Tl IE KNOWLEDGE 11 B

NRE Mock Exam 2

Doctor's coaching acadmey

Dr Zia
 Doctor's coaching acadmey

Medicine and allied

1. A 60yo man presents with dysphagia and pain on swallowing both solids and liquids. A barium meal
shows gross dilatation of the esophagus with a smooth narrowing at the lower end of the esophagus
with high pressure on manometry What is the SINGLE most likely cause of dysphagia?

a. Achalas.

b. Myasthenia gravis

c. Esophageal carcinoma

d. Esophageal web

2. A pregnant lady came with pain in her calf muscle with local rise in temp to the antenatal clinic. What
tx should be started?

a. Aspirin

b. LMWH c.

Paracetamol

d. Cocodamol

e. Aspirin and heparin

3. A 53yo female presents with an acute painful hot knee joint. She is a known case of RA. On
examination, the knee is red, tender and swollen. The hamstring muscles are in spasm. Her temp is
38.5C and BP is 120/80mmHg. What is the SINGLE best next inv?

a. Joint aspiration for cytology and culture and sensitivity

b. Joint aspiration for positive birefrengent crystals

c. Joint aspiration for negative birefrengent crystals

d. Blood culture

4. A pt with an acute pain in the big toe came to the ED,he has positive history for monosodium urate
crystals, What drug should be given to relieve symptoms?

a. NSAIDs

b. Allopurinol

c. Ibuprofen

d.methotrexate

5. A 45yo man keeps having intrusive thoughts about having dirt under the bed. He can’t keep himself
from thinking about these thoughts. If he tries to resist, he starts having palpitations. What is the most
likely dx? a. OC personality b. OCD c. Schizophrenia d. Panic disorder e. Phobia

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6. A 74yo man who has been a smoker since he was 20 has recently been dx with SCLC. What serum
electrolyte picture will confirm the presence of SIADH? a. High serum Na, low serum osmolarity, high
urine osmolarity b. Low serum Na, low serum osmolarity, high urine osmolarity c. Low serum Na, high
serum osmolarity, high urine osmolarity d. High serum Na, low serum osmolarity, low urine osmolarity
e. High serum Na, high serum osmolarity, low urine osmolarity

7. A man brought into the ED after being stabbed in the chest. Chest is bilaterally clear with muffled
heart sounds. BP is 60/nil. Pulse is 120bpm. JVP raised. What is the most likely dx? a. Pulmonary
embolism b. Cardiac tamponade c. Pericardial effusion d. Hemothorax e. Pneumothorax

8. A 75yo man collapsed while walking in his garden. He recovered fully within 30 mins with BP 110/80
mmHg and regular pulse of 70bpm. He has a systolic murmur on examination. His activities have been
reduced lately which he attributes to old age. What is the definitive diagnostic inv that will assist you
with his condition?

a. ECG

b. Echo

c. 24h ECG monitoring

9. A woman has electric pains in her face that start with the jaw and move upwards. Her corneal reflexes
are normal. What is the most likely dx?

a. Atypical face pain b. Trigeminal neuralgia c. Tempero-mandibular joint dysfunction d. Herpes zoster

10.a patient presented with progressive jaundice ,wight loss ,polyuria ,polydipsia and bronze
discoloration of skin,his ferritin is high and TIBC is low,BSR 250 most likely diagnoses will be?

a.wilsen disease

b.hemochromatosis

c.alpha 1 antitrypsin deficiency

b.primary biliary cirrhosis

11. In CRF, main cause of Vit D deficiency and secondary hyperparathyroidisem is the failure of

a. Vit D absorption in intestines

b. 25 alpha hydroxylation of Vit D c. Excess Vit D loss in urine d. 1 alpha hydroxylation of Vit D

12. A 35yo man presents with progressive breathlessness. He gave a hx of polyarthralgia with painful
lesions on the shin. CXR: bilateral hilar lymphadenopathy. What’s the most likely dx? a. Bronchial
asthma b. Cystic fibrosis c. Sarcoidosis d. Bronchiectasis e. Pneumonia

13. A 24yo college student presents with nausea, vomiting, headache, neck stiffness and a fever of
38.4C. What is the most appropriate empirical antibiotic to be started? a. Ceftriaxone b. Penicillin c.
Gentamicin d. Tazobactam e. Meropenem

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14. A 56yo lady has developed severe right sided headache which worsens whenever she comes to
bright light since the last 4 days. She feels nauseated, but doesn’t vomit. What is the most likely dx? a.
SAH b. Brain tumor c. Migraine d. Cluster headache e. Subdural headache

15. An 8yo child who is tall for his age and has a refractory error for which he wears glasses has
presented with severe crushing chest pain. What is the most likely dx? a. Fragile X syndrome b. Prader-
willi syndrome c. DiGeorge syndrome d. Marfans syndrome

16. A 60yo diabetic complains of pain in thigh and gluteal region on walking up the stairs for the last 6
months. She is a heavy smoker and has ischemic heart disease. What is the most appropriate dx? a.
Thromboangitis Obliterans b. Sciatica c. DVT d. Atherosclerosis e. Embolus

17. A 47 yo ex-soldier suffers from low mood and anxiety. He can’t forget the images he faces before
and has always had flashbacks. He is not able to watch the news because there are usually some reports
about war. What is he suffering from? a. Depression b. PTSD c. Panic attack d. Agoraphobia e. GAD

18. A 28 yo drug user presents to the ED with collapse and anuria. His serum K+ = 7.5mmol/L. CXR =
early pulmonary edema,tall T wav4es on ECG. What is the next appropriate management? a. Urgent
hemodialysis b. IV calcium gluconate c. IV insulin + dextrose

19. A lady comes in severe liver disease and hematemesis. Her INR is >10. What should she be given? a.
FFP b. Steroids c. Whole blood d. IV fluids e. Vit K

20. A 56yo woman is known case of pernicious anemia. She refuses to take hydroxycobalamin IM as she
is needle shy. She asks for oral medication. Why will oral meds be not effective? a. Intrinsic factor def b.
Malabsorption c. Irritated gastric mucosa d. Lack of gastric acidity

21. A 57yo man presents with weight loss, tiredness, fever and abdominal discomfort. Exam: spleen
palpable up to the umbilicus. Labs: WBC=127, Hgb=8.7, Plt=138,Philadelphia chromosome positive.
What is the most likely dx? a. CML b. AML c. CLL d. AML e. Polycythemia

22. A 60yo woman was found by her son. She was confused and had urinary incontinence. She has
recovered fully after 6h with no neurological complaints. What is the most likely dx? a. Stroke b.
Vestibular insufficiency c. TIA d. Intracranial hemorrhage

23. A 65yo woman presents with headache. She also complains of dizziness and tinnitus. He has recently
realized she has visual problems. There is hx of burning sensation in fingers and toes. On exam:
splenomegaly, itchy after hot bath. Labs: RBC=87, Hgb=31.9, Plt=796. What is the dx? a. CML b. CLL c.
Polycythemia vera d. Myelofibrosis e. NHL

24. . A young girl presenting with fever, headache, vomiting, neck stiffness and photophobia. She has no
rashes. What is the most appropriate test to confirm dx? a. Blood culture b. Blood glucose c. LP d. CT

25. A 60yo pt who has had a MI a week back presents with dyspnea and pericardial rub. ECG shows ST
elevation. CXR: loss of margin at costo-vertebral angle. What is the single most likely cause? a. Cardiac
tamponade b. Mitral regurge c. Dressler’s syndrome d. Atrial fib e. Emboli

26, A 7yo child presented with chronic cough and is also found to be jaundiced on examination. What is
the most likely dx? a. Congenital diaphragmatic hernia b. Congenital cystic adenematoid malformation c.
Bronchiolitis d. RDS e. Alpha 1 antitrypsin deficiency.

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28. ECG of an 80yo pt of ICH shows saw-tooth like waves, QRS complex of 80ms duration, ventricular
rate=150/min and regular R-R interval. What is the most porbable dx? a. Atrial fib b. Atrial flutter c. SVT
d. Mobitz type1 second degree heart block e. Sinus tachycardia

29. A 45yo man who is diabetic and HTN but poorly compliant has chronic SOB, develops severe SOB and
chest pain. Pain is sharp, increased by breathing and relieved by sitting forward. What is the single most
appropriate dx? a. MI b. Pericarditis c. Lung cancer d. Good pastures syndrome e. Progressive massive
fibrosis

30. A 40yo woman suddenly collapsed and died. At the post-mortem autopsy, it was found that there a
bleed from a berry aneurysm from the circle of Willis. In which space did the bleeding occur? a.
Subarachnoid b. Subdural c. Extradural d. Subparietal e. Brain ventricles

31. A 46yo man is being investigated for indigestion. Jejunal biopsy shows deposition of macrophages
containing PAS (Periodic acid-schiff) +ve granules. What is the most likely dx? a. Bacterial overgrowth b.
Celiac disease c. Tropical sprue d. Whipple’s disease e. Small bowel lymphoma

32. A child complains of bloody diarrhea and pain for two weeks duration. On colonoscopy , submucosal
broad base ulcers are seen . What should be the management? a. Sulfasalazine b. paracetamol c.
Ibuprofen d. Metronidazole

33. A 55yo man has weight loss, dyspnea and syncope. He smokes 20 cigarettes/day. Inv confirms
squamous cell carcinoma in the left bronchus. What is the single most likely biochemical abnormality to
be a/w the condition? a. Hypercalcemia b. Hyperkalemia c. Hypoernatremia d. Hypocalcemia e.
Hypomagnesium

34. A 36yo pt came with diarrhea, bleeding, weight loss and fistula. What is the single most likely dx? a.
Celiac disease b. Crohns disease c. UC d. IBS

35.A 10yo boy presents with generalized swelling. This has been present for 4days and included swollen
ankles and puffiness of the face. It started a few days after he had a mild cold with runny nose. His only
Past medical history was eczema. Urine analysis: hematuria, proteinuria 10g/24h, creat 60umol/l and
albumin=15g/l,bipsy shows deposition of igA in mesengium with granular pattres. What is the single
most likely dx? a. IgA nephropathy b. HSP c. Minimal change nephropathy d. Wilson’s disease e. Cardiac
failure

36. A 23 year old man has been using intravenous drugs. You explain to him the dangers of this,
including the risk of contracting a blood borne virus such as Hepatitis B. Which of the following
laboratory tests will first become abnormal after acquiring hepatitis B infection? A. Bilirubin B. Hepatitis
B surface antigen C. Hepatitis B core IgM antibody D. Alanine aminotransferase (ALT) E. Anti-hepatitis B
e antibody

37. A 30 year old homeless lady has cough, sputum and a fever for the past few months. She complains
of night sweats and has lost 13 kg in the past 6 months. A chest X-ray was performed which showed
apical involvement with infiltrates and cavitation in the upper lobe of the right lung. What is the next
SINGLE most appropriate test to perform? A. Acid-Fast Bacilli smear B. Mantoux test C. Interferon
Gamma test D. Bronchoscopy E. Computed tomography

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38. A 45 year old chronic smoker attends the outpatient department with complaints of persistent
cough and copious amount of purulent sputum. He had history of measles in the past. On examination,
finger clubbing is noted and inspiratory crepitations on auscultation is heard. A chest X-ray shows tram
track opacies. What is the SINGLE most likely diagnosis? A. Interstitial lung disease B. Bronchiectasis C.
Asthma D. COPD E. Sarcoidosis

39.40 year old retired shipyard worker presented with weight loss,sob and vague chest pain,on xray of
chest there is pleural plaques,you are suspecting mesothelioma,which of the following occupational
exposure is link with this malignancy?

a.sarcoidoses

b.asbestoses

c.silicoses

d.pnumoconioses

39.A 13 year old child presents to you with history of bloody diarrhoea and decreased urination. The
mother states that the child developed fever, vomiting, abdominal pain, and diarrhoea that started 5
days ago. On physical examination, the patient appears ill. He is pale and lethargic. Laboratory results
show: Haemoglobin 9gm/dl Platelets 80000 There was fragmented red cells on blood film,Deranged
Rfts. What is the SINGLE most likely diagnosis? A. Ulcerative colitis B. Haemolytic uraemic syndrome C.
Thrombotic thrombocytopenic purpura (TTP) D. Hepatorenal syndrome

40.60 year old presented for evaluation of fatigue and weakness,on examination paller positive,labs hb
10gm/dl,lymphocytosis 5000/mm3,smear show smudge cells,the findings are suggestive of?

a.CLL
b.CML

C.ALL

D.AML

40.a known epileptic patient who has missed his dose quiet a few times is now presented with
generalized tonic clonic fits and LOC for more than 5 mins and he didn’t regains consciousness in
between the attack,in ER the doctor gaved him i/v larazepam, what is you diagnoses?

a.grand mal seizures

b.petit mal seizures

c.status epilpticus

d.jacksonian seizures

42.a 70 years old having problem in recalling thnings,recently having difficulty in daily activites as he
often forget his home address and names of family members,there is no problem in gait,no hallucination
and now history of any stroke in the past,you have started him on choline esterase inhibitors
rivastegmine and he improved what will be you diagnose?

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]a.picks disease

b.alzheimers disease

c.vascular demetia

d.lewy body dementia

43. A 58 year old man with a history of type 1 diabetes mellitus and hypertension for 13 years develops
sudden central chest pain and abdominal pain for 45 minutes. The pain radiates to his jaw. It started
while he was driving and it was associated with cold sweating and dyspnoea. He describes the pain as a
dull pain. What is the SINGLE most likely diagnosis?

A. Myocardial infarction B. Pericarditis C. Pulmonary embolism D. Costochondritis E. Pneumothorax

44.a known case of heart failure having complains of orhthopnia,cough with frothy sputum and
shortness of breath o/E patient is having bilateral fine crepths,decrease air entry and a stony dull
percussin,cxr shows bilateral pleural effusion.which criteria is used to differentiate between exudative
and transudative pleural effusion?

a.weils criteria

b.lights criteria

c.ransons criteria

d.apache criteria

45.a patient presented with complains of epigastric pain which is more after meal and relives when he
skip meals these findings are mostly suggestive of ?

a.duodenal ulcer

b.gastric ulcer

c.mesenteric ischemia

d.pancreatitis

46.55 year old presented to opd for evaluation of backache that has starting recently,he also complains
of weakness ,easy fatigueabilty and undocumented wight loss labs.serum calcium 14mg(N 8 to10)

Hb 8 gm/dl ,serum protein electrophoresis shows m spikes and urine positive for bens jones protiens

Diagnoses of multiple myeloma is made,this malignancy involves which type of cells?

a.plasma cells of bone marrow

b.plasma cells of lungs

c.plasma cells of lymphnodes

d.b lymphocytes

47.young girl with recurrent infections,episodes of epistaxis,and easy fatigeabilty,

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Bloodcp.hb 08gm/dl

Platelets 34000

Wbc of 2000 ,

You are suspected aplastic anemia which of the following findings will be seen of bonemarrow biopsy?

a.hypercellular bonemarrow

b.hypocellular bone marrow/drytap

c.blast cells

d.fibroses

48.which among the following is not a myeloproliferative disorder?

a.CML

b.Myelofibroses

c.Polycythemia

d.myelodysplastic syndrome

49.a patient on 5th day post MI is having pansystolic murmur radiating to axillary,echo shows rupture of
pappilary muscles , most vulnarble time for rupture is?

a.1-3 days

b.3-7 days

c.7 -14 days

d.24 hrs after MI

50.a known case of IBDS is presentd with painful red nodular swelling on shin of tibia,most likely
diagnoses will be?

a.erythema multiforme

b.cellulitis

c.erythema nodosum

d.dermatitis

51.patient having history of herpes simplex infection is now presented with skin lesion having targetoid
appearance,dx?

a.erythema multiforme

b.steven jhonsen syndrome

c.eczema

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d.urticaria

52.a known alcoholic presented with rash over extenser surface of elbow and neck,his aunt was having
the same problem few years ago,o/e there is pink salmon colred rash with silver scales and bleed after
minor scratch these findings are suggestive of?

a.psoriases

b.scaleded skin syndrome

c.erysipelas

d.eczema

53.a child with honey/golden color cursting and fever these findings are suggestive of?

a.impetigo

b.folliculitis

c.erysipelas

d.scalded skin syndrome

PEDIATRICS

54.A 6m child presents with fever and cough. His mother has rushed him to the ED asking for help.
Exam: temp=39C and the child is feeding poorly. Dx? a. Bronchiolitis b. Asthma c. Bronchitis

55. A 6wk child is brought in with vomiting, constipation and decreased serum K+. What is the dx? a.
Pyloric stenosis b. Duodenal atresia c. Hirschsprung disease d. Achalasia cardia e. Tracheo-esophageal
fistula

56.a child start to crawal ,develops stranger fear ,can hold objects,imitates bye bye,say mama he is at
which age according the developmental miles stone?

a.6M

b.7M

c.14M

d.9M

57.which of the following vacciene should be given at the age of 6th ,10th,14th week.?

a.penta

c.BCG

d.MMR
c.measels

58 a child is born with cyanotic heart disease which of the following is the most common cyanotic heart
disease of new born?

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a.TOGV

b.TOF

c.TRUNCUS ARTRIEOSES

D.PDA

59.A 8 month old child is presented to OPD for evaluation of stunted growth,on examination the child is
having round moon face,apathic look,skin rash and abdominal distention these findings are suggestive
of?

a.marasmus

b.kwashiorkor

c.marasmic kwashiorkor

d.hypothyroidisem

60.Following an emergency caesarean section for fetal distress, a baby is in poor condition. His heart
rate is 90 beats/minute. He is blue at extremities but his body is pink. He has some limb flexion and
muscle tone. He is gasping for air irregularly and grimaces on aggressive stimulation. What Apgar score
does this newborn infant have? A. 8 B. 7 C. 6 D. 5 E. 4

61.A 5 week old male infant presents to clinic with jaundice during routine check-up. His mother reports
a normal vaginal delivery at term with a birth weight of 3.5 kg. On examination, the baby is irritable,
below average centiles for weight, and the liver is enlarged. Pale stools and dark urine on diaper were
observed. The mother is currently not breastfeeding and had picked him on formula. What is the SINGLE
most likely diagnosis? A. Galactosemia B. Glucose-6-phosphate dehydrogenase (G6PD) deficiency C. Rh
incompatibility D. Congenital viral infection E. Biliary atresia

62. A young anxious mother of a 1 year old boy comes to you requesting a test for cystic fibrosis as her
brother died from cystic fibrosis. What is the SINGLE most appropriate investigation? A. Sweat test B.
Heel prick test C. Breath test D. Chest X-ray E. Genetic testing of parents

63. A 12 year old boy presents with severe watery diarrhoea for the past 7 days. His urine output is low,
mucous membranes are dry, and skin turgor is decreased. What is the SINGLE most appropriate initial
management? A. Antibiotic B. Antimotily C. Antiemetic D. Fluid replacement E. Reassurance

64.9 month old child is presented with progressive jaundice,weakness ,his mother states that he was
normal till 6m of age,o/e spleen and liver are palpable lab.microcytic hypochromic anemia with hb
6gm/dl ,there is increase in HBA2 and HBF and significant decrease in HBA1, what is your diagnoses?

a.alpha thalassemia

b.beta thalaseemia minor

c.beta thalaseemia major

d.sickle cell anemia

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65. infant is presented to your clinic for evaluation of puffy face,distended abdomen,constipation,o/e
face is dull ,with protruded tongue these findings are suggestive of?

a.creatinisem

b.kwashiorkor

c.botulisem

d.nephrotic syndrome

66.a child is presented with high grade fever ,toxic look continuous cough followed by inspiratory whoop
and post cough vomiting ,most likely organisem will be?

a.corynebecterium diptheriae

b.hemophilus influenza

c.bordetella pertussis

d.respiratory syncytial virus

67.a new born is presented with jaundice ,dark urine and clay colored stool along with itching his
unconjugated bilirubin is raised and there is risk of kernicterus what will be the best treatment option?

a.phenoborbitol

b.phototherapy

c.blood transfusion

d.venesection

68..a child having history of pharyngitis is now presented with migratory joint pain ,lumps and bumps
under the skin and a rash with clear centre and redness on margins,labs.increase ASO TITRE,what will be
the preferred antibiotcs in rheumatic fever?

a.benzyl penicillin

b.erythromycin

c.ceftriaxone

d.gentamicin

surgery and allied

69. -33 year old female presented with foul smelling greenish discharge from nippleDx
a.Ductal papilloma
b.breast abscess
c.ductal ectasia
d.mastits

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70. 25 years old presented with painless mobile lump in the left breastBiopsy shows round lump with
clear margins and separated from fats
Dx
a.fat necrosis
b.breast carcinoma
c.fibroadenoma
72-patient presented with swelling in the neck which moves on swollowing USG shows sold lump
What is next step
a.FNAC
b.thyroid scan
c.core biopsy
d.MRI
73. A 55yo man has had severe pain in the right hypochondrium for 24h. The pain comes in wavesand is
accompanied by nausea. Nothing seems to relieve the pain. He feels hot and sweaty buthas normal
temp. What is the most appropriate next inv?

a. US Abdomen

b. ERCP

c. MRCP

d. Serum amylase

e. UGI endoscopy

74. A 49 yo pt presents with right hypochondriac pain. Inv show a big gallstone. What is the
mostappropriate management?

a. Lap Cholecystectomy

b. Reassure

c. Low fat diet

d. Ursodeoxycholic acid

e. Emergency laparotomy

75.A 34yo pt presents with 50% partial thickness burns. What should be the most appropriate
management?

a. IV fluids calculated from the time of hospital arrival

b. IV fluids calculated from the time of burn

c. No IVF d. IV dextrose stat

e. Burns ointment

76.A 64yo man has been waking up in the middle of the night to go to the bathroom. He also had
difficulty in initiating micturition and complains of dribbling. A dx of BPH was made after a transrectal US

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guided biopsy and the pt was prepared for a TURP. What electrolyte abnormality is highly likely due to
this surgery?

a. Hypokalemia

b. Hypocalcemia

c. Hyperkalemia

d. Hyponatremia

e. Hypernatremia

77.A young man is brought to the ED after a RTA. His GCS on initial evaluation is 6. What ist he most
appropriate next step?

a. CT

b. MRI

c. IV fluids

d. Secure airway

78.A woman 5 days post-op for bilateral salphingo-oopherectomy and abdominal hysterectomy has
developed abdominal pain and vomiting a/w abdominal distension and can’t pass gas. No bowel sounds
heard, although well hydrated. What is the most appropriate next step?

a. XR abdomen

b. Exploratory laparoscopy

c. CT

d. USG

79.A 47 yo man met with a RTA. He has multiple injuries. Pelvic fx is confirmed. He has not passed urine
in the last 4 hrs. What is the next appropriate management for this pt? a. Urethral catheter b.
Suprapubic catheter c. IV fluids d. IV furosemide

80. A 49 yo pt presents with right hypochondriac pain. Inv show a big gallstone. What is the most
appropriate management? a. Lap Cholecystectomy b. Reassure c. Low fat diet d. Ursodeoxycholic acid

81.A 67yo female who had undergone a radical mastectomy now comes with the complaint of swelling
and redness in her right upper limb. Involvement of which of the following structures explain these
symptoms? a. Epitrochlear LN b. Cephalic vein c. Subclavian artery d. Axillary group of LN

82.. A 34yo man after a car crash is in the ED and deteriorating. His GCS has fallen from 13 to 7.
What is the most appropriate next step? a. CT b. Burr hole c. MRI d. Intubation e. IV fluids

83.A 22yo sexually active male came with 2d hx of fever with pain in scrotal area. Exam: scrotal skin
is red and tender. What is the most appropriate dx? a. Torsion of testis b. Orchitis c. Inguinal hernia
d. Epididymo-orchitis

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84.. A 45yo woman presents with discharge from the left nipple. The discharge is brownish-
green and foul smelling. What is the most likely dx? a. Duct papilloma b. Intra-ductal papilloma
c. Duct ectasia d. Mammary duct fistula e. Breast abscess

85.A 33 year old man is brought into the emergency department following a road traffic accident.
He is seen to be very short of breath. He has no breath sounds over the right side of his chest. On
percussion, the right chest is noted to be hyper-resonant. On examination, his trachea is deviated to
the left. His heart rate is 120 beats/minute. His blood pressure is 90/65 mmHg, and has an oxygen
saturation of 85% on 15 L of oxygen. What is the SINGLE most appropriate course of action? A.
Arterial blood gas B. Urgent chest X-ray C. Needle decompression D. Insertion of a chest drain

86.A 32 year old man presents with painless haematuria and flank pain. His blood pressure is 155/98
mmHg. The rest of the physical examination was otherwise unremarkable. What is the SINGLE most
likely diagnosis? A. Bladder cancer B. Adult polycystic kidney disease C. Thrombotic thrombocytopenic
purpura (ITP) D. Prostate cancer E. Haemolytic uraemic syndrome (HUS)

87.Which of the following tumor is most radiosensitive?

(a) Breast carcinoma

(b) Prostate carcinoma

(c ) Colorectal adenocarcinoma

(d) Seminoma

88.a child presentd with pain RIF and raised tLC ,there is history of sore throat few days ago,diagnoses?

a.appendicits

b.meckle diverticulitis

c.mesenteric ischemia

d.mesenteric adenitis

89.estimated blood loss in pelvic fracture will be?

a.2L

b.1.5L

c.1L

d.750ml

90.which of the following is best investigation to diagnose hemhorroids?

a.proctoscopy

b.coloscopy

c.barium enema

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d.usg

91.meckles diverticulum is remanent of

a.stensen duct

b.wolffian duct

c.mullarian duct

d.vitelline duct

92.a marker to diagnose pancreatic cancer/

a.ca 125

b.cea

c.LDH

d.CA 19-9

93.investigation of choice to diagnose strictures of urethra is?

a.urine culture

b.xray KUB

c.urethrogram

d.cystoscopy

94.which of the following is treatment of choice for inguinal hernia?

a.hernioplasty

b.herniorrhapy

c.herniotomy

d.lockwood procedure

95.after an RTA patient presented with massive bleed his blood group is unknown which blood can be
transfused in emergency?

a.o negative

b.o positive

c.ab positive

d.whole blood

96.best treatment option for grade 2 hemhooids?

a.banding

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b.sclerotherapy

c.conservative

d.hemorrhoidectomy

97.best for removal of stones from common bile duct is?

a.usg

b.mrcp

c.ercp

d.laprotomy

98.anatomical landmark to trace appendix during appendectomy is ?

a.tenia coli

b.mesentries

c.greater omentum

d.lesser sac

99.a patient with appendicitis is now having sweeling and lump in right iliac fossa what will be the next
management plan?

a.open appendectomy

b.laproscopic appendectomy

c.laprotomy

d.conservative management

100.which of the following are indication of cholecystectomy?

A.family history of gall bladder CA.

b.porcelin gall bladder

c.gall stones

d.all of the above

101.which of the following thyroid malignancy invade s blood vessesl and capsule?

a.pappillary ca

b.anaplastic ca

c.follicular CA

d.medullary CA

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102.a diabetic patient present with acute swellen tender painful leg,on examination there is sweeling
redness tenderness and wound have irregular margins,diagnoses?

a.cellulitis

b.DVT

c.varicose ulcer

d.lymphedema

103.which type of gangrene is commonly seen in diabetic foot?

a.wet gangrene

b.dry gangrene

c.gas gangrene

d.mix

104. the most common organisem responsible for wound infecton in surgical wards.

a.streptococcus

b.staphylococcus

c.klebsiella

d.pseudomonus

105.which type of shock is associated with sever burn?

a.cardiogenic shock

b.anaphylactic shock

c.septic shock

d.hypovoumic shock

106.a patient having weight 60 kb and height 170cm,calculate his BMI?

a.30

b.24

c.28.2

d.20.9

107.what is the ideal time for giving prophylactic antibiotcs before surgery?

a.1hr

b.2hr

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c.4hr

d.3hrs

108.choice of antibiotics in a patient planned for abdominal surgery would be?

a.penicillin

b.cephalosporins

c.cephalosporins plus metrondizole

d.gentamicin plus metrondizole

109.most common site for varicosity of legs are?

a.medial aspect

b.lateral aspect

c.anterior aspect

d.dorsal aspect

110.scoring method to assess mortality risk in acute pancreatitis ?

a.ransens criteria

b.crp criteria

c.weils criteria

d.apache 2 criteria

111. a patient who was presentd with appendicitis is now having geralized abdominal pain ,high grade
fever absent bowel sound ,guarding and rigidity what is the next step?

a.conservative management

b.appendictomy

c.laprotomy

d.oschner sherrin regiem

112.a patient presented with abd pain ,constipation ,vominting and abdominal distention since 02
days,loud bowel sound are audible,what is next step?

a.usg abd

b.xray abdomen

c.ct abd

d.laprotomy

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113.after a trauma which of the following can lead to death immediately?

a.hemhhorage

b.head injury

c.airway obstruction

d.flial chest

114.a mother is concerned because her 1m boy has a swelling in scrotum,he was born
prematurely,sweeling is transilluminable.diagnoses/

a.seminoma

b.hydrocele

c.spermatocele

d.orchitis

115.25 year old has a single testis,on investigation the other testis is in abdomen what is the best
management option?

a.orchidectomy

b.orchidopexy

c.reassuarce

d.iv testosterone

116.33 year old lady having history of mother death from breast ca,what screeing would you
recommend to this lady?

a.mammography yearly

b.usg breast yearly

c.Mri yearly

d.reassurence

117.23 year old presents with a 1cm small smooth firm mobile lump in the breast she is very anxious
what is the most appropriate inv?

a.usg breast

b.mamography

c.FNAC

D.mamography and USG

Gynecology

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118 A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with
sudden onset of epigastric pain associated with nausea and vomiting. Her temp is 36.7C. Exam: she
is found to have RUQ tenderness. Her blood results show mild anemia, low platelets, elevated liver
enzymes and hemolysis. What is the most likely dx?

a. Acute fatty liver of pregnancy b.

b. Acute pyelonephritis
c. c. Cholecystitis
d. d. HELLP syndrome e. Acute hepatitis
119 A 38yo woman has delivered after an induced labor which lasted 26h. choose the single most
likely predisposing factor for postpartum hemorrhage?
a. Atonic uterus
b. Cervical/vaginal trauma
c. Rupture uterus
d. Fibroid uterus e.
120 .A 24yo 18wk pregnant lady presents with pain in her lower abdomen for the last 24h. She
had painless vaginal bleeding. Exam: abdomen is tender, os is closed. What is the most probable
dx? a. Threatened miscarriage
b. Inevitable miscarriage
c. Incomplete miscarriage
d. Missed miscarriage

121.A 27yo presents with abdominal pain, bleeding, vomiting and diarrhea. Her LMP was 7wks ago.
Exam: abdominal tenderness, BP=90/60mmHg. What is the next appropriate management?

a. Immediate laparotomy

b. Laparoscopy

c. Salpingotomy

d. Salpingectomy

122.A 28yo female who delivered 6wks ago feels sad and has no interest in feeding the baby. She
has been eating poorly and having difficulty sleeping. She feels weak throughout the day and has
stopped taking the baby out of the house. She also says that the baby has evil eyes. What is the
most likely dx?

a. Postpartum blues

b. Postpartum depression

c. Postpartum psychosis

d. Schizophrenia

123.A 20yo pregnant 32wks by date presents to the antenatal clinic with hx of painless vaginal
bleeding after intercourse. Exam: P/A – soft and relaxed, uterus=dates, CTG=reactive. Choose
the single most likely dx?
a. Abruption of placenta

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b. Antepartum hemorrhage
c. Placenta previa
d. Placenta percreta
124.A 28yo woman has been admitted at 38wks gestation. Her BP=190/120mmHg and
proteinuria +++. Immediately following admission she has a grand-mal seizure. What is the
single most appropriate initial management?
a. Diazepam IV
b. Fetal CTG
c. Hydralazine IV
d. Magnesium sulphate IV
125. A premenopausal 40 yrs old female presents with amenorrhea, galactorrhea, loss of libido
and infertility. During investigation an adenoma of pituitary is indentified. Which of the
following statements goes with the diagnosis.
(a) Increases ACTH levels
(b) Elevated of serum prolactin
(c ) Decreased TSH
(d) High dose estrogen therapy does not have an effect on this neoplasm
126.In a woman of 40 with a suspected premalignant lesion of cervix , one of the following
investigation would be cheaper, easier nd about 90% reliable for the laboratory diagnosis of the
lesion
a. Fine needle aspiration cytology (F.N.A.C)
b. Cervical biopsy
c. PAP cytology smear
d. Tumor markers
127. a young primigravida is 2 month pregnant LMP was on 10th 15 January 2024,calculate her
Expected date of delivery.?
a.15 oct 2024
b.26sep 2024
c.25 oct 2024
d.10thsept 2024
128.a female is having b hcg positive and scan shows gestational sac in her uterus but she has
irregular cycle how will you asses gestational age in first trimester?
a.crown rump length
b.biparietal diameter
c.femoral length
d.head circumference
129.a couple is seeking adivse on contraception as husband is suffering from HBV,select best
method of contraception?
a.cocps
b.barriers
c.iucds
d.mirena
130.a lady has missed two pills and during this period there is unprotected sexual intercourse in
the first week of ocps,what will you advise her?
a.take missed pill and continue
b.no need to take the missed pills

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c.start new pack

d.take missed pill and use additional contraception.
131.a female is presented with history of DVT,buddchiari syndrome and recurrent
abortions,currently she is on aspirin ,anti cardiolipin antibodies are positive ,diagnoses?
a.asherman syndrome
b.kallman syndrome
c.sheehan syndrome
d.antiphospholipid syndrome
132.maximum dilation of cervix during latent phase of labour?
a,1-3cm
b.5-8cm
c.4-7cm
d.8-10cm
133.. a diabetic lady presented with vaginal itching and discharge ,she describe it as white curdy
discharge most like etiology is ?
a.becterial
b.fungal
c.viral
d.protozoa
134.a female is having recurrent abortion due to cervical incompetence ,what is the best time for
applying macdonalds sutures?
a.14th week
b.18th week
c.15th week
d.5th week

physiology
PHYSIOLOGY

135. The cell which produces surfactant is called:

(a) Type I alveolar
(b) Type II alveolar
(c ) Interstitial cell
(d) Free alveolar macrophage
136.ECG of the patient with electrolyte disturbance shows prolonged PR interval, inverted T wave, and
prominent U wave. He has

(a) High K concentration

(b) Hypercalcemia

(c ) Hypokalemia

(d) Low Plasma calcium.

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137. 40 yr male patient presented with chest pain for 30 minutes , ECG shows ST segment elevation in
lead II, III, aVF, He is suffering from .

(a) Anterior wall MI

(b) Anterolatral wall M

I © Anteroseptal MI

(d) Inferior wall MI

138. A patient shows progressive prolongation of PR interval in successive heart beats followed by a
drop of beat… he s most likely having.

(a) Atrial flutter

(b) Complete AV block

(c ) First degree AV block

(d) Mobitz I block

139. Action of PTH on kidneys is:

(a) Increased Calcium excretion

(b) Reduced calcium absorption by tubules

(c) Inhibitation of phosphate reasbsorption in proximal tubules

(d) Increase in urninary excretion of NH4+ and H+ ions

140 Neurotransmitter that controls prolactin secretion is:

(a) Serotonin

(b) Somatostatin

(c) Acetyl choline

(d) Dopamine

141. Growth hormone secretion would most likely be suppressed under which of the following
conditions?

(a) Acromegaly

(b) Gigantism

(c)deep sleep

(d) Acute hyperglycemia

142.Erythropoetin is secreted from:

(a) Macula densa of kidney

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(b) Liver cell

(c) Peritubular interstitium of Kidney

143 A person who has had a traumatic brain injury seems to be able to understand the written and
spoken word but cannot create the correct sounds to be able to speak a word that is recognizable. This
person most likely has damage to which area of the brain?

(a) Wernicke’s area (

b) Broca’s area

© Angular gyrus

(d) Dentate nucleus

144. Cardiac Muscles cannot be tetanized because: (a) Action potential (b) Gap junction (c) Long
duration of contraction (d) Long refractory period/plateu phase

145 .cold clammy skin,decrease urine output and raised jvp is suggestive of?

a.hypovoumic shock

b.anaphylactic shock

c.cardiogenic shock

d.septic shock.

146.which of the following ion is responsible for repolarization and resting membrane potential?

a.sodium

b.pottasium

c.clacium

d.chloride

147.which of the following is not hormone of anterior pituitary?

a.gonadotrophins

b.TSH

c.GH

d.ADH

148.which of the following cells are responsible to secrete PTH?

a.follicular cells

b.chief cells

c.parafollicular cells

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d.delta cells

pathology

149.The dx cells of Hodgkin disease are:

a. T-cells

b. R-Stenburg cells

c. B-cells d.

Macrophages

150.What is the pathological change in Barret’s esophagitis?

a. Squamous to columnar epithelium

b. Columnar to squamous epithelium

c. Dysplasia

d. Metaplasia

151. A 14 year old boy has pain and swelling at the angles of the jaw bilaterally. He has a temperature of
38.4 C. He has been complaining of dry mouth and sore ears and he finds it difficult to talk. On
examination, his scrotum is also swollen and oedematous and the testes are impalpable. What is the
SINGLE most likely diagnosis?

A. Acute mastoiditis

B. Epididymo-orchitis

C. Acute otitis media

D. Mumps

152. A School going boy with a history of streptococcal pharyngitis subsequently develops chest paint
that is relieved on leaning forward and aggravated by lying down. On auscultation the clinician detects a
murmur. He orders a pericardial tap and sends the specimen to the hospital labortary for analysis. The
fluid shows protein content more than 3.0 gm/dl and specific gravity more than 1.015. the fluid best
described as.

(a) Exudates

(b) Transudate

(c ) Effusion

(d) Serous fluid

153 A 70 yr old female undergoes hip replacement surgery. Two days later she develops tachypnea and
delirium, which progressed to coma. Peripheral blood showed anemia and thrombocytopenia, what is
most likely diagnosis?

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(a) thromboembolisem

(b) Fat embolism

© Myocardial infraction

(d) Deep venous thrombosis

154 labortary worker is aske to sterilize a pair of surgical gowns in an autoclave. What are the
recommendations he should follow for setting the temperature and time?

(a) 121c for 15-20 min

(b) 150 c for 10 min

(c ) 100 c for 30 min

(d) 200 c for 50 min

155. 15year old presented with high grade fever ,headached and neck rigidity,lp was performed which
shows increase polymoprhs(neutrophils),decrease glucose and increased proteins,these findings are
suggestive of?

a.fungal meningitis

b.pyogenic meningitis

c.viral meningitis

d.tubercular meningitis

156. A forty yr old man complains of upper abdominal pain, watery foul smelling diarrhea and flatulence
for the past two weeks. He drank spring water on a camping trip near abbotabad. Trophozoites were
found on examination. Which is the most likely protozoan involved: (a) Cryptosporidium (b) Giardia
lamblia © Entamoeba coli (d) Trichomonas

157. The type of pneumoconiosis most commonly associated with dusts encountered in the mining of
coal; in the grinding and polishing of metals and stone and in sandblasting is: (a) Anthracosis (b) Silicosis
(c ) Asbestosis (d) Berylliosis

158.a 14 year old with primary amenhorrea,short height and streak ovaries on ultrasound and bicuspid
aortic valve will have which of the following karyotyping pattern?

a XX

b XY

c. XXX

d XO

159.a lady has deliverd a baby with features of down syndrome(trisomy 21),what is the single most
important risk factor for such chromosomal abnormality?

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a.advance maternal age

b.early pregnancy

c. maternal weight less than 50 kg

d.advance paternal age

160.which of the following is responsible for quartan fever?

a.plasmodium malariae

b.plasmodium falciparum

c.plasmodium vivax

d.plasmodium ovale

161..black water fever/cerebral malria/malignant tertian fever is caused by which of the following?

a.plasmodium falciparum

b.plasmodium knowelsi

c.plasmodium ovale

d.plasmodium vivax

162. a young patient presented with high grade fever having evening rise,along with abdominal pain and
constipation ,rose pots are present and tip of spleen in palpable along with decrease lymphocyte on
blood cp.which of the following investigation is most specific in the first week of typhoid /entric fever?

a.blood culture

b.stool culture

c.atibody/widal test

d.serology

163.a patient is sputum positive for acid fast bacilli after 2 month of ATT,you are suspecting multidrug
resitence TB ,resitence to which of the following drugs is common?

a.INH,RIFAMPICIN

B.INH ALONE

C.RIFAMPICIN ALONE

D.INH,RIFAMPICIN ,MOXIFLOXACIN PLUS INJECTIBLE ATT

164.students of 5th grade are presented with perianal itching,which of the following parasite is
respondsble?

a.trichcuris

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b.toxoplasma

c.entameba histolytica

d.enterobius vermicularis

165.a patient with high grade fever and new onset murmur is suspected to have infective endocarditis
what is the most common casue of acute infective endocarditis?

a.st.bovis

b.st.viridans

c.staph aureus

d.st pyogenase

166.sore throat with atypical pneumonia followed by coombs positive autoimmune hemolytic anemia is
suggestive of?

a.legionella

b.mycoplasma

c.pneumocystis jiroveci

d.staph aureus

PHARMACOLOGY

167.A diabetic patient is complaining of constipation,bloating due to diabetic gastropresis what

drug you will prescribe?
a.metoclorpromide
b.ondensatron
c.omeprazole
d.prochlorperazine
168 a patient who has just finished first session of chemotherapy is complaining of nausea and
vomiting ,which durg will be best in this case?
a.metoclorpromide
b.steriods
c.ondansetron/5ht antagonist
d.apprepitant
169.which of the following antihypertensive can cause first dose hypotension?
a.AceI/PRILS
B.ARBS/SARTANS
C.CCBS/DIPINES
D.ALPHABLOCKERS/ZOSINS
170.A patient is having trigeminal neuralgia which antiepileptic is best for him?
a.valproic acid
b.carbamezapine
c.phenytoin

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d.phenobarbitol

171.which of the following drug can cause dissociative anesthesia?

a.propofol
b.midazolam
c.ketamine
d.halothane
172..a patient was taking antipsychotics and has developed extrapyramidal side effects which of
the following is not a expyramidal side effects?
a.acute dystonia
b.akathesia
c.parkinson features
d.hyperthermia
173.which of the following drug can be used in prophylaxis of gout?
a.allopurinol
b.nsaids
c.cochicene
d.steriods
174.a known case of sjogren syndrome is complaining of dry eyes dry mouth which drug will be
beneficial in him?
a.atropine
b.pilocarpine
c.neostegmine
d.carbachol
175.teeth discoloration is side effect of?
a.macrolides
b.tetracyclines
c.quinolones
d.penicillins
176.which of the following drug can be given as a prophylaxis for meningococcal meningitis?
a.ciprofloxacin
b.clarithromycin
c.penicillin
d.linezolids

ENT

177.A 10yo girl presents with hoarseness of the voice. She is a known case of bronchial asthma and has
been on oral steroids for a while. What is the most likely cause of hoarseness? a. Laryngeal candidiasis b.
Infective tonsillitis c. Laryngeal edema d. Allergic drug reaction e. Ludwigs angina

178. A 10yo boy presents with nose bleed. What measure should be taken to stop the bleeding? a. Press
base of the nose b. Ice packs c. Press soft parts of the nose d. Start tranexemic acid e. IV fluids

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179. 5yo child complains of sore throat and earache. He is pyrexial. Exam: tonsils enlarged and
hyperemic, exudes pus when pressed upon. What is the single most relevant dx? a. IM b. Acute follicular
tonsillitis c. Scarlet fever d. Agranulocytosis e. Acute OM

180.A 55 year old man has auricular pain and tinnitus on his left ear. On inspection, a painful vesicular
rash around the auditory canal is noted. He also has decreased hearing on the left ear. What is the
SINGLE most likely diagnosis? A. Acute mastoiditis B. Cholesteatoma C. Ramsay Hunt syndrome D.
Herpes zoster ophthalmicus E. Otitis media with effusion

181. an adult was eating in a resturant suddenly developed chokinng ,

what immediate maneuver should be done to save the patient?

a.Hemlich maneuver

b.hallpike maneuver

c.log roll method

d.valsalva maneuver

182. a young lady presented with complaine of vertigo when she changes side in the bed while lying
supine there is no other abnormality Dx
a.acoustic neuroma
b.Benign positional vertigo
c.Menere’s disease
d.cerebellar lesion
183.which of the following menure is done to diagnosed BPPV
a-Hall pikes mauvere
b-Romberg test
c-Head roll test
d-a and c
184.patient presented with episodes of sensory neurol hearing loss, ringing in the ear and vertigo
These episodes are recurrent no other Abnormality findingsDx
a-autoscelrosis
b.otitis interna
c.lybrinthitis
d.meniers disease

ophthalmology
185.a patient presented for evaluation of a whitish growth on the eye,o/e there is a fibrovascular triangular
growth encroaching the cornea,dx?

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a.pinguecela
b.pterygium
c.pseudoterigium
d.stye
186.a hypertensive patient is having silver wiring in retina ,he is at which stage of retinopathy?
a.grade 1
b.grade2
c.grade 3
d.grade 4
187.a patient with bilateral red eye ,thick mucoid discharge ,sandy sensations along with itching in both
eyes,dx?
a.viral conjunctivitis
b.becterial conjunctivitis
c.allergic conjunctivitis
d.chemical conjunctivitis
188.a patient with bilateral red eye,decrease vision o/e cornia is opacified and there is
geographical/dendritc ulcer over cornea,dx?
a.fungal keratitis
b.herpes keratitis
c.allergic keratitis
d.protozoal keratitis
189.fungal keratitis is common in?
a.agriculture worke
b.bakery workers
c.swimmers
d.goldsmith
Anatomy.

189. 22yo man has a reduced conscious level and a fixed dilated pupil after being involved in a MVC.
Choose the single most appropriate option?

a. Facial nerve

b. Oculomotor nerve

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c. Olfactory nerve

d. Optic nerve

e. Trigeminal nerve

190. A man complains of loss of sensation in his little and ring finger. Which nerve is most likely to be
involved? a. Median nerve b. Ulnar nerve c. Radial nerve d. Long thoracic nerve e. Axillary nerve

191. A patient has an anterior wall infarct of the left ventricle. Which vessel will most likely have a
thrombus? (a) Right coronary artery (b) Left anterior descending artery (c ) Left circumflex artery

192 Damage to the 6th cranial nerve will produce which of the following deficits in eye movement? (a)
Inability to move the eyes in a vertical up and down motion (b) Inability to rotate the eyes within the eye
socket (c) Inability to move the eyes laterally towards the midline (d) Inability to move the eyes laterally
away from the midline

193.which of the following nerve injury will occur if there is fracture to surgical neck of humerous?

a.radial nerve

b.ulnar nerve

c.musculocutaneous nerve

d.axillary nerve

194.a patient after modified radical mastectomy is now presented with winging of scapuls,which nerve
is most likely damage?

a.thoracodorsal nerve

b.axillary nerve

c.long thoracic nerve

d.radial nerve

195. 2.patient cannot abduct the arm from 15 to 90 degree,which of the following nerve is injured?

a.median

b.ulnar

c.axillary

d.radial

196. which of the following is not a content of femoral sheath in femoral canal?

a.femoral artery

b.femoral vein

c.femoral nerve

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d.femoral lymohnodes

197. what is the anatomical location of nipple?

a.fourth intercostal space

b.5th intercostal space

c.third intercostal space

198.fractured shaft of humerus with radial nerve damage usually donot have the following feature

a. Wrist drop

b.Sensory loss over posterior aspect of forearm

c. Sensory loss over lateral aspect of forearm

d. All of the above

199 Lower motor neuron lesion is associated with

A. Exaggerated reflex
B. Hypotonia
C. Pendular knee jerk
D. Loss of touch sensation on affected side

200.. patient is presented with hip drop on left side(trendelenburg gait? which nerve is injured?

a.right superior gluteal nerve

b.right inferior gluteal nerve

c.left superior gluteal nerve

d.left inferior gluteal nerve

201.patient cannot touch is left shoulder with right arm ,nerve injury?

a.axillary

b.musculocutaneous

c.radial

d.ulnar

202.which of the following structure passes lateral to cavernous sinus?

a.troclear nerve

b.occulomotor nerve

c.opthalmic division of trigeminal

d.all of the above

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203..sesation of visions are primarily received in which lobe?

a.frontal lobe

b.parietal lobe

c.occipital lobe

d.temporal lobe

204.loss of flexion,adducted and pronated hand are features of ?

a.klumpkes paralysis

b.ducchene paralysis

c.pancoast tumor

d.cervical rib

205.Which one of the following hypothalamic nuclei is esponsible for the detection of core body
temperature

A. Anterior hypothalamus
B. Lateral hypothalamus
C. Periventricular nucleus
D. Arcuate nucleus

Community
206. if the growth rate of Pakistanis 1.9,what will be its population doubling time?
a.36 years
b.40 yrs
c.26yrs
d.32yrs
207.incidence of disease means?
a.new cases
b.new plus old cases
c.old cases
d.dead persons
208.pakistan is currently at which stage of demographic cycle?
a.late expanding
b.early expanding
c.low stationary
d.high stationary
209.in epidemiological studies tip of iceberg means
a.hidden cases
b.dead persons
c.features which a doctor see
d.features which a doctor dnt see

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