142. Patient with ICD collapses, ICD imaging modality
a. Chest x ray
b. MRI
c. CT
d. USG
Answer (a) Chest X ray
Reference: Harrison: 18 th edition/ just above table 233-9/ chapter 233./Emedicine:http://emedicine.medscape.com/article/162245-overview#aw2aab6c12
143. A patient on amphotericin B develops hypokalemia of 2.3meq/l. K+ supplementation requires is?
a. 40meq over 24 hrs
b. 60meq over 24 he's
c. 80 meq over 24 hrs
d. 120-160meq over 24 hrs
Answer (A) 40meq over 24 hrs
Reference: Harrison 18th edition, chapter 46
143. A patient with 12cm abscess in liver which was drained under sonographic monitoring 3 times and On follow up a residual cavity of 4cm was found to be present .An oral lumicidal drug was given for 14 days. Next plan of action shall be:
a. Stool examination serially
b. USG weekly for 1 month followed by monthly USG till 1 year.
c. USG weekly for 1 month followed by CT scan at 3 months.
d. Monthly CT scan
Answer (b) USG weekly for 1 month followed by monthly USG till 1 year.
Reference: Harrison 18 th edition chapter 202
144. Which of the following is Not true aboutpolymyositis ?
a. Limb girdle weakness
b. Ophthalmoplegia
c. Para-neoplastic syndrome
d. Spontaneous discharge in EMG.
Answer (B) Ophthalmoplegia
Reference: Harrison 18th chapter 383
145. 35 year old female with recurrent renal stone. not advised is:
a. Increase water
b. Restrict protein
c. Restrict salt
d. Ophthalmoplegia
Answer (D) Ophthalmoplegia
Reference: Harrison 18th edition/ chapter 281/page 1817/ Reference: www. Uptodate.com/contents/prevention of recurrent calcium stones in adults, Campbell’s urology chapter 43
146. A 28 yr old man has lenticonus and ESRD now. His maternal uncle also died of similar illness. Diagnosis is
a. ARPKD
b. ADPKD
c. Oxalosis
d. Alport's syndrome
Answer: (D) Alport’s syndrome
Reference: Harrison 18th Chapter 357
147. Pinna calcification Except
a. Gout
b. Onchrnosis
c. Frost bite
d. Addisons disease
Answer (a) Gout
Reference :Chapter 54. Skin Manifestations of Internal Disease, Harrison 18th (www.nejm.org/doi/full/10.1056/NEJMicm1000193)
148. Which of the following doesnot need treatment?
a. Neuroblastoma
b. Burkitts
c. t cell lymphoblastic leukemia
d. Not Recalled
Answer is A
Reference: Nelson 18th text book of pediatrics/chapter 498
149. With ageing, a slight decrease in cognitive impairment is seen due to increase in level of
a. Homocysteine
b. Taurine
c. Methionine
d. Cysteine
Answer (a) Homocysteine
Reference: CMDT 2012 / page 1620
150. A Patient presents with pain in Meta-Tarso-Phalangeal joints and is a known case of Chronic Renal Failure. This is due to accumulation of-
a. Rh factor
b. Uric acid
c. Serum urea
d. HLA B27 typing
Answer (b) Uric Acid
Reference: Harrison 18th edition/table 280.4/ chapter280 and http://www.ncbi.nlm.nih.gov/pubmed/21321568
151. SARS causative agent
a. Corona-virus
b. Picorna-virus
c. Myxovirus
d. Recalled
Answer: (a) Corona-virus
Reference :Harrison 18th edition-chapter 179
152. Blink reflex is used for?
a. Mid pontine lesions
b. Neuromuscular transmission
c. Axonal neuropathy
d. Motor neuron disease
Answer (a) Mid pontine lesions
Reference: http://www.ncbi.nlm.nih.gov/pubmed/17727783/ Clinical value of blink reflex
153. Grisel syndrome all are true except:
a. Post-adeniodectomy
b. Conservation treatment
c. Inflammation of cervical spine ligaments
d. No need for neurosurgeon
Answer (d) No need for neurosurgeon
Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2639892/
154. Cervical syringomyelia all are seen except
a. Burning sensation in hands
b. Hypertrophy of abductor pollicisbrevis
c. Plantar extensor
d. Absent biceps reflex.
Answer: (b) Hypertrophy of abductor pollicisbrevis
Reference: Harrison textbook of medicine 18 th edition chapter 377/ above figure 377-7http://emedicine.medscape.com/article/1151685-clinical
155. 70year female is on treatment with Alendronate for severe osteoporosis.Now she complains of pain in right thigh. What is the next investigation to be performed?
a. DEXA scan
b. x ray
c. Serum vitamin D levels
d. Serum alkaline phosphate levels
Answer (b) X-ray
Reference: CMDT 2012/page 1118
156. A 70 year old retired Military person with good previous medical record complains of bi-temporal headache which is decreased in lying down position. He states that he gets relief by giving pressure over bilateral temples. The patient also complains of loss of appetite with feeling feverish.
a. Chronic tension headache
b. Temporal arteritis
c. Migraine
d. Fibromyalgia
Answer (b) Temporal arteritis
Reference: CMDT 2011 page 819 and http://emedicine.medscape.com/article/809492-clinical#a0216
157. A patient of rheumatoid arthritis develops sudden onset Quadriparesis, , increased muscle tone of limbs with exaggerated tendon jerks and worseningof gait. The investigation to be done:
a. Flexion and extension Cervical area X ray of neck
b. MRI brain
c. EMG and NCV
d. Carotid angiography
Answer( a) Flexion and extension Cervical area X ray of neck
Reference:Harrison chapter 15/18 th edition
159. Type 1 renal tubular acidosis all are trueExcept?
a. Renal stones
b. Hypokalemia
c. > 4mg/ day Sodium bicarbonate
d. Urine pH > 5.
Answer (c) > 4mg/ day Sodium bicarbonate
Reference: Harrison 18th edition 284/ CMDT 2011 page 862
160. A diabetes mellitus patient with fungal infection of sinuses and peri-orbital region with significant visual impairment:
a. Amphotericin B
b. Itraconazole
c. Ketoconazole
d. Broad spectrum antibiotics
Answer: Amphotericin B
Reference: Harrison 18th Edition/ Chapter 205
161. Gait apraxia?
a. ACA
b. MCA
c. PCA
d. Posterior choroidal artery
Answer: (a) Amphotericin B
Reference: chapter 24 Harrison18th : Gait and balance disorders
162. Prions, which of following is correct
a. Long incubation period
b. Destroyed by autoclaving at 121C
c. Nucleic acid present
d. Immunogenic
Answer (a) Long incubation period
Reference: The following lines are excerpt from Harrison 18th chapter 383:
163. A patient with Tubercular meningitis was taking ATT regularly. At end of 1 month of regular intake of drugs deterioration in sensorium is noted in condition of the patient. Which of the following investigations is not required on emergency evaluation?
a. MRI
b. NCCT
c. CSF examination
d. Liver function tests
Answer (c) CSF examination
References: included in the text
Therefore the following logical conclusion can be:
ALTERED SENSORIUM due to Hepatic encephalopathy secondary to hepatotoxicity of ATT. Hence LFT should be performed.
ALTEREDED SENSORIUM due to Obstructive hydrocephalus could lead to raised ICT leading to pressure on midbrain and resultant status. Therefore a MRI scan can identify the process and necessitate a neurosurgical consult.
(Page 540 of OP GHAI 7th edition) ALTERED SENSORIUM due to end-arteritis resulting in brain infarction and hypo-dense lesions. Tubercular encephalopathy results in diffuse edema of brain simulating post-infective allergic encephalopathy, Necrotizing or hemorrhagic leuko-encephalopathy may occur in TB meningitis.. In choice NCCT is given and it can identify infarction as well cerebral Edema.
The que3stion mentions altered sensorium in the patient and if we see the table in (Fig 376-1 harry boy 17th edition Harrison) on altered sensorium, imaging should be performed. Lumbar puncture now can precipitate the ominous herniation of the brain.
164. What is feature of temporal arteritis
a. Giant cell arteritis
b. Granulomatous vasculitis
c. Necrotizing vasculitis
d. Leucocytoclasticvasculitis
Answer (a) Giant cell arteritis
Reference: Harrison: 18th edition/ chapter 326
165. A patient withHepatits C, exhibits hypo-complimentemia, 2g/day proteinuria andhematuria is present. The most probable diagnosis is: REPEAT
a. M.P.G.N.
b. Cryo-globulinemia
c. Membranous Glomerulopathy
d. Post-infectious Glomerulonephritis
Answer (a) M.P.G.N.
Reference: Chapter 326/ Harrison 18th edition/http://emedicine.medscape.com/article/329255-clinical/CMDT 2012 pg 899.
166. All are indicated in a patient increased s. cysteine and multiple renal stones except:
a. Cysteamine or
b. Increase fluid intake
c. Alkalinisation of urine
d. Pencillamine
Answer: (a) Cysteamine or
Reference: CMDT 2012/ page 923/chapter 287 harrison 18th edition
a. Chest x ray
b. MRI
c. CT
d. USG
Answer (a) Chest X ray
Reference: Harrison: 18 th edition/ just above table 233-9/ chapter 233./Emedicine:http://emedicine.medscape.com/article/162245-overview#aw2aab6c12
143. A patient on amphotericin B develops hypokalemia of 2.3meq/l. K+ supplementation requires is?
a. 40meq over 24 hrs
b. 60meq over 24 he's
c. 80 meq over 24 hrs
d. 120-160meq over 24 hrs
Answer (A) 40meq over 24 hrs
Reference: Harrison 18th edition, chapter 46
143. A patient with 12cm abscess in liver which was drained under sonographic monitoring 3 times and On follow up a residual cavity of 4cm was found to be present .An oral lumicidal drug was given for 14 days. Next plan of action shall be:
a. Stool examination serially
b. USG weekly for 1 month followed by monthly USG till 1 year.
c. USG weekly for 1 month followed by CT scan at 3 months.
d. Monthly CT scan
Answer (b) USG weekly for 1 month followed by monthly USG till 1 year.
Reference: Harrison 18 th edition chapter 202
144. Which of the following is Not true aboutpolymyositis ?
a. Limb girdle weakness
b. Ophthalmoplegia
c. Para-neoplastic syndrome
d. Spontaneous discharge in EMG.
Answer (B) Ophthalmoplegia
Reference: Harrison 18th chapter 383
145. 35 year old female with recurrent renal stone. not advised is:
a. Increase water
b. Restrict protein
c. Restrict salt
d. Ophthalmoplegia
Answer (D) Ophthalmoplegia
Reference: Harrison 18th edition/ chapter 281/page 1817/ Reference: www. Uptodate.com/contents/prevention of recurrent calcium stones in adults, Campbell’s urology chapter 43
146. A 28 yr old man has lenticonus and ESRD now. His maternal uncle also died of similar illness. Diagnosis is
a. ARPKD
b. ADPKD
c. Oxalosis
d. Alport's syndrome
Answer: (D) Alport’s syndrome
Reference: Harrison 18th Chapter 357
147. Pinna calcification Except
a. Gout
b. Onchrnosis
c. Frost bite
d. Addisons disease
Answer (a) Gout
Reference :Chapter 54. Skin Manifestations of Internal Disease, Harrison 18th (www.nejm.org/doi/full/10.1056/NEJMicm1000193)
148. Which of the following doesnot need treatment?
a. Neuroblastoma
b. Burkitts
c. t cell lymphoblastic leukemia
d. Not Recalled
Answer is A
Reference: Nelson 18th text book of pediatrics/chapter 498
149. With ageing, a slight decrease in cognitive impairment is seen due to increase in level of
a. Homocysteine
b. Taurine
c. Methionine
d. Cysteine
Answer (a) Homocysteine
Reference: CMDT 2012 / page 1620
150. A Patient presents with pain in Meta-Tarso-Phalangeal joints and is a known case of Chronic Renal Failure. This is due to accumulation of-
a. Rh factor
b. Uric acid
c. Serum urea
d. HLA B27 typing
Answer (b) Uric Acid
Reference: Harrison 18th edition/table 280.4/ chapter280 and http://www.ncbi.nlm.nih.gov/pubmed/21321568
151. SARS causative agent
a. Corona-virus
b. Picorna-virus
c. Myxovirus
d. Recalled
Answer: (a) Corona-virus
Reference :Harrison 18th edition-chapter 179
152. Blink reflex is used for?
a. Mid pontine lesions
b. Neuromuscular transmission
c. Axonal neuropathy
d. Motor neuron disease
Answer (a) Mid pontine lesions
Reference: http://www.ncbi.nlm.nih.gov/pubmed/17727783/ Clinical value of blink reflex
153. Grisel syndrome all are true except:
a. Post-adeniodectomy
b. Conservation treatment
c. Inflammation of cervical spine ligaments
d. No need for neurosurgeon
Answer (d) No need for neurosurgeon
Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2639892/
154. Cervical syringomyelia all are seen except
a. Burning sensation in hands
b. Hypertrophy of abductor pollicisbrevis
c. Plantar extensor
d. Absent biceps reflex.
Answer: (b) Hypertrophy of abductor pollicisbrevis
Reference: Harrison textbook of medicine 18 th edition chapter 377/ above figure 377-7http://emedicine.medscape.com/article/1151685-clinical
155. 70year female is on treatment with Alendronate for severe osteoporosis.Now she complains of pain in right thigh. What is the next investigation to be performed?
a. DEXA scan
b. x ray
c. Serum vitamin D levels
d. Serum alkaline phosphate levels
Answer (b) X-ray
Reference: CMDT 2012/page 1118
156. A 70 year old retired Military person with good previous medical record complains of bi-temporal headache which is decreased in lying down position. He states that he gets relief by giving pressure over bilateral temples. The patient also complains of loss of appetite with feeling feverish.
a. Chronic tension headache
b. Temporal arteritis
c. Migraine
d. Fibromyalgia
Answer (b) Temporal arteritis
Reference: CMDT 2011 page 819 and http://emedicine.medscape.com/article/809492-clinical#a0216
157. A patient of rheumatoid arthritis develops sudden onset Quadriparesis, , increased muscle tone of limbs with exaggerated tendon jerks and worseningof gait. The investigation to be done:
a. Flexion and extension Cervical area X ray of neck
b. MRI brain
c. EMG and NCV
d. Carotid angiography
Answer( a) Flexion and extension Cervical area X ray of neck
Reference:Harrison chapter 15/18 th edition
159. Type 1 renal tubular acidosis all are trueExcept?
a. Renal stones
b. Hypokalemia
c. > 4mg/ day Sodium bicarbonate
d. Urine pH > 5.
Answer (c) > 4mg/ day Sodium bicarbonate
Reference: Harrison 18th edition 284/ CMDT 2011 page 862
160. A diabetes mellitus patient with fungal infection of sinuses and peri-orbital region with significant visual impairment:
a. Amphotericin B
b. Itraconazole
c. Ketoconazole
d. Broad spectrum antibiotics
Answer: Amphotericin B
Reference: Harrison 18th Edition/ Chapter 205
161. Gait apraxia?
a. ACA
b. MCA
c. PCA
d. Posterior choroidal artery
Answer: (a) Amphotericin B
Reference: chapter 24 Harrison18th : Gait and balance disorders
162. Prions, which of following is correct
a. Long incubation period
b. Destroyed by autoclaving at 121C
c. Nucleic acid present
d. Immunogenic
Answer (a) Long incubation period
Reference: The following lines are excerpt from Harrison 18th chapter 383:
163. A patient with Tubercular meningitis was taking ATT regularly. At end of 1 month of regular intake of drugs deterioration in sensorium is noted in condition of the patient. Which of the following investigations is not required on emergency evaluation?
a. MRI
b. NCCT
c. CSF examination
d. Liver function tests
Answer (c) CSF examination
References: included in the text
Therefore the following logical conclusion can be:
ALTERED SENSORIUM due to Hepatic encephalopathy secondary to hepatotoxicity of ATT. Hence LFT should be performed.
ALTEREDED SENSORIUM due to Obstructive hydrocephalus could lead to raised ICT leading to pressure on midbrain and resultant status. Therefore a MRI scan can identify the process and necessitate a neurosurgical consult.
(Page 540 of OP GHAI 7th edition) ALTERED SENSORIUM due to end-arteritis resulting in brain infarction and hypo-dense lesions. Tubercular encephalopathy results in diffuse edema of brain simulating post-infective allergic encephalopathy, Necrotizing or hemorrhagic leuko-encephalopathy may occur in TB meningitis.. In choice NCCT is given and it can identify infarction as well cerebral Edema.
The que3stion mentions altered sensorium in the patient and if we see the table in (Fig 376-1 harry boy 17th edition Harrison) on altered sensorium, imaging should be performed. Lumbar puncture now can precipitate the ominous herniation of the brain.
164. What is feature of temporal arteritis
a. Giant cell arteritis
b. Granulomatous vasculitis
c. Necrotizing vasculitis
d. Leucocytoclasticvasculitis
Answer (a) Giant cell arteritis
Reference: Harrison: 18th edition/ chapter 326
165. A patient withHepatits C, exhibits hypo-complimentemia, 2g/day proteinuria andhematuria is present. The most probable diagnosis is: REPEAT
a. M.P.G.N.
b. Cryo-globulinemia
c. Membranous Glomerulopathy
d. Post-infectious Glomerulonephritis
Answer (a) M.P.G.N.
Reference: Chapter 326/ Harrison 18th edition/http://emedicine.medscape.com/article/329255-clinical/CMDT 2012 pg 899.
166. All are indicated in a patient increased s. cysteine and multiple renal stones except:
a. Cysteamine or
b. Increase fluid intake
c. Alkalinisation of urine
d. Pencillamine
Answer: (a) Cysteamine or
Reference: CMDT 2012/ page 923/chapter 287 harrison 18th edition
