FMGE Previous Year Question Papers

Q1. A day-case patient needs the most rapid emergence possible once the vaporiser is switched off at the end of a 20-minute procedure. Which property of the inhalational agent best predicts how quickly he will wake?

• A. A high oil-gas partition coefficient
• B. A high minimum alveolar concentration
• C. A low blood-gas partition coefficient
• D. A high saturated vapour pressure

Answer: C. A low blood-gas partition coefficient

Q2. An anaesthetist sites a lumbar epidural using the loss-of-resistance technique. Which structure does the needle tip traverse immediately before it enters the epidural space?

• A. Interspinous ligament
• B. Ligamentum flavum
• C. Supraspinous ligament
• D. Dura mater

Answer: B. Ligamentum flavum

Q1. A woman cannot abduct her right eye and reports horizontal double vision that is worst on looking to the right. Which nerve is affected?

• A. Right oculomotor nerve
• B. Right trochlear nerve
• C. Right abducens nerve
• D. Right optic nerve

Answer: C. Right abducens nerve

Q1. Phase II hepatic metabolism renders lipophilic drugs water-soluble for excretion. Which conjugation reaction handles the greatest share of this load, catalysed by UDP-glucuronosyltransferase?

• A. Sulfation
• B. Acetylation
• C. Glutathione conjugation
• D. Glucuronidation

Answer: D. Glucuronidation

Q2. A child of short stature has sun-sensitive facial erythema, recurrent infections and cultured cells showing a striking increase in sister chromatid exchange. A defect in which class of enzyme underlies this disorder?

• A. Nucleotide excision repair endonuclease
• B. DNA helicase
• C. Mismatch repair protein
• D. DNA polymerase III

Answer: B. DNA helicase

Q1. A young adult on a prolonged fat-restricted diet develops dry, rough skin with keratotic papules at the hair follicles, and separately reports difficulty seeing at dusk. Which single deficiency explains both?

• A. Vitamin B2
• B. Vitamin C
• C. Vitamin A
• D. Vitamin K

Answer: C. Vitamin A

Q2. A man with chronic alcohol dependence has a symmetrical pigmented scaly rash confined to the neck and the backs of the hands, with diarrhoea and impaired memory. Which vitamin should be replaced?

• A. Niacin
• B. Thiamine
• C. Riboflavin
• D. Cobalamin

Answer: A. Niacin

Q1. An adult has a unilateral middle-ear effusion that has not settled over three months, together with a firm upper cervical lymph node. Which investigation should be arranged first?

• A. Pure tone audiometry
• B. Myringotomy with grommet insertion
• C. Plain sinus radiograph
• D. Nasopharyngeal endoscopy with biopsy

Answer: D. Nasopharyngeal endoscopy with biopsy

Q1. Under the insanity defence as applied in Indian law, an accused is exempt from criminal liability if unsoundness of mind at the time of the act prevented them from knowing which of the following?

• A. That the act was against their own interest
• B. The nature of the act, or that it was wrong or contrary to law
• C. That the act would be discovered
• D. The identity of the victim

Answer: B. The nature of the act, or that it was wrong or contrary to law

Q2. A family develop vomiting and diarrhoea about ten hours after eating foraged mushrooms, appear to recover the following day, then develop jaundice and coagulopathy on day three. Which toxin is responsible?

• A. Muscarine
• B. Psilocybin
• C. Amatoxin
• D. Gyromitrin

Answer: C. Amatoxin

Q1. Which feature of a previous caesarean section carries the lowest risk of uterine rupture during a subsequent trial of labour?

• A. A previous low transverse incision
• B. A previous classical vertical incision
• C. A previous inverted T incision
• D. A previous low vertical incision extending into the upper segment

Answer: A. A previous low transverse incision

Q2. After ovulation, which hormone converts proliferative endometrium into secretory endometrium capable of supporting implantation?

• A. Oestradiol
• B. Follicle stimulating hormone
• C. Prolactin
• D. Progesterone

Answer: D. Progesterone

Q3. Haemolytic disease of the newborn from ABO incompatibility occurs almost exclusively when the mother is group O. Which antibody property explains this?

• A. Anti-A and anti-B in group O mothers are largely IgM and cross the placenta
• B. Anti-A and anti-B in group O mothers are largely IgG and cross the placenta
• C. IgA antibodies are actively transported across the placenta
• D. IgD antibodies fix complement on fetal red cells

Answer: B. Anti-A and anti-B in group O mothers are largely IgG and cross the placenta

Q1. A child has been convulsing for 20 minutes despite two adequate doses of intravenous lorazepam. What is the next appropriate step?

• A. Give a third dose of lorazepam
• B. Start oral carbamazepine
• C. Load with intravenous levetiracetam
• D. Observe for spontaneous termination

Answer: C. Load with intravenous levetiracetam

Q2. A hypertensive patient taking hydrochlorothiazide is found to have a serum potassium of 3.0 mmol/L. Adding which agent would best correct this while maintaining blood pressure control?

• A. Furosemide
• B. Acetazolamide
• C. Metolazone
• D. Spironolactone

Answer: D. Spironolactone

Q1. An infant has absent T and B lymphocyte function, and deoxyadenosine accumulates to levels toxic to lymphocytes. Deficiency of which enzyme causes this?

• A. Thymidine phosphorylase
• B. Adenosine deaminase
• C. Arginase
• D. Xanthine oxidase

Answer: B. Adenosine deaminase

Q2. Within minutes of a wasp sting a patient develops stridor, urticaria and hypotension. The reaction is mediated by antibody bound to which cell-surface receptor?

• A. Fc-gamma-RIII on natural killer cells
• B. Complement receptor 1 on erythrocytes
• C. Fc-epsilon-RI on mast cells
• D. MHC class II on macrophages

Answer: C. Fc-epsilon-RI on mast cells

Q1. A patient with a painful red eye, photophobia and blurred vision has cells and flare in the anterior chamber with deposits on the corneal endothelium. What is the diagnosis?

• A. Acute angle-closure glaucoma
• B. Bacterial conjunctivitis
• C. Central retinal vein occlusion
• D. Acute anterior uveitis

Answer: D. Acute anterior uveitis

Q2. A child with multiple cafe-au-lait macules and axillary freckling develops painless proptosis with reduced vision in one eye. Which tumour is most likely?

• A. Vestibular schwannoma
• B. Optic nerve glioma
• C. Retinoblastoma
• D. Sphenoid wing meningioma

Answer: B. Optic nerve glioma

Q1. A pedestrian struck by a car sustains fractures of the tibia and fibula at the same level, at the height of the vehicle's bumper. What is the eponym for this injury pattern?

• A. Pilon fracture
• B. Maisonneuve fracture
• C. Bumper fracture
• D. Toddler's fracture

Answer: C. Bumper fracture

Q1. A patient with marked leucocytosis, basophilia and massive splenomegaly is suspected of chronic myeloid leukaemia. Which finding confirms the diagnosis?

• A. Detection of the BCR-ABL1 fusion gene
• B. A low leucocyte alkaline phosphatase score
• C. Basophilia on the peripheral smear
• D. A hypercellular marrow on biopsy

Answer: A. Detection of the BCR-ABL1 fusion gene

Q2. Neutrophil extracellular traps are webs of chromatin and granule proteins released by activated neutrophils. Which statement about them is correct?

• A. They are formed by drawing the organism into a phagocytic vacuole
• B. They require intact mitochondrial oxidative phosphorylation to form
• C. They are released only by eosinophils
• D. They trap extracellular microbes and can expose nuclear autoantigens implicated in SLE

Answer: D. They trap extracellular microbes and can expose nuclear autoantigens implicated in SLE

Q1. A child with diarrhoea is restless and irritable, drinks eagerly when offered fluid, and the skin pinch goes back slowly. Under IMNCI, how is this classified and treated?

• A. No dehydration, treated with Plan A
• B. Some dehydration, treated with Plan B
• C. Severe dehydration, treated with Plan C
• D. Persistent diarrhoea, referral only

Answer: B. Some dehydration, treated with Plan B

Q2. A malnourished preschool child has a dry, lustreless conjunctiva with foamy triangular patches on the temporal bulbar conjunctiva. Which deficiency is this, and what are the patches called?

• A. Vitamin C deficiency with subconjunctival haemorrhages
• B. Riboflavin deficiency with angular blepharitis
• C. Vitamin A deficiency with Bitot spots
• D. Zinc deficiency with photophobia

Answer: C. Vitamin A deficiency with Bitot spots

Q1. Six hours after his first dose of haloperidol, a young man develops sustained painful twisting of the neck and upward deviation of both eyes. Which treatment should be given immediately?

• A. Oral propranolol
• B. An intramuscular anticholinergic such as benztropine
• C. Intravenous dantrolene
• D. Conversion to a long-acting depot preparation

Answer: B. An intramuscular anticholinergic such as benztropine

Q2. A trekker ascending rapidly above 3500 m develops headache, nausea and insomnia. Which drug both prevents and treats this by producing a metabolic acidosis that stimulates ventilation?

• A. Furosemide
• B. Prochlorperazine
• C. Nifedipine
• D. Acetazolamide

Answer: D. Acetazolamide

Q1. In the carotid body, a fall in arterial PO2 depolarises the glomus cell. This happens because hypoxia inhibits which channel?

• A. Oxygen-sensitive potassium channels
• B. Voltage-gated sodium channels
• C. L-type calcium channels
• D. Epithelial chloride channels

Answer: A. Oxygen-sensitive potassium channels

Q2. CFTR is a cyclic-AMP-regulated channel. Which ion does it conduct, and what follows in the airway when it is lost?

• A. Sodium, with excess airway surface liquid
• B. Potassium, with a depolarised epithelium
• C. Chloride, with reduced airway surface liquid and thick secretions
• D. Calcium, with impaired ciliary beating

Answer: C. Chloride, with reduced airway surface liquid and thick secretions

Q1. Village Health, Sanitation and Nutrition Day is held at the anganwadi centre to deliver immunisation, antenatal checks and nutrition counselling. How often is it held?

• A. Once a week
• B. Once a month
• C. Once a quarter
• D. Twice a year

Answer: B. Once a month

Q2. In the disaster management cycle, which phase directly follows the response phase?

• A. Mitigation
• B. Preparedness
• C. Impact
• D. Recovery and rehabilitation

Answer: D. Recovery and rehabilitation

Q3. A woman with iron deficiency anaemia is counselled about her diet. Which of the following most reduces absorption of dietary non-haem iron?

• A. Tannins in tea taken with meals
• B. Ascorbic acid from citrus fruit
• C. Germination of pulses
• D. Fermentation of cereals

Answer: A. Tannins in tea taken with meals

Q4. Fertility, mortality and migration are together described as which of the following?

• A. The demographic dividend
• B. The demographic window
• C. The components of demographic change
• D. The epidemiological transition

Answer: C. The components of demographic change

Q5. ANMOL was introduced to support auxiliary nurse midwives in the field. What does it provide?

• A. A monthly printed register delivered to sub-centres
• B. A tablet-based application for recording and updating beneficiary data at the point of service
• C. A telephone helpline for antenatal advice
• D. A televised training series

Answer: B. A tablet-based application for recording and updating beneficiary data at the point of service

Q1. A young man with schizophrenia has gained 12 kg and developed dyslipidaemia on olanzapine. Which agent has the most favourable metabolic profile to switch to?

• A. Clozapine
• B. Paliperidone
• C. Amisulpride
• D. Ziprasidone

Answer: D. Ziprasidone

Q2. A patient insists that an outside agency is moving his limbs and producing sensations in his body against his will. What is this first-rank symptom called?

• A. Somatic passivity
• B. Thought insertion
• C. Delusion of reference
• D. Depersonalisation

Answer: A. Somatic passivity

Q1. A patient is counselled before pelvic radiotherapy. Radiosensitivity rises with mitotic rate and falls with differentiation, so which tissue inside the treatment field will show injury earliest?

• A. Fibrous scar tissue
• B. Intestinal crypt epithelium
• C. Mature bone matrix
• D. Peripheral nerve trunk

Answer: B. Intestinal crypt epithelium

Q2. In oncological PET-CT, tumour uptake reflects increased glycolysis. Which radiopharmaceutical is used?

• A. Technetium-99m methylene diphosphonate
• B. Fluorine-18 fluorodeoxyglucose
• C. Iodine-131 sodium iodide
• D. Gallium-68 DOTATATE

Answer: B. Fluorine-18 fluorodeoxyglucose

Q1. A man in his forties develops bilateral gynaecomastia and is found to have a small solid intratesticular nodule with a raised serum oestradiol. Which tumour is most likely?

• A. Classical seminoma
• B. Mature teratoma
• C. Embryonal carcinoma
• D. Leydig cell tumour

Answer: D. Leydig cell tumour

Q1. Before elective surgery an anaesthetist asks the patient to sit upright, open the mouth and protrude the tongue without phonating, then assigns a grade. What is being assessed?

• A. The view of the glottis obtained at direct laryngoscopy
• B. The patient's systemic fitness for anaesthesia
• C. The pharyngeal structures visible, to predict difficult laryngoscopy
• D. The thyromental distance, to predict difficult mask ventilation

Answer: C. The pharyngeal structures visible, to predict difficult laryngoscopy

Q2. Which anaesthetic technique for cataract surgery uses no needle at all, and so carries no risk of globe perforation or retrobulbar haemorrhage?

• A. Peribulbar block
• B. Topical anaesthesia with proparacaine drops
• C. Retrobulbar block
• D. Facial nerve block

Answer: B. Topical anaesthesia with proparacaine drops

Q1. During vein harvesting at the ankle, the nerve accompanying the great saphenous vein just in front of the medial malleolus is divided. What deficit follows?

• A. Weakness of ankle dorsiflexion
• B. Loss of sensation over the lateral border of the foot
• C. Weakness of great toe extension
• D. Numbness along the medial side of the leg and foot

Answer: D. Numbness along the medial side of the leg and foot

Q2. The growth plate between epiphysis and diaphysis is united by hyaline cartilage and permits no movement. What joint is this, and what becomes of it at skeletal maturity?

• A. A syndesmosis, which persists as fibrous tissue
• B. A synchondrosis, which ossifies into a synostosis
• C. A symphysis, which remains fibrocartilaginous
• D. A synovial joint, which retains its cavity

Answer: B. A synchondrosis, which ossifies into a synostosis

Q1. A neonate has profound hypotonia, a high forehead, hepatomegaly and markedly raised plasma very-long-chain fatty acids. Failure of which organelle explains the biochemical finding?

• A. Lysosome
• B. Smooth endoplasmic reticulum
• C. Peroxisome
• D. Golgi apparatus

Answer: C. Peroxisome

Q2. A breastfed neonate develops vomiting, jaundice, hepatomegaly and bilateral cataracts in the first weeks of life. Urine is positive for a reducing substance but negative on a glucose oxidase strip. Which enzyme is deficient?

• A. Galactokinase
• B. UDP-galactose-4-epimerase
• C. Galactose-1-phosphate uridyltransferase
• D. Fructose-1-phosphate aldolase

Answer: C. Galactose-1-phosphate uridyltransferase

Q1. A man develops several deep, painful genital ulcers with ragged undermined edges two weeks after unprotected intercourse, with tender suppurative inguinal nodes. Which organism is responsible?

• A. Treponema pallidum
• B. Haemophilus ducreyi
• C. Klebsiella granulomatis
• D. Chlamydia trachomatis serovar L2

Answer: B. Haemophilus ducreyi

Q1. A patient with post-traumatic hearing loss undergoes HRCT of the temporal bone. Which structure cannot be resolved, and why?

• A. The malleus, because the tympanic membrane obscures it
• B. The vestibular aqueduct, because it contains air
• C. The internal auditory canal, because it lies outside the field
• D. The organ of Corti, because it is soft tissue below the resolution of CT

Answer: D. The organ of Corti, because it is soft tissue below the resolution of CT

Q2. A universal newborn hearing screening programme needs a first-line test that is quick, needs no sedation and requires no response from the baby. Which test is used?

• A. Pure tone audiometry
• B. Speech audiometry
• C. Otoacoustic emissions
• D. Rinne and Weber tuning fork tests

Answer: C. Otoacoustic emissions

Q1. A bullet recovered at autopsy shows spiral scratch marks running along its surface. What produces these, and what is their forensic value?

• A. Contact with the lands of the rifled barrel, allowing the individual weapon to be identified
• B. Contact with the cartridge case, allowing the ammunition batch to be traced
• C. Passage through clothing, indicating the range of fire
• D. Deformation against bone, indicating the wound track

Answer: A. Contact with the lands of the rifled barrel, allowing the individual weapon to be identified

Q2. A farmer is bitten on the foot by a snake 20 minutes ago and has local swelling with oozing from the puncture site. What should be done first, before transfer?

• A. Apply a tight arterial tourniquet above the knee
• B. Incise the bite site and apply suction
• C. Infiltrate antivenom locally around the bite
• D. Immobilise the limb, keep it at or below heart level, and transfer urgently

Answer: D. Immobilise the limb, keep it at or below heart level, and transfer urgently

Q1. Exclusive breastfeeding means no other food or fluid, not even water. For how long is it recommended, and what follows?

• A. 3 months, then complete weaning
• B. 6 months, then complementary feeding with breastfeeding continued to 2 years or beyond
• C. 9 months, then substitution with animal milk
• D. 12 months, then complementary feeding

Answer: B. 6 months, then complementary feeding with breastfeeding continued to 2 years or beyond

Q2. Which definition of puerperal pyrexia should prompt a sepsis screen after delivery?

• A. Any temperature above 37.5 C within the first 6 hours
• B. A single reading above 38 C in the first hour after delivery
• C. A temperature of 38 C or more on any two of the first ten days postpartum, excluding the first 24 hours
• D. A temperature above 39 C at any point during labour

Answer: C. A temperature of 38 C or more on any two of the first ten days postpartum, excluding the first 24 hours

Q1. An older man has back pain, anaemia, hypercalcaemia and an M-spike on serum protein electrophoresis. Which urinary finding supports myeloma, and why does a standard dipstick miss it?

• A. Haemoglobinuria, because the dipstick detects only intact red cells
• B. Free immunoglobulin light chains, because the dipstick detects albumin rather than globulins
• C. Glycosuria, because the dipstick threshold is set too high
• D. Myoglobinuria, because the dipstick cannot separate it from haem

Answer: B. Free immunoglobulin light chains, because the dipstick detects albumin rather than globulins

Q2. A young woman has headaches, transient visual blurring and easy bruising. Platelets are 900 x 10^9/L with normal haemoglobin and white cell count, and a JAK2 V617F mutation is present. What is the diagnosis?

• A. Polycythaemia vera
• B. Reactive thrombocytosis
• C. Primary myelofibrosis
• D. Essential thrombocythaemia

Answer: D. Essential thrombocythaemia

Q1. A man with HIV and a CD4 count of 90 has a dry cough, desaturation on exertion, bilateral perihilar ground-glass change and a raised LDH. Which organism is most likely, and how is it confirmed?

• A. Pneumocystis jirovecii, on induced sputum or lavage with silver or immunofluorescent staining
• B. Cryptococcus neoformans, on India ink staining of sputum
• C. Mycobacterium tuberculosis, on Ziehl-Neelsen staining
• D. Aspergillus fumigatus, on serum galactomannan alone

Answer: A. Pneumocystis jirovecii, on induced sputum or lavage with silver or immunofluorescent staining

Q2. A woman's red cells fail to agglutinate with anti-A, anti-B and anti-H, and her serum agglutinates group O donor cells. Which blood can she safely receive?

• A. O negative blood
• B. AB positive blood
• C. Blood from another Bombay phenotype donor only
• D. Any group, since she carries neither A nor B antigen

Answer: C. Blood from another Bombay phenotype donor only

Q1. A patient cannot close the right eye fully and develops corneal drying and punctate erosions. Which nerve is affected, and which muscle has failed?

• A. Oculomotor nerve, with weakness of levator palpebrae superioris
• B. Facial nerve, with weakness of orbicularis oculi
• C. Trigeminal nerve, with loss of corneal sensation
• D. Sympathetic supply, with weakness of Muller's muscle

Answer: B. Facial nerve, with weakness of orbicularis oculi

Q2. A patient with raised intracranial pressure develops horizontal diplopia and cannot abduct either eye. Why is this nerve affected early, and what does it tell you about the site of the lesion?

• A. It has the shortest intracranial course, so it localises the lesion to the pons
• B. It lies in the cavernous sinus wall, so it localises the lesion there
• C. It is compressed at the tentorial edge, so it localises to the uncus
• D. Its long intracranial course makes it vulnerable to stretch, so it is a false localising sign

Answer: D. Its long intracranial course makes it vulnerable to stretch, so it is a false localising sign

Q1. After a dashboard injury the hip lies fixed in flexion, adduction and internal rotation, and both internal and external rotation are blocked and painful. What has happened?

• A. Anterior dislocation of the hip
• B. Intracapsular fracture of the femoral neck
• C. Posterior dislocation of the hip
• D. Fracture of the pubic ramus

Answer: C. Posterior dislocation of the hip

Q1. Which organ is a primary lymphoid organ, and what makes it primary rather than secondary?

• A. Thymus, because lymphocytes develop and undergo selection there before encountering antigen
• B. Spleen, because it filters blood-borne antigen
• C. Lymph node, because germinal centre reactions occur there
• D. Peyer's patches, because they sample gut antigen

Answer: A. Thymus, because lymphocytes develop and undergo selection there before encountering antigen

Q2. Which biomarker rises earliest after myocardial injury, and why is troponin still the diagnostic test of choice?

• A. CK-MB rises first, but troponin remains elevated for longer
• B. LDH rises first, but troponin costs less
• C. Myoglobin rises first and is more cardiac-specific than troponin
• D. Heart-type fatty acid binding protein rises first, but troponin is far more cardiac-specific

Answer: D. Heart-type fatty acid binding protein rises first, but troponin is far more cardiac-specific

Q1. A six-week-old has prolonged jaundice, constipation, a large protruding tongue, an umbilical hernia and coarse dry skin. Why does newborn screening for this condition matter so much?

• A. Down syndrome, because early karyotyping changes management
• B. Congenital hypothyroidism, because thyroxine begun in the first weeks prevents irreversible intellectual disability
• C. Galactosaemia, because withdrawing lactose reverses the features
• D. Achondroplasia, because growth hormone improves final height

Answer: B. Congenital hypothyroidism, because thyroxine begun in the first weeks prevents irreversible intellectual disability

Q2. A child can pedal a tricycle and climb stairs putting one foot on each step, but cannot yet hop on one foot. What is the most likely age?

• A. 18 months
• B. 5 years
• C. 3 years
• D. 6 years

Answer: C. 3 years

Q1. Ethosuximide is first-line for childhood absence seizures. Which channel does it block, and where?

• A. T-type calcium channels in thalamic neurons
• B. Voltage-gated sodium channels in cortical neurons
• C. GABA transaminase in presynaptic terminals
• D. AMPA receptors in the hippocampus

Answer: A. T-type calcium channels in thalamic neurons

Q2. A woman with asthma needs migraine prophylaxis. Which drug should be avoided, and why?

• A. Topiramate, because it causes weight gain
• B. Amitriptyline, because it lowers the seizure threshold
• C. Flunarizine, because it raises blood pressure
• D. Propranolol, because beta-2 blockade can precipitate bronchospasm

Answer: D. Propranolol, because beta-2 blockade can precipitate bronchospasm

Q1. What is the approximate glomerular filtration rate in a healthy young adult, and what fraction of renal plasma flow does it represent?

• A. About 60 ml/min, roughly a tenth of renal plasma flow
• B. About 125 ml/min, roughly a fifth of renal plasma flow
• C. About 125 ml/min, roughly half of renal plasma flow
• D. About 600 ml/min, essentially all of renal plasma flow

Answer: B. About 125 ml/min, roughly a fifth of renal plasma flow

Q2. Renal clearance of a substance is calculated as UV/P. What does the resulting figure represent?

• A. The mass of the substance excreted per unit time
• B. The fraction of the filtered load that is reabsorbed
• C. The volume of plasma completely cleared of the substance per unit time
• D. The rate at which urine is formed

Answer: C. The volume of plasma completely cleared of the substance per unit time

Q1. A new chronic disease appears in a population. Incidence climbs steadily, and treatment prolongs survival without curing anyone. What happens to prevalence?

• A. It rises, because prevalence reflects both new cases and longer duration
• B. It falls, because incidence and prevalence move in opposite directions
• C. It is unchanged, because prevalence is independent of incidence
• D. It rises only once the disease becomes curable

Answer: A. It rises, because prevalence reflects both new cases and longer duration

Q2. A gym owner notices that members who drink a particular beverage during workouts lose more weight, and concludes the drink causes the loss. Those members also train more often. How is the observed association best described?

• A. A direct causal association
• B. A dose-response association
• C. Reverse causality, since losing weight leads people to choose the drink
• D. A confounded association, since training frequency is linked to both the drink and the weight loss

Answer: D. A confounded association, since training frequency is linked to both the drink and the weight loss

Q1. A man avoids balconies and glass lifts and feels intense fear on looking down from a height, while recognising the fear as excessive. What is this?

• A. Agoraphobia
• B. Acrophobia
• C. Vestibular vertigo
• D. Panic disorder

Answer: B. Acrophobia

Q2. A woman with a BMI of 27 describes eating very large quantities in a short time with a sense of loss of control, then self-inducing vomiting, several times a week for four months. She is preoccupied with her body shape. What is the diagnosis?

• A. Binge eating disorder
• B. Anorexia nervosa, binge-purge subtype
• C. Bulimia nervosa
• D. Avoidant restrictive food intake disorder

Answer: C. Bulimia nervosa

Q1. A man has a rising PSA after radical prostatectomy but no lesion on conventional imaging. Which PET tracer binds a membrane antigen expressed by prostate cancer cells?

• A. Fluorine-18 FDG
• B. Gallium-68 DOTATATE
• C. Fluorine-18 sodium fluoride
• D. Gallium-68 PSMA

Answer: D. Gallium-68 PSMA

Q1. Ten years after mastectomy with axillary clearance, a woman with long-standing arm lymphoedema develops painless bluish-purple nodules on that arm. What has developed?

• A. Angiosarcoma arising in chronic lymphoedema
• B. Cutaneous metastases from the original breast cancer
• C. Post-radiation fibrosis
• D. Cellulitis complicating lymphoedema

Answer: A. Angiosarcoma arising in chronic lymphoedema

Q1. A child has white hair, very pale skin and nystagmus from birth, with a normal plasma phenylalanine. The defect lies in the enzyme that converts tyrosine to DOPA. Which enzyme, and what is the condition?

• A. Phenylalanine hydroxylase, causing phenylketonuria
• B. Homogentisate oxidase, causing alkaptonuria
• C. Tyrosinase, causing oculocutaneous albinism
• D. Dopamine beta-hydroxylase, causing orthostatic hypotension

Answer: C. Tyrosinase, causing oculocutaneous albinism

Q2. A mature erythrocyte has no mitochondria yet still generates ATP. Which pathway allows this, and where does it run?

• A. The citric acid cycle, in the cytosol
• B. Glycolysis, entirely in the cytosol
• C. Beta oxidation, in the cytosol
• D. Oxidative phosphorylation, on the plasma membrane

Answer: B. Glycolysis, entirely in the cytosol

Q1. Stool is plated on MacConkey agar; some colonies turn pink while others stay pale. What does the colour difference show, and what produces it?

• A. Haemolysis, which clears the medium around the colony
• B. Hydrogen sulphide production, which blackens the colony
• C. Urease activity, which raises the pH
• D. Lactose fermentation, which lowers pH and turns the neutral red indicator pink

Answer: D. Lactose fermentation, which lowers pH and turns the neutral red indicator pink

Q2. A man has a single painless genital ulcer with an indurated base and rubbery non-tender inguinal nodes, three weeks after exposure. Serology is still negative. What will confirm the diagnosis now?

• A. Dark field microscopy of serum expressed from the ulcer base
• B. Gram stain of the ulcer exudate
• C. Tzanck smear from the ulcer edge
• D. Culture on Thayer-Martin medium

Answer: A. Dark field microscopy of serum expressed from the ulcer base

Q1. A patient receives 2 Gy once daily, five days a week, for six weeks. What is this schedule called, and what is the radiobiological reason for splitting the dose?

• A. Hyperfractionation, allowing a higher total dose in less time
• B. Hypofractionation, exploiting a low alpha/beta ratio
• C. Conventional fractionation, letting normal tissue repair sublethal damage between fractions
• D. Brachytherapy, delivering dose from an implanted source

Answer: C. Conventional fractionation, letting normal tissue repair sublethal damage between fractions

Q2. A pan-scan is requested for a polytrauma patient. Which region is not part of the standard protocol, and how is it assessed instead?

• A. The cervical spine, which is cleared clinically in every patient
• B. The limbs, which are imaged with targeted radiographs guided by clinical findings
• C. The abdomen, which is assessed by FAST alone
• D. The head, which is imaged only if consciousness is impaired

Answer: B. The limbs, which are imaged with targeted radiographs guided by clinical findings

Q1. After thyroid surgery a patient aspirates liquids and has reduced sensation above the vocal cords, but the voice is of normal volume and the cords move normally. Which nerve is injured?

• A. Recurrent laryngeal nerve
• B. External branch of the superior laryngeal nerve
• C. Glossopharyngeal nerve
• D. Internal branch of the superior laryngeal nerve

Answer: D. Internal branch of the superior laryngeal nerve

Q2. A patient has a lurching gait, leaning over the affected side during stance, and a positive Trendelenburg sign on the left. Which nerve is most likely injured?

• A. Left superior gluteal nerve
• B. Left inferior gluteal nerve
• C. Left femoral nerve
• D. Left obturator nerve

Answer: A. Left superior gluteal nerve

Q1. The WHO SAFE strategy for trachoma elimination has four components. What does the S stand for, and which stage of disease does it address?

• A. Screening, for active infection among schoolchildren
• B. Surgery, for trichiasis, to prevent corneal blindness
• C. Spectacles, for refractive error after scarring
• D. Sanitation, to reduce fly breeding sites

Answer: B. Surgery, for trichiasis, to prevent corneal blindness

Q2. In chronic hyperglycaemia the lens takes up water, swells and opacifies. Which pathway is responsible, and which product accumulates?

• A. Glycolysis, with lactate accumulating anaerobically
• B. The pentose phosphate pathway, with ribose-5-phosphate accumulating
• C. The polyol pathway, with sorbitol accumulating because lens sorbitol dehydrogenase activity is low
• D. Glycogenolysis, with glucose-1-phosphate accumulating

Answer: C. The polyol pathway, with sorbitol accumulating because lens sorbitol dehydrogenase activity is low

Q1. A 4 cm enhancing renal mass confined to the kidney is found in a woman with a normal contralateral kidney. What is the preferred operation, and why?

• A. Radical nephrectomy, because the risk of tumour spillage is unacceptable
• B. Radical nephrectomy with adjuvant radiotherapy
• C. Percutaneous biopsy followed by surveillance alone
• D. Partial nephrectomy, because it preserves nephrons with equivalent oncological outcome at this size

Answer: D. Partial nephrectomy, because it preserves nephrons with equivalent oncological outcome at this size

Q2. A young man has right-sided hydronephrosis. Urography shows the upper ureter deviating medially behind the inferior vena cava in a fish-hook shape. What is the cause?

• A. Retrocaval ureter, from abnormal persistence of the posterior cardinal vein
• B. Posterior urethral valves
• C. Urethral stricture after instrumentation
• D. Phimosis with chronic retention

Answer: A. Retrocaval ureter, from abnormal persistence of the posterior cardinal vein

Q1. A young man has well-demarcated plaques with silvery scale on both elbows and knees, and fine pits in several fingernails. Scraping the scale away produces pinpoint bleeding. What is that sign called?

• A. Nikolsky sign
• B. Auspitz sign
• C. Darier sign
• D. Koebner phenomenon

Answer: B. Auspitz sign

Q1. A Bier block is planned for forearm surgery. Which local anaesthetic is used, and which is specifically avoided?

• A. Bupivacaine is used; lidocaine is avoided for its short duration
• B. Procaine is used; lidocaine is avoided for allergy risk
• C. Lidocaine is used; bupivacaine is avoided because of cardiotoxicity if the cuff fails
• D. Ropivacaine is used; all other amides are avoided

Answer: C. Lidocaine is used; bupivacaine is avoided because of cardiotoxicity if the cuff fails

Q2. A patient with COPD needs a precisely controlled inspired oxygen concentration that does not vary with his breathing pattern. Which device delivers this, and on what principle?

• A. A simple face mask, which dilutes oxygen with room air
• B. Nasal cannulae, which deliver a fixed flow
• C. A non-rebreathing mask, which prevents any air entrainment
• D. A Venturi mask, which entrains air in a fixed ratio by jet entrainment

Answer: D. A Venturi mask, which entrains air in a fixed ratio by jet entrainment

Q1. A vascular middle-ear tumour arises from paraganglionic tissue travelling with the tympanic branch of the glossopharyngeal nerve. Which tumour is this, and what is its characteristic otoscopic sign?

• A. Cholesteatoma, with a pearly white mass and a marginal perforation
• B. Glomus tympanicum, with a red retrotympanic mass that blanches on positive pressure
• C. Facial nerve schwannoma, with a pale mass and facial weakness
• D. Cholesterol granuloma, with a blue tympanic membrane

Answer: B. Glomus tympanicum, with a red retrotympanic mass that blanches on positive pressure

Q2. A teenage boy has recurrent profuse epistaxis and progressive nasal obstruction, with a vascular mass at the sphenopalatine foramen. Why is biopsy avoided, and what is the treatment?

• A. Biopsy risks seeding malignancy; treatment is radiotherapy alone
• B. Biopsy is painless but non-diagnostic; treatment is observation
• C. Biopsy risks torrential haemorrhage; treatment is embolisation followed by surgical excision
• D. Biopsy risks a CSF leak; treatment is chemotherapy

Answer: C. Biopsy risks torrential haemorrhage; treatment is embolisation followed by surgical excision

Q1. Labetalol is used in hypertensive emergencies including pre-eclampsia. What is its mechanism, and what practical advantage follows?

• A. Pure beta-1 blockade, so heart rate falls without vascular effect
• B. Combined alpha-1 and non-selective beta blockade, so pressure falls without reflex tachycardia
• C. Direct arteriolar dilatation, so afterload falls with reflex tachycardia
• D. Calcium channel blockade, so both rate and afterload fall

Answer: B. Combined alpha-1 and non-selective beta blockade, so pressure falls without reflex tachycardia

Q2. A patient with a triglyceride level of 900 mg/dL is started on a fibrate. Which nuclear receptor does it activate, and what is the main lipid effect?

• A. PPAR-gamma, improving insulin sensitivity and lowering glucose
• B. The LXR receptor, increasing cholesterol efflux
• C. The farnesoid X receptor, reducing bile acid synthesis
• D. PPAR-alpha, increasing lipoprotein lipase activity and lowering triglycerides

Answer: D. PPAR-alpha, increasing lipoprotein lipase activity and lowering triglycerides

Q1. An older woman falls onto an outstretched hand and the wrist shows a dorsal prominence with fullness on the volar side. Which displacement of the distal radial fragment produces this appearance?

• A. Volar displacement with ulnar deviation
• B. Dorsal displacement of the distal ulna alone
• C. Dorsal displacement with radial shortening and supination
• D. Volar angulation with lengthening of the radius

Answer: C. Dorsal displacement with radial shortening and supination

Q1. A man stops his SSRI because of anorgasmia but remains depressed. Which antidepressant carries the lowest rate of sexual dysfunction, and how does it work?

• A. Bupropion, a noradrenaline and dopamine reuptake inhibitor
• B. Paroxetine, a selective serotonin reuptake inhibitor
• C. Venlafaxine, a serotonin and noradrenaline reuptake inhibitor
• D. Clomipramine, a tricyclic with strong serotonergic action

Answer: A. Bupropion, a noradrenaline and dopamine reuptake inhibitor

Q2. A student is brought in an hour after smoking cannabis. Which combination of findings is most characteristic of acute intoxication?

• A. Pinpoint pupils, bradycardia and respiratory depression
• B. Dilated pupils, hypertension, hyperthermia and formication
• C. Nystagmus, ataxia and slurred speech with a smell of solvent
• D. Conjunctival injection, tachycardia, increased appetite and a dreamy altered sense of time

Answer: D. Conjunctival injection, tachycardia, increased appetite and a dreamy altered sense of time

Q1. A child being treated for diabetic ketoacidosis deteriorates six hours into treatment with headache and a falling conscious level. What is the most likely cause, and the main risk factor?

• A. Hypoglycaemia, from an excessive insulin infusion
• B. Cerebral oedema, associated with over-rapid fluid replacement and a fast fall in osmolality
• C. Hypokalaemia, from the insulin-driven potassium shift
• D. Sepsis, from an unrecognised precipitant

Answer: B. Cerebral oedema, associated with over-rapid fluid replacement and a fast fall in osmolality

Q2. Why does creatinine clearance slightly overestimate the true glomerular filtration rate?

• A. Creatinine is reabsorbed in the distal tubule
• B. Creatinine is metabolised within the kidney
• C. A small amount of creatinine is secreted by the proximal tubule in addition to being filtered
• D. Creatinine binds plasma protein and is incompletely filtered

Answer: C. A small amount of creatinine is secreted by the proximal tubule in addition to being filtered

Q1. An elderly man has weeks of unexplained fever and weight loss. The tuberculin test is negative and the chest radiograph normal, yet disseminated tuberculosis is confirmed on bone marrow biopsy. What explains the negative tests?

• A. Prior BCG vaccination masking the tuberculin response
• B. A false-negative film from poor inspiration
• C. Non-tuberculous mycobacterial infection, which does not cross-react
• D. Cryptic disseminated tuberculosis, in which anergy suppresses the tuberculin response and lesions are too small to see on plain film

Answer: D. Cryptic disseminated tuberculosis, in which anergy suppresses the tuberculin response and lesions are too small to see on plain film

Q2. The Child-Pugh score grades severity of chronic liver disease. Which of the following is not one of its five components?

• A. Serum creatinine
• B. Serum bilirubin
• C. Serum albumin
• D. Prothrombin time or INR

Answer: A. Serum creatinine

Q1. A toddler swallows a handful of his mother's iron tablets and develops vomiting, haematemesis and a metabolic acidosis. Which antidote is given, and how does it work?

• A. Sodium calcium edetate, which chelates divalent lead
• B. Desferrioxamine, which chelates free iron and is excreted in the urine
• C. Dimercaprol, which chelates arsenic and mercury
• D. Penicillamine, which chelates copper

Answer: B. Desferrioxamine, which chelates free iron and is excreted in the urine

Q2. In Scammon's growth curves, which tissue grows very little through childhood and then rises steeply at puberty?

• A. Neural tissue
• B. Lymphoid tissue
• C. Genital and gonadal tissue
• D. General somatic tissue

Answer: C. Genital and gonadal tissue

Q1. Investigators identify children who have autism and children who do not, then look back at their vaccination records. What design is this, and which measure of association can it yield?

• A. A cohort study, yielding a relative risk
• B. A cross-sectional study, yielding a prevalence ratio
• C. A randomised trial, yielding an absolute risk reduction
• D. A case-control study, yielding an odds ratio

Answer: D. A case-control study, yielding an odds ratio

Q2. Which of the following is not a component of India's Reproductive and Child Health programme?

• A. Adult literacy and women's economic empowerment
• B. Safe motherhood and antenatal care
• C. Newborn and child health services
• D. Management of reproductive tract and sexually transmitted infections

Answer: A. Adult literacy and women's economic empowerment

Q1. At what completed gestation is a pregnancy defined as post-term, and what is the principal fetal risk?

• A. 40 weeks, with macrosomia alone
• B. 42 weeks, with placental insufficiency and meconium aspiration
• C. 37 weeks, with respiratory distress
• D. 41 weeks, with neonatal jaundice

Answer: B. 42 weeks, with placental insufficiency and meconium aspiration

Q2. A monozygotic twin pregnancy shows a single placenta with no dividing membrane between the fetuses. Around when did the zygote divide, and what is the principal risk?

• A. Days 1 to 3, with no shared structures
• B. Days 4 to 8, with twin-to-twin transfusion
• C. Days 9 to 12, with cord entanglement
• D. After day 13, with conjoined twins

Answer: C. Days 9 to 12, with cord entanglement

Q1. A drowned body is recovered clutching weeds in one hand. The grip was present from the moment of recovery, with no preceding flaccid period. What is this, and what does it indicate?

• A. Rigor mortis, indicating death 6 to 12 hours earlier
• B. Heat stiffening, indicating exposure to fire
• C. Gooseflesh, indicating immersion in cold water
• D. Cadaveric spasm, indicating intense emotion or activity at the instant of death

Answer: D. Cadaveric spasm, indicating intense emotion or activity at the instant of death

Q2. Police recover a skull, and the family provide a photograph of the missing person. Which technique compares the two directly to support identification?

• A. Craniofacial superimposition
• B. Anthropometry using Bertillon measurements
• C. Cheiloscopy
• D. Poroscopy

Answer: A. Craniofacial superimposition

Q1. A child develops a papule on the hand a week after being scratched while playing, followed by tender axillary lymphadenopathy and low-grade fever. Which organism is responsible?

• A. Francisella tularensis
• B. Bartonella henselae
• C. Pasteurella multocida
• D. Yersinia pestis

Answer: B. Bartonella henselae

Q2. A woman has frothy, foul-smelling vaginal discharge with intense itching and a punctate haemorrhagic cervix. Which statement about the causative organism is FALSE?

• A. It is transmitted almost exclusively by sexual contact
• B. Metronidazole is the treatment of choice
• C. It exists in both trophozoite and cyst forms
• D. Motile organisms may be seen on a saline wet mount

Answer: C. It exists in both trophozoite and cyst forms

Q1. A man whose diet has been almost entirely maize for months has diarrhoea, a symmetrical pigmented dermatitis on sun-exposed skin, and memory impairment. Why does a maize-based diet cause this?

• A. Maize protein is deficient in lysine, impairing collagen synthesis
• B. Maize niacin is bound as niacytin and its tryptophan content is low, so niacin cannot be made
• C. Maize phytate binds zinc, preventing its absorption
• D. Maize contains an antivitamin that destroys thiamine

Answer: B. Maize niacin is bound as niacytin and its tryptophan content is low, so niacin cannot be made

Q2. For an enzyme obeying Michaelis-Menten kinetics, what does Km tell you, and how is it affected by substrate concentration?

• A. Km is the substrate concentration at half maximal velocity, and is independent of substrate concentration
• B. Km rises in direct proportion to substrate concentration
• C. Km is the maximal velocity divided by enzyme concentration
• D. Km falls as substrate concentration rises

Answer: A. Km is the substrate concentration at half maximal velocity, and is independent of substrate concentration

Q1. A man has months of back pain, night sweats and weight loss. Imaging shows destruction of two adjacent vertebral bodies with collapse of the intervening disc space and a paraspinal soft-tissue collection. What is the diagnosis?

• A. Multiple myeloma
• B. Ankylosing spondylitis
• C. Tuberculous spondylodiscitis
• D. Metastatic carcinoma

Answer: C. Tuberculous spondylodiscitis

Q2. An elderly man has weight loss, anorexia and iron deficiency anaemia. Chest imaging shows multiple well-defined rounded opacities of varying size in both lungs. What does this pattern represent, and what should be sought?

• A. Haematogenous metastases, prompting a search for a gastrointestinal primary
• B. Primary bronchogenic carcinoma with local spread
• C. Pneumoconiosis from occupational dust exposure
• D. Malignant pleural mesothelioma

Answer: A. Haematogenous metastases, prompting a search for a gastrointestinal primary

Q1. A newborn has a hypoplastic mandible and zygomatic bones, malformed external ears and downslanting palpebral fissures. Maldevelopment of which pharyngeal arch explains this pattern?

• A. Fourth arch
• B. Third arch
• C. Second arch
• D. First arch

Answer: D. First arch

Q2. During excision of the submandibular gland the hypoglossal nerve is divided. What happens when the patient is asked to protrude the tongue, and why?

• A. The tongue deviates towards the side of the lesion, because the intact genioglossus pushes it across
• B. The tongue deviates away from the lesion, because the paralysed genioglossus pulls it
• C. The tongue cannot be protruded at all
• D. Taste is lost over the posterior third of the tongue

Answer: A. The tongue deviates towards the side of the lesion, because the intact genioglossus pushes it across

Q1. Three weeks after uncomplicated cataract surgery a man reports flashes and floaters, then a curtain descending over his vision from above. What has happened, and what is the mechanism?

• A. Endophthalmitis, from intraocular bacterial contamination
• B. Posterior capsular opacification, from lens epithelial proliferation
• C. Cystoid macular oedema, from prostaglandin release
• D. Rhegmatogenous retinal detachment, from a retinal tear allowing fluid beneath the retina

Answer: D. Rhegmatogenous retinal detachment, from a retinal tear allowing fluid beneath the retina

Q2. In with-the-rule astigmatism the vertical corneal meridian is steeper than the horizontal. Which cylindrical correction is therefore appropriate?

• A. A plus cylinder with its axis at 90 degrees
• B. A minus cylinder with its axis at 90 degrees
• C. A minus cylinder with its axis at 180 degrees
• D. A plus cylinder placed at any axis

Answer: B. A minus cylinder with its axis at 90 degrees

Q1. Hair must be removed from an operative site. Which method and timing minimise surgical site infection, and why?

• A. Shaving with a razor the night before, to allow the skin to settle
• B. Depilatory cream applied the previous evening
• C. Clipping immediately before surgery, because razors create microabrasions that become colonised
• D. Shaving on the operating table, because it gives the closest result

Answer: C. Clipping immediately before surgery, because razors create microabrasions that become colonised

Q2. An open appendicectomy is planned. Which incision is centred on McBurney's point, running obliquely along the line of the external oblique fibres?

• A. Lanz incision
• B. Gridiron (McBurney) incision
• C. Rutherford Morison incision
• D. Lower midline incision

Answer: B. Gridiron (McBurney) incision

Q1. A teenager develops abrupt, severely inflamed ulcerating acne nodules with fever, arthralgia and a raised ESR. Which organism drives the underlying acne, and what does the systemic upset represent?

• A. Cutibacterium (Propionibacterium) acnes, with an exaggerated immune response to it
• B. Staphylococcus aureus, with secondary bacteraemia
• C. Malassezia furfur, with follicular invasion
• D. Demodex folliculorum, with mite hypersensitivity

Answer: A. Cutibacterium (Propionibacterium) acnes, with an exaggerated immune response to it

Q2. A patient with plaque psoriasis develops new lesions in a line along a recent surgical scar. What is this called, and what does it signify?

• A. The Auspitz sign, indicating thinned suprapapillary plates
• B. The Koebner phenomenon, indicating active disease
• C. The Nikolsky sign, indicating an intraepidermal split
• D. The Darier sign, indicating mast cell degranulation

Answer: B. The Koebner phenomenon, indicating active disease

Q1. Which method of monitoring neuromuscular blockade gives a reliable measure of the depth of block without needing a pre-paralysis baseline, and how is it read?

• A. Tetanic stimulation, judged by the presence of fade
• B. Train-of-four, read as the ratio of the fourth twitch to the first
• C. Single twitch height, compared with a control twitch
• D. Post-tetanic count, used only in shallow block

Answer: B. Train-of-four, read as the ratio of the fourth twitch to the first

Q1. A 60-year-old man has painless cervical lymphadenopathy, a unilateral middle-ear effusion and reduced mobility of the soft palate. What links these three findings?

• A. A nasopharyngeal tumour obstructing the Eustachian tube and invading locally
• B. Chronic suppurative otitis media with extension
• C. A parapharyngeal abscess
• D. Tuberculous cervical lymphadenitis

Answer: A. A nasopharyngeal tumour obstructing the Eustachian tube and invading locally

Q2. A toddler has a harsh seal-like cough with inspiratory stridor that worsens on crying. At what level does the obstruction lie, and what does the steeple sign on a neck radiograph represent?

• A. Supraglottic, the sign showing a swollen epiglottis
• B. Tracheal, the sign showing an intraluminal foreign body
• C. Subglottic, the sign showing symmetrical subglottic narrowing
• D. Bronchial, the sign showing distal hyperinflation

Answer: C. Subglottic, the sign showing symmetrical subglottic narrowing

Q1. A man with recurrent gout and a raised serum urate is started on long-term urate-lowering therapy. What is the mechanism of the usual first-line agent?

• A. Inhibition of xanthine oxidase, reducing urate production
• B. Inhibition of URAT1, increasing urate excretion
• C. Inhibition of neutrophil microtubule assembly
• D. Conversion of urate to allantoin

Answer: A. Inhibition of xanthine oxidase, reducing urate production

Q2. A traveller returning from India has watery diarrhoea without fever or blood. Which antimotility agent may be used for symptom control, and when must it be avoided?

• A. Octreotide, avoided in secretory diarrhoea
• B. Bismuth subsalicylate, avoided in children
• C. Rifaximin, avoided in renal impairment
• D. Loperamide, avoided if there is fever or bloody stool suggesting invasive infection

Answer: D. Loperamide, avoided if there is fever or bloody stool suggesting invasive infection

Q1. A young man falls on an outstretched hand and is tender in the anatomical snuffbox, but initial radiographs appear normal. Why must he still be immobilised and re-imaged?

• A. A scaphoid fracture may be radiographically occult, and its retrograde blood supply risks avascular necrosis of the proximal pole
• B. A Colles fracture is often missed on a single view
• C. A lunate dislocation is only visible on stress views
• D. A hook of hamate fracture needs a carpal tunnel view

Answer: A. A scaphoid fracture may be radiographically occult, and its retrograde blood supply risks avascular necrosis of the proximal pole

Q2. A young man with ulcerative colitis has six months of low back pain and morning stiffness lasting an hour that improves with exercise. Radiographs show bilateral sacroiliitis. What is the diagnosis, and which HLA is associated?

• A. Rheumatoid arthritis, associated with HLA-DR4
• B. Psoriatic arthritis, associated with HLA-Cw6
• C. Ankylosing spondylitis, associated with HLA-B27
• D. Tuberculous spondylitis, with no HLA association

Answer: C. Ankylosing spondylitis, associated with HLA-B27

Q1. A heavy smoker wants to stop. Which pharmacological options have proven efficacy for cessation?

• A. Mirtazapine alone
• B. Bupropion and varenicline, either of which may be used
• C. Fluoxetine alone
• D. Clonidine as first-line monotherapy

Answer: B. Bupropion and varenicline, either of which may be used

Q2. A woman on lithium becomes pregnant. Which malformation is classically associated with first-trimester exposure?

• A. Neural tube defects
• B. Ebstein anomaly of the tricuspid valve
• C. Cleft lip and palate
• D. Renal agenesis

Answer: B. Ebstein anomaly of the tricuspid valve

Q1. If the radius of an arteriole falls to one third of its original value, by what factor does its resistance to laminar flow increase?

• A. 9 times
• B. 27 times
• C. 81 times
• D. 3 times

Answer: C. 81 times

Q2. A patient has profuse watery diarrhoea that persists during fasting, with hypokalaemia and achlorhydria. Which pancreatic neuroendocrine tumour is responsible?

• A. Insulinoma
• B. Glucagonoma
• C. Gastrinoma
• D. VIPoma

Answer: D. VIPoma

Q1. A patient has paraesthesiae in the hands and feet, an unsteady wide-based gait, pallor and impaired joint position sense. Which deficiency is this, and which tracts are affected?

• A. Vitamin B12 deficiency, affecting the dorsal columns and corticospinal tracts
• B. Thiamine deficiency, affecting the mamillary bodies
• C. Vitamin B6 deficiency, affecting peripheral nerves only
• D. Vitamin E deficiency, affecting the cerebellum alone

Answer: A. Vitamin B12 deficiency, affecting the dorsal columns and corticospinal tracts

Q2. A long-term smoker develops dysphagia from a centrally located lung tumour compressing the oesophagus. Which histological type is most likely, and which paraneoplastic syndrome is associated?

• A. Adenocarcinoma, associated with hypertrophic osteoarthropathy
• B. Small cell carcinoma, associated with SIADH
• C. Squamous cell carcinoma, associated with hypercalcaemia from PTH-related peptide
• D. Large cell carcinoma, associated with gynaecomastia

Answer: C. Squamous cell carcinoma, associated with hypercalcaemia from PTH-related peptide

Q1. What is the pattern of inheritance of neural tube defects, and what does that imply for prevention?

• A. Autosomal recessive, so carrier testing is offered
• B. X-linked dominant, so male fetuses are spared
• C. Multifactorial, so periconceptional folic acid reduces recurrence risk
• D. Autosomal dominant, so half of offspring are affected

Answer: C. Multifactorial, so periconceptional folic acid reduces recurrence risk

Q2. A toddler fed mainly on rice water has pitting oedema of the legs, a distended abdomen, an apathetic expression and hypoalbuminaemia, with weight only mildly reduced. What is the diagnosis?

• A. Marasmus
• B. Kwashiorkor
• C. Indian childhood cirrhosis
• D. Nephrotic syndrome

Answer: B. Kwashiorkor

Q1. A country's population is ageing while its birth rate falls. Which change contributes most to its rising dependency burden?

• A. A falling young-age dependency ratio
• B. A rising old-age dependency ratio
• C. A falling old-age dependency ratio
• D. A rising crude birth rate

Answer: B. A rising old-age dependency ratio

Q2. Blood is spilt on the operating theatre floor. Which agent should be used to decontaminate the spill, and why?

• A. An alcohol-based solution, because it evaporates without residue
• B. A quaternary ammonium compound, because it is non-corrosive
• C. A phenolic compound, because it is sporicidal
• D. A chlorine-releasing agent such as 1% sodium hypochlorite, because it is effective against blood-borne viruses in the presence of organic matter

Answer: D. A chlorine-releasing agent such as 1% sodium hypochlorite, because it is effective against blood-borne viruses in the presence of organic matter

Q1. A woman with newly diagnosed thyrotoxicosis is in her first trimester. Which antithyroid drug is preferred at this stage, and why?

• A. Propylthiouracil, because methimazole and carbimazole carry a risk of embryopathy in the first trimester
• B. Carbimazole, because it crosses the placenta less readily
• C. Radioactive iodine, because it is a single definitive treatment
• D. Methimazole, because it has a lower risk of hepatotoxicity

Answer: A. Propylthiouracil, because methimazole and carbimazole carry a risk of embryopathy in the first trimester

Q2. A woman is six weeks post-delivery, breastfeeding, and wants reliable contraception for about three years before conceiving again. Which method best fits?

• A. Combined oral contraceptive pills
• B. Lactational amenorrhoea alone
• C. An intrauterine device, which gives years of reversible protection and does not affect lactation
• D. Barrier methods alone

Answer: C. An intrauterine device, which gives years of reversible protection and does not affect lactation

Q1. A battery worker has abdominal colic, wrist drop and anaemia. The blood film shows coarse basophilic stippling of red cells. Which poisoning is this, and what is its mechanism?

• A. Chronic lead poisoning, inhibiting ferrochelatase and ALA dehydratase in haem synthesis
• B. Chronic arsenic poisoning, binding sulfhydryl groups
• C. Chronic mercury poisoning, causing tubular damage
• D. Chronic iron overload, causing tissue deposition

Answer: A. Chronic lead poisoning, inhibiting ferrochelatase and ALA dehydratase in haem synthesis

Q2. A man repeatedly obtains sexual gratification by inflicting pain and injury on a consenting partner. What is this paraphilia called?

• A. Voyeurism
• B. Fetishism
• C. Masochism
• D. Sadism

Answer: D. Sadism

Q1. A young woman has itchy hypopigmented scaly patches over the chest and back. KOH mounts show short curved hyphae with clusters of round yeast cells. Which organism, and why does the pigment change occur?

• A. Trichophyton rubrum, which invades the hair shaft
• B. Malassezia furfur, whose azelaic acid inhibits melanocyte tyrosinase
• C. Candida albicans, which forms pseudohyphae
• D. Microsporum canis, which fluoresces under Wood's lamp

Answer: B. Malassezia furfur, whose azelaic acid inhibits melanocyte tyrosinase

Q2. A poorly controlled diabetic presents with black necrotic tissue filling the nasal cavity and eroding the hard palate. Which fungus is responsible, and what makes diabetic ketoacidosis such a strong risk factor?

• A. Aspergillus fumigatus, which needs neutropenia to invade
• B. A Mucorales species, because acidosis frees iron from transferrin and impairs phagocyte function
• C. Candida albicans, because of mucosal overgrowth
• D. Cryptococcus neoformans, because of impaired cell-mediated immunity

Answer: B. A Mucorales species, because acidosis frees iron from transferrin and impairs phagocyte function

Q1. Which organelle contains the acid hydrolases and myeloperoxidase system that digest phagocytosed bacteria, and at what pH does it work?

• A. Peroxisome, at neutral pH
• B. Mitochondrion, at alkaline pH
• C. Lysosome, at acid pH maintained by a proton pump
• D. Golgi apparatus, at neutral pH

Answer: C. Lysosome, at acid pH maintained by a proton pump

Q2. Cholesterol synthesis begins in the cytosol from a two-carbon precursor. What is that precursor, and which enzyme catalyses the rate-limiting step?

• A. Malonyl CoA, with acetyl CoA carboxylase
• B. Oxaloacetate, with citrate synthase
• C. Propionyl CoA, with methylmalonyl mutase
• D. Acetyl CoA, with HMG-CoA reductase

Answer: D. Acetyl CoA, with HMG-CoA reductase

Q1. A patient has intermittent dysphagia and chest pain. Barium swallow shows multiple simultaneous non-propulsive tertiary contractions giving a corkscrew appearance, and the lower oesophageal sphincter relaxes normally. What is the diagnosis?

• A. Achalasia cardia
• B. Diffuse oesophageal spasm
• C. Oesophageal carcinoma
• D. Peptic stricture

Answer: B. Diffuse oesophageal spasm

Q2. Which contrast study gives the best distension and mucosal detail of the small bowel by infusing barium and methylcellulose through a naso-jejunal tube?

• A. Barium meal
• B. Barium meal follow-through
• C. Enteroclysis
• D. Barium enema

Answer: C. Enteroclysis

Q1. Which muscle, by virtue of its low oblique fibres inserting on the medial patella, is the main restraint against lateral patellar dislocation during knee flexion?

• A. Rectus femoris
• B. Gracilis
• C. Vastus lateralis
• D. Vastus medialis obliquus

Answer: D. Vastus medialis obliquus

Q1. A woman has chronic watering and mucopurulent regurgitation from the left eye with a swelling below the medial canthus. Sac syringing shows a blocked nasolacrimal duct. What is the definitive treatment?

• A. Dacryocystorhinostomy, creating a bypass between sac and nasal cavity
• B. Dacryocystectomy, removing the sac
• C. Probing of the nasolacrimal duct
• D. Topical antibiotics alone

Answer: A. Dacryocystorhinostomy, creating a bypass between sac and nasal cavity

Q2. An elderly man has sudden painless total loss of vision in one eye. Fundoscopy shows a pale oedematous retina with a cherry-red spot at the fovea. What has occurred, and why is the fovea red?

• A. Central retinal vein occlusion, with venous congestion
• B. Vitreous haemorrhage, obscuring the retina
• C. Central retinal artery occlusion, with the intact choroidal circulation showing through the thin fovea
• D. Optic neuritis, with disc swelling

Answer: C. Central retinal artery occlusion, with the intact choroidal circulation showing through the thin fovea

Q1. An elderly man immobilised after a hip fracture develops unilateral calf swelling, warmth and tenderness. What is the most likely diagnosis, and which element of Virchow's triad predominates?

• A. Deep vein thrombosis, with venous stasis predominating
• B. Compartment syndrome, with raised fascial pressure
• C. Cellulitis, with bacterial entry through skin
• D. Arterial occlusion, with embolic obstruction

Answer: A. Deep vein thrombosis, with venous stasis predominating

Q2. A 23-year-old woman has a firm, smooth, freely mobile 2 cm breast lump. Imaging and core biopsy confirm a fibroadenoma. What is the appropriate management?

• A. Immediate wide local excision
• B. Reassurance with follow-up, since excision is only needed for growth, symptoms or patient preference
• C. Start tamoxifen
• D. Mastectomy with sentinel node biopsy

Answer: B. Reassurance with follow-up, since excision is only needed for growth, symptoms or patient preference

Q1. Histology of a scaly plaque shows parakeratosis, elongated rete ridges, thinning of the suprapapillary plate and collections of neutrophils within the stratum corneum. What are those neutrophil collections called, and what is the diagnosis?

• A. Civatte bodies, in lichen planus
• B. Munro microabscesses, in psoriasis
• C. Pautrier microabscesses, in mycosis fungoides
• D. Kamino bodies, in Spitz naevus

Answer: B. Munro microabscesses, in psoriasis

Q2. An institutionalised child with intellectual disability has thick warty crusts on the hands, feet and trunk with intense scaling, and several contacts have developed itch. Which variant of scabies is this, and why is it so infectious?

• A. Nodular scabies, with a hypersensitivity reaction
• B. Animal scabies, which is self-limiting
• C. Crusted (Norwegian) scabies, because the crusts carry an enormous mite burden
• D. Scabies incognito, masked by topical steroid

Answer: C. Crusted (Norwegian) scabies, because the crusts carry an enormous mite burden

Q1. A fixed-performance oxygen mask draws in a constant proportion of room air as oxygen passes through a narrow jet. Which physical principle governs this entrainment?

• A. The Bohr effect
• B. Boyle's law
• C. The Bernoulli principle, where a fast jet creates a fall in lateral pressure
• D. Dalton's law of partial pressures

Answer: C. The Bernoulli principle, where a fast jet creates a fall in lateral pressure

Q2. Immediately after a right subclavian vein cannulation attempt the patient desaturates, and the right upper chest is hyperresonant with reduced breath sounds. What has happened, and what is the immediate action?

• A. Arterial puncture, needing direct pressure
• B. Cardiac tamponade, needing pericardiocentesis
• C. Chylothorax, needing conservative management
• D. Pneumothorax, needing urgent decompression and a chest drain

Answer: D. Pneumothorax, needing urgent decompression and a chest drain

Q1. An unimmunised 6-year-old has fever, sore throat, a grey membrane over the tonsils that bleeds when peeled, and marked cervical swelling. Which organism, and what causes the systemic complications?

• A. Epstein-Barr virus, through lymphoproliferation
• B. Corynebacterium diphtheriae, through an exotoxin inhibiting elongation factor 2
• C. Streptococcus pyogenes, through superantigen release
• D. Candida albicans, through mucosal invasion

Answer: B. Corynebacterium diphtheriae, through an exotoxin inhibiting elongation factor 2

Q2. A patient with a dead ear from labyrinthitis is tested with a tuning fork on the affected side. Bone conduction appears better than air conduction. Why is this result misleading?

• A. It is a true negative Rinne, confirming conductive loss
• B. It is a false negative Rinne, because the sound is being heard by the opposite functioning cochlea through the skull
• C. It is a false positive Rinne, from tuning fork placement error
• D. It is a true positive Rinne, confirming normal hearing

Answer: B. It is a false negative Rinne, because the sound is being heard by the opposite functioning cochlea through the skull

Q1. An obese diabetic woman on oral agents is admitted with symptomatic hypoglycaemia. Which class is most likely responsible, and why?

• A. Metformin, which suppresses hepatic gluconeogenesis
• B. A thiazolidinedione, which improves insulin sensitivity
• C. A DPP-4 inhibitor, which prolongs incretin action
• D. A sulfonylurea, which stimulates insulin release regardless of the blood glucose

Answer: D. A sulfonylurea, which stimulates insulin release regardless of the blood glucose

Q2. Which antihypertensive is regarded as the safest first-line choice in pregnancy-induced hypertension, and which classes are absolutely contraindicated?

• A. Methyldopa is safe; ACE inhibitors and ARBs are contraindicated because of fetal renal damage
• B. Lisinopril is safe; beta-blockers are contraindicated
• C. Losartan is safe; calcium channel blockers are contraindicated
• D. Atenolol is safe; all other classes are contraindicated

Answer: A. Methyldopa is safe; ACE inhibitors and ARBs are contraindicated because of fetal renal damage

Q1. A posterior hip dislocation is reduced. Which nerve must be examined before and after reduction, and what deficit would it produce?

• A. The femoral nerve, causing loss of knee extension
• B. The obturator nerve, causing loss of hip adduction
• C. The sciatic nerve, causing foot drop and loss of sensation below the knee laterally
• D. The superior gluteal nerve, causing a Trendelenburg gait

Answer: C. The sciatic nerve, causing foot drop and loss of sensation below the knee laterally

Q2. A 9-year-old has six months of gradually worsening hip pain and a limp, with limited abduction and internal rotation, but is otherwise well with normal growth. Radiographs show a small, sclerotic, fragmented femoral capital epiphysis. What is the diagnosis?

• A. Developmental dysplasia of the hip
• B. Slipped capital femoral epiphysis
• C. Septic arthritis of the hip
• D. Legg-Calve-Perthes disease

Answer: D. Legg-Calve-Perthes disease

Q1. Three days after his last drink, a man with alcohol dependence becomes disoriented and agitated, with coarse tremor, autonomic overactivity and vivid visual hallucinations of insects. What is this, and what is the treatment of choice?

• A. Delirium tremens, treated with a long-acting benzodiazepine and thiamine
• B. Wernicke encephalopathy, treated with glucose
• C. Korsakoff psychosis, treated with antipsychotics
• D. Alcoholic hallucinosis, treated with reassurance

Answer: A. Delirium tremens, treated with a long-acting benzodiazepine and thiamine

Q2. A man of 43 is convinced, without any evidence, that his daughter intends to kill him. He is otherwise lucid, well-kempt, employed and has no hallucinations or thought disorder. What is the diagnosis?

• A. Paranoid schizophrenia
• B. Delusional disorder
• C. Delirium
• D. Obsessive-compulsive disorder

Answer: B. Delusional disorder

Q1. After resection of the terminal ileum, which substance is most likely to become deficient, and why can body stores delay the deficiency for years?

• A. Folate, because the jejunum also absorbs it
• B. Iron, because the duodenum compensates
• C. Vitamin B12, because it is absorbed only in the terminal ileum and hepatic stores last several years
• D. Calcium, because vitamin D compensates

Answer: C. Vitamin B12, because it is absorbed only in the terminal ileum and hepatic stores last several years

Q2. Which change shifts the oxygen-haemoglobin dissociation curve to the left, and what is the functional consequence?

• A. A rise in 2,3-BPG, releasing more oxygen to tissues
• B. A fall in pH, releasing more oxygen to tissues
• C. A rise in temperature, releasing more oxygen to tissues
• D. Alkalosis, so haemoglobin binds oxygen more tightly and releases less to tissues

Answer: D. Alkalosis, so haemoglobin binds oxygen more tightly and releases less to tissues

Q1. A patient with sudden pleuritic chest pain and dyspnoea has a raised D-dimer and is haemodynamically stable. Which investigation confirms pulmonary embolism?

• A. Doppler echocardiography
• B. CT pulmonary angiography
• C. Ventilation-perfusion scanning in all patients
• D. Chest radiography

Answer: B. CT pulmonary angiography

Q2. A young man develops an asymmetrical large-joint arthritis, sterile urethritis and conjunctivitis about three weeks after an episode of dysentery. What is the diagnosis, and which HLA is associated?

• A. Rheumatoid arthritis, with HLA-DR4
• B. Reactive arthritis, with HLA-B27
• C. Gonococcal arthritis, with no HLA association
• D. Psoriatic arthritis, with HLA-Cw6

Answer: B. Reactive arthritis, with HLA-B27

Q1. Maternal antibody crosses the placenta and coats fetal red cells, which are then destroyed by splenic macrophages. Which type of hypersensitivity is haemolytic disease of the newborn?

• A. Type I, IgE-mediated
• B. Type II, antibody-mediated cytotoxicity
• C. Type III, immune complex mediated
• D. Type IV, cell mediated

Answer: B. Type II, antibody-mediated cytotoxicity

Q2. Why is intramuscular vitamin K given to every newborn, and what does it prevent?

• A. Gut flora are not yet established and placental transfer is poor, so clotting factors II, VII, IX and X are low, risking haemorrhagic disease of the newborn
• B. Hepatic immaturity causes unconjugated hyperbilirubinaemia, risking kernicterus
• C. Breast milk lacks vitamin C, risking scurvy
• D. Vitamin A stores are low, risking keratomalacia

Answer: A. Gut flora are not yet established and placental transfer is poor, so clotting factors II, VII, IX and X are low, risking haemorrhagic disease of the newborn

Q1. A patient from a north-eastern state has uncomplicated Plasmodium falciparum malaria. Under the national programme, what is the recommended treatment?

• A. Chloroquine for three days
• B. Artemisinin-based combination therapy, with primaquine as a single dose
• C. Sulfadoxine-pyrimethamine alone
• D. Mefloquine alone

Answer: B. Artemisinin-based combination therapy, with primaquine as a single dose

Q2. How is the maternal mortality ratio defined, and why is it expressed against live births rather than population?

• A. Maternal deaths per 1000 population, to allow comparison between districts
• B. Maternal deaths per 1000 live births, matching the infant mortality rate
• C. Maternal deaths per 100,000 live births, because live births approximate the population at risk of pregnancy
• D. Deaths of women of reproductive age per 100,000 population

Answer: C. Maternal deaths per 100,000 live births, because live births approximate the population at risk of pregnancy

Q1. Which combination of findings fulfils the Amsel criteria for bacterial vaginosis?

• A. Curdy white discharge, pH below 4.5, budding yeasts and pruritus
• B. Frothy green discharge, pH above 5, motile flagellates and a punctate cervix
• C. Mucopurulent cervical discharge, normal pH, intracellular diplococci and contact bleeding
• D. Thin homogeneous discharge, pH above 4.5, a positive amine test and clue cells on microscopy

Answer: D. Thin homogeneous discharge, pH above 4.5, a positive amine test and clue cells on microscopy

Q2. Which statement about vasectomy is INCORRECT?

• A. It is performed under local anaesthesia
• B. The no-scalpel technique is widely used
• C. The vas deferens is the structure divided
• D. Sterility is immediate, so no additional contraception is required

Answer: D. Sterility is immediate, so no additional contraception is required

Q1. A man with alcohol dependence stops drinking. Which withdrawal feature appears latest, and at roughly what interval?

• A. Coarse tremor and sweating, within 6 to 12 hours
• B. Generalised seizures, within 12 to 48 hours
• C. Delirium tremens, typically after 48 to 96 hours
• D. Transient hallucinations with clear sensorium, within 12 to 24 hours

Answer: C. Delirium tremens, typically after 48 to 96 hours

Q2. A physician refers patients for imaging and receives a share of the radiologist's fee in return. What is this practice called, and why is it professional misconduct?

• A. Dichotomy, or fee-splitting, because it lets financial gain rather than clinical need drive referral
• B. Covering, because an unqualified person is being assisted
• C. Adultery, because a professional relationship is abused
• D. Euthanasia, because patient autonomy is overridden

Answer: A. Dichotomy, or fee-splitting, because it lets financial gain rather than clinical need drive referral

Q1. Which tarsal bone lies between the head of the talus and the three cuneiforms, on the medial side of the foot?

• A. Calcaneus
• B. Cuboid
• C. Lateral cuneiform
• D. Navicular

Answer: D. Navicular

Q2. Which basal ganglia structure is formed by the putamen and globus pallidus together, and lies lateral to the internal capsule?

• A. Caudate nucleus
• B. Lentiform nucleus
• C. Claustrum
• D. Subthalamic nucleus

Answer: B. Lentiform nucleus

Q1. Which intravenous induction agent is preferred for day-case surgery, and what property makes it so?

• A. Thiopentone, because of its rapid redistribution
• B. Etomidate, because of cardiovascular stability
• C. Ketamine, because it preserves airway reflexes
• D. Propofol, because rapid clearance gives a clear-headed recovery with antiemetic effect

Answer: D. Propofol, because rapid clearance gives a clear-headed recovery with antiemetic effect

Q2. A patient emerging from anaesthesia is agitated, with vivid unpleasant dreams and hallucinations. Which agent is responsible, and how is the reaction reduced?

• A. Propofol, reduced by slower injection
• B. Etomidate, reduced by premedication with steroid
• C. Ketamine, reduced by co-administration of a benzodiazepine
• D. Thiopentone, reduced by using a lower dose

Answer: C. Ketamine, reduced by co-administration of a benzodiazepine

Q1. A cell is disrupted and its contents separated by differential centrifugation. In which fraction will lactate dehydrogenase be found, and why?

• A. The mitochondrial fraction, because it feeds the electron transport chain
• B. The lysosomal fraction, because it is an acid hydrolase
• C. The nuclear fraction, because it binds chromatin
• D. The cytosolic fraction, because it catalyses the final step of glycolysis

Answer: D. The cytosolic fraction, because it catalyses the final step of glycolysis

Q2. A man on haemodialysis for fifteen years develops carpal tunnel syndrome and shoulder pain from amyloid deposits. Which protein forms the fibrils, and why does it accumulate?

• A. AL amyloid, from monoclonal light chains
• B. AA amyloid, from chronic inflammation
• C. Transthyretin, from an inherited mutation
• D. Beta-2 microglobulin, because it is not cleared by conventional dialysis membranes

Answer: D. Beta-2 microglobulin, because it is not cleared by conventional dialysis membranes

Q1. A man develops a well-defined dusky red plaque on the same patch of forearm skin each time he takes an NSAID, healing with pigmentation. What is this reaction called, and what is the mechanism?

• A. Fixed drug eruption, from memory T cells resident in that patch of skin
• B. Urticaria, from IgE-mediated mast cell degranulation
• C. Erythema multiforme, from immune complex deposition
• D. Post-inflammatory hyperpigmentation, from melanin incontinence alone

Answer: A. Fixed drug eruption, from memory T cells resident in that patch of skin

Q2. Which nail change is regarded as most specific for psoriasis, produced by parakeratosis of the nail bed showing through the plate?

• A. Nail pitting
• B. Onycholysis
• C. The salmon patch or oil-drop sign
• D. Beau's lines

Answer: C. The salmon patch or oil-drop sign

Q1. Which property of brainstem evoked response audiometry makes it suitable for testing an uncooperative or sedated patient?

• A. It is subjective and needs the patient to signal
• B. It is invasive, requiring a transtympanic electrode
• C. It measures middle-ear compliance only
• D. It is objective, requiring no voluntary response, and estimates sensorineural threshold

Answer: D. It is objective, requiring no voluntary response, and estimates sensorineural threshold

Q2. A woman has nasal obstruction despite an abnormally roomy nasal cavity, anosmia, and foul greenish crusts, with atrophic turbinates. What is the condition, and which surgical option narrows the airway?

• A. Atrophic rhinitis, treated with Young's operation to close the nostril
• B. Deviated nasal septum, treated with septoplasty
• C. Vasomotor rhinitis, treated with vidian neurectomy
• D. Nasal polyposis, treated with polypectomy

Answer: A. Atrophic rhinitis, treated with Young's operation to close the nostril

Q1. Barberio's test is applied to a stain and yields yellow rhombic crystals. What does this confirm, and is it presumptive or confirmatory?

• A. Blood, presumptive only
• B. Semen, confirmatory for spermine
• C. Saliva, confirmatory for amylase
• D. Urine, presumptive for urea

Answer: B. Semen, confirmatory for spermine

Q2. A woman falsely claims to have been pregnant and later produces another woman's infant as her own, to gain from a man. What is such a child legally termed?

• A. A posthumous child
• B. A child of superfetation
• C. A child of superfecundation
• D. A supposititious child

Answer: D. A supposititious child

Q1. A woman at 9 weeks has light vaginal bleeding and mild cramps. The cervical os is closed, the uterus is of appropriate size, and ultrasound shows a live intrauterine fetus. What is the diagnosis and the management?

• A. Inevitable abortion, requiring evacuation
• B. Threatened abortion, managed expectantly with reassurance
• C. Incomplete abortion, requiring curettage
• D. Missed abortion, requiring medical evacuation

Answer: B. Threatened abortion, managed expectantly with reassurance

Q2. A woman develops secondary amenorrhoea after a vigorous curettage for retained products. Pregnancy test is negative and hysterosalpingography shows multiple filling defects in the cavity. What has occurred?

• A. Sheehan syndrome, from pituitary infarction
• B. Kallmann syndrome, from GnRH deficiency
• C. Polycystic ovary syndrome, from anovulation
• D. Asherman syndrome, from intrauterine adhesions after endometrial trauma

Answer: D. Asherman syndrome, from intrauterine adhesions after endometrial trauma

Q1. A woman has tight shiny skin extending above the elbows, Raynaud phenomenon, reflux, interstitial lung disease and anti-topoisomerase I antibodies. Which subtype is this, and which complication most threatens life?

• A. Limited cutaneous systemic sclerosis, threatened by pulmonary hypertension
• B. Dermatomyositis, threatened by malignancy
• C. Diffuse cutaneous systemic sclerosis, threatened by scleroderma renal crisis and lung fibrosis
• D. Mixed connective tissue disease, threatened by myositis

Answer: C. Diffuse cutaneous systemic sclerosis, threatened by scleroderma renal crisis and lung fibrosis

Q2. A woman with essential thrombocythaemia and a JAK2 mutation asks why she is at risk despite a normal haemoglobin. What is the principal hazard, and what is the usual first-line treatment for a low-risk patient?

• A. Bleeding only, treated with tranexamic acid
• B. Marrow failure, treated with transfusion
• C. Leukaemic transformation, treated with chemotherapy
• D. Thrombosis and, less often, bleeding, treated with low-dose aspirin

Answer: D. Thrombosis and, less often, bleeding, treated with low-dose aspirin

Q1. A child has profuse painless watery stools described as rice-water, with rapid dehydration and no fever. Which organism, and what is the mechanism of the diarrhoea?

• A. Vibrio cholerae, whose toxin raises cyclic AMP and drives chloride secretion
• B. Shigella dysenteriae, which invades colonic mucosa
• C. Entamoeba histolytica, which causes flask-shaped ulcers
• D. Enterohaemorrhagic E. coli, which causes haemolytic uraemic syndrome

Answer: A. Vibrio cholerae, whose toxin raises cyclic AMP and drives chloride secretion

Q2. Which mosquito transmits Zika, dengue and chikungunya, and what feature of its behaviour makes control difficult?

• A. Anopheles species, which bite at night
• B. Culex quinquefasciatus, which breeds in dirty water
• C. Aedes aegypti and Aedes albopictus, which bite by day and breed in small clean domestic water collections
• D. Mansonia species, which attach to aquatic plants

Answer: C. Aedes aegypti and Aedes albopictus, which bite by day and breed in small clean domestic water collections

Q1. Which spinal orthosis provides three-point fixation to limit flexion of the thoracolumbar spine and is used after a stable compression fracture?

• A. Milwaukee brace
• B. Boston brace
• C. Halo vest
• D. Taylor brace

Answer: D. Taylor brace

Q2. After a road accident a man's leg lies in flexion, abduction and external rotation, and appears lengthened. Which injury is this, and how does its posture differ from the commoner variety?

• A. Anterior hip dislocation, whereas the commoner posterior dislocation lies flexed, adducted and internally rotated with shortening
• B. Posterior hip dislocation, whereas anterior dislocation is shortened
• C. Intertrochanteric fracture, which shortens and externally rotates
• D. Femoral neck fracture, which shortens and internally rotates

Answer: A. Anterior hip dislocation, whereas the commoner posterior dislocation lies flexed, adducted and internally rotated with shortening

Q1. A young man has recurrent unilateral acute anterior uveitis. Which HLA allele is associated, and which systemic diseases should be sought?

• A. HLA-B51, with Behcet disease
• B. HLA-B27, with ankylosing spondylitis, reactive arthritis and inflammatory bowel disease
• C. HLA-DR3, with Sjogren syndrome
• D. HLA-A29, with birdshot retinochoroidopathy

Answer: B. HLA-B27, with ankylosing spondylitis, reactive arthritis and inflammatory bowel disease

Q2. A patient has ptosis, a constricted pupil that fails to dilate in the dark, and reduced sweating on the same side of the face. Which pathway is interrupted, and which muscle causes the ptosis?

• A. The parasympathetic supply, with levator palpebrae weakness
• B. The oculomotor nerve, with levator palpebrae weakness
• C. The facial nerve, with orbicularis oculi weakness
• D. The sympathetic pathway, with weakness of the superior tarsal muscle of Muller

Answer: D. The sympathetic pathway, with weakness of the superior tarsal muscle of Muller

Q1. Anaphylaxis after eating shellfish is a type I hypersensitivity reaction. Which mediator accounts for the immediate phase within minutes, and which for the late phase hours afterwards?

• A. Complement C3a immediately, and antibody later
• B. Preformed histamine immediately, and newly synthesised leukotrienes and cytokines later
• C. Interferon gamma immediately, and histamine later
• D. Immune complexes immediately, and neutrophils later

Answer: B. Preformed histamine immediately, and newly synthesised leukotrienes and cytokines later

Q2. Which neurodegenerative disease is characterised by intraneuronal neurofibrillary tangles of hyperphosphorylated tau together with extracellular amyloid beta plaques?

• A. Huntington disease
• B. Amyotrophic lateral sclerosis
• C. Alzheimer disease
• D. Parkinson disease

Answer: C. Alzheimer disease

Q1. A 30 kg child is kept nil by mouth before surgery. Using the Holliday-Segar method, what is the daily maintenance fluid requirement?

• A. 1000 mL
• B. 1700 mL
• C. 2500 mL
• D. 3000 mL

Answer: B. 1700 mL

Q2. A child has had repeated fractures with minimal trauma over two years, blue sclerae, abnormal dentition and a similarly affected parent. Which protein is defective?

• A. Type II collagen
• B. Fibrillin-1
• C. Type I collagen
• D. Dystrophin

Answer: C. Type I collagen

Q1. A boy of normal intelligence reads and writes at age level but cannot master arithmetic despite a year of individual tuition. Under DSM-5, how is this classified?

• A. Attention deficit hyperactivity disorder
• B. Intellectual disability, mild
• C. Specific learning disorder with impairment in mathematics
• D. Autism spectrum disorder

Answer: C. Specific learning disorder with impairment in mathematics

Q2. Seven hours after surgery a man with a history of regular drinking hears threatening voices but is fully oriented with stable observations and no tremor. What is the diagnosis, and what distinguishes it from delirium tremens?

• A. Delirium tremens, distinguished by the hallucinations
• B. Acute transient psychotic disorder, distinguished by the surgery
• C. Alcoholic hallucinosis, distinguished by a clear sensorium and intact orientation
• D. Post-operative delirium, distinguished by the timing

Answer: C. Alcoholic hallucinosis, distinguished by a clear sensorium and intact orientation

Q1. In a dehydrated adult, which nephron segment reabsorbs the largest absolute volume of filtered water, and is that reabsorption regulated by ADH?

• A. The proximal convoluted tubule, reabsorbing about two thirds isosmotically and independently of ADH
• B. The thin descending limb, under ADH control
• C. The distal convoluted tubule, under ADH control
• D. The collecting duct, which reabsorbs the largest volume

Answer: A. The proximal convoluted tubule, reabsorbing about two thirds isosmotically and independently of ADH

Q2. On the left ventricular pressure-volume loop, which event marks the end of isovolumetric contraction and the start of ejection?

• A. Closure of the mitral valve
• B. Opening of the aortic valve
• C. Closure of the aortic valve
• D. Opening of the mitral valve

Answer: B. Opening of the aortic valve

Q1. An obese adolescent has hip and referred knee pain with limited internal rotation, and the hip rolls into external rotation when flexed. Radiographs show the femoral head slipping posteroinferiorly relative to the neck. What is the diagnosis?

• A. Slipped capital femoral epiphysis
• B. Legg-Calve-Perthes disease
• C. Developmental dysplasia of the hip
• D. Transient synovitis

Answer: A. Slipped capital femoral epiphysis

Q2. A young man has right flank pain, fever and pain on passive extension of the right hip, with leukocytosis. CT shows a rim-enhancing collection within the right psoas muscle. What is the diagnosis, and which sign was elicited?

• A. Acute appendicitis, with Rovsing sign
• B. Psoas abscess, with a positive psoas stretch sign
• C. Acute pyelonephritis, with renal angle tenderness
• D. Testicular torsion, with an absent cremasteric reflex

Answer: B. Psoas abscess, with a positive psoas stretch sign

Q1. Screening detects a disease earlier than it would otherwise have been diagnosed. What is the interval between screen detection and the usual clinical diagnosis called, and what bias does it create?

• A. Generation time, creating selection bias
• B. Incubation period, creating information bias
• C. Lead time, creating an apparent gain in survival even if death is not postponed
• D. Latent period, creating recall bias

Answer: C. Lead time, creating an apparent gain in survival even if death is not postponed

Q2. In rural India, how large a population does one accredited social health activist normally serve?

• A. About 500
• B. About 1000
• C. About 3000
• D. About 5000

Answer: B. About 1000

Q1. An elderly man has low back pain, weight loss and obstructive urinary symptoms. Radiographs show sclerotic vertebral lesions. Which malignancy is most likely, and why are the metastases sclerotic rather than lytic?

• A. Renal cell carcinoma, which is typically lytic
• B. Bladder carcinoma, spreading directly
• C. Multiple myeloma, which is purely lytic
• D. Prostatic carcinoma, whose metastases stimulate osteoblastic bone formation

Answer: D. Prostatic carcinoma, whose metastases stimulate osteoblastic bone formation

Q2. A man with long-standing varicose veins has a healed ulcer above the medial malleolus, with surrounding pigmentation and induration. Which type of ulcer, and what is the underlying mechanism?

• A. Arterial ulcer, from large-vessel occlusion
• B. Venous ulcer, from sustained ambulatory venous hypertension
• C. Neuropathic ulcer, from loss of protective sensation
• D. Tuberculous ulcer, from direct inoculation

Answer: B. Venous ulcer, from sustained ambulatory venous hypertension

Q1. A 4-year-old has generalised oedema, heavy proteinuria and hypoalbuminaemia, with no haematuria or hypertension. What is the likely histology, and the first-line treatment?

• A. Minimal change disease, treated with oral corticosteroids
• B. Focal segmental glomerulosclerosis, treated with cyclosporine
• C. Membranous nephropathy, treated with cyclophosphamide
• D. Post-streptococcal glomerulonephritis, treated with penicillin

Answer: A. Minimal change disease, treated with oral corticosteroids

Q2. An elderly man with benign prostatic enlargement becomes dizzy and hypotensive on a non-selective alpha-blocker. Which agent should replace it, and why?

• A. Doxazosin, because it is longer acting
• B. Terazosin, because it is better tolerated
• C. Tamsulosin, because it is relatively selective for alpha-1A receptors in prostatic smooth muscle
• D. Prazosin, because it has a shorter half-life

Answer: C. Tamsulosin, because it is relatively selective for alpha-1A receptors in prostatic smooth muscle

Q1. The deep inguinal ring is an opening in which layer of the abdominal wall, and what lies immediately medial to it?

• A. External oblique aponeurosis, with the conjoint tendon medially
• B. Internal oblique aponeurosis, with the rectus sheath medially
• C. Fascia transversalis, with the inferior epigastric vessels medially
• D. Peritoneum, with the median umbilical fold medially

Answer: C. Fascia transversalis, with the inferior epigastric vessels medially

Q2. A boy has a mid-shaft humeral fracture with weak wrist extension and numbness over the dorsal first web space. Which nerve is injured, and where does it lie?

• A. Axillary nerve, at the surgical neck
• B. Ulnar nerve, in the cubital tunnel
• C. Median nerve, in the antecubital fossa
• D. Radial nerve, in the spiral groove of the humerus

Answer: D. Radial nerve, in the spiral groove of the humerus

Q1. Which intravenous induction agent must be avoided in acute intermittent porphyria, and why?

• A. Propofol, because it inhibits haem synthesis
• B. Ketamine, because it raises porphyrin excretion
• C. Thiopentone, because barbiturates induce ALA synthase and precipitate an attack
• D. Etomidate, because it suppresses adrenal steroidogenesis

Answer: C. Thiopentone, because barbiturates induce ALA synthase and precipitate an attack

Q2. Why is laparoscopic surgery hazardous in a patient with severe cardiac disease?

• A. Carbon dioxide is absorbed, causing a respiratory alkalosis
• B. Pneumoperitoneum raises intra-abdominal pressure, reducing venous return while systemic vascular resistance rises
• C. Reverse Trendelenburg increases preload excessively
• D. The absence of a laparotomy wound prevents adequate analgesia

Answer: B. Pneumoperitoneum raises intra-abdominal pressure, reducing venous return while systemic vascular resistance rises

Q1. Which of the following enzymes does NOT contain copper at its active site?

• A. Manganese superoxide dismutase
• B. Tyrosinase
• C. Lysyl oxidase
• D. Cytochrome c oxidase

Answer: A. Manganese superoxide dismutase

Q2. Nitric oxide is generated by nitric oxide synthase. Which amino acid is the substrate, and what is the co-product?

• A. Glycine, producing serine
• B. Lysine, producing carnitine
• C. Arginine, producing citrulline
• D. Methionine, producing homocysteine

Answer: C. Arginine, producing citrulline

Q1. A man has a sharply demarcated, raised, painful erythematous plaque on the shin with fever and a clear border against normal skin. Which organism, and which layer of skin is involved?

• A. Staphylococcus aureus, involving the deep dermis and fat
• B. Streptococcus pyogenes, involving the upper dermis and superficial lymphatics
• C. Haemophilus influenzae type b, involving subcutaneous tissue
• D. Clostridium perfringens, involving fascia and muscle

Answer: B. Streptococcus pyogenes, involving the upper dermis and superficial lymphatics

Q2. Which specimen and test confirm SARS-CoV-2 infection in a symptomatic patient, and why is that method chosen?

• A. Serum antibody testing, because it detects recent infection
• B. Chest CT alone, because the pattern is specific
• C. A nasopharyngeal swab tested by reverse transcription PCR, because it detects viral RNA directly
• D. Blood culture, because viraemia is constant

Answer: C. A nasopharyngeal swab tested by reverse transcription PCR, because it detects viral RNA directly

Q3. An outbreak of unknown cause requires simultaneous testing for several candidate pathogens from one sample. Which PCR format is designed for this?

• A. Multiplex PCR, using several primer pairs in one reaction
• B. Nested PCR, using two sequential primer pairs
• C. Real-time PCR, quantifying a single target
• D. Reverse transcription PCR, converting RNA to cDNA

Answer: A. Multiplex PCR, using several primer pairs in one reaction

Q1. Removing the scale from a psoriatic plaque produces pinpoint bleeding. Which histological features explain this?

• A. Subepidermal blistering with eosinophils
• B. Acantholysis within the epidermis
• C. Dermal mucin deposition
• D. Thinned suprapapillary plates over dilated, tortuous dermal papillary capillaries

Answer: D. Thinned suprapapillary plates over dilated, tortuous dermal papillary capillaries

Q1. A young man has a displaced nasal bone fracture with obvious deformity and marked swelling. When should reduction be performed, and why?

• A. Within the first 12 hours, before any swelling develops
• B. At 5 to 10 days, once swelling settles but before the bones unite
• C. At 3 weeks, once callus is forming
• D. At 6 weeks, as a formal rhinoplasty

Answer: B. At 5 to 10 days, once swelling settles but before the bones unite

Q1. A dying declaration is admissible in Indian courts even though the declarant can never be cross-examined. What is the reasoning behind that exception?

• A. It must always be recorded by a magistrate, which guarantees accuracy
• B. A person who believes death is imminent is presumed to have no motive to lie
• C. Medical certification of the injuries substitutes for cross-examination
• D. The signature of an independent witness makes it self-proving

Answer: B. A person who believes death is imminent is presumed to have no motive to lie

Q2. A neck wound has clean-cut edges but the underlying tissues are crushed and a cervical vertebra is divided. Which weapon class produced it?

• A. A light sharp-edged weapon, producing an incised wound
• B. A blunt weapon, producing a laceration
• C. A pointed weapon, producing a stab wound
• D. A heavy sharp-edged weapon, producing a chop wound

Answer: D. A heavy sharp-edged weapon, producing a chop wound

Q1. A woman with eclampsia is on magnesium sulphate. Which finding means the next dose must be withheld?

• A. Absent patellar reflexes
• B. Sluggish but present patellar reflexes
• C. A respiratory rate of 16 per minute
• D. A urine output of 40 ml per hour

Answer: A. Absent patellar reflexes

Q2. A 16-year-old has primary amenorrhoea with normal breast and pubic hair development, and ultrasound shows no uterus. What is the next investigation, and what is it distinguishing?

• A. Serum prolactin, to exclude a pituitary adenoma
• B. Karyotype with serum testosterone, to distinguish Mullerian agenesis from androgen insensitivity
• C. LH and FSH, to confirm ovarian failure
• D. Hysterosalpingography, to assess the cavity

Answer: B. Karyotype with serum testosterone, to distinguish Mullerian agenesis from androgen insensitivity

Q1. A patient with infective endocarditis has tender raised nodules on the finger pulps and separate painless flat macules on the palms and soles. What are these two lesions, and how do their mechanisms differ?

• A. Both are septic emboli and both are tender
• B. Osler nodes are septic emboli; Janeway lesions are immune complexes
• C. Osler nodes are tender and immune-complex mediated; Janeway lesions are painless septic emboli
• D. Both are immune complex deposits and both are painless

Answer: C. Osler nodes are tender and immune-complex mediated; Janeway lesions are painless septic emboli

Q2. A man has episodic headache, palpitations and drenching sweats with paroxysmal hypertension, and raised 24-hour urinary metanephrines. What is the diagnosis, and which drug must be started first?

• A. Phaeochromocytoma, starting alpha blockade before any beta blocker to avoid unopposed alpha stimulation
• B. Essential hypertension, starting a thiazide
• C. Renal artery stenosis, starting an ACE inhibitor
• D. Thyrotoxicosis, starting carbimazole

Answer: A. Phaeochromocytoma, starting alpha blockade before any beta blocker to avoid unopposed alpha stimulation

Q1. A man in a plaster cast for a tibial fracture has escalating pain worsened by passive stretch of the toes, with tense swelling. What is the diagnosis, and what is the definitive treatment?

• A. Deep vein thrombosis, treated with anticoagulation
• B. Compartment syndrome, treated by urgent fasciotomy
• C. Cast pressure sore, treated by windowing the cast
• D. Arterial injury, treated by embolectomy

Answer: B. Compartment syndrome, treated by urgent fasciotomy

Q2. A child with chronic osteomyelitis passes a fragment of dead bone through a discharging sinus. What is this fragment called, and what is the sleeve of new bone around it called?

• A. Involucrum, surrounded by a sequestrum
• B. A cloaca, surrounded by periosteum
• C. A Brodie abscess, surrounded by sclerosis
• D. A sequestrum, surrounded by an involucrum

Answer: D. A sequestrum, surrounded by an involucrum

Q1. A squash ball strikes the eye and blood collects in the anterior chamber. Which vessels usually bleed?

• A. The major arterial circle of the iris at the ciliary body
• B. The central retinal artery
• C. The short posterior ciliary arteries
• D. The episcleral venous plexus

Answer: A. The major arterial circle of the iris at the ciliary body

Q2. A man with Bell's palsy cannot close one eye and has punctate corneal erosions from exposure. What is the correct order of management?

• A. Immediate permanent tarsorrhaphy in all cases
• B. Topical steroids, then corneal grafting
• C. Intensive lubricants and taping at night, escalating to a bandage contact lens or temporary tarsorrhaphy if the cornea deteriorates
• D. Refractive surgery to reduce corneal exposure

Answer: C. Intensive lubricants and taping at night, escalating to a bandage contact lens or temporary tarsorrhaphy if the cornea deteriorates

Q1. Which enzyme allows cancer cells to divide indefinitely, and how?

• A. Telomerase, by rebuilding the telomeric repeats lost at each division
• B. Topoisomerase, by relieving supercoiling
• C. Helicase, by unwinding the double helix
• D. RNA polymerase, by increasing transcription

Answer: A. Telomerase, by rebuilding the telomeric repeats lost at each division

Q2. A thyroid biopsy shows overlapping cells with optically clear nuclei, nuclear grooves and intranuclear inclusions, with psammoma bodies. What is the diagnosis, and how does it usually spread?

• A. Follicular carcinoma, spreading haematogenously
• B. Papillary carcinoma, spreading by lymphatics to cervical nodes
• C. Medullary carcinoma, arising from parafollicular C cells
• D. Anaplastic carcinoma, spreading by direct invasion

Answer: B. Papillary carcinoma, spreading by lymphatics to cervical nodes

Q1. A child is convulsing at home and no intravenous access is available. Which route and drug should be used first?

• A. Buccal midazolam or rectal diazepam, since both are absorbed without venous access
• B. Intramuscular phenytoin, which is reliably absorbed
• C. Oral sodium valproate
• D. Wait for intravenous access before giving anything

Answer: A. Buccal midazolam or rectal diazepam, since both are absorbed without venous access

Q2. A child with immune thrombocytopenia has a platelet count of 40 x 10^9/L, scattered petechiae and occasional mild epistaxis, but no mucosal or serious bleeding. What is the appropriate management?

• A. Immediate intravenous immunoglobulin
• B. A course of high-dose corticosteroids
• C. Anti-D immunoglobulin
• D. Observation with education and safety advice, since treatment is guided by bleeding rather than the count

Answer: D. Observation with education and safety advice, since treatment is guided by bleeding rather than the count

Q1. A patient with alcohol dependence is admitted for elective surgery. Which regimen best prevents withdrawal complications?

• A. Symptom-triggered benzodiazepine using a withdrawal scale, with parenteral thiamine given before any glucose load
• B. Haloperidol alone, to control agitation
• C. Intravenous glucose first, to correct hypoglycaemia
• D. Abrupt abstinence with observation only

Answer: A. Symptom-triggered benzodiazepine using a withdrawal scale, with parenteral thiamine given before any glucose load

Q2. A patient describes his mood as persistently low, while the examiner observes him smiling and animated throughout. Which terms describe what the patient reports and what the examiner observes?

• A. Both are described as mood
• B. Both are described as affect
• C. Mood is what the patient reports; affect is what the examiner observes, and here they are incongruent
• D. Affect is what the patient reports; mood is what the examiner observes

Answer: C. Mood is what the patient reports; affect is what the examiner observes, and here they are incongruent

Q1. A patient's mouth droops to the left. The forehead wrinkles normally on the right and the right eye closes fully. Which lesion is this?

• A. A right lower motor neurone facial palsy
• B. A left lower motor neurone facial palsy
• C. A left upper motor neurone facial palsy
• D. A right upper motor neurone facial palsy, since bilateral cortical input spares the forehead

Answer: D. A right upper motor neurone facial palsy, since bilateral cortical input spares the forehead

Q2. Which cutaneous receptor detects high-frequency vibration, and what adaptation property allows this?

• A. Merkel discs, which are slowly adapting
• B. Ruffini endings, which are slowly adapting
• C. Pacinian corpuscles, which are rapidly adapting with a layered capsule
• D. Free nerve endings, which are non-adapting

Answer: C. Pacinian corpuscles, which are rapidly adapting with a layered capsule

Q1. On an axial brain image, which structure shows the cerebral peduncles anteriorly and the colliculi posteriorly, with the cerebral aqueduct between them?

• A. The pons
• B. The midbrain
• C. The medulla
• D. The cerebellum

Answer: B. The midbrain

Q2. On ultrasound of the liver, which vessel has bright echogenic walls because it is invested by fibrofatty connective tissue of the portal tracts?

• A. The hepatic veins
• B. The inferior vena cava
• C. The hepatic artery
• D. The portal vein

Answer: D. The portal vein

Q1. A man had a vasectomy four weeks ago. What contraceptive advice should the couple be given, and why?

• A. No further precautions are needed
• B. Continue additional contraception until azoospermia is confirmed, usually after about three months or 20 ejaculations
• C. The woman should take oral contraceptives for one month
• D. Hormonal treatment should be given to the man for two months

Answer: B. Continue additional contraception until azoospermia is confirmed, usually after about three months or 20 ejaculations

Q2. How does WHO define blindness in terms of visual acuity in the better eye with best correction?

• A. Less than 6/60
• B. Less than 3/60
• C. Less than 6/18
• D. Less than 1/60

Answer: B. Less than 3/60

Q1. A man with metastatic prostate cancer is started on goserelin. What is its mechanism, and what must be co-prescribed initially?

• A. An LHRH agonist causing an initial testosterone surge, so an anti-androgen is added to prevent tumour flare
• B. A direct androgen receptor blocker needing no cover
• C. A 5-alpha reductase inhibitor reducing prostate volume
• D. A cytotoxic agent requiring antiemetics

Answer: A. An LHRH agonist causing an initial testosterone surge, so an anti-androgen is added to prevent tumour flare

Q2. Which serum tumour marker is used to monitor pancreatic adenocarcinoma, and what limits its diagnostic use?

• A. Alpha-fetoprotein, raised in pregnancy
• B. CA 15-3, raised in benign breast disease
• C. Carcinoembryonic antigen, raised in smokers
• D. CA 19-9, which is also raised in obstructive jaundice and is absent in Lewis-negative individuals

Answer: D. CA 19-9, which is also raised in obstructive jaundice and is absent in Lewis-negative individuals

Q1. A pregnant woman has an uncomplicated lower urinary tract infection. Which antibiotic is appropriate, and which class must be avoided?

• A. Nitrofurantoin or cephalexin is appropriate; fluoroquinolones are avoided for fetal cartilage toxicity
• B. Ciprofloxacin is appropriate; penicillins are avoided
• C. Doxycycline is appropriate; cephalosporins are avoided
• D. Co-trimoxazole is appropriate throughout pregnancy

Answer: A. Nitrofurantoin or cephalexin is appropriate; fluoroquinolones are avoided for fetal cartilage toxicity

Q2. A non-pregnant woman has uncomplicated acute cystitis. Which agent is recommended first-line, and why?

• A. Ciprofloxacin, because of its broad spectrum
• B. Doxycycline, because it covers atypicals
• C. Amoxicillin, because resistance is rare
• D. Nitrofurantoin, because it concentrates in urine and spares the gut flora, limiting resistance

Answer: D. Nitrofurantoin, because it concentrates in urine and spares the gut flora, limiting resistance

Q1. Which nerve supplies biceps brachii, brachialis and coracobrachialis, and what sensory territory does it continue as?

• A. Radial nerve, continuing as the posterior cutaneous nerve of the forearm
• B. Median nerve, supplying the lateral palm
• C. Ulnar nerve, supplying the medial forearm
• D. Musculocutaneous nerve, continuing as the lateral cutaneous nerve of the forearm

Answer: D. Musculocutaneous nerve, continuing as the lateral cutaneous nerve of the forearm

Q2. At which vertebral level does the coeliac trunk arise from the abdominal aorta?

• A. T10
• B. L1
• C. L2
• D. T12

Answer: D. T12

Q1. Entonox is a 50:50 mixture of nitrous oxide and oxygen. What is its pin index position, and why does the pin index system exist?

• A. Position 7, to prevent a cylinder being connected to the wrong yoke
• B. Position 5, to identify the cylinder by colour
• C. Position 2 and 5, to allow interchange with oxygen
• D. Position 3 and 5, to indicate a medical gas mixture

Answer: A. Position 7, to prevent a cylinder being connected to the wrong yoke

Q2. Under the Indian colour coding for medical gas cylinders, what colour is a nitrous oxide cylinder?

• A. Black body with a white shoulder
• B. Grey body with a black and white shoulder
• C. White throughout
• D. Blue throughout

Answer: D. Blue throughout

Q1. Carbonic anhydrase catalyses the hydration of carbon dioxide. Which trace element is essential at its active site?

• A. Iron
• B. Calcium
• C. Potassium
• D. Zinc

Answer: D. Zinc

Q2. Which hormone suppresses gluconeogenesis, and by which key mechanism?

• A. Glucagon, by raising cyclic AMP
• B. Cortisol, by inducing gluconeogenic enzymes
• C. Insulin, by reducing transcription of PEP carboxykinase and lowering fructose-2,6-bisphosphate turnover in favour of glycolysis
• D. Adrenaline, by mobilising glycogen

Answer: C. Insulin, by reducing transcription of PEP carboxykinase and lowering fructose-2,6-bisphosphate turnover in favour of glycolysis

Q1. An infant weaned from breast milk develops a sharply demarcated erosive rash around the mouth, anus and fingertips, with diarrhoea and hair loss. Which deficiency, and what is the treatment?

• A. Zinc deficiency (acrodermatitis enteropathica), treated with oral elemental zinc
• B. Iron deficiency, treated with ferrous sulphate
• C. Vitamin A deficiency, treated with retinol
• D. Calcium deficiency, treated with supplementation

Answer: A. Zinc deficiency (acrodermatitis enteropathica), treated with oral elemental zinc

Q2. A child burns severely after minutes of sun exposure, with freckling on exposed skin and several skin cancers by adolescence. Which repair pathway is defective?

• A. Mismatch repair
• B. Nucleotide excision repair of ultraviolet-induced pyrimidine dimers
• C. Base excision repair of oxidised bases
• D. Homologous recombination repair

Answer: B. Nucleotide excision repair of ultraviolet-induced pyrimidine dimers

Q1. Two days after a head injury a woman has clear watery discharge from one nostril that increases on leaning forward. What is the diagnosis, and which bedside feature supports it?

• A. Allergic rhinitis, supported by sneezing
• B. Post-traumatic vasomotor rhinitis, supported by nasal blockage
• C. CSF rhinorrhoea, supported by a target or halo sign on filter paper
• D. Haemosinus, supported by blood-stained discharge

Answer: C. CSF rhinorrhoea, supported by a target or halo sign on filter paper

Q2. Which laboratory test most specifically confirms that nasal fluid is cerebrospinal fluid?

• A. Beta-2 transferrin assay, since this isoform is essentially unique to CSF
• B. Glucose oxidase strip testing
• C. Protein estimation
• D. Culture and sensitivity

Answer: A. Beta-2 transferrin assay, since this isoform is essentially unique to CSF

Q1. In an autopsy for suspected poisoning, stomach with contents, a portion of small intestine and liver are preserved. Which additional organ is routinely preserved, and why?

• A. Lung, because volatile poisons concentrate there
• B. Brain, because it stores lipid-soluble poisons
• C. Heart, because it shows toxic myocarditis
• D. Kidney, because it is the route of excretion for most poisons and heavy metals

Answer: D. Kidney, because it is the route of excretion for most poisons and heavy metals

Q2. A wound has ragged margins, bruised edges, tissue bridging in its depth and crushed hair bulbs. Which type of wound is this, and which weapon caused it?

• A. An incised wound from a sharp blade
• B. A laceration from a blunt force
• C. A stab wound from a pointed weapon
• D. An abrasion from a tangential graze

Answer: B. A laceration from a blunt force

Q1. Which organism is the commonest cause of pelvic inflammatory disease, and what makes it so damaging to fertility?

• A. Neisseria gonorrhoeae, because it causes acute purulent salpingitis
• B. Chlamydia trachomatis, because infection is often silent and causes tubal scarring before it is detected
• C. Gardnerella vaginalis, because it alters vaginal flora
• D. Bacteroides species, because they form abscesses

Answer: B. Chlamydia trachomatis, because infection is often silent and causes tubal scarring before it is detected

Q2. Early transvaginal ultrasound shows two concentric echogenic rings around a small fluid collection in the uterus. What does this double decidual sign confirm?

• A. A true intrauterine gestational sac, distinguishing it from the pseudosac of an ectopic pregnancy
• B. An ectopic pregnancy
• C. A complete hydatidiform mole
• D. A missed abortion

Answer: A. A true intrauterine gestational sac, distinguishing it from the pseudosac of an ectopic pregnancy

Q1. For which category of infection control precautions is a fit-tested N95 respirator required, and give an example.

• A. Contact precautions, for example MRSA colonisation
• B. Droplet precautions, for example influenza
• C. Airborne precautions, for example pulmonary tuberculosis or measles
• D. Standard precautions, for all patient contact

Answer: C. Airborne precautions, for example pulmonary tuberculosis or measles

Q2. A newborn has a unilateral facial port-wine stain in the ophthalmic trigeminal distribution and later develops seizures and glaucoma. What is the syndrome, and which vessels are abnormal?

• A. Sturge-Weber syndrome, with a leptomeningeal capillary-venous malformation
• B. Klippel-Trenaunay syndrome, with limb overgrowth
• C. Von Hippel-Lindau disease, with retinal haemangioblastoma
• D. Hereditary haemorrhagic telangiectasia, with mucosal telangiectases

Answer: A. Sturge-Weber syndrome, with a leptomeningeal capillary-venous malformation

Q1. Small white spots on an erythematous buccal mucosa appear two days before a rash. What are they called, and which infection do they signal?

• A. Forchheimer spots, in rubella
• B. Koplik spots, in measles
• C. Nagayama spots, in roseola
• D. Aphthous ulcers, in Behcet disease

Answer: B. Koplik spots, in measles

Q2. Which organism's spores are used as the biological indicator for validating steam autoclave cycles, and at what temperature?

• A. Bacillus atrophaeus at 160 degrees C dry heat
• B. Clostridium tetani spores at 100 degrees C
• C. Geobacillus stearothermophilus at 121 degrees C moist heat
• D. Pseudomonas aeruginosa at 80 degrees C

Answer: C. Geobacillus stearothermophilus at 121 degrees C moist heat

Q1. A teenager has knee pain and a radiograph shows an aggressive metaphyseal lesion with periosteal elevation forming a Codman triangle and a sunburst pattern. What is the diagnosis?

• A. Ewing sarcoma
• B. Osteoid osteoma
• C. Osteosarcoma
• D. Giant cell tumour

Answer: C. Osteosarcoma

Q2. A woman treated in a cast for a Colles fracture develops numbness of the thumb, index and middle fingers with weak thumb abduction. Which complication has occurred?

• A. Ulnar nerve compression at Guyon's canal
• B. Median nerve compression in the carpal tunnel
• C. Radial nerve palsy from the cast
• D. Extensor pollicis longus rupture

Answer: B. Median nerve compression in the carpal tunnel

Q1. Parasympathetic secretomotor fibres to the lacrimal gland relay in which ganglion, and by which nerve do they reach the gland?

• A. Ciliary ganglion, via the short ciliary nerves
• B. Otic ganglion, via the auriculotemporal nerve
• C. Submandibular ganglion, via the lingual nerve
• D. Pterygopalatine ganglion, via the zygomatic and lacrimal nerves

Answer: D. Pterygopalatine ganglion, via the zygomatic and lacrimal nerves

Q2. Under WHO categories, a person whose better eye has a best-corrected acuity of 6/60 but worse than 6/18 falls into which group?

• A. Blindness
• B. Moderate visual impairment
• C. Severe visual impairment
• D. Normal vision

Answer: B. Moderate visual impairment

Q1. Which ion is the final common mediator of irreversible cell injury, and what does its rise activate?

• A. Calcium, activating phospholipases, proteases and endonucleases
• B. Copper, activating oxidative enzymes
• C. Selenium, activating glutathione peroxidase
• D. Magnesium, activating kinases

Answer: A. Calcium, activating phospholipases, proteases and endonucleases

Q2. Ischaemic infarction of the brain produces which pattern of necrosis, and why does it differ from the heart?

• A. Coagulative necrosis, because protein denaturation dominates
• B. Liquefactive necrosis, because the brain is lipid-rich, low in supporting stroma, and microglial hydrolases dominate
• C. Caseous necrosis, because of granuloma formation
• D. Fat necrosis, because of lipase release

Answer: B. Liquefactive necrosis, because the brain is lipid-rich, low in supporting stroma, and microglial hydrolases dominate

Q1. Under WHO criteria, what mid-upper arm circumference in a child aged 6 to 59 months indicates severe acute malnutrition?

• A. Below 14.5 cm
• B. Below 13.5 cm
• C. Below 12.5 cm
• D. Below 11.5 cm

Answer: D. Below 11.5 cm

Q2. Which of the following disorders is inherited in an autosomal recessive pattern?

• A. Hereditary spherocytosis
• B. Osteogenesis imperfecta type I
• C. Sickle cell anaemia
• D. Von Willebrand disease

Answer: C. Sickle cell anaemia

Q1. Six weeks after a road accident a man has intrusive flashbacks, avoids driving, and is hypervigilant and unable to work. What is the diagnosis, and what distinguishes it from the acute condition?

• A. Acute stress disorder, since symptoms began immediately
• B. Post-traumatic stress disorder, since symptoms have persisted beyond one month
• C. Panic disorder, since the attacks are unexpected
• D. Adjustment disorder, since there is an identifiable stressor

Answer: B. Post-traumatic stress disorder, since symptoms have persisted beyond one month

Q2. The McNaughton rules on criminal responsibility for the mentally ill are reflected in which section of the Indian Penal Code?

• A. Section 84
• B. Section 85
• C. Section 86
• D. Section 87

Answer: A. Section 84

Q1. Which of the following causes hypoxic hypoxia, in which arterial oxygen tension itself is reduced?

• A. Carbon monoxide poisoning
• B. Cyanide poisoning
• C. Severe anaemia
• D. A right-to-left intracardiac shunt

Answer: D. A right-to-left intracardiac shunt

Q2. What does the PR interval on the electrocardiogram represent, and what prolongs it?

• A. Atrial and AV nodal conduction, prolonged by first-degree AV block
• B. Ventricular depolarisation, prolonged by bundle branch block
• C. Ventricular repolarisation, prolonged by hypokalaemia
• D. Atrial repolarisation, prolonged by ischaemia

Answer: A. Atrial and AV nodal conduction, prolonged by first-degree AV block

Q1. On M-mode lung ultrasound, normal pleural sliding produces a granular pattern below a smooth line. What is this called, and what replaces it in pneumothorax?

• A. The seashore sign, replaced by the barcode or stratosphere sign
• B. The barcode sign, replaced by the seashore sign
• C. The lung point, replaced by A-lines
• D. The deep sulcus sign, replaced by B-lines

Answer: A. The seashore sign, replaced by the barcode or stratosphere sign

Q2. A 10-year-old girl has a painless structural scoliosis with no neurological signs, normal vertebral morphology and no underlying disorder. What is the most likely cause?

• A. Congenital vertebral malformation
• B. Neurofibromatosis type 1
• C. Idiopathic scoliosis
• D. Neuromuscular scoliosis

Answer: C. Idiopathic scoliosis

Q1. What does NITI Aayog stand for, and what body did it replace?

• A. Newer Initiative for Transforming India, replacing the Finance Commission
• B. National Institution for Transforming India, replacing the Planning Commission
• C. Nutrition Intake for India, replacing the Food Corporation
• D. National Institute for Technology in India, replacing the UGC

Answer: B. National Institution for Transforming India, replacing the Planning Commission

Q2. A community camp measures blood pressure and blood glucose in apparently well adults to detect undiagnosed disease. Which level of prevention is this?

• A. Primordial prevention
• B. Primary prevention
• C. Secondary prevention, through early detection in the presymptomatic phase
• D. Tertiary prevention

Answer: C. Secondary prevention, through early detection in the presymptomatic phase

Q1. A man has right upper quadrant pain after fatty meals with fever. Which imaging test should be done first, and why?

• A. CT with contrast, for the best anatomical detail
• B. MRCP, to map the biliary tree
• C. Ultrasound, because it detects gallstones and wall thickening cheaply without radiation
• D. HIDA scan, as the initial screening test

Answer: C. Ultrasound, because it detects gallstones and wall thickening cheaply without radiation

Q2. Two days after femoral shaft fixation a young man becomes confused and hypoxic with a petechial rash over the axilla and conjunctiva. What is the diagnosis?

• A. Pulmonary thromboembolism
• B. Fat embolism syndrome
• C. Air embolism
• D. Transfusion-related acute lung injury

Answer: B. Fat embolism syndrome

Q1. How is a drug's therapeutic index calculated, and what does a narrow index imply?

• A. ED50 divided by LD50; a narrow index means a wide safety margin
• B. LD50 divided by ED50; a narrow index means small dose changes may cause toxicity, so monitoring is required
• C. Cmax divided by Cmin; a narrow index means rapid clearance
• D. Volume of distribution divided by clearance; a narrow index means a short half-life

Answer: B. LD50 divided by ED50; a narrow index means small dose changes may cause toxicity, so monitoring is required

Q2. Among the following opioids, which is the most potent by weight, and roughly how does it compare with morphine?

• A. Pethidine, about one tenth as potent
• B. Pentazocine, about equipotent
• C. Fentanyl, roughly a hundred times more potent
• D. Codeine, about a tenth as potent

Answer: C. Fentanyl, roughly a hundred times more potent

Q1. Failure of the rostral (anterior) neuropore to close around day 25 produces which malformation?

• A. Anencephaly
• B. Spina bifida occulta
• C. Rachischisis
• D. Meningocele

Answer: A. Anencephaly

Q2. The inferior angle of the scapula lies opposite which vertebral level, a landmark used when auscultating the lung bases?

• A. T3
• B. T5
• C. T7
• D. T8

Answer: D. T8

Q1. During adult cardiopulmonary resuscitation, what rate and depth of chest compression are recommended?

• A. 100 to 120 per minute, 5 to 6 cm deep
• B. 60 to 80 per minute, 3 cm deep
• C. 80 to 100 per minute, 4 cm deep
• D. 140 to 160 per minute, 7 cm deep

Answer: A. 100 to 120 per minute, 5 to 6 cm deep

Q2. At which interspace is subarachnoid block performed in an adult, and why not higher?

• A. L3 to L4, because the spinal cord ends at about L1 to L2 and the needle meets only cauda equina fibres
• B. T12 to L1, above the artery of Adamkiewicz
• C. L1 to L2, at the conus
• D. L5 to S1, to avoid the epidural veins

Answer: A. L3 to L4, because the spinal cord ends at about L1 to L2 and the needle meets only cauda equina fibres

Q1. Fluoride in a grey-top blood tube preserves glucose by inhibiting glycolysis. Which enzyme does it inhibit?

• A. Hexokinase
• B. Phosphofructokinase-1
• C. Pyruvate kinase
• D. Enolase

Answer: D. Enolase

Q2. Maple syrup urine disease results from failure to decarboxylate the keto acids of which amino acids, and which enzyme complex is defective?

• A. Aromatic amino acids, with phenylalanine hydroxylase
• B. Sulphur-containing amino acids, with cystathionine synthase
• C. Basic amino acids, with ornithine transcarbamylase
• D. Branched-chain amino acids, with branched-chain alpha-keto acid dehydrogenase

Answer: D. Branched-chain amino acids, with branched-chain alpha-keto acid dehydrogenase

Q1. A young woman has fever, painless oral ulcers and a photosensitive erythematous rash across the cheeks and bridge of the nose that spares the nasolabial folds. What is the diagnosis?

• A. Systemic lupus erythematosus
• B. Dermatomyositis
• C. Rosacea
• D. Melasma

Answer: A. Systemic lupus erythematosus

Q2. A man with recent unexplained weight loss develops sudden widespread eruptive seborrhoeic keratoses. What is this sign, and what does it demand?

• A. Acanthosis nigricans, demanding a glucose tolerance test
• B. Actinic keratosis, demanding cryotherapy
• C. Cutaneous candidiasis, demanding topical antifungals
• D. The sign of Leser-Trelat, demanding a search for internal malignancy, typically gastrointestinal

Answer: D. The sign of Leser-Trelat, demanding a search for internal malignancy, typically gastrointestinal

Q1. In an infant, which part of the airway is narrowest, and what practical consequence follows for intubation?

• A. The supraglottis, so a smaller blade is used
• B. The glottis, so a cuffed tube is essential
• C. The subglottis at the cricoid ring, so an oversized tube risks post-extubation stridor
• D. The epiglottis, so it must be lifted directly

Answer: C. The subglottis at the cricoid ring, so an oversized tube risks post-extubation stridor

Q2. Juvenile nasopharyngeal angiofibroma occurs almost exclusively in adolescent males. From which site does it arise, and what does that explain about spread?

• A. The nasal septum, so it stays midline
• B. The maxillary antrum, so it presents with facial swelling
• C. The nasopharyngeal roof, so it obstructs both choanae equally
• D. The sphenopalatine foramen, from where it extends into the pterygopalatine fossa and skull base

Answer: D. The sphenopalatine foramen, from where it extends into the pterygopalatine fossa and skull base

Q1. Under the Hindu Marriage Act, which of the following is a recognised ground for divorce rather than for nullity?

• A. Sterility of either partner
• B. Frigidity in the wife
• C. Impotence arising after the marriage has been consummated
• D. Poverty of the husband

Answer: C. Impotence arising after the marriage has been consummated

Q2. Which section of the Indian Penal Code deals with causing miscarriage without the woman's consent?

• A. Section 312
• B. Section 313
• C. Section 314
• D. Section 315

Answer: B. Section 313

Q1. A 15-year-old has primary amenorrhoea with normally developed breasts and pubic hair and no other abnormality. What is the appropriate first investigation?

• A. Reassurance and review in a year
• B. Pelvic ultrasound, to establish whether a uterus is present
• C. Hysterosalpingography
• D. Immediate karyotyping

Answer: B. Pelvic ultrasound, to establish whether a uterus is present

Q2. A woman at 8 weeks has light bleeding and pain, a closed os, a uterus matching dates, and ultrasound shows a single live intrauterine pregnancy. What is the management?

• A. Dilatation and curettage
• B. Combined oestrogen and progesterone therapy
• C. Expectant management with rest and progesterone support if indicated
• D. Immediate medical evacuation

Answer: C. Expectant management with rest and progesterone support if indicated

Q1. Which statement about tremor is correct?

• A. Essential tremor is rare, affecting under 1 in 1000 people
• B. A resting tremor that improves on movement is typical of Parkinson disease
• C. Physiological tremor is always pathological
• D. Cerebellar tremor is maximal at rest

Answer: B. A resting tremor that improves on movement is typical of Parkinson disease

Q2. A 20-year-old recruit has an HbA1c of 6.1% and a fasting glucose of 120 mg/dL, with no symptoms. How is this categorised?

• A. Normal glucose tolerance
• B. Prediabetes, with impaired fasting glucose
• C. Diabetes mellitus
• D. Maturity-onset diabetes of the young

Answer: B. Prediabetes, with impaired fasting glucose

Q1. Which statement correctly describes the diphtheritic membrane?

• A. A grey membrane confined to the tonsil that peels away cleanly
• B. A grey pseudomembrane extending beyond the tonsils that bleeds when removed, because it is adherent to necrotic mucosa
• C. A white curdy membrane wiped off easily
• D. A yellow membrane limited to the soft palate

Answer: B. A grey pseudomembrane extending beyond the tonsils that bleeds when removed, because it is adherent to necrotic mucosa

Q2. Which mechanism of bacterial gene transfer is mediated by a bacteriophage, and what is its practical significance?

• A. Conjugation, transferring plasmids through a pilus
• B. Transformation, taking up naked DNA
• C. Transduction, which can carry toxin genes such as those of Corynebacterium diphtheriae
• D. Transposition, moving genes within a genome

Answer: C. Transduction, which can carry toxin genes such as those of Corynebacterium diphtheriae

Q1. A 6-year-old has elbow pain and swelling after a fall, and the radiograph appears normal apart from a raised posterior fat pad. What does this indicate?

• A. A normal variant needing no treatment
• B. An occult supracondylar fracture with a haemarthrosis, which should be splinted and re-imaged
• C. A dislocated elbow requiring reduction
• D. A pulled elbow requiring supination manoeuvre

Answer: B. An occult supracondylar fracture with a haemarthrosis, which should be splinted and re-imaged

Q2. A man has mild weakness with a normal alkaline phosphatase, raised calcium, raised phosphate and a normal parathyroid hormone. What is the most likely cause?

• A. Primary hyperparathyroidism
• B. Osteomalacia
• C. Vitamin D toxicity, which raises both calcium and phosphate while suppressing PTH into the normal or low range
• D. Osteoporosis

Answer: C. Vitamin D toxicity, which raises both calcium and phosphate while suppressing PTH into the normal or low range

Q1. What is the commonest cause of blindness in India, and why is it considered avoidable?

• A. Cataract, because it is reversible by surgery
• B. Refractive error, because spectacles correct it
• C. Glaucoma, because drops arrest it
• D. Trachoma, because antibiotics cure it

Answer: A. Cataract, because it is reversible by surgery

Q2. A head-injured patient with rising intracranial pressure develops a fixed dilated pupil. On which side, and which structure is compressed?

• A. Contralateral to the lesion, from optic nerve compression
• B. Ipsilateral to the lesion, from uncal herniation compressing the oculomotor nerve
• C. Contralateral, from midbrain shift
• D. Ipsilateral, from sympathetic interruption

Answer: B. Ipsilateral to the lesion, from uncal herniation compressing the oculomotor nerve

Q1. Berry aneurysms form at branch points of the circle of Willis. Which structural defect underlies them?

• A. Loss of the endothelium from hypertension
• B. A congenital deficiency of the tunica media and internal elastic lamina at arterial bifurcations
• C. Adventitial inflammation
• D. Intimal lipid deposition

Answer: B. A congenital deficiency of the tunica media and internal elastic lamina at arterial bifurcations

Q2. A man who worked 20 years in a shipyard has breathlessness, and HRCT shows bilateral pleural plaques with basal fibrosis. Which pneumoconiosis is this, and which malignancy is associated?

• A. Silicosis, associated with tuberculosis
• B. Coal worker's pneumoconiosis, associated with emphysema
• C. Berylliosis, associated with granulomas
• D. Asbestosis, associated with mesothelioma and bronchogenic carcinoma

Answer: D. Asbestosis, associated with mesothelioma and bronchogenic carcinoma

Q1. A 12 kg child with diarrhoea is restless and thirsty, with absent tears and a slow skin pinch. Under WHO Plan B, how much ORS should be given in the first four hours?

• A. 300 ml
• B. 600 ml
• C. 900 ml, calculated at 75 ml per kg
• D. 1200 ml

Answer: C. 900 ml, calculated at 75 ml per kg

Q2. Why is newborn screening for congenital hypothyroidism performed on a blood spot rather than waiting for clinical signs?

• A. Because clinical features appear immediately at birth
• B. Because most affected newborns look normal at birth, and delay beyond the first weeks causes irreversible neurological damage
• C. Because the condition resolves spontaneously
• D. Because treatment is only effective after one year

Answer: B. Because most affected newborns look normal at birth, and delay beyond the first weeks causes irreversible neurological damage

Q1. A woman has repeated unexpected episodes of chest pain, palpitations and a fear of dying, peaking within ten minutes and settling in under half an hour, with normal investigations. What is the diagnosis?

• A. Acute psychosis
• B. Panic disorder
• C. Post-traumatic stress disorder
• D. Mania

Answer: B. Panic disorder

Q2. Which of the following is NOT one of the stages described in the Kubler-Ross model of grief?

• A. Denial
• B. Anger
• C. Bargaining
• D. Agitation

Answer: D. Agitation

Q1. What produces the dicrotic notch on the aortic pressure trace?

• A. Passive ventricular filling
• B. The rapid ejection phase
• C. Closure of the aortic valve with brief backflow against the cusps
• D. Isovolumetric contraction

Answer: C. Closure of the aortic valve with brief backflow against the cusps

Q2. Which statement about isovolumetric relaxation is correct?

• A. Both the aortic and mitral valves are closed while ventricular pressure falls at constant volume
• B. The semilunar valves are open
• C. It corresponds to the QRS complex
• D. It produces the 'a' wave of the jugular venous pulse

Answer: A. Both the aortic and mitral valves are closed while ventricular pressure falls at constant volume

Q1. A hypertensive man has sudden tearing chest pain radiating to the back. Contrast CT shows an intimal flap dividing the aortic lumen in two. What is the diagnosis?

• A. Aortic dissection
• B. Pulmonary embolism
• C. Aortic aneurysm without dissection
• D. Cardiac myxoma

Answer: A. Aortic dissection

Q2. Which nuclear medicine study is regarded as the most reproducible for measuring left ventricular ejection fraction?

• A. Thallium-201 SPECT
• B. Multigated acquisition (MUGA) blood pool scanning
• C. PET myocardial perfusion imaging
• D. Sestamibi scanning with pharmacological stress

Answer: B. Multigated acquisition (MUGA) blood pool scanning

Q1. What does inertisation of biomedical waste achieve?

• A. Incineration of infectious waste at high temperature
• B. Autoclaving before landfill
• C. Mixing waste with cement and lime so that toxic constituents cannot leach into groundwater
• D. Segregation into colour-coded bags

Answer: C. Mixing waste with cement and lime so that toxic constituents cannot leach into groundwater

Q2. Which animal is the amplifier host for Japanese encephalitis, and why does that matter for control?

• A. Cattle, which are the preferred feed source
• B. Pigs, which develop high viraemia without illness, so siting piggeries away from homes reduces transmission
• C. Dogs, which are the reservoir
• D. Ardeid birds, which are dead-end hosts

Answer: B. Pigs, which develop high viraemia without illness, so siting piggeries away from homes reduces transmission

Q1. A man after a road accident is agitated, with a respiratory rate of 40, blood pressure 90/40, absent breath sounds and a hyperresonant left chest with tracheal deviation to the right. What is the immediate action?

• A. Urgent intravenous fluids
• B. Obtain a chest radiograph first
• C. Intubate the patient
• D. Immediate needle decompression, followed by a chest drain

Answer: D. Immediate needle decompression, followed by a chest drain

Q2. How should a conscious patient be positioned for nasogastric tube insertion, and why?

• A. Supine with the neck extended, to straighten the airway
• B. Supine with the neck flexed, to close the glottis
• C. Sitting upright with the neck slightly flexed, which closes the airway and directs the tube towards the oesophagus
• D. Lateral with the neck extended

Answer: C. Sitting upright with the neck slightly flexed, which closes the airway and directs the tube towards the oesophagus

Q1. Which corticosteroid has the shortest duration of action, and what is its main clinical use?

• A. Hydrocortisone, used for physiological replacement and acute adrenal crisis
• B. Dexamethasone, used for cerebral oedema
• C. Triamcinolone, used intra-articularly
• D. Deflazacort, used in muscular dystrophy

Answer: A. Hydrocortisone, used for physiological replacement and acute adrenal crisis

Q2. A woman with epilepsy plans pregnancy. Which antiepileptic carries the highest teratogenic risk, and what defect is associated?

• A. Lamotrigine, associated with cardiac defects
• B. Carbamazepine, associated with limb defects
• C. Sodium valproate, associated with neural tube defects and impaired neurodevelopment
• D. Levetiracetam, associated with cleft palate

Answer: C. Sodium valproate, associated with neural tube defects and impaired neurodevelopment

Q1. The parotid duct pierces buccinator and opens into the oral vestibule opposite which tooth?

• A. The second maxillary molar
• B. The first mandibular molar
• C. The first maxillary premolar
• D. The second mandibular molar

Answer: A. The second maxillary molar

Q2. Trismus in tetanus and after inferior alveolar nerve block is due to spasm of which muscle?

• A. Buccinator
• B. Lateral pterygoid
• C. Mentalis
• D. Medial pterygoid

Answer: D. Medial pterygoid

Q1. A patient's larynx is graded at direct laryngoscopy according to how much of the glottis is visible. Which grading system is this, and how does it differ from an airway assessment made before induction?

• A. The Cormack-Lehane grade, made at laryngoscopy, whereas the Mallampati score is a bedside prediction made beforehand
• B. The Mallampati score, made after induction
• C. The ASA grade, made preoperatively
• D. The Wilson score, made at laryngoscopy

Answer: A. The Cormack-Lehane grade, made at laryngoscopy, whereas the Mallampati score is a bedside prediction made beforehand

Q2. Which inhalational agent is associated with immune-mediated hepatitis on repeat exposure, and what is the mechanism?

• A. Halothane, through trifluoroacetylated liver proteins acting as neoantigens
• B. Sevoflurane, through compound A formation
• C. Isoflurane, through carbon monoxide production
• D. Nitrous oxide, through methionine synthase inhibition

Answer: A. Halothane, through trifluoroacetylated liver proteins acting as neoantigens

Q1. The urea cycle spans two cellular compartments. Which steps occur where?

• A. Entirely within mitochondria
• B. Entirely within cytosol
• C. The first two steps in mitochondria and the remainder in cytosol
• D. The first two in cytosol and the remainder in mitochondria

Answer: C. The first two steps in mitochondria and the remainder in cytosol

Q2. Which codon initiates translation, and which amino acid does it specify in eukaryotes?

• A. UAA, specifying no amino acid
• B. UGA, specifying selenocysteine
• C. AUG, specifying methionine
• D. UAG, specifying glutamine

Answer: C. AUG, specifying methionine

Q1. Which of the following is NOT a feature of congenital syphilis?

• A. Hutchinson incisors
• B. Higoumenakis sign
• C. Painful genital ulceration acquired at birth
• D. Interstitial keratitis

Answer: C. Painful genital ulceration acquired at birth

Q2. Which treatment repigments vitiligo by combining a photosensitiser with ultraviolet A?

• A. Topical retinoids
• B. Systemic corticosteroids
• C. Psoralen with UVA phototherapy
• D. Nd-YAG laser

Answer: C. Psoralen with UVA phototherapy

Q1. A child has a persistent middle-ear effusion with conductive hearing loss and no infection. What is the mainstay of treatment?

• A. Radical mastoidectomy
• B. Myringotomy with grommet insertion to ventilate the middle ear
• C. Temporal bone resection
• D. Tonsillectomy alone

Answer: B. Myringotomy with grommet insertion to ventilate the middle ear

Q2. A patient has fever and a neck swelling, and the tonsil is displaced medially with trismus, but the uvula is not deviated. Where is the collection?

• A. Peritonsillar (quinsy)
• B. Retropharyngeal space
• C. Parapharyngeal space
• D. Submandibular space

Answer: C. Parapharyngeal space

Q1. A toddler has swallowed kerosene from a bottle and is now coughing. How should gastrointestinal decontamination be approached?

• A. Immediate gastric lavage, to remove the hydrocarbon before absorption
• B. Induced emesis with syrup of ipecac
• C. Activated charcoal, which binds hydrocarbons effectively
• D. No gastric emptying at all, because a low-viscosity hydrocarbon is far more dangerous aspirated than absorbed

Answer: D. No gastric emptying at all, because a low-viscosity hydrocarbon is far more dangerous aspirated than absorbed

Q2. Which test is confirmatory rather than merely presumptive for a bloodstain?

• A. The Kastle-Meyer test
• B. The benzidine test
• C. Spectroscopic examination for haemoglobin derivatives
• D. The ortho-toluidine test

Answer: C. Spectroscopic examination for haemoglobin derivatives

Q1. Non-immune hydrops fetalis is detected at 26 weeks. Which fetal infection is classically responsible, and by what mechanism?

• A. Epstein-Barr virus, through lymphoproliferation
• B. Parvovirus B19, by infecting erythroid precursors and causing severe fetal anaemia and high-output failure
• C. Human papillomavirus, through placental invasion
• D. Influenza virus, through direct myocarditis

Answer: B. Parvovirus B19, by infecting erythroid precursors and causing severe fetal anaemia and high-output failure

Q2. Which factor in an obstetric history does NOT predispose to uterovaginal prolapse?

• A. Precipitate labour
• B. Prolonged second stage
• C. Bearing down before full dilatation
• D. A timely mediolateral episiotomy

Answer: D. A timely mediolateral episiotomy

Q1. A resting ECG shows a short PR interval with a slurred initial upstroke of the QRS complex. What is that upstroke called, and what does it represent?

• A. A J wave, representing hypothermia
• B. A delta wave, representing ventricular pre-excitation through an accessory pathway
• C. An epsilon wave, representing arrhythmogenic right ventricular cardiomyopathy
• D. A U wave, representing hypokalaemia

Answer: B. A delta wave, representing ventricular pre-excitation through an accessory pathway

Q2. Why must AV nodal blocking drugs be avoided in atrial fibrillation with Wolff-Parkinson-White syndrome?

• A. They shorten the accessory pathway refractory period, allowing very rapid conduction to the ventricles and possible ventricular fibrillation
• B. They cause profound bradycardia
• C. They precipitate torsades de pointes
• D. They have no effect on the accessory pathway

Answer: A. They shorten the accessory pathway refractory period, allowing very rapid conduction to the ventricles and possible ventricular fibrillation

Q1. Biopsy from a chronic verrucous foot lesion shows thick-walled, brown, septate sclerotic bodies dividing by internal septation. What is the diagnosis?

• A. Histoplasmosis
• B. Chromoblastomycosis
• C. Coccidioidomycosis
• D. Candidiasis

Answer: B. Chromoblastomycosis

Q2. How does Bacillus anthracis appear on Gram stain, and what arrangement is characteristic?

• A. Gram-positive cocci in clusters
• B. Gram-negative diplococci
• C. Gram-positive rods with squared ends in chains, resembling bamboo
• D. Gram-positive bacilli with spherical ends

Answer: C. Gram-positive rods with squared ends in chains, resembling bamboo

Q1. A woman has bony swelling of the distal and proximal interphalangeal joints with sparing of the metacarpophalangeal joints and wrists. Which arthritis, and what are the nodes called?

• A. Rheumatoid arthritis, with Bouchard nodes
• B. Psoriatic arthritis, with dactylitis
• C. Gout, with tophi
• D. Osteoarthritis, with Heberden nodes at the DIP and Bouchard nodes at the PIP

Answer: D. Osteoarthritis, with Heberden nodes at the DIP and Bouchard nodes at the PIP

Q2. A tennis player repeatedly dislocates his shoulder and can reduce it himself each time. What is this, and what lesion usually underlies it?

• A. An acute first-time dislocation, with a rotator cuff tear
• B. Recurrent anterior dislocation, usually with a Bankart lesion of the anteroinferior labrum
• C. Inferior dislocation, with axillary nerve injury
• D. A fracture of the upper humerus

Answer: B. Recurrent anterior dislocation, usually with a Bankart lesion of the anteroinferior labrum

Q1. Which laser is used for peripheral iridotomy in angle-closure glaucoma, and what is its mechanism?

• A. Argon laser, by thermal coagulation
• B. Nd-YAG laser, by photodisruption creating a full-thickness opening
• C. Excimer laser, by photoablation
• D. CO2 laser, by vaporisation

Answer: B. Nd-YAG laser, by photodisruption creating a full-thickness opening

Q2. In dacryocystorhinostomy, an opening is created between the lacrimal sac and which part of the nose?

• A. Inferior meatus
• B. Middle meatus
• C. Superior meatus
• D. Sphenoethmoidal recess

Answer: B. Middle meatus

Q1. Stellate suppurative granulomas with necrotic centres in a lymph node draining a scratch suggest which infection?

• A. Cat scratch disease caused by Bartonella henselae
• B. Tuberculous lymphadenitis
• C. Sarcoidosis
• D. Histoplasmosis

Answer: A. Cat scratch disease caused by Bartonella henselae

Q2. A graft taken from a different species is termed what, and what is the main barrier to its use?

• A. An autograft, limited by donor site morbidity
• B. An isograft, limited by donor availability
• C. A xenograft, limited by hyperacute rejection against preformed antibodies
• D. An allograft, limited by HLA mismatch

Answer: C. A xenograft, limited by hyperacute rejection against preformed antibodies

Q1. A continuous machinery murmur is heard below the left clavicle in an infant with bounding pulses. Which lesion, and why is the murmur continuous?

• A. Ventricular septal defect, with systolic shunting
• B. Atrial septal defect, with fixed splitting
• C. Tetralogy of Fallot, with an ejection murmur
• D. Patent ductus arteriosus, because aortic pressure exceeds pulmonary pressure throughout the cardiac cycle

Answer: D. Patent ductus arteriosus, because aortic pressure exceeds pulmonary pressure throughout the cardiac cycle

Q2. Menkes kinky hair disease results from defective transport of which metal, and what is the biochemical consequence?

• A. Zinc, impairing wound healing
• B. Copper, impairing lysyl oxidase and so collagen and elastin cross-linking
• C. Iron, impairing haem synthesis
• D. Selenium, impairing glutathione peroxidase

Answer: B. Copper, impairing lysyl oxidase and so collagen and elastin cross-linking

Q1. Which intervention has NO role in the immediate management of an acutely violent psychiatric patient?

• A. Oral or intramuscular benzodiazepine
• B. Cognitive behavioural therapy
• C. Intramuscular haloperidol
• D. Electroconvulsive therapy in refractory catatonic excitement

Answer: B. Cognitive behavioural therapy

Q2. What is meant by double depression?

• A. A major depressive episode lasting more than two years
• B. Major depression together with obsessive-compulsive disorder
• C. A major depressive episode superimposed on pre-existing persistent depressive disorder (dysthymia)
• D. Depression accompanied by panic attacks

Answer: C. A major depressive episode superimposed on pre-existing persistent depressive disorder (dysthymia)

Q1. Which ion is present at the lowest free concentration inside the cell, and why does this matter?

• A. Free calcium, kept at about 100 nanomolar so that small influxes act as an effective second messenger
• B. Magnesium, kept low to permit ATP binding
• C. Potassium, kept low to maintain the resting potential
• D. Protein, kept low to prevent oncotic swelling

Answer: A. Free calcium, kept at about 100 nanomolar so that small influxes act as an effective second messenger

Q2. What is the resistance of a muscle to passive stretch when the patient is relaxed, and how does it differ from spasticity?

• A. Spasticity, which is constant through the range
• B. Tone, which is the normal baseline resistance, whereas spasticity is velocity-dependent and increases with rapid stretch
• C. Rigidity, which is velocity-dependent
• D. Clonus, which is rhythmic

Answer: B. Tone, which is the normal baseline resistance, whereas spasticity is velocity-dependent and increases with rapid stretch

Q1. Which two imaging modalities depend on the same underlying physical principle?

• A. CT and MRI
• B. Ultrasound and HIDA scanning
• C. MRI and PET
• D. CT and plain radiography, both using differential attenuation of X-rays

Answer: D. CT and plain radiography, both using differential attenuation of X-rays

Q2. A woman has right upper quadrant pain and a positive Murphy sign, but ultrasound is equivocal for cholecystitis. Which study best confirms cystic duct obstruction?

• A. Repeat ultrasound in 24 hours
• B. Hepatobiliary iminodiacetic acid (HIDA) scanning, where non-visualisation of the gallbladder confirms obstruction
• C. Plain abdominal radiography
• D. Barium meal

Answer: B. Hepatobiliary iminodiacetic acid (HIDA) scanning, where non-visualisation of the gallbladder confirms obstruction

Q1. Which mosquito genus has spotted wings and rests at an angle to the surface, and which disease does it transmit?

• A. Anopheles, transmitting malaria
• B. Culex, transmitting filariasis
• C. Aedes, transmitting dengue
• D. Mansonia, transmitting brugian filariasis

Answer: A. Anopheles, transmitting malaria

Q2. In the plains, one primary health centre is designed to serve a population of approximately how many?

• A. 3000
• B. 5000
• C. 20000
• D. 30000

Answer: D. 30000

Q1. What is the commonest immediate complication after splenectomy?

• A. Reactionary haemorrhage, often from a slipped hilar ligature or short gastric vessel
• B. Pancreatic fistula
• C. Overwhelming post-splenectomy infection
• D. Portal vein thrombosis

Answer: A. Reactionary haemorrhage, often from a slipped hilar ligature or short gastric vessel

Q2. An elderly farmer has a slowly growing indurated ulcer with everted edges on the lower lip and a firm submental node. What is the diagnosis, and why is the lower lip typically affected?

• A. Basal cell carcinoma, which spares mucosa
• B. A plunging ranula, arising from the sublingual gland
• C. An epulis, arising from the gingiva
• D. Squamous cell carcinoma, because the lower lip receives the greatest cumulative sun exposure

Answer: D. Squamous cell carcinoma, because the lower lip receives the greatest cumulative sun exposure

Q1. Exenatide is used in type 2 diabetes. What is its mechanism, and why does it rarely cause hypoglycaemia alone?

• A. DPP-4 inhibition, prolonging endogenous incretins
• B. A GLP-1 receptor agonist, which augments insulin release in a glucose-dependent manner
• C. Inhibition of intestinal alpha-glucosidase
• D. PPAR-gamma agonism, improving insulin sensitivity

Answer: B. A GLP-1 receptor agonist, which augments insulin release in a glucose-dependent manner

Q2. Prostaglandins, thromboxanes and leukotrienes are all derived from which precursor, released from membrane phospholipid by phospholipase A2?

• A. Stearic acid
• B. Linoleic acid
• C. Arachidonic acid
• D. Linolenic acid

Answer: C. Arachidonic acid