ligament fibroid

Q.10    Serum albumin level is a component of which of the following scoring systems:
a. Ranson’s criteria       b. APACHE II score
c. Child’s scoring          d. ASA physical status

Q.11    Oxytocin-
a. originates in the supra-optic nucleus of the hypothalamus
b. is essential  for the onset of labour
c. stimulates the growth of uterine musculature
d. is synthesized by paraventicular nucleus of the hypothalamus

Q.12    Which of the following is an important feature of Herpes Simplex kertatitis?
a. Ciliary Congestion
b. Corneal haze
c. Pannus             
d. Reduced corneal sensation

Q.13    Association of sexual precocity, multiple cystic bone lesion and endocrinopathies is seen in ?
a. Mc cune- Albright’s syndrome
b. Granulos cell tumor
c. Arrenhoblastoma
d. Prolactinoma

Q.14    Moth eaten alopecia is seen in ?
a. Black dot tinea         b. Telogen effluvium
c. Alopecia areata         d. Secondary syphilis

Q.15    A 12 year old child a known case of rheumatic heart disease, presents with low grade fever of one month duration. She has pallor, splenomegaly, clubbing and microscopic hematuria. The most important you would like to do is :
a. Antistreptolysin O titre  b. C Reactive Protein
c. Urine culture                d. Blood culture

Q.16    Mallory bodies are derived from :a
a. Cytokeratin               b. Desmin
c. Laminin                    d. Vimentin

Q.17    All of the following drugs inhibit microbial cell wall synthesis except :
a. Neomycin                 b. Vancomycin
c. Meropenem             d. Bacitracin

Q.18    Fish tank granuloma is caused be :
a. Mycobacterium ulcerans
b. Mycobacterium marinum
c. Mycobacterium kansasi
d. Mycobacterium szulgai

Q.19    Which of the following is not True of spasmodic croup ?
a. History of fever is present
b. Cough is metallic
c. Larynx is a pale edematous
d. Occurs mostly at nights

Q.20    The most common cause of bronchopulmonary aspergillosis is :
a. Aspergillus fumigates b. Aspergillus clavatus
c. Aspergillus flavus       d. Aspergillus niger

Q.21    All of the following are indicators of physical quality of life index, EXCEPT:
a. Infant mortality rate
b. Life expectancy at one year
c. Level of living
d. Literacy

Q.22    “La Facies Sympathique” may be seen in :
a. Hanging                    b. Strangulation
c. Drowning                  d. Suffocation

Q.23    Antigens presented along with HLA class I stimulate
a. CD8 cells                  b. CD4 cells
c. CD2 cells                  d. CD19 cells

Q.24    Cell shape and physical  structure is provided by :
a. Cell membrane        b. Microtubules
c. microfilaments         d. golgi apparatus

Q.25    The cavity of mesencephalic brain vesicle is :
a. Lateral ventricle       b. third ventricle
c. Fourth ventricle        d. Cerebral aqueduct

Q.26    Stiffening of the body muscles after death due to the bread- down of ATP is known as ?
a. Cadaveric rigidity                 
b. Cadaveric spasm
c. Post mortem hypostasis
d. Post mortem lividity

Q.27    Commonly,” One dietary cycle “refers to :
a. One day                    b. 7 days
c. 14 days                    d. 21 month

Q .28   “shrinking lung”  is a feature of “:
a. Rheumatoid arthritis                        b. SLE
c. Systemic sclerosi                 d. Polymyositis

Q.29    Wolffian duct remnant may present in the female as :
a. Gartner’s cyst           b. Bartholin’s cyst
c. Endometriotic cyst   d. Fimbrial cyst

Q.30    Rodent ulcer is the other name for :
a. Squamous cell carcinoma
b. Malignant melanoma
c. Basal cell carcinoma
d. Actinic keratosis

Q.31    The first step in conducting an epidemic investigation is to :
a. Determine the case count
b. Calculate the incubation period
c. Determine the population at risk
d. Verify the diagnosis

Q.32    The following syndrome is associated  with bronchiectasis:
a. Kallmann’s syndrome
b. Kartagener’s  syndrome
c. Kostmann’s syndrome
d. Klinefelter syndrome

Q.33    In exocrine pancreatic cancer, the commonest tumor marker  to be elevated is :
a. CA -125   b. CEA   c. CA- 15-3    d. CA- 19-9

Q.34    Recurrences of herpes genitalis:
a. more with HSV-2 than HSV-1
b. same in both HSV-1 and HSV-2
c. more in HSV-1 than HSV-2
d. Variable and insignificant with either type of HSV

Q.35    Which of the following drugs is useful in the long term treatment of alcohol dependence ?
a. Acamprosate                        b. Chlordiazepoxide
c. Flumazenil                d. Imipramine

Q.36    March fracture is
a. Stress fracture of neck of 2nd metatarsal
b. Stress fracture of neck of talus
c. Compression fracture of calcaneum
d. Fracture lower end of fibula

Q.37    Most frequent association of cryptorchidism is with :
a. Epididymo-orchitis  
b. Hernia
c. Infertility             
d. Malignant transformation
Q.38    All of the following are adverse effects of long-term corticosteroids EXCEPT:
a. Hypoglycemia          b. Psychosis
c. Peptic ulcers                        d. Osteoporosis

Q.39    Laser iridotomy is done in :
a. Open Angle glaucoma
b. Angle closure glaucoma
c. Iridocyclitis
d. Posterior capsular opacification

Q.40    An emerging viral pathogen causing pyelonephritis  in kidney allografts is :
a. Rotavirus             b. Herpes simplex  virus
c. Polyoma virus      d. Influeza virus

Q.41    Epidemic outbreak in birds is called:
a. Enzootic                   b. Epornithic
c. Zoonotic                   d. Amphixenoses

Q.42    The narrowest portion of fallopian tube is :
a. Interstitial part         b. Isthmus
c. Ampullary                 d. Infundibulum

Q.43    The commonest variety of urinary bladder cancer is ?
a. Squamous  cell carcinoma
b. Basal cell carcinoma
c. Transitional cell carcinoma
d. Adenocarcinomas

Q .44   The commonest systemic abnormality associated with renal cell carcinoma Is :
a. Hypertension                       b. Polycythemia          
c.  Elevated ESR           d. Pyrexia

Q.45    Which of the following condition cause congestive heart failure in neonates:
a. Bicuspid Aortic valve           
b. Teralogy of fallot
c. ASD
d. Total anomalous pulmonary venous return

Q.46    The cause of gunstock deformity is :
a. Supracondylar fracture
b. Fracture both bones forearm
c. Fracture surgical head of humerus
d. Fracture fibula

Q.47    Which of these statements about ulcerative colitis (UC) and colon carcinoma is falce :
a. The risk of carcinoma increases with duration of UC
b. Overall risk is less than 5%
c. Cancer of rectum is more common than that of colon
d. Surgery is indicated if biopsy shows severe epithelial dysplasia

Q.48    A hypersensitive patient who is a chronic smoker presented with recurrent hemoptysis. On examination he had cushingoid features. Investigation  revealed raised ACTH levels  not suppressed by dexamethasone. The single diagnosis which can account  for all his symptoms is ?
a. Multiple Endocrine neoplasia I
b. Pitutory adenoma
c. Adenocortical adenoma
d. Ectopic ACTH producing tumor

Q.49    All of the following  are skin antiseptics Except :
a. chlorhexidine                       b. ethyl guaiacol
c. isopropyl alcohol      d. Povidone iodine

Q.50    Cyclin B is required for cell cycle progression from :
a. G0 to G1   b. G1 to S  c. S to G2  d. G2 to M

Q.51    Which among the following drugs is LEAST likely to cause neutropenia ?
a. Chlorambucil                        b. Methotrexate
c. Cyclophosphamide   d. Vincristine

Q.52    Which virus is NOT a teratogenic virus ?
a. Rubella                     b.. Cytomegalovirus
c. Herpes simplex        d. Measles    

Q.53    The commonest valvular lesion in SLE related cardiac disease is :
a. Tricuspid regurgitation
b. Mitral regurgitation
c. Mitral stenosis
d. Aortic regurgitation

Q.54    Safe lights in a radiographic darkroom are ideally light of which colour?
a. Red    b. Blue      c. White     d. Yellow

Q.55    Which joints is not fused in triple arthrodesis?
a. Tibiotalar                  b. Calcaneo cuboid
c. Talo navicular           d. Talo calcaneal

Q.56    Tramline calcification of the cerebral cortex is seen in ?
a. Tuberous sclerosis
b. Sturge- weber syndrome
c. Von Hippel Lindau  disease
d. Von Recklinghausen’s disease

Q.57    Which of these is a sign of left atrial enlargement on a PA chest radiograph ?
a. Elevation of the right main bronchus
b. Double density on the left side of the heart  shadow
c. Discrete bulge of the left cardiac margin right
d. Displacement of the trachea to the right

Q.58    District mental health program war first implemented in :
a. Bellary district, Karnataka
b. Trichy, Tamil Nadu
 c. Agra, Uttar Pradesh
d. Mumbai, Maharashtra

Q.59    The disease which imported in to country in which they do not otherwise occur is termed as ?
a. Endemic                   b. Exotic
c. Epidemic                  d. Pandemic

Q.60    ‘ Gandy- Gamma’ nodules are typically seen In chronic venous congestion of :
a. Lung     b. Kidney     c. Liver     d. Spleen

Q.61    Which of the morphological from of Leishmania donovani is seen in man ?
a. Promastigote                       b. Trypomastigote
c. Amastigote              d. Epimastigote

Q.62    The primary visual area is located in the walls of :
a. Parieto – occipital sulcus
b. Superior temporal sulcus
c. Posterior part of calcarine sulcus
d. Central Sulcus

Q.63    Thumb print sign in neck radiograph is characteristically seen in :
a. Ludwig’s angina        b. Croup
c. Epiglottis                  d. Lemierre’s disease

Q.64    One of the most commonly used drug world wide is :
a. Cannabis   b. Alcohol  c. Caffeine  d. Cocaine

Q.65    The following may be found in the cortex of the ovary EXCEPT:
a. Primordial follicles    b. Granulosa Cells
c. Hilus cells                 d. Corpus luteum

Q.66    A 30 year old female patient underwent total thyroidectomy. After surgery patient complained of inability to raise her voice pitch. The most likely cause is injury to ?
a. Internal branch of superior laryngeal nerve
b. External branch of superior laryngeal nerve
c. Recurrent laryngeal  nerve
d. Ansa cervicalis

Q.67    Lung compliance is increased in :
a. The presence of intra- alveolar fluid
b. Acute respiratory distress syndrome
c. Idiopathic pulmonary fibrosis
d. Emphysema

Q.68    A 2 year old male child has a head circumference of 55 cms . Which one of the following intra-uterine infection he might have acquired ?
a. Rubella                     b. Toxoplasmosis
c. Herpes                     c. Hepatitis

Q.69    Which one of the following is  a life threatening  complication of talc pleurodesis?
a. empyema   
b. reexpansion pulmonary edema
c. hemothorax

Q.70    Haab striae are seen in :
a. Congenital glaucoma
b. Birth trauma
c. Keratoconus
d. Pseudoexfoliation glaucoma

Q.71    Hepatocellular carcinoma is associated with infection caused by :
a. Hepatitis C virus       b. Hepatitis E virus
c. Hepatitis G virus       d. Hepatitis A virus

Q.72    In thyroid gland iodide is transported into the lumen of the follicles by :
a. endocytosis       b. pendrinprotein
c. antiport              d. primary active transport

Q.73    The vitamin present in the fatty acid synthase complex is :
a. Thiamine                  b. Folate
c. Pantothenate                       d. Pyridoxine

Q.74    All of the following are anti- pseudomonal cephalosporins  Except :
a. ceftazidime              b. cefoperazone
c. cefpodoxime                        d. cefpirome

Q.75    All of the following are true about acute rhinosinusitis EXCEPT  :
a. It is less than 2 weeks of duration
b. Can arise from infectious and non infectious cause
c. most patients improve without antibiotics
d. fungal variety is called mucormycosis

Q.76    The art of winning friends and influencing people is called :
a. Counseling               b. Persuasion
c. Education                 d. Motivation

Q.77    Pseudomembranous colitis is caused by :
a. Clostridium botulinum
b. Clostridium perfrigens
c. Clostridium difficile
d. Clostridium tetani

Q.78    Which of the following carcinomas has a better prognosis ?
a. Supraglottis              b. Glottis
c. Subglottis                 d. Epiglottis

Q.79    Which of the following organism in pus is acid fast with 1% sulphuric acid :
a. Achinomyces israeli
b. Nocardia brasiliensis
c. Streptomyces somaliensis
d. Blasomyces dermatitidis

Q.80    The dartos muscle is innervated by:
a. ilioinguinal nerve      b. iliohypogastric nerve
c. sympathetic nerve   d. pudendal nerve

Q.81    REM sleep
a. is associated with dreamless sleep
b. occupies 80% of the total sleep time in full term infants
c. is associated with sleep walking
d. is associated with depressed muscle tone

Q.82    Otomycosis is caused by :
a. Aspergillus niger
b. Histoplasma capsulatum
c. Rhinosporidum seeberi
d. Cryptococcus neoformans

Q.83    Type of anemia developing commonly in a patient carcinoma stomach is :
a. Aplastic anemia       b. megaloblastic anemia
c. Haemolytic anemia d. Iron deficiency anemia

Q.84    The commonest valvular lesion in SLE related cardiac disease is?
a. Tricuspid regurgitation
b. Mitral regurgitation
c. Mitral stenosis
d. Aortic regurgitation

Q.85    The following drug is predominantly a dual serotonin and norepinephrine reuptake inhibitor :
a. Fluvoxamine             b. Dulaxetine
c. Fluoxetine                d. Paroxetine

Q.86    In triage, green color indicates :
a. Ambulatory patients.
b. Moribund patients
c. High priority treatment or transfer
d. Medium priority or transfer

Q.87    Bexarotene an oral retinoid is indicated in :
a. Severe acne vulgaris                b. pustular psoriasis
c. Mycosis fungoides         d. lichen planus

Q.88    Which of the following is the most common of sensory neural hearing loss in adults?
a. Meniere’s disease
b. presbycusis
c. cerebellopontine angel tumor
d. trauma

Q.89    Drugs that may increase anticoagulant effect of warfarin include all of the following except :
a. Fluconazole              b. Aspirin
c. Rifampicin                d. Metronidazole

Q.90    Gastrointestinal stromal tumour originates from :
a. Interstitial cells of cajal      b. Parietal cells
c. Enteroendocrine cells        d. Chief cells

Q.91    Retina develops from :
a. Neural ectoderm                  b. Endoderm
c. Surface ectoderm                d. Mesoderm

Q.92    Consumption of even a moderate amount of alcohol during pregnancy is associated with :
a. Goiter- like symptoms in the fetus
b. Mental retardation in the newborn
c. Increased risk of spontaneous abortion
d. Fetal alcohol syndrome

Q.93    Hamman’s sing is seen in :
a. pneumomediastinum             b. pericardial effusion
c. SVC obstruction          d. thyrotoxicosis

Q.94    Which one of the following is acontraindication for Liver transplantation:
a. Ongoing substance abuse
b. Hepatorenal syndrome
c. Portal hypertension
d. Acute liver failure

Q.95    Amongst the following, the LEAST risk of malignant disease of bone or cartilage is seen with :
a. Chondroblastoma    
b. Maffucci’s syndrome
c. Ollier’s disease        
d. Familial retinoblastoma syndrome

Q.96    A 13 year old male is injected with 5 TU of tuberculin antigen. After 72 hours , reading recorded is 15mm x 10mm . Which of the following statements is true regarding the test result :
a. Positive test – Type I reaction
b. Positive test – Type IV reaction
c. Negative test – Type I reaction
d. Negative test – Type Iv reaction

Q.97    Oral hairy leukoplakia occurs in :
a. Carcinoma tongue
b. Oral candidiasis
d. Infectious Mononucleosis

Q.98    Blackwater fever is seen in :
a. Leishmaniasis          b. Falciparum malaria
c. Trypanosomiasis       d. leptospirosis

Q.99    The gap in time between the onset of primary case and the secondary case is called :
a. Serial interval
b. Generation Time
c. Communicable period
d. Median Incubation period

Q.100  The cell which forms blood – testis barrier is :
a. Spermatogonia    b. primary  spermatocyte
c. Leydig cell           d. sertoli cells

Q.101  Which among the following is not and adverse effect of furosemide ?
a. Hypokalemia            b. Ototoxicity
c. Hypercalcemia         d. Hyperuricemia

Q.102  In giant cell tumor of bone, the tumour cell are :
a. Sinusoidal lining cells
b. Osteoclastic giant cells
c. Fibroblastic cells
d. Mononuclear stromal cells

Q.103  Germ theory of disease was advanced by :
a. Louis Pasteur
b. Lemmuel Shattuck
c. William Budd
d. Anton van leeuwenhoek

Q.104  Copper sulphate poisoning manifests with :
a. Acute hemolysis
b. High anion gap acidosis
c. Peripheral neuropathy
d. Rhabdomyolysis

Q.105  The sensory nerve supply of the fallopian tube and ovary is from which nerve roots?
a. D6 to D8                   b. D8 to D10
c. D10 to D12               d. L1 to L2

Q.106  The most common benign lesion of the liver is :
a. Hemangioma          
b. Hepatic adenoma
c. Focal nodular hyperplasia
d. Hepatoblastoma

Q.107  Coeliac plexus block :
a. Can be used to relieve pain from intra-abdominal malignancy
b. May cause constipation
c. May cause hypertension
d. Cause constriction of the sphincter of Oddi

Q.108  A child whose weight for height is > 80% and height for age is < 90% is said to be :
a. normal                     b . stunted
c. wasted                     d. Wasted and stunted

Q.109  The ratio between the uterine corpus and the cervix at birth is :
a. 1:1       b. 1:2       c. 2:1      d. 3:1

Q.110  The typical orphan- Annie eye’ nucleus is described in :
a. Serous cystadenocarcinoma of ovary
b. Renal cell carcinoma
c. Papillary carcinoma of thyroid
d. Seminoama

Q.111  The major cause of low birth in countries with high proportion of low birth weight is :
a. Maternal anemia      
b. Pre- term
c. Maternal malnutrition
d. Intra uterine growth retardation

Q.112  Planned end-point of all activites is :
a. Objectives                b. Goals
c. Targets                     d. Results

Q.113  Chronic zinc deficiency causes :
a. Hirsutism                 b. Gynecomastia
c. Stunted growth        d. Hypergeusia

Q.114  Enteroclysis is
a. Contrast study of small bowl fluroscopicaly
b. Double contrast study of colon fluroscopicaly
c. Laparoscopic lysis of adhesion
d. Enema with chemical substance

Q.115  Regarding spinal anaesthesia:
a. The spinal cord terminates  at L4
b. Aqueous 0.5% bupivacaine  Is hyperbaric
c. Bradycardia may be treated with IV Ephedrine
d. High block impairs the ability to cough

Q.116  Which is true of Panic disorder ?
a. It is characterized by recurrent and unpredictable  panic attack
b. The panic attacks always occur in specific situation
c. Autonomic symptoms are rare in panic disorder
d. The panic attacks evolve very slowly

Q.117  The veins of the pericardium drain into
a. Superior vena cava
b. inferior vena cava
c. azygos vein        
d. left brachiocephalic vein

Q.118  Blood flow of resting skeletal muscle is :
a. 1-1.5ml/ 100 gm/ min
b. 2-4ml/ 100 gm/ min
c. 5-7ml/ 100 gm/ min
d. 8-10 ml/ 100 gm/ min

Q.119  Tension pneumothorax is associated with :
a. Mediastinal displacement away from the lesion
b. Decreased percussion note on the side of the lesion
c. Increased blood pressure 
d. Stridor

Q.120  Carriers of Avirulent organisms are called :
a. Healthy carriers        b. Temporary carriers
c. Inapparent carriers  d. Pseudo- carriers

Q.121  An adenofibroma of ovary in which the epithelial component consists of nests of transitional cells is called
a. Thecoma
b. Granulosa cell tumour
c. Brenner tumour  
d. Serous  cystadenofibroma

Q.122  All of the following drugs can be used for the prophylaxis of migraine EXCEPT :
a. Propranolol               b. Sumatriptan
c. Amitriptyline             d. Flunarizine

Q.123  The biosynthesis of the enzyme pyruvate carboxylase is repressed by ?
a. Insulin                      b. Glucagon
c. Cortisol                     d. Epinephrine

Q.124  Test used to find fixed flexion deformity of hip is ? 
a. Levin Punch test      b. Thomas test
c. Telescopy test         d. Lasegue test
Q.125  Which of the following radio- nucleides is used to identify ectopic gastric mucosa ?
a. 99m Tc- pertechnetate
b. 99m Tc- sulphur colloid
c. 99m Tc- labeled red cells
d. 99m Tc- albumen macroaggregates

Q.126  The highest risk of malignant transformation in the oral cavity is seen in ?
a. Oral submucous fibrosis
b. Erythroplakia
c. Oral lichen planus
d. Discoid lupus erythematosus

Q.127  Left ovarian vein drains into
a. Left renal vein          b. Internal ileac vein
c. Inferior vena cava    d. Azygos vein

Q.128  Sjogren’s Syndrome Affects
a. Exocrine glands        b. Paracrine glands
c. endocrine glands     d. autocrine glands

Q.129  Treatment of choice for septate uterus with a high pregnancy success rate is :
a. Strassman operation
b. Jones and jones operation
c. Tomkins operation
d. Hysteroscopic metroplasty

Q.130  A 62 year man with carcinoma lung presented to emergency department with respiratory distress . ECG showed electrical alternans . Most likely diagnosis is :
a. pneumothorax        
b. pleural effusion       
c. cardiac temponade
d. constrictive pericarditis

A 4-year old male child is brought to he pediatric outpatient department with sore throat and fever for two days and noisy breathing with inability  to swallow for the past four hours. Examination showed a toxic , tachypneic child with inspiratory stridor and drooling of saliva. There is suprasternal, supraclavivular and intercostals recession during inspiration. No stridor  heard during expiration .

Q.131  The child’s clinical presentation suggests :
a. Intrathoracic airway obstruction
b. Extrathoracic airway obstruction
c. Belladonna poisoning
d. Bronchopneumonia

Q.132  The appropriate next course of action is :
a. Arrange things for securing airway
b. Give urgent stomach wash
c. Immediate throat examination for a foreigen body
d. Sedate the child

Q.133  X- ray neck lateral view in this child is likely to reveals :
a. Steeple sign             b. Thumb sign   
c. Scabbard trachea     d. Normal airway

Q.134  The child needs to be treated with :
a. Neostigmine                               b. Chelating agent
c. Urgent adenoidectomy     d. Antibiotics

A 75 –year old woman with chronic atrial fibrillation presented to the hospital with a 2 – day history of colicky abdominal pain . The physical examination revealed hypoactive bowel sounds and diffuse abdominal tenderness. Laboratory tests showed a white- cell count of 19,400 per cubic millimeter with 92 %  neutrophils, a blood urea nitrogen level of 42 mg per deciliter ( 15 mmol per  liter ) , and a serum creatinine level of 3.0 mg per deciliter (267 ยตmol per liter )

Q.135  The plain skiagram in this patient would have revealed
a. Gas under the diaphragm
b. Dilated sigmoid colon
c. Dilated gas filled small bowel with thickening of the wall
d. Colon cut off sign

Q.136  The investigation of choice would be
a. Contrast enhanced CT abdomen
b. Duplex Doppler of the abdomen
c. MRI scan of the abdomen
d. Ultrasonography of abdomen

Q.137  The most probable diagnosis in this patient would be ?
a. Portal vein thrombosis
b. Mesenteric ischemia
c. Intestinal perforation
d. Lynch syndrome

Q.138  The common cause for this problem would be
a. Occlusion of the portal vein
b. Occlusion of the superior mesenteric vessel
c. Occlusion of the inferior mesenteric vessel
d. Perforation of the duodeneum

A twenty year old female patient was stabbed with an ice pick in the xiphistemum , brought to the causality in stupor, very pale, tachycardia, feeble pulse prominent neck veins and muffled heart sounds on auscultation

Q.139  The investigation of choice in this patient would be
a. Bedside ultrasound of chest
b. Electrocardiogram
c. CT chest
d. Plain chest skiagram

Q.140  The most likely problem in this patient is :
a. tension pneumothorax
b. haemothorax
c. pericardial tamponade
d. diaphragmatic hernia

Q.141  Immediate treatment of this condition is
a. massive infusion through wide bore needle
b. immediate ILC placement  (inter costal drain)
c. immediate thoracotomy
d. pericardiocentesis

A 60 year old male has a long standing history of breathlessness. He has been a heavy smoker since the age of 20 years. Physical examination reveals an anxious male who is emaciated , puffing for breath but is not cyanosed. The chest is barrel shaped .

Q.142  An additional clinical finding would be
a. elevated domes of the diaphragm
b. left ventricular hypertrophy
c. muffled heart sounds
d. gynecomastia

Q.143  The primary pathology of the lung in this patient is associated with which of the following pathogenetic mechanisms?
a. Type I hypersensitivity
b. unabated action of proteases
c. deposition of immune complexes
d. deficiency of a protein produced by the liver
Q.144  The investigation of choice in this patient would be
a. High resolution CT
b. Contrast Enhanced CT
c. Plain skiagram chest
d. Ultrasound chest

A 45 yr old nulliparous perimenopausal women comes with a 6 cm lump in the right upper quadrant with puckering of the overlying skin and a small of ulceration, on further examination she has three axillary firm palpable lymph node in the same side, she also has one lymph node in the supraclavicular area, rest of the systems are clinically normal .

Q.145  The most appropriated investigation which was ordered from the outpatient department was :
a. Estimation of BRCA I/II
b. Core needle biopsy
c. Mamogram
d. Ultrasonography

Q.146      The clinical staging of this case would be
a. T3 N2 M1
b. T4 N2 M0
c. T4a N3c M0
d. T4b N3b M0 Schwartz p 452
A 38 year old homeless male develops sudden onset hematemesis following a bout of severe vomiting and retching . He had not complaints prior to the onset of his symptoms. On examination , he is pale and looks enxious. The vital sign are normal . Lab investigation show normal liver function tests , a low Hb and a high MCV . Chest X- ray is normal .

Q.147  The probable diagnosis in the patient is :
a. Variceal vein         
b. Mallory weiss Syndrome
c. Barrett’s esophagus
d. Boerhave’s disease

Q.148  He should have an immediate
a. Barium swallow  b. Upper GI scopy 
c. Chest  X- ray      d. ultrasound of abdomen

Q.149  The above problem on endoscopy would appear as
a. dilated veins in lower esophagus
b. growth in the lower esophagus
c. linear tear in the OG junction
d. whitish plaques in esophagus

A 58 year old healthy man was evaluated for a toothache of 2 days’ duration . He was treated with oral penicillin and an opiate analgesic and advised to have the affected teeth pulled. He returned less than 24 hours later reporting severe swelling in the neck sore throat , chills and chest pain. On examination the floor of this oral cavity was indurated and woody, and he had marked tenderness and adenopathy throughout his neck. He had erythema spreading from his neck down over his anterior chest wall where his chest pain was localized .
Q.150  The patient was suffering from
a. Quinsy                      b. Ludwigs angina
c. Acute parotitis          d. Angioneurotic edema

Q.151  This condition is an surgical emergency as it can lead to
a. air way obstruction     
b. difficulty in swallowing
c. aspiration pneumonia

Q.152  The infection spreads to the
a. submental, sublingual, and submandibular spaces
b. parapharangeal spaces
c. nasopharyngeal area
d. sinusis

Q.153  The treatment of choice in such an condition would be
a. Surgical decompression antibiotic and intensive care
b. Antifungal Therapy
c. Removal of the offending tooth
d. Continue the penicillin in larger doses
A 40 year old veterinarian presented with complaints of abdominals pain. On examination he was found be  icteric, the liver was palpable, Ultrasonograph revealed the presence of cyst in the right lobe of liver.

Q.154  The clinical picture is suggestive of infection caused by
a. Enteromonas hominis
b. Echinococcus granulosus
c. Endolimax nana
d. Enterobiusbenmicularis

Q.155  The definitive hosts of the agent causing this infection are
a. Human     b. Dogs      c. Reptiles      d. Deer

Q.156  The skin hypersensitive test performed in this infection is the
a. Patch test
b. Napier’s aldehyde test
c. Casoni’s test
d. Sabin- Feldman dye test

Q.157  The antigen used to perform the skin test is sterilized using the   
a. Hot air oven             b. Gamma radiation
c. Autoclaving              d. Seitz filter

A healthy 10 year old girl presented to her physician with nontender, well- circumscribed, mobile, slightly hyperkeratotic, erythematous plazues on the dorsal aspect of the interphalangeal joints of both thumb s. The plaques had developed over several months

Q.158  These bilaterally sycuntrical lesion are known as
b. Garrod’s pads
b. Herbeden nodules
c. Erythema nodosum
d. Erythema marginatum

Q.159  The diagnosis in this healthy young girls would be
a. bulimia nervosa        b. rheumatic fever
c. rheumatoid arthritis d. scarlet fever

Q.160  This kind of knuckle pads are also associated with all of the following EXCEPT ?
a. Dupuytren’ contracture
b. Ledderhose’ syndrome
c. Bart- pumphery syndrome
d. Rheumatic  carditis

A 45 year- old man presented with a 3 year history of a painless, soft and slow – growing swelling of the neck, upper trunk, upper back and shoulders. The patient had a history of heavy alcohol consumption and was non-smoker. Laboratory blood analysis showed minor elevation in as partate aminotransferase (71 U per liter) , ala-nine aminotransferase (49 U per liter), and total cholesterol ( 235 mg per deciliter [6.08 mmol per liter]). Triglye- diffuse , nonencapsulated fatty deposits in the mediastinum and in the subcutaneous and deeper fascial compartments of the neck, upper and back.

Q.161  The probable diagnosis of the patient is
a. Tuberculosis             b. Rheumatoid arthritis
c. Madelung’s disease   d. Hodgkin’s lymphoma

Q.162  This condition is seen in
a. Renal insufficiency    b. Hypercalcemia
c. Tuberculosis             d. Alcohol dependency

Q.163  This condition is more common in
a. Male                         b. Females
c. Indians                     d. Children
 Q.164 The treatment for this patient would be
a. Statins                      b. Aspirin
c. B complex                d. Anticoagulants

Q.165  Which enzyme is specific indicator of alcohol induced liver damage
a. SGOT                        b. SGPT
c. GGTP                        d. All of the above

A 25 year old female patient presented with history of bilateral hearing loss and tinnitus which worsened during pregnancy . She can hear better in noisy environment . She speaks in a low volume monotonous voice. Examination showed normal looking ear drums bilaterally and Rinne test negative bilaterally. Pure tone audiometry revealed Air-bone with dip in bone conduction at 2 KHz

Q.166  What is the most probable diagnosis
a. Meniere’s disease
b. Secretory otitis media
c. Bilateral acoustic neuroma
d. Otosclerosis

Q.167  Rinne test negative bilaterally means:
a. Bilateral conductive hearing loss
b. Bilateral sensorineural hearing loss
c. Bilateral normal middle ear function
d. Bilateral acoustic nerve tumors

Q.168  In the above patient, dip in bone conduction at 2 KHz is called
a. Moore’s sign             b. Carhart’s notch
c. Schwartz’s sign        d. Thumb sign

Q.169  The treatment of this patient is
a. Endolymphatic sac decompression
b. Myringotomy and grommet insertion
c. Stapedotomy and piston insertion
d. Retrosigmoid approach and exicision    

 A 6yr old child who presented with perianal pruritus, excoriation of skin and nocturnal enuresis was diagnosed to be infected with a parasite causing autoinfection

Q.170  The causative agent is
a. Trichinella spiralis
b. Giardia lamblia
c. Enterobius vermicularis
d. Wuchereria bancrofti

Q.171  The adult forms of the parasite are known to inhabit the
a. Caecum, appendix  & ascending colon
b. Subcutaneous tissues
c. Subcutaneous & lymphatic tissues
d. Proximal small intestine

Q.172  The infective from of the parasite for human in the
a. Filariform larvae        b. Embryonated egg
c. Trophozoite form     d. Quadrinucleate cyst 

Q.173  The causative agent is diagnosed by the
a. NIH swab method
b. String test
c. Hetrazan test
d. Encysted larvae on muscle biopsy

A 60 year old male present with progressive difficulty in swallowing, vomiting and occasional regurgitation for the past 3 months . Barium studies showed marked dilatation of the upper esophagus with narrowing of the lower segment. Manometry shows absent esophageal peristalsis.

Q.174  The pathogenesis of his condition is most likely related to
a. Reflux of gastric acid into the lower esophagus
b. abnormal dilatation of lower esophageal vein
c. incompetence of the lower esophageal sphincter 
d. absence of ganglion cells in the myenteric plexus of the esophagus

Q.175  Which of the following condition is he most likely at risk of developing ?
a. Mallory weiss syndrome
b. Peptic ulcer disease
c. Squamous cell carcinoma of the esophagus
d. Rupture of esophangeal varices

Q.176  He would also present to clinician with
a. recurrent chest infection
b. recurrent bleeding upper GI
c. recurrent colicky abdominal pain
d. esophangeal perforation

Q.177  This patient needs to have
a. balloon dilatation     b. endoscopic banding
c. sclerotherapy          d. proton pump inhibitor

A 69 year old female is being evaluated for constipation and episode of blood stained stools. Lab investigation show normal CBC and barium studies showed out – pouching of the sigmoid colon in multiple areas

Q.178  This patient has most likely developed the complication of
a. Pseudomyxoma peritonei
b. herniation of the colonic wall at the sites of  focal defects
c. absence of ganglion cells in the meissner plexus within the colon
d. atherosclerotic narrowing of the mesenteric arteries

Q.179  Three weeks later she develops fever. Left sided abdominal pain and diarrhea. Viral signs are : T- 102° F (38° C), with tenderness in the left iliac fossa. Probable causes is
a. Metastasis to the liver
b. Acute ischemic colitis
c. Perforation of the colon
d. Crohn’ disease

Q.180  The investigation of choice in this patient with the above complication would be
a. Computed Tomography
b. Ultrasound abdomen
c. Colonoscopy with biopsy
d. Barium enema