Includes Modet Papers of — Guru Cobind Singh Indraprastha University (2018-2008)
Second Prof CDeliti University) 2019-2007
Covering 12 Years Question Papers vritfa. Explanations & References from Latest Editions of Standard Textbooks (<%p66ins SJ4SE; Harsh MoFian 7tH dl 8tH ed; KtfyT 7th dl 8tH ed.; flnanthanarayan dl (Pani^efs 10tH ed; JLrora's Parasitology 5th ed; Peddy 34tH ed; (Pari^ fi's 7tH dl 8tfi ed )
•Pharmacology
•Microbiology
•Forensic Medicine & Toxicology
Edited by
Sudhir Kumar Singh
Contri6utors
Swati Mehra
Mansi Midha
Swati Mishra
Mrinalini Bakshi
CBS UG Exam Series 2020
Decode your University Exams with CBS MBBS DE-CODE Semi-solved Series
Request to Readers
DearReaders, 'No work is complete without the support of our readers'.
The book "MBBS De-Code Semi-Solved Series, 2nd edition, is an outcome of our readers' demand and their support bysharing question papers and updates related to the exams We take the pride privilege to thank all those students without whom this endeavor couldn't be achieved And hope this book will help you to develop the approach and skills of answer writing. In the pursuit of providing the forthcoming titles of semi-solved series for the undergraduates, we request our readers to share the recent questions of upcoming exams or any previous exam papers which are not covered in this edition at feedback@cbspd.com or WhatsApp the questions on + 91-9555590180.
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Second Professional Examination
Second Edition (2019–2007)
Contributors
INCLUDES RecentPapersof2019-2018& PreviousYears'Papersof GuruGobindSingh IndraprasthaUniversity asModelPapers (seepg.no.RP-1toRP-68)
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MAULANA AZAD MEDICAL COLLEGE, NEW DELHI
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Dear Readers,
Request to Readers
‘No work is complete without the support of our readers’.
The book MBBS De-Code Semi-Solved Series, 2nd edition, is published on the demand of our readers. We really appreciate their support by sharing question papers and updates related to the exams.
This is our privilege to thank all those students who have made this endeavor successful. We hope, this book will help you to develop the approach and skills of answer writing.
In the pursuit of providing the forthcoming titles of semi-solved series for the undergraduates, we request our readers to share the recent questions of upcoming exams or any previous exam papers which are not covered in this edition at feedback@cbspd.com or WhatsApp the questions on + 91-9555590180.
Your contribution will be highly appreciated and acknowledged in the upcoming title(s) of this series. Any students who share the latest question paper or the additional papers at the earliest with us will get the complimentary copy of MBBS DE-CODE Semi-solved Series IIIrd Prof/Final Prof book along with our other CBS books (optional).
Publishers
Dear Readers,
From the Publisher’s Desk
It is our pleasure to publish the second edition of this highly-acclaimed book. We are extremely grateful to our readers and extend heartily thanks for accepting and appreciating the 1st edition of MBBS DE-CODE Semi-solved Series.
In this 2nd edition, we have focused on four subjects—Pathology, Pharmacology, Microbiology and Forensic Medicine & Toxicology of IInd Prof. Questions of last 12 years (2019–2007) of Delhi University have been presented, subject-wise. In writing the answers, special care has been taken to make them appropriate, authentic and up to the mark. Each answer is referenced from the standard textbooks of its relevant subjects.
The standardized answers presented in the book have been strategized after various brainstorming sessions. The answers given here have been checked and cross-checked several times by the subject experts, and finally reviewed and edited for enhancing the quality of content and authentication of the answers. All the suggestions provided by the reviewers have been critically evaluated and properly incorporated in the answers to make them as standard model answers. We believe that by going through the questions and answers, the students can develop good command over writing well-framed answers.
Apart from the solved questions of the last 12 years, the special feature of this book is “Extra Edge Section” in fully colored format, and with valuable additions like, "Model Papers" and Clinical Pattern Multiple Choice Questions. Extra Edge includes—Subject-wise important Spotters, Tables and MCQs from the exam point of view. This section is the compilation of content from CBS Exam Books of the relevant subject. Tables included in the book carry important information related to the subject, which will help you revise the important facts before the examination. For better recall and visualization, the colored spotters play an important role in this book. Important MCQs from the related subjects are given for the purpose of revision and quick recall of the facts before examination. Another important feature is the inclusion of subject-wise Clinical Multiple Choice Questions, in order to increase the understanding of clinical cases and their application. It also includes previous IInd year MBBS papers of Guru Gobind Singh Indraprastha University as model papers to make the students aware of new questions and topics asked in the university examination.
Hope this book would prove quite handy and very useful in developing your skills and will enhance your style of answer writing!
I am grateful to Mr Satish Kumar Jain (Chairman) and Mr Varun Jain (Managing Director), M/s CBS Publishers and Distributors Pvt Ltd for believing in us and providing us a platform for the project.
The job of developing this title was tedious and the people involved in it need special appreciation. I would like to extend my special thanks to all the contributors—Dr Swati Mehra, Dr Mansi Midha, Dr Mrinalini Bakshi and Dr Swati Mishra who played a vital role for developing this title throughout. Their inputs were valuable and much appreciated. They have given the realistic meaning to the line that Team Work makes Dreams Work. I also appreciate the efforts taken by Ms Nitasha Arora (Production Head & Content Strategist) for managing the task and accomplishing it on time.
My special thanks to Dr Sudhir Kumar Singh, who take out the time from his busy academic schedule in editing this book.
My special thanks to Dr J Magendran for providing valuable inputs in Forensic Medicine & Toxicology.
My heartfelt thanks to Dr Praveen Kumar Gupta, Dr Vandana Puri, Dr Ranjan Kumar Patel, Dr Malathi Murugesan and Dr Sudhir Kumar Singh for providing content support in drafting the Extra Edge section and Clinical Pattern Multiple Choice Questions.
I would also like to thank Dr Anju Dhir (Project Manager & Senior Scientific Coordinator), Shivendu Bhushan Pandey (Senior Editor), Mr Ashutosh Pathak (Senior Proof Reader) and all the production team members Mr Bunty Kashyap, Mr Phool Kumar, Mr Chaman Lal, Mr Prakash Gaur, Mr Chander Mani, Ms Tahira Parveen, Ms Babita Verma, Ms Manorama Gupta, Mr Raju Sharma, Mr Manoj Chaudhary, Mr Vikram Chaudhary, Mr Manoj Malakar, Mr Arun Kumar and Mr Rahul Negi for devoting laborious hours in designing and typesetting of the book.
Last but not the least, my special thanks to Ms Shagufta Khan (Sr Marketing Manager, PGMEE & Nursing) and entire sales team for their efforts in collecting the previous year question papers of Delhi University from the students.
I would like to end my thoughts with one very old saying “If you like this book tell others and if you don't like this book tell me." You can contact me at below given email id/mobile number.
Although this book is based on year-wise pattern, for a quick glance over important topics, this list has been prepared alphabetically under each subject, respectively
1. A 45-year-old female patient presented with vaginal discharge. Her pap smear revealed HSV infection. What inclusions do you suspect in this case:
a. Cowdry A bodies
b. koilocytosis
c. Guarnieri bodies
d. Warthin-Finkeldey giant cells
e. Ground-Glass Change
f. Atypical lymphocytes
2. A patient presents with biventricular failure and narrow pulse pressure. His CXR was suggestive of Dilated cardiomyopathy. Which of the following statements tell correctly about etiology:
1. Idiopathic (most common)
2. Genetic (most common)
3. Postpartum state can be a causative
4. Alcohol can cause direct toxicity to cause DCM
5. Most common cause of sudden death in young athletes
a. Option 1, 3, 4 are true
b. Option 2 and 5 are true
c. Option 5 is true, all others are false
d. All options are false
3. A 1-year-old boy presented with hepatosplenomegaly and delayed milestones. The liver biopsy and bone marrow biopsy revealed presence of histiocytes with PAS-positive Diastase resistant material in the cytoplasm. Electron microscopic examination of these histiocytes is most likely to reveal the presence of:
a. Birbeck granules in the cytoplasm
b. Myelin figures in the cytoplasm
c. Parallel rays of tubular structures in lysosomes
d. Electron dense deposit in the mitochondria
4. A 50-year old post menopausal woman comes with complaints of bleeding per vaginum. Which one of the following investigations is NOT required:
a. Endometrial biopsy
b. Diagnostic laparoscopy
c. Hysteroscopy
d. Pap smear
5. In a 40-year-old woman, pap smear shows atypical glandular cells, The next step of management should be:
a. Repeat pap smear after three months
b. Colposcopic directed cervical biopsy
c. Colposcopy: cervical biopsy, endocervical curettage and endometrial biopsy
d. Hysteroscopy and directed endometrial biopsy
6. A patient develops skin necrosis 3 days after being started on warfarin for deep vein thrombosis. What is the most likely cause?
1. Antiphospholipid antibody syndrome
2. Protein C deficiency
3. Disseminated intravascular coagulation
4. Thrombotic thrombocytopenic …………
a. Only 1
c. 1 and 3
b. Only 3
d. 1, 2, 3
7. Children with germ line retinoblastoma are more likely to develop other primary malignancies in their later lifetime course. Which of the following can occur in such patients?
a. Osteosarcoma of lower limbs and soft tissue sarcoma
b. Thyroid carcinoma
c. Seminoma
d. Squamous cell carcinoma
8. A person is having painless lymphadenopathy. On biopsy, binucleated owl shaped nuclei with clear vacuolated area is seen. On IHC CD 15 and CD 30 were positive. What is the most probable diagnosis?
a. Nodular sclerosis
b. Large granular lymphocytic lymphoma
c. Lymphocyte depletion type
d. Lymphocyte predominant HD
9. A 10-year-old boy with mass in the abdomen. On imaging the para-aortic LN is enlarged. On biopsy starry sky appearance is seen. What is the underlying abnormality?
a. p53 gene mutation
b. RB gene mutation
c. Translocation involving BCR-ABL genes
d. Translocation involving MYC gene
Clinical Pattern MCQs
10. A 60-year-old male presents with generalized lymphadenopathy and hepatosplenomegaly. Immunophenotype: CD5 and CD19 are positive and CD10 negative. Diagnosis:
a. Follicular lymphoma b. Burkitt lymphoma
c. Hairy cell leukemia d. CLL
11. An elderly male presents with anemia and fatigue. O/E splenomegaly-2 cm palpable below costal margin. Hemogram showed Pancytopenia. Which is the most common etiology?
a. Hairy cell leukemia b. CML
c. Thalassemia d. Follicular lymphoma
12. A 55-year-old gentleman presented with history of right upper quadrant discomfort, jaundice, pruritis, fever, fatigue and weight loss. His serum bilirubin and alkaline phosphatase levels are raised and he also gives history of treatment for inflammatory bowel disease. He is most likely to be suffering from:
a. Benign bile duct stricture with cholangitis
b. Biliary worms
c. Bile duct malignancy
d. Primary sclerosing cholangitis
13. A 2-year-old child presents with scattered lytic lesions in the skull. Biopsy revealed Langerhans giant cells. The most commonly associated marker with this condition will be:
a. CD la b. CD57
c. CD3 d. CD68
14. True about BCR-ABL ‘traits’ are all except?
a. P190 has an indolent course
b. P190 is a bad prognostic factor
c. P230 is positive in chronic neutrophilc leukemia
d. P230 has an indolent course
15. 45/m presented with leuko-erythroblastic blood picture with dacrocytes. What is bone marrow finding?
a. Fatty degeneration with erythroid cell hyperplasia with megakaryocytes
b. Abundant fat cells
c. Focal cellular marrow with hypocellular areas and atypical megakaryocytes
d. Hypercellular marrow with prominent blasts
16. A 25-year-old female came to OPD 1 year after postpartum. She was treated for iron deficiency anemia while pregnancy. Now she is pale and her Hb was 5% and reticulocyte count was 9%. Her corrected retic count is?
a. 6 b. 4.5
c. 3 d. 1
17. A 25-year-old patient presents with the history of dyspnea on exertion for 3 weeks. Investigations revealed Hb–7g/dl, reticulocyte count 18% and positive coomb’s test. Diagnosis:
a. Autoimmune hemolytic anemia
b. Paroxysmal nocturnal hemoglobimuria
c. Sickle cell anemia
d. Hereditary spherocytosis
18. A 17/F underwent FNAC for a lump in the breast which was non-tender, firm and mobile. Which of the following features would suggest finding of a benign breast disease?
a. Dyscohesive ductal epithelial cells without cellular fragments
b. Tightly arranged ductal epithelial cells with bare nuclei
c. Stromal predominance with spindle cells
d. Polymorphism with single or arranged ductal epithelial cells
19. A 25-year-old male presented with swelling in the wrist joint. Histopathological examination showed spindle cells and Verocay bodies. What is the most likely diagnosis?
a. Neurofibroma
b. Schwannoma
c. Lipoma
d. Squamous cell carcinoma
20. 70 M presented to AIIMS OPD with fatigue. Fasting sugar was 110 mg%, PP was 180 mg%, Hba1c was 6.1%. What is your diagnosis?
a. Prediabetes
b. Stress induced
c. Normal
d. Diabetes
21. 2-year-old child presents with short stature and café-au-lait spots. Bone marrow aspiration yields a little material and mostly containing fat. What is your diagnosis:
a. Fanconi anemia
b. Dyskeratosis congenita
c. Tuberous sclerosis
d. Osteogenesis imperfect
22. A female presents with history of progressive breathlessness. Histology shows heterogenous patchy fibrosis with several fibroblastic foci. The most likely diagnosis is:
a. Cryptogenic organizing pneumonia
b. Non specific interstitial pneumonia
c. Usual interstitial pneumonia
d. Desquamative interstitial pneumonia
23. A trauma patient presents at emergency department. There is no time for cross matching. FFP of which blood group can be transfused safely?
a. O RH D positive
b. O RH D negative
c. AB RH D positive
d. AB RH D negative
24. 25-year-old female presented with swelling in front of neck. TSH levels were elevated. Biopsy showed lymphocytic infiltration and Hurthle cells. Which of the following is the possible diagnosis?
a. Graves’ disease
b. Hashimoto’s thyroiditis
c. Medullary carcinoma thyroid
d. Papillary carcinoma thyroid
25. 11. A 8-year-old child presented with history of recurrent infections. The child had rashes. Investigations revealed low platelets. What could be the probable cause?
a. Job syndrome
b. Wiskott-Aldrich syndrome
c. Henoch-Schonlein purpura
d. Hyper IgM syndrome
26. A 23-year-old lady presented with diarrhoea, vomiting and poor appetite. Biopsy showed crypt hyperplasia, villous atrophy and CD8+ cells in the lamina propria. What could be the diagnosis?
a. Whipple’s disease
b. Chronic pancreatitis
c. Environmental enteropathy
d. Celiac disease
Answer Keys
27. A 25-year-old female presented with swelling around the knee joint. Biopsy showed giant cells interspersed with mononuclear cells. What is your diagnosis?
a. Rheumatoid arthritis b. Osteosarcoma
c. Aneurysmal bone cyst d. Giant cell tumor
28. A 30-year-old female presented with 4 cm mass in the right breast. Biopsy showed densely packed cells with bland nuclei and mucin infiltrating the stroma. What is your diagnosis?
a. Invasive papillary carcinoma
b. Medullary carcinoma
c. Apocrine carcinoma
d. Colloid carcinoma
29. Patient came with swelling in midline of neck measuring 2 cm in size. Histopathological examination showed Orphan Annie eye nuclei. What is the most likely diagnosis?
a. Medullary carcinoma
b. Papillary carcinoma thyroid
c. Toxic nodular goitre
d. Follicular thyroid carcinoma
30. A 55-year-old male presents with severe chest pain radiating to the left arm. ECG shows ST segment elevation in the V4, V5 and V6 leads. CK-MB and troponin levels are found to be increased. The most likely cause for the increase in enzyme in serum is:
a. Clumping of nuclear chromatin
b. Lysosomal Autophagy
c. Mitochondrial swelling
d. Cell membrane defects
Pharmacology
1. A patient came to casualty with acute attack of asthma after starting treatment of glaucoma. The causative drug is:
a. Timolol b. Betaxolol
c. Clonidine d. Acetazolamide
2. A treatment naive 13-year-old patient of rheumatoid arthritis with deformity given in picture. How will you start treatment?
a. 3 months of NSAID
b. Single TNF alpha inhibitors
c. Start methotrexate and short course of steroids
d. Start Leflunomide
3. A patient of rheumatoid arthritis is not responding to NSAIDs and methotrexate for 6 months. What will you do next?
a. Start single DMARD
b. Increase dose of methotrexate
c. Replace leflunomide with methotrexate
d. Add sulfasalazine and hydroxychloroquine
4. You have to give 180 mg of ceftriaxone to a patient in 2 mL syringe which has 10 divisions per mL. Concentration of this drug in vial is 500mg/5ml. How many divisions should be filled in 2 mL syringe to give 180 mg?
a. 18
c. 2
b. 1.8
d. 20
5. A patient comes 6 hours after consuming morphine and presents with pin point pupils and respiratory depression. T ½ of morphine is 3 hours and Volume of distribution (Vd) is 200 L. Plasma concentration is 0.5 microgram/ml. Calculate the initial morphine dose consumed.
a. 100 mg
c. 10 mg
b. 400 mg
d. 50 mg
6. A patient was administered 200 mg of a drug. 75 mg of the drug is eliminated in 90 minutes. If the drug follows first order kinetics how much drug will remain after 6 hours?
a. 6.25 mg
c. 25 mg
b. 12.5 mg
d. 50 mg
7. An 80 kg man is in shock. Vasopressor has to be started at 10 microg/kg/min. One vial has 200 mg in 5 mL and 2 vials were diluted to 250 mL. If 16 drops = 1ml, calculate drops per min required.
a. 4 b. 8
c. 16 d. 24
8. A person has given 0.175 g oral digoxin with bioavailability 70%. The amount of drug reaching in systemic circulation is:
a. 0.175 b. 0.175 × 0.7
c. 0.175/7 d. 0.175 + 0.7
e. 0.175 + 1/0.7
9. An anticancer drug is given by continuous intravenous infusion. If the plasma concentration at steady state is 10 mg/mL and clearance is 20 mL/ hour, what would be the infusion rate if half-life is 2 minutes?
a. 200 mg/hour b. 400 mg/hour
c. 800 mg/hour d. 1600 mg/hour
e. 3200 mg/hour
10. A Male with insulin dependent diabetes having macular edema develops glaucoma. Which drug should be used as the least resort to treat?
a. Alpha agonist b. Prostaglandin analogue
c. Pilocarpine d. Beta blocker
11. A child presented with history of ingestion of some unknown plant and developed mydriasis, tachycardia, dry mouth, warm skin and delirium. Which of the following group of drugs is likely to be responsible for the symptoms of this child?
a. Anticholinergic b. Sympathomimetic
c. Opioid d. Benzodiazepine
12. A 28-year-old woman has been treated with several autonomic drugs for about a month. Which of the following signs would distinguish between an overdose of muscarinic blocker and a ganglionic blocker?
a. Blurred vision
b. Dry mouth and constipation
c. Mydriasis d. Postural hypotension
13. A new drug effect was compared as compared to placebo in phase I trial in healthy volunteers. The effect of the new drug is predominantly on which receptors
Placebo New BP 120/80 100/50 HR 70/mm 110/mm
a. α1 and α2
b. β1 and β2
c. α1, α2 and β1 d. α2 and β2
14. Primary action of nitrates in a patient of angina is:
a. Coronary vasodilation
b. Decreases preload
c. Decreases afterload
d. Decreases heart rate
15. A man presents with chest pain. ECG shows ST segment depression in leads V1-V4. Which of the following should not be given?
a. Beta blocker b. Thrombolytic
c. Morphine d. Aspirin
16. A patient was started on fluphenazine. After few weeks of treatment, he started developing tremors, rigidity, bradykinesia and excessive salivation. First line of management for this patient is
a. Trihexyphenidyl b. Pramipexole
c. Amantadine d. Selegiline
17. A patient of CAD with history of MI 2 months back, diabetes mellitus with LDL 126, HDL 32 and triglycerides 236. What should be given:
a. Atorvastatin 80 mg
b. Rosuvastatin 10 mg
c. Fenofibrate
d. Fenofibrate and rosuvastatin
18. A female developed a feeling of an insect crawling on her legs at night which was relieved by shaking her legs. Which of the following is the drug of choice for her condition?
a. Pramipexole b. Gabapentin
c. Vit B12 d. Iron tablets
19. A 34-year-old male presents to the outpatient department with a complaint of pain in the right sided jaw pain. Each episode of pain is lasting for around 30 seconds. The present complaint was present for the past one month but the increased in the number of episodes per day brought her to the clinic. Those episodes are increasing especially when she walks out in the cold. The mechanism of action of drug of choice in this patient is?
a. Prevention of Na+ influx
b. Increase the time of Cl– channel opening
c. Increase the frequency of Cl– channel opening
d. Decrease in the Ca+2 influx
20. A 59-year-old female patient taking medications for hypertension and congestive cardiac failure. She suddenly develops skin rashes along with swelling of tongue, lips as well as eyes, causing her breathing difficulty. Which one of the following medications is the reason for the untoward effects?
a. Propranolol b. Hydrochlorthiazide
c. Captopril d. Clonidine
21. A 16-year-old girl was on antiepileptic for treatment of seizure episodes while asleep. She had no seizure for 6 months and NCCT and EEG was normal. What is further management?
a. Stop treatment
b. Continue for 2 years
c. Lifelong treatment
d. Stop treatment and follow up with 6 monthly EEG
22. A female with history of previous pregnancy associated with neural tube defect. What should be the prophylactic dose of folic acid given in microgram?
a. 4 b. 40
c. 400 d. 4,000
23. A patient presented with right lower quadrant pain. He was already treated for right renal stone disease. Which of the following opioid is partial agonist at mu and full agonist at kappa?
a. Pentazocin
b. Buprenorphine
c. Tramadol
d. Fentanyl
24. A patient an antipsychotic drugs develops temperature of 104°C, BP about 150/100 and abnormal behavior. What is the likely diagnosis?
a. Aggravation of psychosis
b. Dystonia
c. Neuroleptic malignant syndrome
d. Akathisia
25. A 15-year-old boy needs to go for a long distance in bus. Which of the following drugs would be useful for him?
a. Desloratiadine b. Cetirizine
c. Diphenhydramine d. Promethazine
26. A bed ridden female patient with catheter related UTI by beta lactamase producing klebsiella pneumoniae. Which of the following drug will you choose?
a. Ampicillin
b. Beta lactams and beta lactamase inhibitors
c. 2nd generation cephalosporins
d. 3rd generation cephalosporins
Clinical Pattern MCQs
27. A patient is on indinavir, zidovudine, lamivudine and ketoconazole. He developed breast hypertrophy, nephrolithiasis, hyperlipidemia and central obesity; identify the drug causing these side effects amongst all:
a. Lamivudine
b. Indinavir
c. Ketoconazole
d. Zidovudine
28. A patient, diagnosed with rheumatoid arthritis, was on medications. After 2 years, developed blurring of vision and was found to have corneal opacity. Which of the following drug most likely causes that?
a. Sulfasalazine b. Chloroquine
c. Methotrexate d. Leflunomide
Answer Keys
29. A patient on lithium therapy developed hypertension. After being started on thiazides for hypertension, he suffered from coarse tremors and other symptoms suggestive of lithium toxicity. Explain the likely mechanism of this interaction.
a. Thiazide inhibits metabolism of lithium
b. Thiazides increases tubular reabsorption of lithium
c. Thiazides acts as add on drug for lithium
d. Thiazides and lithium both cause tremors
30. In an orthopedic surgery, a patient was given acetyl choline receptor competitive blocker drug. Which of the following could be used as recovery against this blockade?
a. Neostigmine b. Physostigmine
c. Pyridostigmine d. Succinylcholine
Microbiology
1. A 5-year-old child presented to the OPD with complaints of rectal prolapse. On examination stunting and growth retardation was documented; What is the parasitological cause for this clinical feature?
a. Trichuris trichiura
b. Trichinella spiralis
c. Giardia Lamblia
d. Enterobius vermicularis
2. A 35-year-old man presented with dry cough and rusty coloured sputum. He has history of eating in Chinese restaurant very often with consumption of crabs often; What is the probable causative agent in this condition?
a. Diphyllobothrium latum
b. Pneumocystis jirovecii
c. Paragonimus westermani
d. Strongyloides stercoralis
3. A child is suffering from recurrent chronic infections with encapsulated bacteria; Which subclass of IgG does the child has deficiency?
a. IgG1
b. IgG2
c. IgG3
d. IgG4
4. An AIDS patient presented to OPD with dyspnoea and respiratory illness; Which of the following is suitable to diagnose the opportunistic infection commonly seen in AIDS patient?
a. Sputum microscopy
b. Broncho alveolar lavage
c. Chest X-ray
d. CT scan
5. 12-year-old presents with vomiting within 3 hours of consumption of food at a party. What is the likely organism responsible for the symptoms:
a. Staphylococcus aureus
b. Salmonella
c. Clostridium botulinum
d. Clostridium perfringens
6. A farmer presents to the emergency department with painful inguinal lymphadenopathy and history of fever and flu like symptoms. Clinical examination reveals an ulcer in the leg. Which of the following strains should be used to detect suspected bipolar stained organisms:
a. Albert’s stain b. Wayson’s stain
c. Ziehl Neelson stain d. Mc Fayden’s stain
7. A patient has prosthetic valve replacement and he develops endocarditis 8 months later. Organism responsible is:
a. Staph aureus b. Strep viridans
c. Staph epidermidis d. HACEK
8. An HIV positive patient with CD4 count 300/cu.mm presents with mucosal lesion in the mouth. On microscopy budding yeast cells and pseudohyphae are seen. What is the likely diagnosis?
a. Candidiasis b. Oral hairy leukoplakia
c. Lichen planus d. Diphtheria
9. A child presents with sepsis. Bacteria isolated showed beta hemolysis on blood agar, resistance to bacitracin, and a positive CAMP test. The most probable organism causing infection is:
a. Streptococcus pyogenes
b. Streptococcus agalactiae
c. Enterococcus
d. Streptococcus pneumonia
10. In a school, child had abscess on lower leg. Swab taken revealed Gram-positive β-hemolytic streptococci, and these were bacitracin sensitive. School physician observed that similar organism was isolated from throats of many other children. Which of the following is true statement with regards to this patient:
a. Difference in surface protein can differentiate the pathogenic bacteria from the pharyngeal culture bacteria
b. Component C carbohydrate can differentiate the pathogenic bacteria from the throat culture bacteria
Clinical Pattern MCQs
c. MEG 3 positive are throat culture streptococci
d. Depending on the M protein the cutaneous pathogenic bacteria can be differentiated from the pharyngeal culture bacteria
11. A child presents with infective skin lesion of the leg. Culture was done which showed Gram-positive cocci in chains which were hemolytic colonies. The test to confirm the organism is:
a. Bile solubility b. Optochin sensitivity
c. Bacitracin sensitivity d. Catalase positive
12. A boy with skin ulcer on leg, culture reveals beta hemolysis. Culture from school children with sore throat some days back also revealed beta hemolysis. What is the similarity between both:
a. Mec A gene is related to it
b. M protein is same
c. Carbohydrate antigen is same
d. Strains causing both are same
13. A 11-year-old child presented with sore throat since 3 days, which medium is used to culture the throat swab:
a. Blood agar b. LJ medium
c. Stewart medium d. Chocolate agar
14. A beta hemolytic bacteria is resistant to vancomycin. It shows growth in 6.5% NaCl, is non bile sensitive. It is likely to be:
a. Streptococcus agalactiae
b. Streptococcus pneumoniae
c. Enterococcus
d. Streptococcus bovis
15. A patient presents with signs of pneumonia. The bacterium obtained from sputum was a Grampositive cocci which showed alpha hemolysis on sheep agar. Which of the following test will help to confirm the diagnosis?
a. Bile solubility b. Coagulase test
c. Bacitracin test d. cAMP test
16. A person presents with pneumonia. His sputum was sent for culture. The bacterium obtained was Gram-positive cocci in chains and alpha-hemolytic colonies on sheep agar. Which of the following will help in confirming the diagnosis:
a. Novobiocin b. Optochin
c. Bacitracin d. Oxacillin
17. A chronic alcoholic is presenting with clinical features of meningitis. Most likely organism which will grow on CSF culture:
a. Streptococcus pneumoniae
b. N. meningitidis
c. Listeria monocytogenes
d. E. coli
18. A young lady complains of sore throat for 3 days along with fever and headache. On examination, she was severely dehydrated, her BP was found to be 90/50 mm Hg and on the distal aspect of the cuff, small red spots were noted. What could be the most probable etiological agent responsible for causing these symptoms:
a. Brucella abortus
b. Brucella suis
c. Neisseria meningitidis
d. Staphylococcus aureus
19. An intern while doing phlebotomy spilled blood in the floor accidentally. What is the next ideal step in the disinfection of blood?
a. Pour 1% hypochlorite solution
b. Cover with a cloth/material
c. Mop the floor
d. Call infectious control unit
20. Patient presenting with abdominal pain, diarrhea is taking clindamycin for 5 days. Treated with metronidazole, the symptoms subsided. What is the causative agent:
a. Clostridium difficile
b. Clostridium perfringens
c. Clostridium welchii
d. Clostridium marneffi
21. A 52-year-old man has undergone lung transplantation. Two months after transplantation, he developed pulmonary symptoms and diagnosed as having bilateral diffuse interstitial pulmonary pneumonitis and bron-chiolitis. Which of the following etiological agent is responsible in this condition?
a. Cytomegalovirus b. Herpes simplex virus
c. Epstein Barr virus d. Varicella zoster virus
e. Rhino virus
22. A 70-year-old lady refused to take influenza vaccine and developed influenza. She died due to pneumonia 1 week after contracting influenza. Which is the most common cause of acute post influenza pneumonia:
a. Cytomegalovirus
b. Legionella
c. Staphylococcus aureus
d. Measles
23. A 35-years-old female with h/o fever for five days, headache, back ache with rash in the back and fore arm presents with decreased platelet count; Which test is helpful at this stage for diagnosis?
a. NS1 antigen detection
b. IgM ELISA
c. IgG ELISA d. PCR
24. A patient presents with headache, high fever and meningismus. Within 3 days he become unconscious. Most probable causative agent:
a. Naegleria fowleri
b. Acanthamoeba castellani
c. Entamoeba histolytica
d. Trypanosoma cruzi
25. A patient presenting from West Bengal with fever, lymphadenopathy. Serological test showed rk39 positive. What is the treatment of choice?
a. Sodium stibogluconate
b. Artemesinin
c. Chloroquine
d. Dapsone
26. A 48-year-old immunocompromised patient attended the emergency block with complaints of abdominal pain, vomiting and dyspnea. On examination and baseline investigation, he was diagnosed as gastro-intestinal perforation with paralytic ileus. The most common cause of this disseminated infection in immunocompromised patient is due to the following. Identify it:
a. Rhabditiform larvae of S. stercoralis
b. Filariform larvae of S. stercoralis
c. Adult female worm of S. stercoralis
d. Adult male worm of S. stercoralis
e. Egg of S. stercoralis
27. A patient coming from Himachal Pradesh, presents with multiple skin lesions. Microscopy reveals cigar shaped yeast cells and asteroid bodies. Microscopy of culture shows flower like pattern. Identify the agent:
a. Candida sp.
b. Sporothrix schenckii
c. Epidermophyton floccosum
d. Rhizopus
Answer Keys
28. A 5-year-old child presented with fever, rashes all over her body, head ache and altered sensorium. Which is the best method for diagnosis of this encephalitis?
a. PCR
b. Viral culture
c. ELISA
d. Tzanck smear
29. A 19-year-old female college student has fever, sore throat and lymphadenopathy accompanied by lymphocytosis with atypical cells and an increase in sheep cell agglutinins. Diagnosis is most likely?
a. Infectious hepatitis
b. Infectious mononucleosis
c. Chicken pox
d. Herpes simplex infection
30. A 48-year-old woman develops fever and focal neurological signs. MRI shows a left temporal lobe lesion. Most appropriate test that can be used to confirm the diagnosis of HSV encephalitis is:
a. Brain biopsy
b. Tzanck smear
c. PCR assay for viral DNA in CSF
d. Serum IgM antibody detection
Forensic Medicine & Toxicology
1. A circular bullet wound, erythema seen around the margin, blackening & tattooing present. What is the range?
a. Close shot entry wound
b. Close shot exit wound
c. Distant shot entry wound
d. Distant shot exit wound
2. A person in alleged to have been dead and body is not found. Proof is produced that the same person has not been heard of for seven years by his friend and relative, death is presumed under:
a. S. 107 IEA b. S. 108 IEA
c. S. 105 IEA d. S. 106 IEA
3. A rugby player hit his head on the post whilst involved in a tackle. He was unconscious for 5 min but regained full consciousness and sat on the sideline until the end of the game. He was then noted to be drowsy and over the past 30 min became confused and no longer obeyed commands. Most likely diagnosis is:
a. Extradural hematoma
b. Subdural hematoma
c. Subarachnoid hematoma
d. Cerebral edema
4. A farmer ingested unknown poisonous seeds and had pain and vomiting. Soon he developed paralysis of lower limb which ascends till it affected the respiratory muscles and he died within two days. The poisoning is due to:
a. Dhatura
b. Strychnos nux vomica
c. Conium maculatum
d. Opium
5. As per Mental health care act, an individual with a known psychotic disorder on treatment and is not a minor, can choose to decide the caretaker and the course of treatment. This is called as:
a. Advance directive
b. Treatment directive
c. Mental will
d. Future directive
6. An adult came to casualty with complaints of rapid heart rate. On examination everything else was normal except for episodic tachycardia and occasional extra systole and ambylopia. Which of the following is the cause of it?
a. Nicotine
b. Cannabis
c. Atropine
d. Cocaine
7. Heera lals’s 10-year-old child presented in casualty with snake bite since six hours. On examination no systemic signs are found and lab investigations are normal except localized leg swelling <5 cm. Next step in management.
a. Incision and suction of local swelling
b. IV anti-snake serum
c. S/c anti snake serum at local swelling
d. Observe the patient for progression of symptoms wait for antivenom therapy
8. Man hit by car is thrown up and hits road divider and falls on the ground, sustains head injury then run over by another car. Cause of head injury:
a. Primary impact injury
b. Secondary impact injury
c. Primary injury
d. Secondary injury
9. Patient’s relative gives a history of tattoo, however it was not found during autopsy. What should be dissected to find it:
a. Lymph node
b. Skin
c. Spleen d. Kidney
10. A 16-year-old girl come to a doctor with fractured forearm. She told she tripped and fell but cigarette burns were observed on her forearm. What will be your next step?
a. To infrom higher authorities
b. To do a complete physical examination
c. To tell or discuss with colleagues that she is a case of abuse
d. To call local social worker for help
11. A small girl with neuropsychiatry symptoms has a habit of licking paint in walls. Symptoms due to inhibition of:
a. ALA dehydratase b. ALA synthase
c. Heme oxygenase d. CPG oxidase
12. An 18 year-old girl was brought to OPD, labia major separated, labia minora flabby, fourchette tear present and vaginal is roomy but Hymen is intact. What could be possible?
a. True virgin b. False virgin
c. Premenstrual stage d. Molestation
13. An infant is brought to casualty with reports of violent shaking by parents. Most characteristic injury is:
a. Long bone fracture
b. Ruptured spleen
c. Subdural haematoma
d. Skull bone fracture
14. In the skeletal remains in a building suspected to be of a male, the length of humerus is 24.5 cm. The stature of the person will be:
a. 130.095 cm b. 93.59 cm
c. 143.00 cm d. 110.00 cm
15. A person falsely perceives that his close friend has been replaced by an exact double. This phenomenon is referred to as:
a. Cotard syndrome b. Fregoli syndrome
c. Capgras syndrome d. Delusional perception
16. A 14-year-old raped girl coming with 22 weeks pregnancy. What should not be done in this case?
a. Male doctor can examine in the presence of female attendant
b. No need for vaginal swab
c. No need to confirm pregnancy
d. Termination of pregnancy can be done with her consent by a gynecologist
17. 23 years female was cheated in name of marriage & a man was in contact with her belongs to:
a. Sec. 492 IPC b. Sec. 493 IPC
c. Sec. 494 IPC d. Sec. 495 IPC
18. A person ‘X’ hits another person ‘Y’ with a wooden stick on provocation. This leads to formation of a bruise 3 cm x 3 cm on the forearm. No other injuries are noted. Which of the following is true, regarding his punishment:
a. Imprisonment for one year and/or fine of ` 1,000
b. Imprisonment for two year and/or fine of ` 5,000
c. Imprisonment for one month and/or fine of ` 500
d. Rigorous imprisonment for six months
19. Two farmers were brought dead, autopsy done revealed viscera that had the smell of bitten almonds. The most likely poisoning is due to:
a. Organophosphorus
b. Morphine
c. Atropine
d. Hydrocyanic acid
20. A person a brought by police from the railway platform. He is talking irrelevent and having dry mouth with hot skin, dilated pupils, staggering gait and slurred speech. The possible diagnosis is:
a. Alcohol intoxication
b. Carbamate poisoning
c. Organophosphorus poisoning
d. Datura poisoning
21. A dead body is found to have marks like branching of a tree in front of the chest. The most likely cause of death is:
a. Firearm
b. Lightening injury
c. Injuries due to bomb blast
d. Road traffic accident
22. A lady died due to natural death within seven year after her marriage. The inquest in this case will be done by:
a. Forensic expert
b. Deputy superintendent of police
c. Sub-divisional magistrate
d. Coroner
23. A middle aged man presents with paresthesia of hand & feet. Examination reveals presence of ‘mees’ lines in the nails and rain drop pigmentation in hands. The most likely causative toxin is:
a. Lead
b. Arsenic
c. Thallium
d. Mercury
24. A-25-year old person sustained injury in right eye. He developed right corneal opacity following injury. Left eye was already having poor vision. Corneoplasty of right eye was done and vision was restored. Medicolegally such injury is labeled as:
a. Grievous b. Simple
c. Serious d. Dangerous
25. A boy has 20 permanent and 8 temporary teeth. His age is more likely to be:
