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NIZAM’S INSTITUTE OF MEDICAL SCIENCES Punjagutta, Hyderabad – 500 082, A.P., India.

Set: C

NIMSET 2012

Question Booklet

Entrance Examination for Admission to MD/MS

Subject NIMSET 2012

19 February 2012 Marks 150 Time: 2 hours: 30 min

• Please verify whether the number printed on this question booklet

corresponds to your hall-ticket number

• Please read the instructions on the OMR-Answer sheet carefully

• Each question in this booklet is followed by four alternative answers Select the one that is most appropriate

Oval in the OMR-Answer sheet

and darken the corresponding

• Please return this question booklet along with your OMR-Answer sheet

• Answer sheets not accompanied with the question booklets will not be

corrected

• Wrong answers carry negative marks

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Q1. Figure below depicts splitting of 2nd heart sound (S2) in normal and three different abnormal conditions. The conditions 1,2 and 3 represent which one of the following respectively:

A) atrial septal defect (ASD), tetralogy of Fallot (TOF), left bundle branch block (LBBB) B) LBBB, TOF, ASD C) TOF, LBBB, ASD D) ASD, LBBB, TOF Q2. In which of the following conditions is endoscopic sinus surgery contraindicated A) choanal atresia B) lateral frontal sinus disease C) frontoethmoid mucocoele D) CSF leak

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Q3. Which one of the following secondary skin lesions represents excessive accumulation of stratum corneum A) lichenification B) scale C) crust D) scar Q4. Which of the following drug acts by inhibiting the enzyme inosine monophosphate dehydrogenase A) azathioprine B) alefacept C) mycophenolate mofetil D) pimecrolimus Q5. Which of the following is most suggestive of neonatal small bowel obstruction A) generalized abdominal distension B) failure to pass meconium in the first 24 hours C) bilious vomiting D) refusal of feeds Q6. Nonscarring alopecia can be seen in all of the following A) hypothyroidism

except

B) hyperthyroidism C) tinea capitis D) sarcoidosis Q7. Gluteus maximus muscle A) is supplied by inferior gluteal nerve B) is supplied by superior gluteal nerve C) is supplied by both superior and inferior gluteal nerves D) takes part in the formation of gluteal fold

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Q8. To reduce pain during her childbirth, an obstetrician performs a local nerve block on his 25-year-old patient while she is in the lithotomy position, as depicted in the given figure. Which of the following structures will remain fully sensitive following administration of this local anesthetic

A) lower anal canal B) rectum C) perineal body D) urogenital diaphragm

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Q9. The histology of endometrium shown below depicts which one of the phases

A) postmenstrual B) early proliferative C) late proliferative D) secretory phase Q10. Effectiveness of oral contraceptive is reduced during concomitant use with antiepileptic drugs because of their A) increased rate of excretion B) decreased rate of metabolism C) increased rate of metabolism D) decreased rate of excretion

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Q11. The pattern of inheritance shown in this pedigree is seen in which genetic condition

A) neurofibromatosis B) beta thalassemia C) Duchenne muscular dystrophy D) Huntington disease Q12. Regarding HIV virus 1. HIV belongs to the family Rhabdoviridae. 2. Hypochlorite solution at a concentration of 0.5% available chlorine is recommended for inactivation of HIV. 3. HIV is an extremely heat resistant virus. 4.It may take 2-8 weeks for antibodies to appear after infection A) only 1,2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct Q13. Which of the following is commonly referred to as the "21" amino acid A) Homocysteine B) Selenocysteine C) Cystine D) Taurine Q14. Most frequent arterial involvement by arteriography in Takayasu's arteritis A) common carotid B) renal C) aortic arch D) subclavian

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Q15. The fundus picture below depicts

A) central retinal artery occlusion B) age related macular degeneration C) retinitis pigmentosa D) papillitis Q16. In obstetric practice, contraction stress testing is primarily a test of A) fetal condition B) uterine function C) uteroplacental function D) maternal circulatory status Q17. Supramalleolar osteotomy is a procedure suitable for correction of which one of the following deformities of the lower extremity A) external tibial torsion B) equinus deformity of foot C) pes varus deformity D) equinovarus deformity of foot Q18. Regarding medullary carcinoma of thyroid, Assertion: total thyroidectomy is the operation of choice Reason

: these tumours are usually multicentric

A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

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Q19. The earliest imaging finding in chronic pancreatitis is A) dilatation of the main pancreatic duct B) dilatation of the secondary duct C) small calcifications in parenchyma D) ductal stones Q20. In chest radiograph in frontal view detection of pleural fluid is feasible when the fluid volume is at least

A) 10 to 20 ml B) 50 to 80 ml C) 100 to 200 ml D) 300 ml Q21. Following feature/features of indirect inguinal hernia differentiate it from direct inguinal hernia 1.neck of indirect hernia is lateral to epigastric vessels 2.indirect hernia occurs in the elderly 3.surgery of choice for indirect hernia in young adults is herniotomy alone 4.indirect hernia never strangulate A) only 1,2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct Q22. Carbon dioxide narcosis may be a feature of A) obesity hypoventilation syndrome B) atypical pneumonia C) interstitial pulmonary fibrosis D) farmer's lung Q23. Regarding tinnitus, Assertion: it is more annoying in quiet surroundings, particularly at night Reason

: ambient noise has a masking effect

A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

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Q24. Regarding acute pancreatitis Assertion: choledocholithiasis has to be evaluated in all cases Reason A) Both Assertion and Reason are true, and Reason is the correction explanation for Assertion

: pancreatic calculi are invariably seen in association with cholelithiasis

B) Both Assertion and Reason are true, and Reason is not the correction explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q25. The treatment of choice in a newly diagnosed achalasia cardia is A) radiofrequency ablation B) laparoscopic cardiomyotomy C) botulinum toxin D) pneumatic dilatation Q26. A researcher is testing the antipyretic effect of a new drug against paracetamol in 50 patients of fever, half of whom were assigned to each drug. Which of the following statements is true A) this is a retrospective case control study. B) a t test is an appropriate test to analyse the results. C) since this is an observational study, it will not have a p value. D) a correlation regression analysis will help decide if the new drug is better. Q27. In a woman presenting to the emergency outpatient of a hospital with uterine bleeding in the second half of pregnancy, the simplest and safest method for diagnosis of placenta previa is A) digital vaginal examination in the outpatient B) transabdominal ultrasound C) speculum examination D) computerised tomography Q28. The delivery of breech of fetus spontaneously as far as umbilicus followed by assisted maneuvers by the operator with or without maternal expulsive efforts is called as A) spontaneous breech delivery B) total breech extraction C) partial breech extraction D) assisted breech delivery Q29. Anticentromere antibody is typically associated with A) psoriatic arthritis B) Behcet's syndrome C) limited forms of systemic sclerosis D) eosinophilic fasciitis

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Q30. A woman aged 22 years with 8 weeks of gestation presents with sudden onset of severe abdominal pain associated with loss of consciousness. Per vaginal examination revealed tender cervical movements. The most probable diagnosis is A) hypoglycemia B) ruptured ectopic pregnancy C) appendicitis D) ovarian cyst Q31. A 3 year male child presented with complaints of recurrent upper respiratory tract infections, recurrent skin boils from the age of 6months. He was a product of a consanguineous marriage. On examination he was malnourished , had nystagmus, hypopigmented hair, multiple skin boils, generalized lymphadenopathy and mild hepatosplenomegaly. His elder sibling also had similar complaints and died at the age of 5yrs. A blood examination done showed Hb of 9gm%, TLC 15,000,Platelet 1.5 lakhs , normochromic,normocytic picture, large inclusions in all the nucleated blood cells.The most probable diagnosis is A) Chediak -Higashi syndrome B) chronic granulomatous disease C) hyper Ig E syndrome D) leukocyte adhesion deficiency Q32. A 50 year old man with history of persistent shoulder pain had a jerking injury of the shoulder. On examination, 6 weeks later, he is unable to abduct his arm. Passive abduction was normal and he could keep the arm up once it had been raised above the right angle. This suggests A) partial tear of rotator cuff B) full thickness tear of rotator cuff C) isolated infraspinatus weakness D) isolated subscapularis weakness Q33. Clinical features of prolapsed intervertebral disk at L5-S1 level include all of the following

except

A) loss of ankle jerk B) weakness of flexor hallucis longus C) straight leg raising test positive D) loss of knee jerk

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Q34. Shown below is the dorsal view of the hand. The shaded area indicated by an arrow is supplied by

A) dorsal branch of ulnar B) radial nerve C) posterior cutaneous nerve of forearm D) median nerve Q35. During a clinical assessment done with the purpose of forming an opinion about the patient's mind and degree of responsibility, which of the following suggests feigned insanity A) peculiar fixed facial expression B) dirty and filthy habitus C) resentment to frequent examination D) gradual onset Q36. Punched-out ulcer covered with a blackened scab (eschar) is characteristic of A) Plague B) Scrub typhus C) Q fever D) Leptospirosis Q37. A 24 year old woman attempts suicide by ingesting 50 acetaminophen tablets. She is rushed to the emergency department. Which of the following treatments would the attending physician most likely order A) Alkalinization of urine B) Ca 2+ / EDTA chelation C) Protamine sulfate D) N-acetylcysteine

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Q38. A bruise in the centre of the neck, across the windpipe is seen in which of the following methods of strangulation A) bansdola B) garrotting C) mugging D) throttling Q39. Which of the following is the most common cause of uniocular polyopia A) cataract B) subluxated lens C) third nerve palsy D) rupture of superior oblique muscle Q40. The instrument shown below is primarily used to clamp which one of the following structures during surgery

A) intestines B) ureter C) blood vessels D) Fallopian tube Q41. An infant aged 10 months chokes while feeding. He becomes apneic and obtunded. One can do all these manouveres

except

A) Heimlich's maneuver B) back blows and chest thrust C) rescue breaths D) jaw lift Q42. Frontal bone scalloping and or bowing of cerebellum with effacement of cisterna magna found in the fetus in second trimester ultrasound are diagnostic of A) hydrocephalus B) open spina bifida C) omphalocoele D) intestinal obstruction

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Q43. The abnormality detected in the radiographs below is

A) scaphoid fracture B) keinbock's disease C) March fracture D) Boxer's fracture

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Q44. Shown below is the visceral surface of the spleen. The area indicated by an arrow represents which one of the following impressions

A) renal B) colic C) gastric D) pancreatic Q45. Substance which is incapable of inducing antibody formation by themselves but can react specifically with antibodies A) complete antigen B) hapten C) epitope D) paratope

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Q46. The bony abnormalities shown in the pictures are seen in which genetic metabolic disorder

A) mucopolysaccharidosis B) metachromatic leucodystrophy C) Gaucher's disease D) glycogen storage disorder

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Q47. Complement can be activated by all of the following

except

A) immunoglobulin G (IgG) combined with antigen B) complex polysaccharides C) killer T cells D) endotoxin Q48. Post-exposure prophylaxis involves administration of immune globulin and vaccination for all of the following infections

except

A) hepatitis B B) tetanus C) rabies D) hepatitis C Q49. In a solitary pulmonary nodule detected on a plain radiograph which of the following features will have the highest weight in favour of a diagnosis of malignancy

A) ex smoker, quit smoking for 8 years B) smooth margins C) size more than 3 cm D) popcorn ball calcification Q50. "Citron bodies"seen in a Gram stained film from an exudate suggests infection due to A) Clostridium perfringens B) Clostridium novyi C) Clostridium tetani D) Clostridium septicum Q51. The presence of cleaved active caspases in a cellular microenvironment is suggestive of A) impending cell division B) coagulative necrosis C) cellular apoptosis D) cell differentiation Q52. After the first few breaths in a normal new born all of the following changes occur in the circulation

except

A) systemic vascular resistance increases B) the shunt through ductus arteriosus reverses to left to right C) pulmonary vascular resistance increases D) the ductus venosus closes

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Q53. Regarding osteomalacia Assertion: there is accumulation of unmineralized bone matrix Reason A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

: there is an over production of bone matrix

B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q54. In collagen synthesis, Vitamin C is required for A) Oxidation of procollagen B) Hydroxylation of procollagen C) Glycosylation of preprocollagen D) Cross linking between collagen chains Q55. True statement/statements regarding confidence intervals 1. they reflect the precision of the statistic measured. 2. they provide an estimate of significance of difference in means . 3. they provide an estimate of the magnitude of difference between two groups 4. overlapping confidence interval between two groups suggests a difference between the two groups A) only 1,2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct

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Q56. The schematic diagram below demonstrates the neurotransmitters, marked as numbers, in the peripheral nervous system. The option which represents the correct sequence of neurotransmitter 1,2,3 and 4 is

A) acetylcholine,noradrenaline,acetylcholine,noradrenaline B) acetylcholine,noradrenaline,acetylcholine,acetylcholine C) acetylcholine,acetylcholine,noradrenaline,noradrenaline D) acetylcholine,noradrenaline,acetylcholine,adrenaline Q57. The mechanisms of antimicrobial action of vancomycin, erythromycin and metronidazole is respectively A) DNA damage, inhibition of protein synthesis, cell wall damage B) DNA damage, cell wall damage, inhibition of protein synthesis C) cell wall damage, DNA damage, inhibition of protein synthesis D) cell wall damage, inhibition of protein synthesis, DNA damage Q58. A 20 year old female requests for postcoital contraceptive after having unprotected sex. Drug/ drugs which can be used as postcoital contraceptive are 1.Levonorgestrel and Ethinylestradiol combination. 2.Mifepristone. 3.Levonorgestrel alone. 4.Norethindrone enanthate. A) only 1,2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct Q59. Kussmaul's sign is A) a paradoxical fall in jugular venous pressure (JVP) during inspiration B) a paradoxical fall in JVP during expiration C) a paradoxical rise in JVP during inspiration D) a paradoxical rise in JVP during expiration

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Q60. Tympanogram is constructed by recording the range of compliance on altering the pressure within the external auditory meatus from A) +200 mm H2O to -200 mm H2O B) +100 mm H2O to -500 mm H2O C) +300 mm H2O to -300 mm H2O D) +50 mm H2O to -1000 mm H2O Q61. Thirst centre in the hypothalamus is stimulated effectively by A) increased plasma osmolality and volume B) increased plasma osmolality and decreased blood volume C) decreased plasma osmolality and increased pasma volume D) injection of vasopressin into the hypothalamus Q62. A 50 year old lady, a recently diagnosed patient of schizophrenia was started on olanzapine. After 10 days of medication she developed high grade fever with confusion, dysarthria, rigidity and elevated serum creatinine phosphokinase. The most likely possibility is A) agranulocytosis with sepsis B) severe psychosis C) neuroleptic malignant syndrome D) myocarditis Q63. Management of massive pulmonary oedema due to Indian scorpion sting include all of the following

except

A) sodium nitroprusside B) hydralazine C) prazosin D) phenylephrine Q64. Regarding injection of sodium tetradecyl sulphate(sclerosant) into superficial varicose vein of legs, Assertion :After the injection local compression is not required Reason

A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

:the sclerosant destroys lipid membranes of the endothelial cells leading to thrombosis, fibrosis and obliteration (sclerosis) of veins

B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q65. A 12 year old boy presented with fresh bleeding per rectum. Colonoscopy revealed a pedunculated single rectal polyp-1cm in diameter with a smooth and glistening surface. This type of rectal polyp would be A) tubulovillous adenoma B) inflammatory pseudopolyp C) lymphomatous polyp D) juvenile polyp

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Q66. A surgeon has resected a part of the intestines following laporotomy. As per the Bio-medical waste Rule1998, the surgeon is expected to place surgically removed human organs in A) yellow plastic bag B) red plastic bag C) white puncture proof container D) black plastic bag Q67. Progesterone causes A) myometrial contraction B) development of breast ducts C) inhibition of LH secretion D) a fall in body temperature at ovulation Q68. The factor/factors that differentiate acute lung injury (ALI) from acute respiratory distress syndrome. 1. timing of etiological factor 2. level of PEEP 3. pattern of infiltrates on chest radiograph 4. PaO2/FiO2 ratio A) only 1,2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct Q69. Feature/features of alcohol withdrawal with delirium tremens 1. auditory hallucinations 2. tremors 3. increased drowsiness 4. autonomic disturbances A) only 1,2, and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct

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Q70. In the diagram depicted below, the pelvic dimension that is being measured is

A) bi-ischial diameter B) diagonal conjugate C) posterior saggital diameter D) inter-spinous diameter

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Q71. Which of the following can be inferred from the given graph that plots changes in the percentage of the filtered amount of substances remaining in the tubular fluid along the length of the nephron

A) nearly 40% of Na+ and water are reabsorbed in the proximal tubule B) fluid leaving the proximal tubule is isotonic C) fluid in loop of henle is isotonic D) most of the water is reabsorbed in collecting duct Q72. A 20 year old girl presented with a bony swelling in the distal femur. The biopsy revealed the following picture. The likely diagnosis is

A) osteosarcoma B) Ewing's tumor C) giant cell tumor D) tuberculous osteomyelitis

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Q73. A 20 year old girl comes with complaints of decreased blood flow during menstrual cycle. She also gives history of galactorrhea and headache. The investigation of choice is A) ultrasound pelvis B) serum progesterone C) serum prolactin D) mammography Q74. The structure/structures which constitute Caudal Pharyngeal complex 1. Dorsal portion of the fourth pharyngeal pouch. 2. Ventral portion of the fourth pharyngeal pouch. 3. Lower part of the ultimobranchial body. 4. Third pharyngeal pouch. A) only 1,2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct

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Q75. Shown below is a diagramatic representation of the femur in individuals of different age groups. YM = yellow marrow, RM = red marrow.The age groups with femur depicted in figures 1,2 and 3 respectively are

A) child, adult, aged B) aged, adult, child C) adult, child, aged D) adult, aged, child

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Q76. Shown below is a schematic representation of a type of malignant tumor of tibia.

The tumor is most likely to be A) osteosarcoma B) Ewing's tumor C) Multiple myeloma D) metastatic tumor Q77. Correct position of the neck for performing bronchoscopy is

A) flexed on thorax with head flexed on atlanto-occipital joint

B) extended on thorax with head extended on atlanto-occipital joint C) flexed on thorax with head extended on atlanto-occipital joint D) extended on thorax with head flexed on atlanto-occipital joint Q78. Complications of chronic anterior uveitis include 1. glaucoma 2. cystoid macular edema 3. band keratopathy 4. retinal breaks A) only 1, 2, and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct

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Q79. Voriconazole can be used for the treatment of infections caused by which of the following fungi 1. Fluconazole resistant candida albicans 2. Fluconazole resistant non albicans candida species 3. Aspergillus species 4. Zygomycetes

A) only 1, 2 and 3 are correct B) only 1and 3 are correct C) only 2 and 4 are correct D) only 4 is correct Q80. In the histology of renal corpuscle shown below, the structure pointed by the arrow is

A) glomerular capillary epithelium B) capsular epithelium C) mesangial cells D) macula densa

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Q81. Which one of the following structures is not

A) hepatic artery

present with in the free border of lesser omentum

B) portal vein C) inferior vena cava D) bile duct Q82. An 18 year old nulliparous woman complained of right lower quadrant pain over several years and had a right adnexal mass which on ultrasonogram was suggestive of dermoid cyst. She had a guaiac positive stool in the past but none currently. During surgery for removal of dermoid she is found to have a Meckel's diverticulum with slight thickening at the tip. Regarding further management of diverticulum A) leave the patient alone B) it should be removed as it is symptomatic and has atypical features C) it should be removed at a later date to prevent future complications D) to be removed only if symptoms recur Q83. In primary open angle glaucoma, demonstration of which of the following is enough to make the diagnosis in the presence of normal open angle on gonioscopy A) raised intraocular pressure B) characteristic optic nerve head changes C) visual field abnormalities D) characteristic optic nerve head changes and visual field abnormalities Q84. A point mutation at the third nucleotide of a codon changing AGA to AGG did not change the final protein structure as both encode for arginine.This illustrates A) acceptable missense mutation B) ambiguous genetic code C) transversion D) degeneracy of genetic code Q85. Which of the following exerts the greatest effect on parathyroid hormone secretion A) plasma phosphate level B) 1.25 dihydroxy cholecalciferol C) intracellular Ca ++ concentration D) extracellular Ca ++ concentration Q86. Anatomical relationship of structures at renal hilum from anterior to posterior A) vein, pelvis, artery B) artery, vein, pelvis C) pelvis, artery, vein D) vein, artery, pelvis

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Q87. The most specific feature for esophageal rupture is A) substernal chest pain B) subcutaneous emphysema C) raised serum amylase

D) pleural effusion on chest radiograph

Q88. For a 7 year old child, with body weight of 21 kg, who cannot be fed enterally but has no other requirement for volume adjustment, the calculated fluid maintenance volume requirement over 24 hours is . A) 1610 ml B) 1520 ml C) 1450 ml D) 1370 ml Q89. In the schematic representation of the fibrinolytic system shown below, the product depicted by "?" is

A) bradykinin B) prekallikrein C) Hagemen factor D) C3a Q90. Which of the following can be used to prevent neonatal cretinism in babies, in areas where endemic goitre in highly prevalent 1. giving thyroxine tablets to women of child bearing age 2. periodic parenteral administration of iodised oil to women of child bearing age 3. enrichment of agricultural land with iodine 4. providing iodised salt for cooking A) only 1, 2, and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct

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Q91. Endothelial / leukocyte adhesion molecules include/includes 1. p-selectin 2. tumor necrosis factor 3. VCAM-1 4. interleukin-1 A) only 1, 2, and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct

D) only 4 is correct

Q92. Which of the following findings suggest strangulation by ligature A) oblique ligature mark B) emphysematous bullae on the surface of the lung C) stretched and elongated neck D) carotid artery damage Q93. In biochemical reaction depicted below, the process that takes place is

A) deamination B) decarboxylation C) hydroxylation D) carboxylation Q94. True statement/statements regarding cyanide poisoning, 1. some compounds can produce corrosive changes in the oral and oesophageal mucosa 2. by any route, death due to cyanide is instantaneous 3. hydrocyanic acid is unstable in light 4. causes cellular dysfunction by coagulative necrosis A) only 1,2 and 3 are correct B) only 1and 3 are correct C) only 2 and 4 are correct D) only 4 is correct

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Q95. A 36 yr old gentleman complained of instability in his right knee. On examination with hips flexed to 45 degrees and knees flexed to 90 degrees, there was increased movement of tibia posteriorly (posterior drawer test positive). The injured structure is A) anterior cruciate ligament B) medial meniscus C) posterior cruciate ligament D) lateral meniscus Q96. Regarding plasma HIV RNA levels Assertion: they increase with duration of illness, irrespective of treatment effects. Reason

: they indicate the magnitude of HIV replication and the rate of CD4+ Tcell destruction

A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q97. An acute extradural hematoma is seen on CT as

A) hyperdense concave lesion B) isodense lentiform (biconvex) lesion C) hypderdense lentiform (biconvex) lesion D) hypodense lentiform (biconvex) lesion Q98. Regarding cromolyn sodium Assertion: It is useful for the treatment of an acute attack of bronchial asthma. Reason

A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

: It inhibits the degranulation of mast cell, thereby preventing the release of chemical mediators of asthma.

B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q99. A 40-year adult male weighing 50 kg suffered circumferential second and third degree burns involving both lower limbs. The approximate requirement of parenteral fluid (lactated Ringer's solution) in the first 8 hours, as calculated by Parkland's formula, is A) 1800 ml B) 2400 ml C) 3600 ml D) 7200 ml

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Q100. The finding of porphyrin in urine is very suggestive of poisoning with which of the following metals A) iron B) thallium C) lead D) mercury Q101. Regarding ESBL producing strains of Gram negative bacilli, Assertion: are resistant to multiple antibiotic groups and may include fluoroquinolones, aminoglycosides, beta lactamase inhibitor combinations and carbapenems. Reason

A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

: A single determinant on a resistance plasmid codes for resistance to all the groups of antibiotics.

B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

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Q102. Shown below is the graphical depiction of temporal trends of growth of different tissues. The graphs 1, 2 and 3 represent which one of the following respectively.

A) brain, lymphoid, viscera B) viscera, brain, lymphoid C) lymphoid, brain, viscera D) brain, viscera, lymphoid Q103. In humans if both noradrenergic and cholinergic systems are blocked, the approximate heart rate would be approximately A) 70 B) 50 C) 100 D) 120 Q104. In ABCD of current basic life support algorithm "D" stands for A) disability B) diagnosis C) defibrillation D) drugs Q105. Which of the following structures cannot be palpated by a vaginal examination A) sigmoid colon B) ureters C) perineal body D) iliopectineal line

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Q106. A 24 year old man came with the complaints of increased joviality, overactivity with reduced sleep for 1 month duration. He also had the belief that he had supernatural powers and was spending money recklessly. Which of the following drugs can be used as prophylaxis to prevent recurrence A) tricyclic antidepressants B) monoamine oxidase inhibitors C) mirtazapine D) carbamazepine Q107. Which one of the following is not

a function of state medical councils

A) issue of warning notices B) maintenance of medical register C) maintenance of standards of medical education D) disciplinary control over the medical practitioners Q108. In the figure given below,

the abnormality can be explained by weakness of A) Right gluteus medius B) Right gluteus maximus C) Left gluteus medius D) Left gluteus maximus

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Q109. Given below is the schematic diagram of lacrimal apparatus. The valve that prevents reflux of tears is located at which site in the diagram

A) site 1 B) site 2 C) site 3 D) site 4 Q110. In Whipple's procedure, which of the following structures is not A) duodenum

removed

B) common bile duct C) portal vein D) head of pancreas Q111. The factor/factors playing a part in the closure of ductus arteriosus at birth 1. increased arterial oxygen tension 2. increased left atrial pressure 3. decreased prostaglandin E2 4. fetal metabolic acidosis A) only 1, 2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct

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Q112. A 38-year-old man has had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve that accompanies the superior thyroid artery is damaged during the surgery. This injury could result in a severe impairment of which of the following function A) relaxing the vocal cords B) rotating the arytenoid cartilages C) tensing the vocal cords D) widening the rima glottidis Q113. A 10 year old girl was admitted with fever and migratory polyarthritis. She also had tachycardia, arrhythmia and pericardial friction rubs. The distinctive pathologic feature within the heart is A) Aschoff bodies B) Asteroid bodies C) Ferruginous bodies D) Schaumann bodies Q114. Regarding management of traumatic dislocation of hip Assertion: the joint should be reduced as an emergency Reason A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

: the longer the head of femur remains out, there is more chance of its becoming avascular

B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q115. Regarding pathogenesis of chronic myeloid leukemia Assertion it is caused BCR-ABL gene fusion. Reason : fusion leads to activation of retinoic acid receptor blocking differentiation of cells A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q116. In which of the following diseases does the activation of T cells play a central role in initiating tissue damage A) penicillin induced anaphylaxis B) rheumatoid arthritis C) Goodpasture's syndrome D) autoimmune hemolytic anemia

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Q117. A 2 year old child is brought to a primary health centre with the complaints of 4 episodes of loose stools over 24 hours.On evaluation the child has no signs of dehydration. According to WHO plan A the following is advised except A) Keep the child home and advise to return if child is not better in 3 days B) advise to give plenty of oral fluids at home C) continue feeding at home D) initial treatment with ORS at a dose of 75ml/kg over 4 hrs in outpatient department Q118. The fourth stage of labour is from A) delivery of fetus to delivery of placenta B) first 24 hours following delivery C) the hour immediately following delivery D) time between delivery and lactation Q119. All the following viruses are associated with malignancies in humans except A) HBV B) HCV C) HAV D) HPV Q120. Reagrding treatment of depression with mono amine oxidase inhibitor -tranylcypramine Assertion: It should not be combined with selective serotonin reuptake inhibitors (SSRI) like escitalopram Reason Thy are counteractive and cancel each other's actions A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

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Q121. Shown below is a barium swallow radiograph at thoracic level in a patient with dsyphagia. The image is suggestive of which one of the following

A) squamous cell carcinoma of esophagus B) leiomyoma of esophagus C) achalasia cardia D) esophageal pouch

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Q122. Mother of a 6-month baby complained that her child's legs do not open equally while changing napkins. Given below is the diagrammatic representation of pelvic skeletal abnormality in the child.

The abnormality is most likely to be A) Perthes' disease B) rickets C) congenital dislocation of hip D) epiphyseal fracture Q123. In the process of secondary active transport involved in molecule movement across cell membranes A) energy expenditure is minimal B) transport of Na + is coupled to that of other molecules C) osmotic gradient is established across cells D) size of intercellular junction is a limiting factor Q124. Regarding features of human enzymes with the temperature coefficient of 2 Assertion: A 10 degree celsius increase in temperature will double the rate of the enzymatic reaction Reason: Heat causes protein denaturation A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

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Q125. A woman aged 24 years appears at 8 weeks of pregnancy and reveals a history of pulmonary embolism seven years ago during her first pregnancy. She was treated with intravenous heparin followed by several months of oral warfarin and had no further evidence of thromboembolic disease for over six years. Which one of the following treatment modalities is most appropriate now A) no specific management with regard to thromboembolism problem B) oral warfarin therapy in the first two trimesters and heparin therapy during 3rd trimester and peuperium C) warfarin therapy throughout pregnancy and peuperium D) the patient should be placed on low dose heparin therapy through out pregnancy and peurperium Q126. Regarding influenza virus infection Assertion: outbreaks are difficult to control with vaccination Reason: influenza virus is known for its frequent change in antigenic structure A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q127. With regard to the obstetric condition, vasa previa, Assertion : bleeding results in hypovolemia and hypotension in mother Reason: bleeding occurs from the fetal side of the placenta A) Both Assertion and Reason are true, and Reason is the correction explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correction explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q128. A patient complains on swaying in dark surroundings and on examination sways markedly on eyes closure. The probable structure involved is A) posterior column B) spinothalamic tract C) cerebellum D) cerebral cortex Q129. In chronic osteomyelitis, a sequestrum represents which one of the following A) vascular bone from periosteum B) cortical bone devoid of vascularity C) bone marrow D) bone chip from the epiphysis

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Q130. Regarding umbilical cord blood stem cells A) have less graft versus host disease B) have more HLA restriction than adult marrow stem cells C) more likely to be contaminated with herpes virus D) large quantities can be obtained from a single source Q131. In the Mallory - weiss syndrome A) the esophageal mucosa is torn away from the gastro - esophageal junction B) patients present with upper GI bleeding which may be severe C) the lesion is usually the result of blunt trauma to the chest D) surgery is required in a majority of cases Q132. The best method for random allocation of treatment groups is A) based on the day of the week B) based on assignment of a previous patient C) using hospital chart numbers D) computer-generated random numbering Q133. Which of the following blood vessel is likely to be damaged in femoral hernia repair A) pubic branch of obrurator artery B) aberrant obturator artery C) cremasteric artery D) testicular artery Q134. The results of various tests in a person with hearing loss are as follows roll over phenomenon present, recruitment present, stapedial reflex present, SISI score 75%. The site of lesion is likely to be in A) middle ear B) cochlea C) retrocochlea D) Heschls gyrus Q135. Left atrial enlargement can be recognized on a chest radiograph as 1. rounding of left heart border 2. double contouring of right cardiac shadow 3. elevated cardiac apex 4. widening of carina A) only 1,2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct

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Q136. The facial skeleton is primarily derived from which of the following embryonic tissues A) sixth pharyngeal arch B) endoderm C) skin ectoderm D) neural crest Q137. With reference to radiation induced damage to tissues: Assertion : neurons are more resistant compared to gonadal cells

Reason : poorly vascularised tissues with low oxygenation are more resistant than tissues with increased oxygenation

A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q138. As per national blood safety policy in India, every unit of blood product should be tested for detection of A) HIV, Hepatitis A, Hepatitis B, CMV and malaria B) HIV, Hepatitis A, Hepatitis B Hepatitis C and malaria C) HIV, Hepatitis B, Hepatitis C, malaria, and syphilis D) HIV, Hepatitis A, Hepatitis B, Hepatitis E and malaria

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Q139. All of the following statements are true regarding left ventricular pressure volume loop given below except

A) 4 to 1 represents isovolumetric relaxation B) point 1 represents opening of mitral valve C) slope of the line 1 to 2 increases with decrease in ventricular compliance (e.g. acute infarction) D) point 4 represents opening of aortic valve Q140. Telomerase activity is usually absent in A) germ cells B) somatic cells C) stem cells D) cancer cells Q141. Wood's light used to map areas of depigmentation works on the principle of A) reduction of specular reflection B) differential reflection of light between heme and melanin C) fluorescence of collagen in the dermis D) visualisation of antigens using fluorecin labelled antibodies Q142. Which of the following phases of wound healing is characterized by erythema and edema of the wound edges A) proliferation B) remodelling C) inflammation D) hemostasis

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Q143. Which one of the statements regarding arterial supply of uterus and ovary is true A) uterine artery arises from internal iliac and ovarian artery from aorta B) uterine artery arises from aorta and ovarian artery from internal iliac C) both uterine artery and ovarian artery arise from aorta D) both uterine artery and ovarian artery arise from internal iliac Q144. The condition depicted below is

A) thyroglossal cyst B) pharyngeal diverticulum C) laryngeal diverticulum D) branchial cyst Q145. In an infant breathing and feeding are possible simultaneously due to A) conical shape of the larynx B) soft , collapsible laryngeal cartilages C) high position of the larynx in the neck D) narrow cricothyroid space Q146. The ideal candidate for an intrauterine contraceptive device is one who is A) nulliparous B) has multiple sexual partners C) has no history of pelvic inflammatory disease D) want to avoid need for medical followup after contraceptive use Q147. An infant aged six months presents with recurrent vomitings and abnormal movements. On examination he was noted to have lighter complexion than his elder sibling. His urine had a musty odour, the most probable diagnosis is: A) phenyl ketonuria B) alkaptonuria C) homocystinuria D) maple syrup urine disease

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Q148. During DNA synthesis the Okazaki fragments in the lagging strand are joined together by which of the following enzyme A) DNA polymerase B) DNA ligase C) DNA helicase D) RNA polymerase Q149. Regarding treatment of malaria with Artesunate combination therapy (ACT), Assertion: it can not be used in the treatment of plasmodium vivax infection Reason: it is not effective for plasmodium vivax infection A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q150. Regarding lower limb deep venous thrombosis, the commonest site of origin of thrombus is A) soleal sinusoids B) femoral vein C) saphenous vein D) pelvic veins