TAS February 2021

EMQS:

1. (A) Coronary sinus drain in:

(B) Y wave in JVP represent opening of:

(C) Ductus venosus open in:

 RT atrium
 Ductus venosus
 Tricuspid regurge
 tricuspid opening
 Left atrium
 Svc
 IVC

2. ( folate , B12, water, CHO, Iron, Protein )

(A) The primary site of Absorption in colon:

(B) The primary site of Absorption in all small intestine
© The primary site of Absorption in distal Ileum

3. (A) what is the site of secretion of the following?

1. Melatonin

2. Glucagon

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 TAS February 2021
3. Calcitonin

 Pinealocytes
 Arcuate nucleus Hypothalamus
 Alpha cells in Langerhans island
 Beta cells in Langerhans island
 Para follicular cells of thyroid (C cells)

4. Statistic questions on sensitivity, negative predictive value,

odds ratio, mean interval, false negative, relative risk

 Specificity
 Likelihood
 RR
A. Probability of -ve people among non-diseased
B. Probability of +ve results among people exposed to ttt
divided by probability of +ve result among people not
exposed to ttt
C. Probability of outcome in those exposed to non-exposed

5. Vitamins:
 Obese child on orlistat.... Vit D
 Acrodermatitis.... Zinc
 Vegan mother.... Vit b12
(Same Q from recalls)

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6. EMQ
1. 16 yr. old girl come to your clinic crying, with multiple sexual
partners , un protected sex with vaginal discharge, foul smell,
oozing and easy bleeding from the vagina , ask about the
mechanism of action of ttt, smear result in gram negative diplo
cocci ;
 Inhibit cell wall synthesis
 Bind to ribosome 50
 Bind to ribosome 30
 Inhibit DNA synthesis
7. Mode of action of the following drugs which used in ttt of JIA

(A) Drug working as INL 1 inhibitor- anakinra

(B) Calcineurin inhibitor - cyclosporine,

(c) TNF inhibitor- infliximab

8. (GBS, Staph aureus, strept pneumonia, klibsiella, pertedella

pertussis, Corynebacterium, Moraxella)

1. Gram positive diplococci

2. Gram negative bacilli
3. Gram negative coccobacilli

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 TAS February 2021
9. (same Q in recalls, same sample paper Q)
3 scenarios of platelet
Options :
(alloimmine, maternal, ITP, CMV, congenital leukaemia,
SLE)
A. FT 2.3 kg, with petechiae and hepatosplenomegaly 2cm, mother
PLT, normal 195 = CMV

B. mother PLT > 200 , FT baby wt. 3.2kg with pastiche , liver , spleen
just palpable= Alloimmine

C. PLT mother 23, mother well, FT baby wt. 3.2kg with pastiche liver
and spleen just palpable= Maternal ITP

10. EMQ
 Vit D dependent ricktis
 X linked hypophosphatemic ricktis
 Vit D resistant ricktis
 Primary hyperparathyroidism
 Acute renal failure
 Chronic renal failure
 Vit D deficiency

(A). 18 years old girl, faltering growth:

 Urea normal
 Creatinine 40 (up to 39 normal),
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 TAS February 2021
 Normal calcium
 Normal phosphate,
 Raised alk ph.
 PTH :8 ( raised)
 25 oh but D (very low )
 1,25 :80 (normal range)
 CA :Creatinine ratio low

(B). 2nd scenario:

 urea normal
 Creatinine 40 high (normal up to 39)
 High Ca
 low phosphate ,,
 raised alk phosph,,
 raised pth 15 (high)
 calcium creatinin ratio : normal

(C ). 3rd scenario:
 Normal Urea
 Creatinine 40 (normal up to 39)
 Normal calcium
 decreased phosphate,
 high ALP
 PTH normal
 Normal vitamin D
 increased cal:creatinin ratio

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 TAS February 2021
11. EMQ

 Vancomycin inhibits glycopeptide in cell wall,

 ciprofloxacin dna gyrase,
 chloramphenicol 50s ribosome,
 dobutamine b1 agonist,
 theophylline phosphodiesterase inh

12. EMQ

mechanism of drugs used in medication of asthma:

( formetrol, salbutamol, montelukast, thiophyllin)

1. leukotriene receptor antagonist

2. prolonged action on B2
3. Phosphodiesterase inhibitor

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 TAS February 2021
BOF QS:

1. What the metabolite increased in DKA:

 increase cellular osmolality
 increase intracellular shift of k
 increase beta-hydroxybutyrate
 bicarbonate retention
 increase gluconeogenesis

2. GBS CSF analysis:

 Normal lymph, high protein, normal glucose

 High lymph, high pnt, normal glucose
 High lymph, low pnt, high glucose
 Normal lymph, normal pnt, low glucose
 High lymph, high pnt, low glucose

3. Father has sickle cell ,mom and father from the same area
mother does not know if she has the disease ,now mother is
pregnant in a monozygotic twins females, the grandfather was
died by sickle cell crisis before , the chance to be a carrier for
each one:

 25%
 50%
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 TAS February 2021
 O%
 100%
 33%

4. Positive bacilli causing meningitis in neonate:

 Listeria monocytogenes
 E.coli
 GBS
 Strep pneumonia

5. Diabetic patient and screened for celiac , what is the

associations:

 HLA DQ2, DQ8

6. What the initial Diagnostic test in celiac:

 IgA anti-tissue glut + total IgA

 total IgA
 IgA anti-tissue glut + total IgG
 AEM (anti-endomyseal)

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7. Baby with conjunctivitis treated with chloramphenicol, what
the mechanism of action:

 Binding to ribosome 30 and inhibit pnt synthesis

 Binding to ribosome 50 and inhibit pnt synthesis
 Inhibit cell wall synthesis

8. Case of HDN which lab will be more dearrnged :

 both PT, APTT

 PT
 PTT
 Bleeding time

9. What changes we can make in model of improvement:

 Plan, do , study, act

10. Child with diarrhoea and vomiting for 3 days, low glucose
and drowsy and +++ketones in urine, what you will find in his
lab:

 raised insulin raised ammonia

 Low insulin and high cortisol
 High insulin, low cortisol
 Low insulin, low cortisol

11. Where is the defect in Morgagni hernia:

 Failure of retrosternal pleuro-peritoneal canal

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 TAS February 2021
 Failure of migration septum transversum
 Defect in retrosternal part of septum transversum

12. Most common type of tracheoesophageal fistula:

 Proximal atresia, distal tracheal and oesophageal fistula

 Proximal and distal oesophageal atresia
 Proximal tracheal and distal oesophageal fistulas
 H type ( not mentioned clearly but describe it )

13. Where is the primary site of IVH 1st occur in PT baby:

 Floor of lateral ventricle

 Foramen of monro
 Body of Forth ventricle
 Choriod plexus
 Sub ependymal germinal matrix
14. Gallick competence of a girl15 yr old with ALL who refuses
chemo for 40% chance cure. She does not like to complete her ttt
Parents want her to proceed:

 Go with parent wishes

 Don’t ttt according to her wish
 Seek legal advice
 Health committe

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 TAS February 2021
15. Patient with RTA, on mechanical vent, what’s the neurological
signs which go with brain stem death? (same scenario in TAS
cases)

 Absent brain stem reflexes

 Persistence Hypothermia for less than 35 degree
 Burse suppression pattern in EEG with prolonged period of
absent activity
 Chyne-stoke breathing
 Abnormal pupillary reflex

16. Radioisotope is favourable than skeletal survey in non-

accidental injury to check for which type of fracture:

 Epiphyseal fracture
 Metaphyseal fracture
 Spiral fracture of tibia
 Post Rib fracture
 Skull fracture

17. MOA of Methylphenidate:

 Dopamine reuptake inhibitor

18. Female with painless palate ulcer, pleurisy not responding to

ttt, diffuse hair loss, Lymphopenia, low C3, C4, low HG and low
albumin, normal IgM and IgG, high liver enzymes ALT ,AST in the
lab, fatigue.... Diagnostic test
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 TAS February 2021
 dsDNA
 cANCA
 PNCA
 ANA
19. tha main Action of adrenaline in anaphylaxis?
 Increased peripheral vascular resistance and reduce
angioedema
 Work on beta2 to increase heart contractility
 Work on bata1 to cause bronchodilation
 Mast cell stabiliser
20. Tidal volume in baby 3kg newborn?
 12-16
 10-14
 28-33
 18-24
21. Corneal reflex:

 Nerves.. V and VII

22. Which drug is potent vasoconstrictor?

 Noradrenaline
 Dobutamine
 Dopamine
 Milrinone
23. RT complete Oculomotor nerve palsy –
 RT ptosis
 Up and out
 Down and in
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 TAS February 2021
 Miosis
24. There was a case about headache and convergent squint
with, failure to move the eye laterally with double vision.

 cranial nerve 6 abducens

25. Anorexia patient, admitted to hospital, asking what factor

most contributes to future bone density, BMI <13

 Oestrogen def.
 Calcium def.
 Cortisol high
 Low IGF
 Low Growth hormone

26. In DKA, what leads to hypokalaemia?

 Osmotic diuresis
 metabolic acidosis
 insulin therapy
27. How to prepare live attenuated vaccine:

 Culture in Non-human host to produce low virulent strain

 Inactivation of disease causing pathogen by formaldehyde
and heat exposure
 Inactivation of toxin which produce symptoms by
formaldehyde
 Mixing part of polysaccharide capsule with protien
 Recombinant vaccine
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 TAS February 2021
28. How Strep Pneumonia strains become resistant to
Fluoroquinolones mechanism

 Mutation of DNA Gyrase, decreasing antibiotics binding to

bacteria
 Produce beta lactamase
 Decrease efflux of antibiotic across cell wall

29. 1 month old baby herpetic encephalitis why there is

increased risk of severe infection in this age:

 No trans placental Ab
 Macrophage low response to antigen
 CD8 cells low response
 Immunoglobulin reach nadir in 3m
 Defect in neutrophilic chemotactic response

30. Plasmalyte composition (same as in oct 2020)

31. During sleep, in normal child, how body responding to

hypoxia:
 Medulla rasp centre
 Carotid body chemoreceptor
 Diaphragmatic Vagal nerve sensation
 Chest wall receptors
 Larynx receptors

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 TAS February 2021
32. PT 8 yrs old, with operated spinabifida and Arnoldchiari
malformation with hydrocephalus with Kyphoscoliosis, with low
oxygen 80% on room air, and 86% on 60% oxygen, FEV1 1.31
(90% of predicted), FVC 1.51(90% of predicted), PH and CO2
normal. They were asking about mechanism
 VQ mismatch
 Decreased alveolar surface
 Restrictive lung Disease
 Moderate airway obstruction
 Lung hypoventilation
33. Starting of ventricle relaxation in ECG-

 T wave
 St segment
 PR interval
 P wave
 J point

34. Burn superficial partial-thickness, what's the deepest layer

affected?
 Papillary dermis
 Reticular dermis
 Stratum basal layer
 Stratum cornium
 Stratum Granulosa

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 TAS February 2021
35. Term new-born losing 10% of his wt in 1st 10 days
mechanism?
 Large body surface insensible water loss
 Increase ANP due to increase blood flow from lung to lt
atrium
 Pass meconium in term baby which decreased water content
 In adequate fluid intake
36. Paracetamol mechanism of conjugation in children

 Glucuronidation
 Sulphation
 Cytochrome 450

37. Commonest enzyme defect causing un-conjugated jaundice

in neonate:

 U5DPG transferase
 G6PD
 Pyruvate kinase
 GGT
 Beta glucorinidase

38. 3 yr boy, diabetic type 1, fits at home, parents gave IM

glucagon, and then fits stopped immediately. Mechanism of
action?

 Stimulates hepatic glycogenolysis

 Have anti-epileptic effect

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 TAS February 2021
 Lipolysis
 Increase cortisol secretion

39. Baby 6 month, with Nephrocalcinosis, hyperchloremic normal

AG metabolic Acidosis, and Nephrocalcinosis, F/H of similar
condition, urine PH 7 .Asked about mechanism...

 Decrease H+ secretion in distal renal tubules due to H/K

ATPase defect.
 Failure of h2co3 reabsorption in proximal CT
 Failure to excrete ammonia .

40. Frusemide site of action.

 Ascending loop of Henle

 Descending loop of Henle
 PCT
 DCT

41. Patient has abdominal pain, petechial rash in LL and Buttocks,

diagnosed as HSP , ask about the pathophysiology :

 IgA leucocytic vasculitis

 Toxic vasculitis
 Necrotic vasculitis

42. Lorazepam mechanism of action...

 GABA agonist (chloride channel)

 NA channel blocker
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 TAS February 2021
 Glutamate antagonist
 Calcium channel blocker

43. Turner, mechanism

 Chromosomal non-disjunction
 Microdeletion
 Imprinting
 Uni-maternal disomy

44. Congenital myotonic dystrophy – ( clear Q)

 Genetic anticipation

45. Baby with cleft palate and other physical signs

What other genetic association mostly present...
 Xo
 Methylation
 22q11 microdeletion
46. H/O headache, Hormone deficient in central DI

 vasopressin

47. CP child need Botox inj, Botox mechanism of action

 Decrease A. Choline release in neuromuscular junction
 Block ACH-choline receptor blocker
48. Anorexia nervosa, most imp. Factor for her future bone
disease "osteopenia", BMI < 13.
 Increased cortisol
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 TAS February 2021
 Decreased calcium
 Decreased food intake
 Hypothyroidism
 Estrogen decrease

49. Girl 15 years e ALL has 40% chance of survival e

chemotheraby , but she donot want to complete chemotherapy ,
parents want her to complete ,what to do (fop)
 Donot treat according to her wish
 Treat as parents want
 Seek legal advice
50. Child e K 7.1 ECG showed tall T wave, widened QRS complex,
what more may be seen in ECG...

 Prolonged PR interval
 Prolonged QTc
 Third degree complete heart block
 Raised ST segment
51. Girl 3 days, she came with vomiting,H/O SIDS, 1 of her siblings
passed away, there was suspicion of IEM, what’s the best to
screen
 Carnitine and lactate*
 Ammonia and lactate.
 Ammonia, acyl carnitine
 Urea, Lactate
52. Vancomycin mech. Of action...

 Bacterial cell wall inhibition

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53. Type of study, RCT trial (it was clear)

Study on Group of patients from 3 hospitals between (2008-

2009), with bronchiolitis, study the effect of giving hypertonic
saline on the rate of hospital admission, patients divided into two
groups, part of them had inhaled hypertonic saline with
salbutamol, and the other part had NS with salbutamol, both
groups were blind.

Conclusion: statistically no difference in rate of admission in both

groups, but clinically there was a difference, so they need to
repeat the study on a large group.

What is the best to describe the study?

 RCT
 Case control
 Cohort study
 Systemic review

55. When you give IV medication, which follow the 1st order
kinetic:

 the drug doesn’t cause toxic effect until all the metabolic
enzymes becomes saturated
 increasing the dose of drug increases the volume of
distribution
 the rate of drug elimination depend on plasma concentration

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 Doubling the dose given, halves the time needed to reach
the steady state concentration.

56. What’s decrease the catabolism of proteins in, unwell child,

 L carnitine
 Insulin
 Cortisol
 glucagon

57. Pro-Coagulation factor synthesized by endothelial blood

vessel wall :

 prothrombin –
 fibrinogen –
 VWF ,
 Thrombin

58. 6 yr old girl with recurrent nausea vomiting followed by

drowsiness and confusion, precipitated by recurrent infection,
brother died in infancy due to IEM, negative consanguity, What
the enzyme defect in here:

 Arginisuccinate synthase def

 MCAD
 Methyl malonic mutase
 Glucose 6 phosphate

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 TAS February 2021
59. Repeated Q of statistics CF screening test Negative predictive
value 100% ( same Q in recalls)

60. A female teenager, previously well, started throwing fits,

vacant spells, abnormal posturing of one limb, jerking, behaviour
change, poor school performance, memory loss. Area of brain
involved

 frontal
 Temporal.
 Occipital
 None of the above

61. in a trial to study oxygen saturation in a PT well baby, the

saturation of 43 preterm babies was recorded all after they
received a mechanical ventilation for less than 6 hours, and
supplemental O2 for less than 48 hours.
 The median saturation was 95% (92-99)
 The median time of saturation between (85-90) was 2%
 The median time of saturation between (80-85) was 1%
What is the most appropriate statement?
1. This study is done to implement change of clinical practice.
2. The lower limit of normal saturation of these population is
92%
3. The percent of time at which saturation is less than 91% is
3%.
4. In BPD saturation should be lower than 90% ??
5. The most frequent saturations recorded is 95% ??
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 TAS February 2021
62. Girl with proptosis and lid lag symptoms.
They asked What Ab?
 TSH Receptor Ab.
 Thyroid Peroxidase Ab
 Thyroglobulin Ab
63. What’s the rule of giving high flow O2 in pneumothorax :
 Decrease Nitrogen concentration
 Improve ventilation
64. in the family of H/O child death due to abuse, what’s the
most common family factor predispose to this:
 Domestic violence
 Alcohol intake
 Drug abuser Parents
 Carers were in foster care
65. In Liver disease, what affects the ADEK vitamins absorption?
 Bile acids
 Decrease chylomicrons
66. Which of the following has polysaccharide vaccine
 HIB
 Pneumococci
 Diphtheria

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67. Skin prick test, what type of allergy
 Type 1 hypersensitivity
68. Baby boy with antenatal US shows pelvicalceal system, and
normal bladder. Asking how to check if there is an obstruction:
 MAG3 with frusemide
 MAG3
 DMSA
69. Ichthyosis vulgaris associated with:
 Fillagrin gene mutation
70. Changes after birth
 Decrease pulmonary blood flow
 Increase pulmonary resistance
 Increase peripheral vascular resistance
71. Calcium resin effect on K excretion
 Exchange Catatonic.
72. The main action of Dobutamine:
 B1 agonist
 Alpha1 agonist
 B2 agonist
 D1,D2 receptors

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73. Operated chylothorax, what type of diet should be given:
 Diet with high MCT to pass directly the portal venous
circulation
 High protein and fat diet
 Long chain fatty acid diet

Thank you to all the doctors who participated to collect

this recall

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