111. 2nd constriction in oesophagus is seen at the following site
a. Where crossed by left main bronchus
b. Crossing of aorta
c. At pharyngoesophageal junction
d. Where it pierces the diaphragm
e. Oesophageal sphincter

The abdominal oesophagus is supplied by the left gastric artery

The thoracic oesophagus is supplied by thoracic aorta and the inferior thyroid artery (a branch
of the thyrocervical trunk)
58. retrospective and prospective studies
a. Retrospective studies start after a disease has occurred
b. In prospective studies the investigator looks back in time to find out what agents or characteristics the
individuals were exposed to and which could lead to disease
c. Case control studies are examples of prospective studies (retrospective study)
d. retrospective studies individuals are identified before occurrence of disease and they are followed up
to see which individuals develop disease
e. looking for risk factors for death due to heart attacks is a prospective study

Cohort is example of prospective and Case control is an example of retrospective.
86. Electrocardiographic changes in hyperkalemia except
a. Peak T waves
b. Increased PR interval
c. Flattening of the P wave
d. U wave (hypokalemia)
e. Widening of the QRS complex
Hyperkalemia: hyper acute T - Flat P – Prolonged PR – Prolonged QRS
Hypokalemia: ST Depression - T wave inversion – Prominent U – Long QU interval
79. Punching consists of blows with the clenched fist and is usually directed at the upper part of the
body of the victim. All the following features are characteristics of a puncture wound EXCEPT
a. Bruising and abrasion are the most common
b. Lacerations may occur over bony prominences
c. Blows on the mouth may split the lips
d. Punching often results in wounds with clean cut, well defined edges
e. Punches in the abdomen in children may rupture the liver
37. All are true regarding the maxillary sinus except:
a. is lined by stratified squamous epithelium (mucoperiosteum)
b. is supplied by the greater palatine nerve
c. opens into the medial meatus
d. is the first sinus to form in life
e. is pyramidal in shape with its base being the nasal bone
69. The type of muscle tissue also known as voluntary muscle is
a. Smooth
b. Cardiac
c. Visceral
d. Peripheral
e. Skeletal
620. The auricle develops from
a. 1st branchial cleft
b. 1st branchial arch
c. 1st and 2nd branchial arch
d. 2nd and 3rd branchial arch
e. 1st, 2nd and 3rd branchial arch
390. When a muscle contacts it
a. Shortens and pushes a bone
b. Lengthen and pulls a bone
c. Lengthen and push the bone
d. Shortens and pulls or pushes a bone
e. Shortens and pulls a bone
486. The breast is supplied by:
a. Lateral thoracic artery.
b. Internal thoracic artery.
c. Intercostal arteries.
d. All of the above.
e. None of the above.
Arterial supply of breast includes: (Axillary – Thoracoacromial - Lateral Thoracic - Internal Thoracic –
Intercostal - Mammary)
39. A 5-year-old child has just had his second generalized tonic-clonic seizure in a 4 month period. You
have recommended starting an anticonvulsant. The parents have concerns about the recommended
medication and would prefer to wait and see if their son has more seizures. How should you respond to
the parents' request?
a. Obtain an ethics consultation.
b. Obtain a court order to treat the child.
c. Report the case as child abuse.
d. Fully inform the parents, and should they refuse to give anticonvulsants to the child, the physician
should abide by the parents' decision.
e. Inform the parents that you are starting another treatment and give them anticonvulsants.
141. Agglutination test for Brucella mainly identifies which class of antibodies?
a. IgG
b. IgM
c. IgA
d. IgE
e. IgD
339. In cystinuria the following do not appear in urine
a. Ornithine
b. Arginine
c. lysine
d. cystine
e. valine
138. All of the following are features of large intestine, Except
a. Large intestine secretes acidic mucus which helps in formation of stools
b. It is a site of mucocutaneous junction
c. Its epithelium contains goblet cells in large numbers
d. Absorbs salt and water
e. it ends at the anal phincter
15. Which of the following is NOT a cause of death
a. Cardiopulmonary arrest
b. Acute Heart failure
c. Cerebral hemorrhage
d. Dengue shock syndrome
e. Hypovolemic shock
562. Voluntary control of the urination is provided by the
a. Detrusor muscle
b. External urethral sphincter
c. Spinal cord
d. Prostatic urethra
e. Internal urethral sphincter
56. A 27-year-old woman at a snowy football game developed marked pallor, tingling and burning of her
nose and fingertips. She most likely had:
a. thromboangiitis obliterans
b. Takayasu's syndrome
c. arteriosclerosis obliterans
d. Raynaud's disease or syndrome
e. arteriolar sclerosis
101. Tetanus is caused by spread of
a. Exotoxin in sympathetic system (Exotoxin induced Spastic paralysis)
b. Exotoxin in para sympathetic system
c. Endotoxin in sympathetic system
d. Endotoxin in parasympathetic system
e. endotoxin in blood
141. Indicate the usual cause of death due to overdose of hypnotics:
a. Depression of the medullary respiratory center
b. Hypothermia
c. Cerebral edema
d. Status epilepticus
e. Bradycardia
126. Among the following, chronic peptic ulcer of the duodenum is best characterized as a lesion that:
a. frequently develops carcinoma as a complication
b. is related to intrinsic factor deficiency
c. occurs in patients with high levels of gastric acidity
d. is the result of cytotoxic antibodies to duodenal epithelial antigen
e. is due to focal infarction of the duodenal mucosa
196. The centers that regulate heart rate are located in the
a. Medulla
b. SA node
c. Carotid sinus
d. Cerebral cortex
e. Wall of the right atrium
71. Epidemiological studies reveal a positive correlation between smoking and cancer of all of the
following organs except:
a. oral cavity
b. esophagus
c. lung
d. urinary bladder
e. skin
Related to Smoking: GIT - Airway and Respiratory - Renal - Blood (AML) - Cervix - Bladder - Liver Pancreas
Famous Cancers not related to smoking: Breast - Prostate - Ovary - Endometrium - Skin
262. The lymph is called
a. Chyle
b. Chyme
c. Miscelle
d. Glycerol
e. Gall
707. Tensor tympani muscle is supplied by:
a. Mandibular nerve
b. Ophthalmic nerve
c. Maxillary nerve
d. Facial nerve
e. Nasocilliary nerve
743. In 60% of people, the sinus node of the heart is supplied by:
a. Direct branch from the aorta
b. Direct branch of the left coronary artery
c. Left anterior descending artery
d. Left circumflex artery
e. Right coronary artery
186. A 22-year-old woman presents with a discrete upper/outer quadrant breast mass. The most likely
diagnosis is :
a. carcinoma
b. fat necrosis
c. fibroadenoma
d. fibrocystic disease
e. intraductal papilloma
431. The muscles iliacus and psoas major are supplied by spinal segments
a. L2 and L3
b. L1 and L2
c. L5 and S1
d. L1,L2, and L3 (iliacopsoas)
e. L4, L5 and S1
572. Which statement is NOT true of hormone effects on the kidneys?
a. ADH increases the reabsorption of water
b. PTH increases the reabsorption of calcium ions
c. Aldosterone decreases the reabsorption of sodium ions
d. ANP increases the excretion of sodium ions
e. Renin-angiotensin-aldosterone system keeps sodium and water balance in check
636. Which of the following is TRUE regarding the celiac trunk?
a. Arises from the abdominal aorta at the level of the 2nd lumbar vertebra (T12)
b. Is accompanied by the celiac vein
c. Gives off the right gastric artery as a direct branch
d. Supplies all parts of the duodenum
e. Gives indirect supply to the gall bladder
Celiac trunk Gives 3 branches: Lt Gastric, Splenic and common hepatic.
Duodenum

Upper half supplied by superior pancreaticoduodenal a branch of Gastroduedenal a branch of
common hepatic which is branch of celiac trunk.

Lower half supplied by inferior pancreaticoduodenal a branch of superior mesenteric which is a
direct branch from abdominal aorta.
Gall bladder

Cystic A from proper hepatic from common hepatic A from Celiac Trunk.
418. Tick the indication for estrogens in oncological practice:
a. Leukemia
b. Cancer of prostate
c. Endometrial cancer
d. Brain tumors
e. Colon cancer
276. Most common type of diabetes is
a. Type I diabetes mellitus
b. Type 2 diabetes mellitus
c. Diabetes insipidus
d. Juvenile diabetes
e. Infant onset diabetes
195. The endocardium lines the chambers of the heart and:
a. Prevents friction when the heart beats
b. Is smooth to prevent abnormal clotting within the heart
c. Prevent backflow of blood into the veins
d. Prevents backflow of blood
e. Helps pump blood
84. Therapeutic index is:
a. A ratio used to evaluate the safety and usefulness of a drug for indication
b. A ratio used to evaluate the effectiveness of a drug
c. A ratio used to evaluate the bioavailability of a drug
d. A ratio used to evaluate the elimination of a drug
e. A ratio used to evaluate the absorption of a drug
14. Right heart failure causes each of the following except:
a. hepatomegaly
b. pulmonary edema
c. ankle edema
d. distended neck veins
e. none of the above
345. Indication for pamidronate administration is:
a. Failure of vitamin D formation in skin
b. Hypoparathyroidism
c. Elevated skeletal turnover
d. Hypercalcemia
e. Hyperkalaemia

Bisphosphonate are used for treatment of 1ry hyperparathyroidism and hypercalcemia.
84. An agent with low pathogenicity and high infectivity result in
a. Clinical case
b. Carrier case
c. Pandemic
d. Endemic
e. Epidemic
20. Which coagulation factor is not dependent on vitamin K?
a. factor I
b. factor II
c. factor VII
d. factor IX,
e. factor X

Vit k dependant clotting factors: 2,7,9,10, protein c
710. The oxygen-hemoglobin dissociation curve shifts to the left under which of the following
circumstances?
a. Carbon monoxide poisoning
b. Decreased pH (acidosis)
c. Increased 2,3-diphosphoglycerate (2,3-DPG)
d. Increased PCO2 (acidosis)
e. Increased temperature
Acidosis, Hyperthermia, increased 2,3 DGP all shift the curve to the right and vice vers.
115. Candidiasis is caused by
a. Candida albicans
b. Aspergillus spp.
c. E. floccosum
d. M. Audouinii
e. Staph. Aureus
73. The definition for a therapeutical dose is:
a. The amount of a substance to produce the minimal biological effect
b. The amount of a substance to produce effects hazardous for an organism
c. The amount of a substance to produce the required effect in most patients
d. The amount of a substance to accelerate an increase of concentration of medicine in an organism
e. The amount of drug that is absorbed after oral ingestion
1. Which bone does belong to the long bone?
a. Sternum
b. costal bone
c. humerus
d. parietal bone
e. scapula
26. care of sore nipples in a breast feeding mother include
a. not exposing the nipples to air
b. applying perfume
c. using soap
d. using alcohol
e. none of the above
613. Untrue about articular cartilage is (Hyaline cartilage)
a. Covers the articular surfaces of all synovial joints
b. Is of hyaline variety in all synovial joints (Synovial joints are lined by FibroCartilage)
c. No ossification with age
d. Is generally devoid of nerves, vessels and perichondrium
e. None of the above
19. Which of the following is NOT an underlying goal of ethics committees?
a. To promote the rights of patients.
b. To promote shared decision making between patients (or their surrogates if decision making is
incapacitated) and their clinicians.
c. To promote fair policies and procedures that maximize the likelihood of achieving good, patientcentered outcomes.
d. To improve the public perception of health care professionals and health care institutions.
e. None of the above
30. The element essential for oxygen transport in the blood is:
a. Calcium
b. Iron
c. Carbon
d. Sodium
e. Potassium
189. The vessel into which the left ventricle pumps blood is the
a. Superior venacava
b. Pulmonary artery
c. Pulmonary vein
d. Inferior venacava
e. Aorta
71. Which of the following you should not do in managing ocular allergies?
a. Rubbing your eyes
b. Washing eyes with cold water frequently
c. Administring anti-allergic eye drops
d. None of the above
e. All of the above
297. Which of the following is CORRECT regarding Hirschsprung's disease?
a. Is due to absent ganglion cells in Auerbach's plexus (distal colon)
b. Ten percent cases involves the recto-sigmoid segment
c. Ten percent cases present with delayed passage of meconium in the first 24 hours after birth
d. The affected segment of bowel appears dilated on barium enema
e. On rectal biopsy, there is a decreased acetylcholinesterase containing cells in the muscularis

Most cases of Hirschsprung disease are diagnosed in the newborn period. Hirschsprung disease
should be considered in any newborn that fails to pass meconium within 24-48 hours of birth.




Although contrast enema is useful in establishing the diagnosis, full-thickness rectal biopsy
remains the criterion standard.
Once the diagnosis is confirmed, the definitive treatment is to remove the aganglionic bowel and
to restore continuity of the healthy bowel with the distal rectum, with or without an initial intestinal
diversion.
The majority of Hirschsprung cases are sporadic. Approximately 10% of Hirschsprung patients
have a family member who was also affected. This predisposition is more common in patients
with longer-segment disease.
Prenatal ultrasonography demonstrating bowel obstruction is rare, except in cases of total colonic
involvement.

Hirschsprung disease should be considered in any newborn with delayed passage of meconium
or in any child with a history of chronic constipation since birth. Other symptoms include bowel
obstruction with bilious vomiting, abdominal distension, poor feeding, and failure to thrive.

Older children with Hirschsprung disease usually have chronic constipation since birth. They may
also show evidence of poor weight gain.

Older presentation is more common in breastfed infants who will typically develop constipation
around the time of weaning.

Despite significant constipation and abdominal distension, children with Hirschsprung disease
rarely develop encopresis. In contrast, children with functional constipation or stool-withholding
behaviors more commonly develop encopresis.
Encopresis is the soiling of underwear with stool by children who are past the age of toilet
training


About 10% of children present with diarrhea caused by enterocolitis, which is hypothesized to
stem from stasis and bacterial overgrowth. This may progress to colonic perforation, causing lifethreatening sepsis.
27. Olfactory and gustatory sensation are lost in head injury due to damage to:
a. Frontal lobe
b. Occipital lobe
c. Parietal lobe
d. Temporal lobe
e. Orbit
348. Causes of bradycardia do not include
a. Hypothyroidism
b. Hyperthyroidism
c. Hypoxia
d. Intracranial lesions
e. Electrolyte abnormalities
48. Bullae differ from vesicles only in:
a. Color
b. Site
c. Size (Bullae are larger than 1 cm while vesicles are less)
d. Smell
e. Discharge
52. All of the following can be seen in trachoma except
a. follicular conjunctivitis (also mucopulunt conjunctivitis - follicular keratitis)
b. Taranta's spots (seen in vernal conjunctivitis)
c. Herbert's pits
d. conjunctival scarring
e. all of the above are false statements
140. Aqueous fluid is produced in which chamber?
a. anterior chamber
b. vitreous chamber
c. posterior chamber
d. trabecular chamber
e. posterior chamber
•
Aqueous humor formation and secretion into the posterior chamber result from active
secretion, which takes place in the double-layered ciliary epithelium
•
Aqueous humor is formed by the ciliary processes.
•
Aqueous humor is produced at an average rate of 2.0–2.5 µL/min, and its composition is altered
as it flows from the posterior chamber, through the pupil, and into the anterior chamber.
216. Which of the following is NOT a sign of an unstable scaphoid fracture?
a. Vertical oblique fracture
b. Comminuted fracture
c. >1 mm displacement
d. Associated perilunate injury
e. Scapholunate angle <60 degrees (normal from 30 to 60 degrees)
unstable scaphoid fracture features include:
•
proximal pole fractures
•
displacement > 1 mm
•
15° scaphoid humpback deformity
•
radiolunate angle > 15° (DISI)
•
intrascaphoid angle of > 35°
•
scaphoid fractures associated with perilunate dislocation
•
comminuted fractures
•
unstable vertical or oblique fractures
•
motion with ulnar or radial deviation
467. Hospitalization is indicated in immune thrombocytopenic purpura if:
a. No life-threatening bleeding is present
b. platelet count more than 20,000/mm3 with no bleeding
c. platelet count less than 20,000/mm3 without bleeding but came from another island
d. well child with normal counts
e. well child but parents are politicians
363. A pedestrian is hit by a speeding car. Radiologic studies obtained in the emergency room, including
a retrograde urethrogram, are consistent with a pelvic fracture with a rupture of the urethra superior to
the urogenital diaphragm. Which of the following should be a part of the management?
a. Immediate percutaneous nephrostomy
b. Immediate placement of a Foley catheter through the urethra into the bladder to align and stent the
injured portions
c. Immediate reconstruction of the ruptured urethra after initial stabilization of the patient
d. Immediate exploration of the pelvis for control of hemorrhage from pelvic fracture and drainage of
the pelvic hematoma
e. Immediate placement of a suprapubic cystostomy tube
If a rupture of the urethra is suspected, a retrograde urethrogram should be obtained before any
attempts are made to place a Foley catheter
If there is incomplete disruption of the urethra, a transurethral Foley catheter can be cautiously
placed across the injury. However, if there is complete disruption, a suprapubic catheter is placed
temporarily and definitive repair is delayed four to six months, at which time the hematoma will have
resolved and the prostate will have descended into the proximity of the urogenital diaphragm.
Percutaneous nephrostomy has no role in the management of this problem.
11. Diseases mimicking anxiety disorder include all the following EXCEPT:
a. Alcohol withdrawal
b. Phaeochromocytoma
c. Temporal lobe epilepsy
d. Hyperparathyroidism
e. Hypocortisolism
131. All of the following are neural tube defects except
a. Myelomeingocoele
b. Anencephaly (lack of development of the cerebral and cerebellar hemispheres and cranial vault and
is an abnormality that is incompatible with life - the most common open neural tube defect)
c. Encephalocele (herniation of the meninges and brain through a calvarium defect)
d. Holoprosencephaly
e. Meningocele
Spina bifida cystica:
This includes meningocele and myelomeningocele. Meningocele is less severe and is characterized by
herniation of the meninges, but not the spinal cord, through the opening in the spinal canal.
Myelomeningocele involves herniation of the meninges as well as the spinal cord through the opening
36. Tumor occurring in the diaphysis is:
a. Lymphoma (diaphysis)
b. Multiple myeloma (diaphysis)
c. Osteoclastoma
d. Giant cell tumor (epiphysis)
e. Simple bone cyst (Can occur both in diaphysis and metaphysis)
Differential diagnosis of lesions in Diaphysis include:
•
simple bone cyst
•
fibrous dysplasia
•
enchondroma
•
metastases
•
myeloma / plasmacytoma
•
lymphoma
•
osteomyelitis
•
osteoid osteoma
•
round cell tumour, e.g. Ewing sarcoma (children)
•
bone infarct
•
Langerhans cell histiocytosis
More uncommon diphyseal lesions include:
•
adamantinoma
•
osteofibrous dysplasia
•
Brown tumour secondary to hyperparathyroidism
•
hydatid cyst
A mnemonic for a short list of diaphyseal lesions is:
CEMENT for Diaphysis (CD)
•
C: bone cysts
•
E: enchondroma/Ewing sarcoma
•
M: bone metastasis
•
E: eosinophilic granuloma
•
N: non-ossifying fibroma (NOF)
•
T: tuberculosis/osteomyelitis
The differential diagnosis for metaphyseal lesions includes:
•
osteomyelitis
•
metastases
•
non-ossifying fibroma
•
enchondroma
•
aneurysmal bone cyst
•
simple bone cyst
•
chondromyxoid fibroma
•
chondrosarcoma
•
cortical desmoid
•
giant cell tumor
•
desmoplastic fibroma
•
intraosseous lipoma
•
osteosarcoma
•
osteoblastoma
Common differential diagnoses of Epiphyseal lesions:
•
chondroblastoma: rare epiphyseal tumour found in young adults; it does not usually extend into
the metaphysis, and does not usually have extension beyond the bone
•
giant cell tumour (GCT): occurs in older childhood and adolescents in whom the epiphyseal
growth plates are closed; it can extend to involve the adjacent metaphysis
•
geode/intraosseous ganglion
•
osteomyelitis
•
clear cell chondrosarcoma
others occur rarely
•
osteosarcoma and osteoblastoma
•
aneurysmal bone cyst (ABC): usually metaphyseal, but if it occurs after the growth plate is
obliterated then it may extend into the epiphysis
•
brown tumour
•
haemophilic pseudotumour
•
enchondroma
231. A 57-year-old man is complaining of chest discomfort and difficulty breathing. He is disoriented and
extremely anxious. Examination reveals bibasilar crackles, a weak carotid pulse, and a blood pressure of
60/30. His SpO2 on room air is 86%. Based on the information provided, this patient should be
categorized as:
a. Asymptomatic
b. Symptomatic but stable
c. Symptomatic and unstable
d. Pulseless
e. Cardiac arrest category
152. A 30-year-old woman presented with a 6-month history of tremor and difficulty in speaking. On
examination, she was found to have increased muscle tone in all four limbs, bradykinesia and 4cm
hepatomegaly. Which laboratory finding would best support a diagnosis of Wilson's disease?
a. Increased incorporation of radioactive copper into ceruloplasmin
b. Low hepatic copper content
c. Low serum ceruloplasmin concentration
d. Low serum copper concentration
e. Low urine copper concentration (incrase Cu in 24h urine sample – used to confirm the diagnosis)
233. A 12-year-old hemophiliac presents to accident and emergency with severe pain after falling over
and banging his right knee. What is the most likely diagnosis of this patient?
a. Osteosarcoma
b. Pseudogout
c. Septic arthritis
d. Gout
e. Haemarthrosis (joint bleeding due to haemophilia or any clotting factor deficincey disease usually
happens after minor trauma)
437. A single hot red joint is most likely due to:
a. Rheumatoid arthritis
b. Septic arthritis
c. Vasculitis
d. SLE
e. Reiter's disease
559. Achondroplasia has the following except
a. Bowing of extremities = genu varum
b. Recurrent otitis media and conductive hearing loss.
c. Short fingers and all of equal length (not all fingers - from second to fourth are the same length separation between middle finger and the long finger giving pattern of trient hand)
d. Lumbar kyphosis (any spine abnormality can occur most commonly lordosis)
e. Obstructive sleep apnea
all other options can occur
64. Follicular growth (in non-ovulating follicle) is usually followed by:
a. Ovulation
b. Cyst formation
c. Atresia
d. Arrest
e. Regression
68. The luteal phase of the menstrual cycle is associated with:
a. High luteinizing hormone level
b. High progesterone levels (secreted by corpus luteum)
c. High prolactin level
d. Low basal body temperature
e. Proliferative changes in the endometrium
499. Duration and antituberculosis drugs depends on
a. patient's age
b. patient's gender
c. type (diagnosis) of tuberculosis
d. weight of patient
e. all of the above
duration of treatment depends on drugs used, drug suscibitibility test, results of the isolate and patient's
response to therapy - Drugs doses depend on weight
39. A 23-year-old female presents to the emergency department complaining of 24 hours of left eye
irritation and redness. She has normal visual acuity, pupillary action, and motor function. There are
several patches of dark red blood scattered across the sclera. The patient denies any history of trauma.
All of the following are important considerations in this setting EXCEPT
a. hypertension
b. coagulopathy
c. ruptured globe
d. incidental ocular trauma
e. domestic violence
214. Which of the following patients generally DOES NOT require surgical intervention because of acute
diverticulitis?
a. A 35-year-old man with no history of diverticulitis
(Extremes of age) (Diverticulitis is a disease of elderly so 35 will be extreme young for it)
of patients with 1st attack have complicated disease and require surgey)
(up to 25%
b. A 68-year-old man status 2 weeks post-renal transplantation (extreme of age)
c. A 55-year-old woman with hypertension and diabetes mellitus (immune compromised states)
d. A 50-year-old man with pneumaturia (Air)
e. A 46-year-old man with right-sided diverticulitis
Indications of surgery include: abdominal or pelvic abscess, fistula, perforation, obstruction,
uncontrolled sepsis, periotonitis, free air, Extremes of age, Immunocompromised
191. An 83-year-old female fell while walking to the bathroom. She complains of severe pain and will not
tolerate any movement of the left leg. The leg is externally rotated and shortened. Which of the
following is the MOST likely location for the fracture?
a. Intertrochanteric
(Hip pain - limb is shortened and externally rotated - Rx by internal fixation)
b. Transcervical
c. Subcapital
d. Subtrochanteric
e. Acetabular
322. In patients with chronic renal failure, which of the following is the most important contributor to
renal osteodystrophy?
a. Impaired renal production of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3]
b. Hypocalcemia
c. Hypophosphatemia (CKD is associated with Hyperphosphatemia and hypocalcemia)
d. Loss of vitamin D and calcium via dialysis (new dialysis techniques don't cause significant loss of Ca or
vit D)
e. The use of calcitriol (used for treatment of this condition)
Renal osteodystrophy is a common complication of chronic renal disease, and the most common
complication secondary to impaired renal production of 1,25(OH)2D3. This leads to a decreased calcium
absorption within the gut as well as impaired renal phosphate excretion
47. Wounds are classified according to the likelihood of bacterial contamination. Which of the following
statement is TRUE regarding wound classifications?
a. A clean-contaminated wound would be one that is associated with an elective colon resection with
adequate mechanical and antibiotic bowel preparation
b. A contaminated wound would include a resection of obstructed bowel with gross spillage of intestinal
contents
c. In a clean wound, no viscus is entered
d. Antibiotic prophylaxis should be administered for all clean-contaminated and contaminated wounds
and selectively in patients involving a clean wound
e. All the above
28. A 36-year-old female nurse comes to the emergency room due to a sensation of fast heart rate,
slight dizziness, and vague chest discomfort. Blood pressure is 110/70. The following rhythm strip is
obtained. What is the diagnosis?
a. Complete Heart Block
b. Atrial fibrillation (AF)
c. Atrial flutter
d. Supraventricular tachycardia (SVT)
e. Ventricular tachycardia (VT)
4. Which of the following is FALSE regarding atropine:
a. may cause bradycardia (used to treat bradycardia in ACLS but it also may induce it) (Atropine induced
bradycardia) (also may cause tachcardia)
b. dilates the pupil in premedicant dose (anti muscarinic .. Ach receptor antagonist or anti cholinergic..
suppresses the parasympathetic system .. sympathetic system takes the upper hand including mydriasis
- decreased secretions and GI motility - Tachycardia)
c. has a shorter duration of action than glycopyrrolate
d. increases the physiological dead space
e. has both muscarinic and nicotinic effects (doesn't have nicotinic effects)
87. Failure to replace lost water leads to
a. Satisfied child
b. Refusal to fluids in a child
c. comfortable child
d. well hydrated child
e. dehydrated child
237. Antepartum hemorrhage may be caused by the following EXCEPT:
a. Placenta previa
b. Cervical cancer
c. Abruptio placenta
d. Ectopic pregnancy (pain rather than bleeding)
e. Vasa praevia
147. A 78-year-old female with a long history of vascular diseases presents after an embolic
cerebrovascular accident (CVA) with servere and unrelenting pain on the right side. She describes the
pain as a severe burning sensation. What is the most likely site of the recent embolic CVA?
a. Frontal lobe
b. Hypothalamus
c. Pons
d. Temporal lobe
e. Thalamus
76. When assessing a patient for acute appendicitis, which of the following describes the obturator sign?
a. Pain produced by internal rotation of the fixed right thigh with the patient supine
b. Pain produced by external rotation of the fixed right thigh with the patient supine
c. Pain produced by extension of the right thigh with the patient in the left lateral decubitus position
d. Pain sensation in the right lower quadrant with palpation of the left lower quadrant
e. Cutaneous hyperesthesia in the T10, T11, and T12 dermatomes
321. chronic bronchial asthma is managed with
a. cough syrup
b. antihistamines
c. mucolytics
d. inhaled steroids
e. antibiotics
149. Which of the following neurologic phenomena is classically associated with herniation of the brain
through the foremen magnum?
a. Third-nerve compression and ipsilateral papillary dilation
b. Catatonia
c. "locked-in" state
d. Miotic pupils
e. Respiratory arrest (medulla compression due to herniation leads to Resoiratory center depression
which may lead to respiratory arrest)
244. Severe neonatal hypoxic ischemic encephalopathy include following except
a. Coma (stupor and coma only in severe)
b. Frequent seizures (doesn’t happen in mild, common in moderate and delayed in severe)
c. Bradycardia (mild tachycardia, moderate bradycardia , severe variable)
d. Hyper alertness (in mild only - mild is having variable conscious level from being hyper alert and
irritable to being lethargic)
e. Hypotension
99. A patient presents to the emergency department with symptoms of Bell's palsy. Which of the
following signs or symptoms are atypical and suggest a more worrisome diagnosis?
a. Facial hemiparesis
b. Taste disturbance (Fcial N responsible for the taste in the anterior third of the tongue and
glossopharyngeal posterior two thirds)
c. Decreased blinking
d. Sparing of the forehead muscles on the affected side : denotes underlying UMNL (Cortical lesion) Facial N palsy (LMNL) forehead must be affected.e. Hearing increased on the affected side.
e. Hearing is increased on the affected side
Other options occur in Facial N palsy
14. The MOST important factor in determining fetal risk from diagnostic imaging is the amount of
ionizing radiation produced by the test. Which of the following tests poses the highest risk for the
developing fetus?
a. Computed tomography (CT) of the head
b. Posteroanterior and lateral chest x-ray
c. Lumbrosacral spine series
d. Abdominal CT
e. Intravenous pyelogram (IVP) (second in order of available choices)
Amount of ionizing irradiation received by fetus in order from the maximum to the minimum:
•
Fluoroscopic barium enema
•
Lumbosacral CT
•
Abdominal CT
•
IV pyelogram
•
Lumbosacral spine series (X RAY)
•
CT pelvimetry
13. Flumazenil:
a. may induce panic attacks in susceptible patients (use in caution with hepatic patients, alcholics,
patients with head injury and patients with panic attacks)
b. has anticonvulsant activity in patients with epilepsy (Used in BZ overdose and in reversal of Conscious
sedation and General anesthesia but not for the respiratory depression and may not revers the amnesia)
(its use maybe associated with seizures and also CNS depression)
c. has a long duration of action (rapid onset and short duration of action)
d. reduces cause nausea and vomiting (nausea and vomiting are the most common side effects)
e. has inverse agonist action at benzodiazepine receptors (Benzodiazepine receptor antagonist)
265. A 50-year-old man complains of a 9-month history of stiffness in the shoulder. The shoulder was
originally extremely painful but now only the stiffness remains. What is the diagnosis?
a. Posterior dislocation of shoulder
b. Anterior dislocation of shoulder
c. Fracture of clavicle
d. Fractured neck of humerus
e. Adhesive capsulitis (first stage is pain with stiffness - second stage stiffness remains while pain
reduces significantly)
57. Rickets in infancy is characterized by all the following EXCEPT:
a. Craniotabes
b. Rachitic rosary
c. Wide open fontanelles
d. Bow legs
e. Widening at the physis
15. . A neonate has respiratory rate of less than
a. 40 per minute
b. 50 per minute
c. 60 per minute
d. 70 per minute
e. 18 per minute
Age Category
Infant
Toddler
Preschooler
School Age
Age Range
0-12 months
1-3 years
4-5 years
6-12 years
Normal Respiratory Rate
30-60 per minute
24-40 per minute
22-34 per minute
18-30 per minute
247. Following do not suggest seizures in a neonate
a. tonic horizontal deviation of eyes
b. sustained eye opening with fixation
c. repeated eye blinking
d. repeated chewing
e. yawning
77. Which of the following regarding Estrogen hormone is CORRECT?
a. It is produced in corpus luteum (progesterone)
b. It is responsible for secretory changes in endometrium (progesterone) (estrogen responsible for
proliferation)
c. It is mainly secreted as E3 by the ovary (mainly as E2)
d. Cannot be detected in the blood of postmenopausal women (high FSH and low Estrogen from 0 to
10)
e. Stimulates sebaceous gland activity (Testosterone so can lead to Acne)
543. A 55-year-old male presents with severe flank pain radiating to the groin associated with nausea
and vomiting. Urinalysis reveals hematuria. A plain abdominal film reveals a radiopaque 5 mm stone in
the area of the ureterovesical junction. Which of the following statement is TRUE regarding this patient's
diagnosis and management?
a. A likely stone composition for this patient would be uric acid (uric acid stones are radiolucent and not
detected by x ray)
b. The stone will likely pass spontaneously with the aid of increased hydration
c. Stone analysis is of relatively little importance (All stones passed should be retrieved for
subsequent analysis)
d. Patients with a calcium oxalate stone and a normal serum calcium level should undergo further
extensive metabolic evaluation (if associated with hypercalcemia)
e. None of the above
It is estimated that 12% of the U.S. population will develop calculus disease during their
lifetime. Males have more than twice the rate of stone formation than females. Caucasians
have between a two to tenfold higher incidence of renal stone disease than Blacks or Asians.
The peak incidence of lithiasis appears to be between the ages of 45 and 64 years. Almost 3/4
of stones are composed of calcium oxalate in combination with calcium phosphate. Magnesium
ammonium phosphate (struvite) or infection stones make up approximately 12% whereas pure
calcium phosphate and uric acid stones each compromise 7%. The diagnosis of renal stones is
made with appropriate history and performance of urinalysis and a non-contrast abdominal
radiograph. Urinalysis of a patient with a urinary stone will have evidence of either gross or
microscopic hematuria in 85%-95% of patients. Eighty-five to 90% of urinary stones are radioopaque. Uric acid stones are typically not radio-opaque.
The majority of stones will pass spontaneously with aid of increased hydration and appropriate
analgesics. All stones passed should be retrieved for subsequent analysis. Patients passing their
first stone should have serum calcium and creatinine levels and a urinalysis in addition to stone
analysis. If the stone is calcium oxalate and the serum calcium level is normal, no further
evaluation is necessary other than encouraging the patient to increase fluid intake. Any patient
with stones composed of uric acid, pure calcium phosphate, cystine, or struvite are at high risk
for continued stone formation and should undergo more extensive metabolic evaluation. In
addition, those patients with recurrent or enlarging stones, including those patients with known
calcium oxalate stones, should undergo a metabolic evaluation.
520. Factors causing gastro esophageal reflux
a. mature lower esophageal sphincter
b. decreased intra-gastric pressure
c. loose pylorus
d. hiatal hernia
e. intact nervous system
354. Which of the following statement regarding hypospadias is CORRECT?
a. It is often associated with chordee (ventral curvature of the penis)
b. It is associated with undescended testes in more than 50% of cases
c. It is a rare fusion defect of the posterior male urethra (anterior urethra)
d. It occurs sporadically, without evidence of familial inheritance (familial)
e. The most common location is penoscrotal region (Distal = glanular: opening is near head of penis)
124. In a 8 weeks pregnant lady, which of the following ultra-sonographic measurement of the fetus is
most useful?
a. Crown rump length (from 6 weeks up to 14 weeks)
b. Biparietal diameter (from 14 weeks to 20 weeks)
c. Femur length (14 weeks to 40 weeks)
d. Placental site
e. Abdominal circumference
383. Which of the following is NOT an indication for postoperative heparinization?
a. Suspected venous thrombosis
b. Risk of embolism following acute myocardial infarction
c. Advanced ischemia secondary to acute embolic occlusion
d. Dissolution of residual thrombus after balloon thromboembolectomy
e. All the above
463. peripheral blood picture in immune thrombocytopenic purpura shows
a. larger platelets
b. microcytic anemia
c. macrocytic anemia
d. leucopenia
e. thrombocytosis
ITP Blood film: Normal RBCs and WBCs morphology, Platlets either normal or some will have large size
(megakaryocytes)
273. A 48-year-old male truck driver presents for evaluation of bright red rectal bleeding with bowel
movements. He also has the feeling that something protrudes through his anus while he strains to move
his bowels but that it withdraws into the bowel when he relaxes. He has no abdominal pain, weight loss,
or other symptoms. A colonoscopy reveals no polyps or tumors but does note internal hemorrhoids.
Which of the following is the best initial treatment for him?
a. High fiber diet, frequent sitz baths, and topical steroid ointment
b. Rubber band ligation
c. Sclerotherapy injection
d. Infrared coagulation
e. Surgical hemorrhoidectomy
•
Conservative is indicated as initial treatment for symptomatic grade 1,2 and 3 – if not improved
then office procedures are recommended.
•
Surgical hemorrhoidectomy is indicated for (large 3rd degree – 4th degree – intolerability or
ineffectiveness of office procedures for grade 1,2 and 3)
526. Forced alkaline diuresis
a. Advise for kerosene poisoning
b. Done in salicylate poisoning (Salicylate poisoning causes metabolic acidosis)
c. Aim is to have plasma pH of 9
d. Bladder is always catheterized
e. Dextrose water is used as fluid
86. All of the following statements are TRUE regarding hernias EXCEPT
a. indirect inguinal hernias result from congenital defects and frequently incarcerate
b. direct inguinal hernias result from acquired defects in the transversalis fascia and rarely incarcerate
c. femoral hernias occur more commonly in males and frequently incarcerate (more in females)
d. acquired umbilical hernias are associated with obesity and pregnancy and frequently incarcerate
e. pelvic hernias are extremely rare but may occur through the sciatic and obturator foramina
444. Which of the following statements about Takayasu's disease is CORRECT?
a. It primarily affects patients of Asian descent
b. It is a nonspecific arteritis affecting the thoracic and abdominal aorta and its major branches
c. The disorder is also characterized by systemic symptoms, including fever, malaise, arthritis and
pericardial pain
d. Usually affects young females
e. All the above
132. All of the following are TRUE of premature rupture of membranes (PROM) EXCEPT
a. the finding of a "ferning" pattern is diagnostic of amniotic fluid
b. nitrazine paper changes to dark blue
c. immediate delivery of the fetus is always indicated in PROM (in certain circumstances only)
d. 90 percent of term patients with PROM will go into labor within 24 h
e. infections can precipitate PROM
326. a silent chest without a wheeze
a. is not asthma
b. it happens in severe life threatening bronchial asthma
c. is mild asthma
d. is moderate asthma
e. none of the above
37. Which of the following statements is true regarding the initial management of the patient with an
Acute Coronary Syndrome (ACS)?
a. Aspirin is effective for patients with STEMI but is ineffective for patients with NSTEMI.
b. Regardless of the infarct location, nitroglycerin can be safely administered for relief of associated
chest discomfort.
c. In a patient with a normal lipid profile statins are not indicated in the initial management of ACS
d. Assuming that vital signs are within normal limits, morphine is the preferred analgesic for patients
with STEMI who experience persistent chest discomfort unresponsive to nitrates.
e. ACS patients whose pain is relieved by nitrates can be discharged home to review in cardiac OPD
within 1-week
347. All the following regarding common bile duct are true EXCEPT:
a. Opens 10 cm distal to the pylorus
b. Lies anterior to inferior vena cava
c. Portal vein lies posterior to it
d. Usually opens into duodenum separate from the main pancreatic duct (ampulla of vater)
e. None of the above
259. Which of the following patients would be most likely to have a placenta previa?
a. 19-year-old G1P0 with vertex presentation
b. 24-year-old G2P1 with cephalic presentation
c. 34-year-old G5P3+1(abortion) with vertex presentation
d. 36-year-old G7P6 with previous 5 LSCS and transverse lie
e. 28-year-old G3, P1+1(abortion), head at 0 station
27. If the large fontanel is the presenting part, what is the presentation?
a. Vertex
b. Sinciput
c. Breech
d. Face
e. Brow
92. All of the following are appropriate options in the treatment of an acute myocardial infarction,
EXCEPT
a. Nifedipine
b. Enalapril
c. Nitroglycerin
d. Aspirin
e. metoprolol
267. You are asked to review a chest X-ray for a colleague. You notice a round opacity. Which of the
following is NOT one of your differential diagnosis?
a. Tuberculosis
b. Asperilloma
c. Lung cancer
d. Sarcoidosis
e. Carcinoid tumour
461. Causes of generalized lymphadenopathy include all of the following EXCEPT:
a. Syphilis
b. Cellulitis
c. Tuberculosis
d. Human immunodeficiency virus infection
e. Ebstein-Barr virus infection
22. An unstable lie is related to all the following EXCEPT:
a. Prematurity
b. Grand multiparty
c. Placenta previa
d. Fundal fibroid
e. Cervical fibroid
37. Leptin is a hormone produced in:
a. Lipocytes
b. Brain
c. Pituitary gland
d. Hypothalamus (site of action)
e. Adrenal gland
Leptin the hormone of energy expenditure”, is a hormone predominantly made by adipose cells that
helps to regulate energy balance by inhibiting hunger. Leptin is opposed by the actions of the
hormone ghrelin, the "hunger hormone". Both hormones act on receptors in the arcuate nucleus of
the hypothalamus to regulate appetite to achieve energy homeostasis.
40. A patch is:
a. A large macule (A macule greater than 1 cm. may be referred to as a patch)
b. Small macule (less than 1 cm)
c. Less than 1 cm in diameter
d. Not seen in nevus flammeus
e. Not found in vitiligo
1.MACULE
A macule is a change in the color of the skin. It is flat, if you were to close your eyes and
run your fingers over the surface of a purely macular lesion, you could not detect it. A
macule greater than 1 cm. may be referred to as a patch.
2. PAPULE
A papule is a solid raised lesion that has distinct borders and is less than 1 cm in diameter.
Papules may have a variety of shapes in profile (domed, flat-topped, umbilicated) and may
be associated with secondary features such as crusts or scales.
3. NODULE
A nodule is a raised solid lesion more than 1 cm. and may be in the epidermis, dermis, or
subcutaneous tissue.
4. TUMOR
A tumor is a solid mass of the skin or subcutaneous tissue; it is larger than a nodule.
(Please bear in mind this definition does not at all mean that the lesion is a neoplasm.)
5. PLAQUE
A plaque is a solid, raised, flat-topped lesion greater than 1 cm. in diameter. It is analogous
to the geological formation, the plateau.
6. VESICLE
Vesicles are raised lesions less than 1 cm. in diameter that are filled with clear fluid.
7. BULLAE
Bullae are circumscribed fluid-filled lesions that are greater than 1 cm. in diameter.
8. PUSTULE
Pustules are circumscribed elevated lesions that contain pus. They are most commonly
infected (as in folliculitis) but may be sterile (as in pustular psoriasis)
9. WHEAL
A wheal is an area of edema in the upper epidermis.
289. Which of the following is TRUE regarding prolapse of umbilical cord?
a. It is not an indication for caesarean section when the baby is viable at 36 weeks
b. Diagnosed when membranes are still intact (Can present with ROM)
c. Is more common when fetus acquires an abnormal lie
d. It has an incidence is 5%
e. Causes severe respiratory alkalosis
What are the risk factors for cord prolapse?
General & Procedure related
**General
● Multiparity , ● Low birth weight less than 2.5 kg ,● Prematurity < 37 weeks , ● Fetal congenital
anomalies, ● Breech presentation
● Transverse, oblique and unstable lie (when the longitudinal axis of the fetus is changing repeatedly), ●
Second twin, ● Polyhydramnios,
● Unengaged presenting part, ● Low-lying placenta, other abnormal placentation
**Procedure related
● AROM, ● Vaginal manipulation of the fetus with ruptured membranes, External cephalic version
(during procedure), Internal podalic version ,● induction of labour, ● Insertion of uterine pressure
transducer.
-Induction of labour with prostaglandins is not associated with cord prolapse.
-Routine ultrasound examination is not sufficiently sensitive or specific for identification of cord
presentation antenatally and should not be performed to predict increased probability of cord prolapse.
278. Biliary atresia need to be operated within
a. First week
b. 2 months of age
c. 6 months of age
d. 1 year of age
e. 5 year of age
259. Which of the following statements regarding the use of adrenalin in ACLS cases is INCORRECT
a. It is used to treat cardiac arrest patients in VF, pulseless VT, asystole and PEA (pulseless electrical
activity)
b. In symptomatic bradycardia patients, it can be considered after atropine (as IV infusion)
c. It is administered as 1mg dose IV every 3-5 minutes during resuscitation of cardiac arrest patients
d. It should never be given via endotracheal tube during resuscitation (3 Methods: IV,IV infusion,
Endotracheal are all used)
e. It can be given to pregnant patients in cardiac arrest
182. A 50-year-old man presents to his GP with headache, tenderness over the scalp and a general
feeling of being tired all the time. He also suffers from muscular aches and feels he has been a bit slow
of late. Which of the following diagnosis is most likely in this man?
a. Temporal arteritis. (if question was least likely)
b. Migraine
c. Tension headache
d. Viral meningitis
e. Cluster headache
600. A low APGAR score at one minute:
a. Is highly correlated with late neurologic sequelae
b. Indicates an academic newborn
c. Has the same significance in premature and term infant
d. Indicates the need for immediate resuscitation
e. Is a useful index of resuscitative efforts
196. The following factors influence the likelihood of transmitting active tuberculosis EXCEPT:
a. Duration of contact with an infected person
b. Environment in which contact occurs
c. Presence of exptrapulmonary tuberculosis
d. Presence of laryngeal tuberculosis
e. Probability of contact with an infection person
224. A 25-year-old, G3P1+1 presents to the emergency room complaining of lower abdominal crampy
pain 6 weeks from her last normal period. She had significant vaginal bleeding but no passage of tissue
& pregnancy test is positive. The patient's most likely diagnosis is:
a. Incomplete abortion
b. Complete abortion
c. Missed abortion
d. Threatened abortion
e. Ectopic pregnancy
199. Which of the following statements regarding diaphragmatic injury after blunt abdominal trauma is
correct?
a. Diaphragmatic herniation is usually apparent on initial upright chest x-ray (missed)
b. The right side of the diaphragm is more commonly injured than the left (left is more common stomach side)
c. CT is not at all helpful in diagnosis (helpful in some)
d. The diagnosis is usually made immediately (delayed)
e. Difficulty in passing a nasogastric tube suggests herniation of abdominal viscera into the chest
155. Antenatal fetal monitoring can NOT be accomplished by:
a. Fetal kick chart
b. Fetal scalp sampling (the only invasive - wrong answer)
c. Non-stress test
d. Obstetric ultrasound and biophysical profile
e. Acoustic stimulation
422. Characteristic features of tetanus include:
a. An incubation period of 2-3 days (7-10 days)
b. The most common initial sign is spasm of the muscles of the jaw
c. Convulsions associated with loss of consciousness
d. Clostridium tetani thrives in aerobic environments
e. Bacteriological isolation of Clostridium tetani from the wound
270. The following are causes of massive splenomegaly EXCEPT:
a. kala azar
b. malaria
c. chronic lymphoid leukaemia
d. myelofibrosis
e. infectious mononucleosis
Other options are involved + visceral Lishmaniasis (Kala Azar) - CML - Hairy cell leukemia - HCL SCHISTOSMIASS - Lymphoma - Gaucher's disease - hereditary spherocytosis - thalassemia - histiocytosis
x - portal vein obstruction - portal hypertension - Neimann-pick disease - Mucopolysaccharidosis
315. Biopsy of a 4-cm sessile polyp of the cecum during a routine screening colonoscopy reveals it to be
a villous adenoma with atypia. Attempt at piecemeal snare polypectomy through the colonoscope is
unsuccessful. Which of the following is the MOST APPROPRIATE management?
a. Right hemicolectomy
b. Colonoscopy with electrocoagulation of the tumor
c. Colonoscopy with repeat biopsy in 6 months
d. Open surgery with colotomy and excision of polyp (if polyp is larger tan 2 or 3 cm)
e. External beam radiation
51. The most commonly serious complication of mucopurulent conjunctivitis is
a. madarosis
b. conjunctival scarring
c. dry eye
d. conjunctivitis sica
e. corneal ulcer (complications range from mild corneal irritation to serious visual loss)
62. Turner's Syndrome is associated with:
a. An absent uterus
b. Normal breast development
c. Primary amenorrhea
d. Hirsutism
e. Normal height (short stature)
305. All of the following are risk factors for hepatocelular carcinoma EXCEPT:
a. Hepatitis C infection
b. Hepatitis B infection
c. Alcoholism
d. Alfatoxins
e. Animal fat in diet
172. The following are complications of multiple pregnancy EXCEPT:
a. Increase incidence of pre-eclamptic toxemia
b. Polyhydramnios
c. Increase incidence of preterm labor
d. Increase incidence of gestational diabetes
e. Increase incidence of placenta previa
Other options are true complications + (IUGR - low birth weight - birth defects - fetal demise or loss placental abruption - twin to twin syndrome - cord entanglement - Cesarian - post partum Haemorrage)
135. A newborn baby has a prominent defect at the base of his spine through which his meninges and
spinal cord is protruding. A failure of which of the following processes is the most common cause of this
type of defect?
a. Development of primary vertebral ossification centers
b. Development of the pedicle
c. Development of the superior articular process
d. Fusion of the vertebral arches
e. All the above
418. Diseases usually spread via the faecal-oral route include all of the following EXCEPT:
a. Poliomyelitis
b. Cholera
c. Hepatitis E
d. Hepatitis B
e. Salmonellosis
237. Best position to reveal small effusions on chest X- ray is:
a. AP view
b. PA view
c. Lateral view
d. Lateral decubitus view
e. Anterior onlique
496. Where in the clotting casade does warfarin exert its effect?
a. Factor Xa
b. Factor II (2,7,9,10)
c. Vitamin K
d. Vitamin A
e. Factor XIL
380. Thyrotrophin stimulates the following processes:
a. Concentration of iodine by thyroid follicles
b. Iodination of thyroglobulin (Peroxidase)
c. Release of thyroxine and triidothyronine
d. De-iodination of thyroid hormones
e. Thyroxin breakdown
120. Which of the following physical signs is not associated with cardiovascular disease?
a. De mussets sign
b. Quinkes sign
c. Kussmauls sign
d. Corrigans sign
e. Cullens sign
513. Valid points in the management of burns on special areas include:
a. The large majority of genital burns are best managed by immediate excision and autografting
b. All digits with deep dermal and full-thickness burns should be immobilized with six weeks of axial
Kirschner wire fixation
c. Deep thermal burns of the central face are best managed with immediate excision and autografting
d. Burns of the external ear are commonly complicated by acute suppurative chondritis if topical
mafenide acetate is not applied
e. All of the above
44. All the following are complications of supracondylar fracture of humerus in children EXCEPT:
a. Compartment syndrome
b. Myositis ossificans
c. Malunion (gun stock deformity)
d. Non Union
e. Ulnar nerve injury
Other options are alll complications + Volkmann’s ischemia + arterial injury
247. Which of the following includes the dietary risk factors thought to play a causative role in
development of colorectal cancer?
a. low fat intake
b. Low fiber intake
c. High smoked food intake
d. High vegetable intake
e. None of the above
194. Which of the following is TRUE regarding appendiceal neoplasms?
a. Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy
(2 cm or more are treated with right hemicolectomy)
b. Appendiceal carcinoma is associated with secondary tumors of the GI tract in up to 60% of patients
c. Survival following right colectomy for a Dukes' stage C appendiceal carcinoma is markedly better than
that for a similarly staged colon cancer at 5 years
d. Mucinous cystadenocarcinoma of the appendix is adequately treated by simple appendectomy, even
in patients with rupture and mucinous ascites
e. Up to 50% of patients with appendiceal carcinoma have metastatic disease, with the liver as the most
common site of spread
55. Otoscopic appearance of a retracted drum head with a hair line or air bubbles is diagnostic of:
a. Acute suppurative otitis media
b. Chronic suppurative otitis media
c. Chronic non-suppurative otitis media
d. Acute non-suppurate otitis media
e. Aerophagia
349. Which deformity in malunited fractures is most likely to be corrected with remodeling?
a. Angular deformity in the middle of diaphysis in the plane of motion of nearby joint
b. Angular deformity in plane of motion of nearby joint when deformity is in metaphyseal area
c. Rotational malalignment
d. Angular deformity near end of bone when angulation is in a plane 90 Degrees to the plane of motion
of nearby joint
e. Shortening of bone length
6. Which of the following statements is FALSE regarding local anaesthetic agents (LA)?
a. the potency of LAs is proportional to their lipid solubility
b. the duration of action is dependent on protein binding
c. agents with low pKa have a faster onset of action
d. all local anaesthetics are vasodilators (Vasoconstrictors)
e. the depth of local anaesthetic block is increased by increasing the dose
77. A feeding infant
a. feeding should start before cleaning the nappy if baby is hungry
b. raising baby's knee on the nursing side is advantageous
c. infant should be supported comfortably with the face held away from mother's breast
d. infant's nose should be tightly held against breast
e. infant's lips should engage considerable areola as well as nipple
2. Cahart's notch is seen in (notch seen in bone conducting audiogram in cases of otosclerosis)
a. Acoustic trauma
b. CSOM
c. Otosclerosis
d. Minnere's disease
e. ASOM
35. A 64-year-old women is brought to emergency department with complain of severe chest pain which
started 45 minutes back. Which of the following statements is true?
a. Oxygen should be administered by non-rebreather mask to all patients experiencing an acute
coronary syndrome (ACS).
b. ST-segments should be monitored in all patients experiencing an ACS.
c. An initial 12-lead ECG should be obtained within 60 minutes of patient contact (prehospital) or 60
minutes of patient arrival in the emergency department.
d. Aspirin is contraindicated in this patients as she may be suffering from gastritis
e. Patients most likely to benefit from reperfusion therapy are those who show ST-segment depression
or nonspecific ST- or T-wave changes on their ECG.
19. Narcotics are commonly used in the administration of general anesthesia for patients undergoing
surgery. Which of the following statement is TRUE regarding this class of agents?
a. Narcotics have both profound analgesic and amnesic properties
b. Narcotics can cause hypotension by direct myocardial depressive effects
c. Naloxone should be used routinely for the reversal of narcotic analgesia
d. Acutely injured hypovolemic patients are at significant risk for decreased blood pressure with the
use of narcotic analgesics
e. Propofol is a new intravenous short-acting narcotic used frequently in the outpatient setting
Acutely injured hypovolemic patients are at significant risk for decreased blood pressure with the use of
narcotic analgesics-narcotics and synthetic analogues belong in the class of drugs called opioids.
narcotics produce profound analgesia and respiratory depression. they have no amnesic properties, no
myocardial depressive effects, and no muscle relaxant properties. narcotics may produce significant
hemodynamic effects indirectly through the release of histamine and/or blunting of the patients
sympathetic vascular tone due to analgesic properties. acutely injured patients may be hypovolemic and
in pain, with high sympathetic tone and peripheral resistance. therefore, such patients can experience a
dramatic drop in systemic blood pressure with minimal doses of opioids. all opioids can be reversed with
naloxone. naloxone reversal, however, can be dangerous because the agent acutely reverses not only
the analgesic effects of the opioid but also analgesics effects of native opioids. naloxone treatment has
been associated with acute pulmonary edema and myocardial ischemia and should not be used
electively to reverse the effects of narcotic.
32. A patient sustained a laceration of the perineum during delivery. It involved the muscles of perineal
body but not the anal sphincter. Such a laceration would be classified as:
a. First degree (superficial skin and/or vaginal mucosa - sparing muscle)
b. Second degree (muscle - sparing anal sphincter)
c. Third degree (Anal sphincter – sparing rectum)
d. Forth degree (rectum)
e. Fifth degree
68. Which of the following lesions is NOT one of the cutaneous stigmata of occult spinal dysraphism?
a. Midline lumbar capillary hemangioma
b. Focal hairy patch over the thoracolumbar spine (Lumbosacral not thoraco)
c. Dermal sinus located above the midsacrum
d. Midline subcutaneous lipoma
41. The most common age group for depression is:
a. Middle-aged men
b. Middle-aged females
c. Young girls
d. Young boys
e. Children
27. Which of the following statement is TRUE regarding the diagnosis and management of hypovolemic
shock?
a. A fall in hematocrit or hemoglobin always accompanies hemorrhagic shock (not immediately)
b. The treatment of shock is generic regardless of the etiology (Treatment of the cause is essential)
c. Pharmacologic intervention to increase myocardial contractility in hypovolemic shock is an important
part of early management (for cardiogenic shock)
d. Complications are less frequent after treatment of hemorrhagic shock than septic or traumatic
shock
e. None of the above
32. In the TNM classification of head and neck cancers, the size of cervical lymph nodes in stage N2b is:
a. &gt;6 cm (N3)
b. &gt;8 cm
c. &lt;6 cm (All N2 less than 6)
d. &gt;10 cm
e. None of the above
N1 Up to 3 - N2 less than 6 - N3 More than 6
295. Commonest cause of failure of arthrography is:
a. Extra-articular injection of contrast
b. Bubbling of air in the joint
c. False positive interpretation
d. False negative interpretation
e. Allergic reaction
30. sleep in children
a. infants sleep less than elder children
b. neonates sleep less than elder children
c. Problems include Sleep walking and Sleep terrors
d. Obstructive sleep apnea cannot be a sleep problem
e. managed with feeding the baby every time baby is awake