Women Medical College, Abbottabad

Final Year MBBS

BLOCK N 2023

1. Evidence-based medicine (EBM) is a 4. Which stage of clinical audit process

systematic approach to identifying the follows developing criteria and
most appropriate strategy for 1 standards?
managing an individual patient. This
approach is based on which of the a. Search for literature
following? b. Data collection 2
c. Data analysis 3
a. Advice gleaned from recently d. Implement necessary changes 4
published literature e. Re-audit 5
b. Strategies effective in previous
patients 5. Evidence-based medicine is "the
c. Analyses of relevant medical conscientious, explicit and judicious
literature use of current best evidence in making
d. Advice given by mentors decisions about the care of ________.
e. Advice given by colleagues
a. Individual Patients
2. What is the first step in applying EBM b. Doctors
(evidence based medicine) concepts to c. Pharmaceuticals
answer a clinical question? d. Technicians
e. Nurses
a. Ask the question
b. Acquire the evidence 6. Palliative care addresses the following
c. Appraise the evidence issues of a serious patients:
d. Apply the evidence
e. Assess the whole process a. physiotherapy & spiritual therapy
only
3. What is the definition of clinical audit? b. emotional aspect only
c. emotional, physical & spiritual
a. A structure activity which is aspect
intended to provide new knowledge d. physical symptoms only
which is genrealisable and intended e. to council the patient for curative
for wider dissemination treatment
b. A process by which protocols and
guidelines are created by policy 7. In palliative care, Hospice is a program:
makers and implemented at national
level a. that provides only the medical
c. A quantifiable method of testing a treatment to the patients
new hypothesis in clinical practice b. that provides counseling &spiritual
d. A quality improvement process that therapy only
seeks to improve patient care and c. that has no effect on the patient
outcomes through systematic management
review of care against explicit d. that gives care to the people who
measures and the implementation of are near the end of life & have
change stopped treatment
e. A quantifiable method of testing a e. that provides only the dietary
new hypothesis in clinical practice support to the serious patients

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BLOCK N FINAL YEAR MBBS-280423

Setting standards - Assess performance by data collection of existing

medical redords, practices, patient outcomes etc - Analyse data and
compare to the standard - Implement the changes needed - Re evaluate
with another clinical audit to see if the changes have brought about an
effect
Clinical Audit Stages
8. A 57-year old male is in pre-surgical
testing for an elective laparoscopic
cholecystectomy. He has an otherwise
unremarkable medical history, and he
is scheduled at 1 PM on the day of
surgery. Which of the following is
against the guidelines for preoperative
fasting:
a. Drinking orange juice at 6 AM
b. Eating toast with apple juice at 6 AM
c. Coffee with cream at 10 AM
d. An omelet with pancakes at 5 AM
e. None of the above Avoid solids 6-8 hours before surgery
and clear fluids 2 hours before a. Thalassemia
9. A 50 yr sold recently diagnosed as AML
undergone chemotherapy which he
tolerated well, but on second day of
chemotherapy session he developed
severe nausea.
Biochemical results are as follows:
Na = 136 mmol/L (N), K= 6.5mmol/L
(High),
Urea = 23 mmol/L (High), creatinin=
200 by mmol/L (High)
What is most likely diagnosis?
a. Chemotherapy induced
hyperkalemia
b. Lactic acidosis
c. TUMORlysis syndrome
d. Blast crisis
e. Delayed Type Hypersentivity
reaction
10.A 15 yrs old boy presented withfatigue,
palpitation and body aches. Hehas 05
month history of repeated attacks of
upper respiratory tract infection &
recurrent epistaxis.
ON EXAMINATION:He is Pale
withpurpras, Nolymph Nodepalpable,
there is no hepatosplenomegaly, No
bone tenderness
Investigations: CBC Hb = 8g/dl, WBC =
2.5X 109, PLT = 50x109
Peripheral blood smear- unremarkable
What is the most probable diagnosis?
a. Acute myeloid leukemia
b. Hemolyctic Anemia
c. Acute lymphoid leukemia Remember Aplastic anemia will present with pancytopenia
d. Aplastic Anemia without any lymphadenopathy or hepatosplenomegaly. This can
e. Меgаlоblastic Anemia distinguish it from myelodysplastic syndrome in some questions
where not a lot of info is given
BLOCK N FINAL YEAR MBBS-280423
11.A 40yr old female presented with O2
month history of lethargy and
dysphagia for solid food. There is no
history of weight loss or indigestion.
ON EXAMINATION: She has glossitis,
and anemia. No other abnormality
found on examination.
Her Barium Swallow showed stricture
in esophagus
Her peripheral blood smear showed
microcytosis, anisocytosis,
poikilocytosis and hypochromia.
What is the most likely diagnosis?
b. Sideroblastic anemia
c. Plummer -Vinson syndrome
d. Megaloblastic anemia
e. Pernicious Amenia
12.A 56yr old male was admitted with
increasing fatigue for the last 06
month.
On Examination: He is pale with
massively enlarged spleen.
His HB is 7.8g/dl, WBC = 39000x109 /
L, PLT = 500X109.
What is most likely diagnosis?
a. Polycythemia rubravera.
b. Chronic Myeloid Leukemia
c. Hypersplenism due to chromic
malaria
d. Iron Deficiency anemia
e. Myelodysplastic syndrome
13.A 30yr old presented with jaundice and
anemia. On workup his Hb is 6.2g/dl
with Reticulocytes count of 7%.LFT’s
revealed increase indirect
hyperbilirubinemia.
What test should be done to confirm
the diagnosis?
a. TIBC
b. Serum ferritin
c. Coomb's test
d. Bonemarrow biopsy
e. S vit B12
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14.A 22 yrs old is known case of the 17.A 60 years old male patient has
lasemia trait. Which portion of presented to your clinic with history of
hemoglobin will be the expected to be intermittent high grade fever with
raised on HB electrophoresis. significant weight loss over the last one
month. On examination he has multiple
a. Hb A2 cervical and axillary lymph nodes. He
b. Hb A has generalized scratch marks all over
c. Hb F his trunk as well. Baseline investigation
d. Hb S revealed Hb 10.6g/dL, White cell count
e. Hb Bart and platelets within normal limits.
Chemistry profile was normal. He
15.A 75 yr old male presented with 06 underwent cervical lymph node biopsy
month history of skin pigmentation, that showed owl-eye shaped abnormal
tingling sensations in the body and cells with cellular surface effacement.
unable to maintain posturalbalance. What is the likely Diagnosis and what
CBC: Hb 7.5g/dl, WBC 3.2X109, MCV are these cells called?
115, MCH26, Platelets 320 a. Classical Hodgkin's Lymphoma -
Peripheral smear showed Macrocytosis Reed-sternberg cells.
and Hypersegmented neutrophils. b. Non- Hodgkin's Lymphoma - Pop-
Serum Ferritin: 200ng (Normal >27ng) corn cells.
What is the most likely diagnosis? c. Lymphoblastic Lymphoma - Smudge
cells.
a. Iron deficiency Anemia d. Classical Hodgkin's Lymphoma -
b. Sideroblastic Anemia Auer Rods.
c. Megaloblastic Anemia e. Non-Hodgkin's Lymphoma - Reed-
d. Anemia of Chronic Disease Stern berg cells.
e. Aplastic Anemia 18.A 32 years old young male has been
recently Diagnosed with Large B Cell
16.A 30 year old female is known case of Non-Hodgkin's Lymphoma. On
Rheumatoid arthritis for last 15 years examination he had multiple bulky
presented with Anemia. cervical, axillary and inguinal lymph
On investigation: nodes. Before the commencement of
CBC: Hb 8.4 g/dl, WBC 5.2X109, MCV chemotherapy that consisted of
86, Platelets 320 steroids aswell, his baseline
Peripheral smear showed Normocytic investigations were within normal
Anemia. limits. He presented to you on his 3rd
What is the most likely diagnosis? day of chemotherapy administration in
the Emergency department with history
a. Iron deficiency Anemia of suddent onset of shortness of
b. Hypersplenism breath, altered sensorium and cloudy
c. Hemolytic Anemia urine. His investigations revealed Hb
d. Anemia of Chronic Disease 11g/dL, WBC 9,000, Platelets 358,000.
e. Marrow infiltration Chemistry profile showed Creatinine
Occurs in RA and SLE 11.1g/dL, Potassium 7.2 micromol/L,
uric acid 13mg/dL (markedly raised),
Calcium 1.8mg/dL.
What is the likely Diagnosis?
a. Acute on Chronic Renal Failure.
b. Metastasis to kidneys.
c. Tumor Lysis Syndrome with Acute
Kidney Injury.
d. Diabetic Ketoacidosis.
e. Steroid induced Psychosis.
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19.A 45 years old male with no co-
morbidities presented to you with
history of left upper abdominal pain
and early satiety since one month. On
examination he had palpable spleen
upto the umbilicus and mild pallor. He
has no significant past or family
history. The rest of the examination
was unremarkable. His blood work
showed Hb 9.4g/dL, WBC 26,000,
Platelet count 410,000. Chemisty
profile was within normal limits. While
further investigating, which is the less
likely diagnosis?
a. Chronic myeloid leukemia.
b. Acute lymphoblastic leukemia.
c. Leishmaniasis.
d. Myelofibrosis.
e. Chronic Malaria.
20.A 54 years old man presented with
generalized weakness , easy fatigability
, early satiety and left upper abdominal
heaviness for last 3 months. Physical
examination revealed pallor and
massive splenomegaly palpable 10 cm
below left costal margin. His blood
workup showed white cell count of
54,000 with 80% neutrophils and
basophilia. Haemoglobin was 10.2g/dL
and Platelet count was 432000 with a
low LAP Score.His abdominal
ultrasound showed massively enlarged
spleen.
What is the likely Diagnosis?
a. Chronic lymphocytic leukaemia
b. Chronic myeloid leukaemia
c. Hairy cell leukaemia
d. Non-Hodgkin’s lymphoma
e. Primary Myelofibrosis
BLOCK N FINAL YEAR MBBS-280423
21.A 15 years old male presented with
bilateral neck swellings and non
resolving fever for the last 02 months.
He also reported weight loss of about 8
kg and marked fatigue which has
compromised his daily life activities.
Clinical examination revealed non
tender enlarged palpable Lymph nodes
in cervical, bilateral axillary and
inguinal region. Blood counts were
normal. Excisional biopsy was done
that showed owl eye shaped abnormal
cells.
What is the first line treatment regimen
used in this disease?
a. R-CHOP
6-8 cycles of ABVD +
b. CHOP
Radiotherapy
c. ABVD
d. BEACOPP
e. R-CVP
22.A 17 years old young female otherwise
normal, presents to your clinic with
history of easily bruisibility and heavy
menstruation. Physical examination
was unremarkable. You order her blood
work and it revealed complete blood
picture within normal limits. Which of
the following is the least required
investigation in this case?
a. Activated partial thromboplastin
time (aPTT)
b. Factor VIII (FVIII) coagulant
activity
c. Ristocetin cofactor (RCoF) activity
d. Concentration of vWF antigen
(vWF:Ag)
e. Bleeding time
23.Tumor Lysis Syndrome is best
characterized by following serum levels
of?
a. Low Calcium, high Potassium, high
phosphate, high uric acid.
b. High calcium, high potassium, high
phosphate, high uric acid.
c. High Calcium, low potassium, high
phosphate, high uric acid.
d. Low Calcium, high potassium, low
phosphate, high uric acid.
e. Calcium, high potassium, low
Magnesium, high uric acid.
4
There is hyperphosphotemia which results in
increased calcium binding leading to hypocalcemia
24.A 52 years old male initially reported 27.A 50 years old patient with chronic
with history of low grade fever for the polyarthritis complains of gritty eyes
last 2 months. He has significant and needs to wet her mouth
weight loss. On further inquiry he repeatedly. RA factor is positive. The
reveals that he has night sweats and most likely diagnosis is
generalized itching. On examination he
has bulky bilateral cervical and axillary a. anterior uveitis
lymph nodes. Contrast enhanced CT b. drug induced anticholinergic effect
scan revealed enlarged abdominal c. episcleritis
lymph nodes as well. His blood workup d. psoriatic arthritis
was unremarkable except for his very e. Sjogren's syndrome
high levels of Serum Uric Acid. His
lymph node biopsy showed Non- 28.A thirty years old female has a one-
Hodgkin's Lymphoma. He received first year history of getting painful blue
cycle of chemotherapy and on 4th day hands on exposure to cold, dysphagia
he presented in the ER with overt and difficulty making a good hand grip
TumourLysis Syndrome with Acute due to severe restriction in the ability
Kidney Injury. He was oliguric to flex her fingers. The most likely
,creatinine was 8.5mg/dL, markedly diagnosis is
raised serum uric acid levels. To lower
his serum uric acid levels, what is the a. carcinoma oesophagus
beat treatment option for this patient? b. dermatomyositis
c. multiple sclerosis
a. Febuxostat. d. Raynaud’s disease
b. Intravenous Hydration with Sodium e. systemic sclerosis
Bicarbonate.
c. Allopurinol. 29.All of the following are deformities of
d. Rasburicase. rheumatoid arthritis except
e. Glucarpidase.
a. button-hole deformity
25.Rheumatoid factor b. radial deviation of the fingers
c. swan neck deformity
a. if negative rules out the diagnosis of d. ulnar deviation of the hand
rheumatoid arthritis e. Z thumb deformity
b. indicates the presence of antibodies
(either IgG or IgM) directed against 30.A 26 years male patient has a 6 months
other antibodies. history of fever and recurrent
c. is positive in 35% of patients with ulcerating skin nodules. His BP is
psoriatic arthritis 180/100. His ESR is 100 mm in the 1st
d. is positive in15% patients with hour and his urine shows microscopic
adult RA haematuria. The most helpful
e. when positive indicates a good investigation to reach a diagnosis will
prognosis Poor prognosis if high titres of be
RF present
26.The following disease is most likely to a. LE cell phenomenon
be mono-articular rather than poly- b. Leucocytosis
articular c. leucopenia
d. micro-aneurysms on renal
a. ankylosing spondylitis Polyarticular arteriography
b. primary osteoarthritis Mostly Polyarticular e. neutrophil leucocytosis
c. reactive arthritis Poly/mono, Asymmetric
d. rheumatoid arthritis Polyarticular, symmetric
e. septic arthritis
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31.A 9 years old boy who had a sore throat 35.Rheumatoid arthritis is
one week back, presented with 3 days a. a bacterial disease
history of migratory polyarthritis, fever b. a milder disease in sero positive
and acute dyspnoea. On examination patients
has tachycardia, 3rd sound gallop and a c. may cause carpal tunnel syndrome
diastolic murmur at the mitral area. The d. more common in males
best treatment option is e. spares the cervical spine
36.A 30 years old lady has history of
a. amoxicillin intravenous chronic polyarthritis predominantly of
b. clopidogril 75 mg plus aspirin 75 mg the small joints of the hands and feet
daily and has now come with fever for the
c. corticosteroids past 10 weeks. On admission she is
d. cyclophosphamide found to have a left sided pleural
e. indomethacin effusion. The pleural aspirate is an
exudate with high LDH and a very low
32.A patient is getting treatment for sugar content. The most helpful
rheumatoid arthritis and develops investigation to reach a diagnosis will
corneal deposits. The drug that has to be
be stopped is a. a positive rheumatoid factor in the
pleural aspirate
a. hydroxychloroquine b. a positive tuberculin (Mantoux) test
b. indomethacin c. blood culture for mycobacteria
c. leflonamide d. cytology of the pleural fluid for
d. methotrexate malignant cells
e. NSAIDs e. ESR of over 80 mm in the first hour
37.A 30 years old female patient came
33.A 22 years young male has 3 years
with history of swollen hands. On
history of sacroiliac pain and backache
examination her PIP & MCP joints are
and stiffness especially in the
swollen and tender bilaterally. The pain
mornings. He seems to improve after
is worse in the morning. Rheumatoid
exercise and gets worse after rest. His
factor is negative. Her anti-CCP
ESR is 100 mm in the 1st hour. The
antibodies are positive. Her long-term
most helpful investigation to reach a
treatment should be
diagnosis will be
a. cyclophosphamide alone
a. anti CCB antibodies b. corticosteroids and NSAIDS.
b. hepatitis B surface antigen c. methotrexate and corticosteroids
c. HLA B27 d. methotrexate and NSAIDs
d. LE cell phenomenon e. non steroidal anti-inflammatory
e. rheumatoid factor drugs (NSAIDS) alone
38.A 22 years old male presented with a
34.A 26 years young lady has a 6 weeks history of lower backache for the last 2
history of severe painful weakness of years. He describes his backache to be
muscles. She has a heliotrope worse in the early morning and
discolouration over her eyelids. Her improves on exercise. On examination
ESR is 90 mm in the 1st hour and the there is straightening of the lumbar
serum CPK levels are very high. The spine. His ESR is 100 mm in the 1st
most likely diagnosis is hour. The most likely diagnosis is
a. ankylosing spondylitis
a. dermatomyositis
b. degenerative disc prolapse
b. muscular dystrophy
c. dengue fever
c. osteomalacia
d. osteomalacia
d. polymyalgia rheumatica
e. TB spine
e. systemic lupus eryhthematosis
Bamboo Spine Loss of normal 6
BLOCK N FINAL YEAR MBBS-280423 spine curvature
39.A 26 years young female has fever, 43.A 25 years old male had an episode of
rash, alopecia, buccal ulcers and dysentery about 2 weeks back from
splenomegaly. The most likely which he recovered. Now he has
diagnosis is arthritis of both knees, red eyes,
dysuria and a urethral discharge. The
a. polyarteritis nodosa most likely diagnosis is
b. polymyositis
c. herpes stomatitis a. E coli cystitis
d. scleroderma b. gonococcal urethritis
e. systemic lupus erythematosus c. Reiter’s syndrome
d. Schogrens syndrome
40.A 32 years old female has scaly non- e. syphilis
itchy skin lesions, for over 15 years. For
the past two years she is finding it 44.A 40 years old female gets repeated
extremely difficult to get up in the attacks of DVT. The current attack is in
mornings because she feels very stiff. both her calves and this is her 8th such
There is asymmetrical arthritis of the attack. She is married for 21 years, has
small joints of both hands along with had multiple abortions but has no living
arthritis of both elbows. Her ESR is 70 child. The most helpful investigation to
mm in the 1st hour. The most likely reach a diagnosis will be
diagnosis is Treat with LMWH during pregnancy
a. anti cardiolipin antibodies
a. anti phospholipid syndrome b. diagnostic D & C
b. Behcet's syndrome c. pelvic ultrasound
c. polyarteritis nodosa d. serum LH and FSH
d. polymyalgia rheumatica e. serum fibrin degradation products
e. psoriatic arthritis
45.A 53 years old obese patient is on
41.A diagnosed SLE patient’s renal treatment for congestive cardiac
functions have recently deteriorated failure. He gets excruciating pain in his
and needs treatment. The best left big toe which wakes him from
treatment option is sleep. When brought to hospital his toe
is red and swollen and he is stopping
a. cephalosporin antibiotics to cover you from touching it. The most likely
for background renal infection diagnosis is
b. corticosteroids and azathioprine
c. corticosteroids and a. acute osteoarthritis
cyclophosphamide b. drug induced lupus
d. haemodialysis if blood urea is over c. gonococcal arthritis
110 mg/dl d. gout
e. intravenous fluids and azathioprine e. haemochromatosis

46.An elderly male who is diagnosed a

42.A 40 years old man has mild
case of carcinoma of prostate with
polyarthritis and extensive psoriasis.
painful bony metastasis admitted
The best treatment option is
indoor for pain management. Which of
the following is more likely to help this
a. corticosteroids
patient?
b. hydroxychloroquine
c. methotrexate a. NSAIDs
d. NSAIDs & corticosteroids b. Paracetamol
e. penicillamine c. Tricyclic drugs
DMARDS first line agent (leflunomide preferred) d. codein
e. Morphine
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47.Which of the following is good indicator 52.A 30 years old female had 15 % burn
of tissue perfusion? involving both thighs. Examination
revealed deep partial thickness burn.
a. pulse How this wound will heal if no
b. blood pressure intervention is done
c. urine output
d. CVP a. Normal healing
e. GCS b. No scarring
c. Hypertrophic scarring
48.A 25 years old female presented with d. Keloid formation
history of flame burn 2 hrs ago. e. Atrophic scar
Examination revealed burned area
involving both upper arms, front of 53.A 30 years old female had 15 % burn
chest, abdomen and head & neck. What involving both thighs. Examination
is total body surface area involved revealed deep partial thickness burn. In
how much time this wound will heal
a. 35 % spontaneously
b. 45 %
c. 55 % a. 1-2 WEEK
d. 25 % b. 2 WEEKS Superficial Partial Thickness
e. 65 % c. 3-4 WEEKS Deep Partial Thickness
d. 6 -8WEEKS
49.A 40 years old female having second e. >8 WEEKS
degree burn brought to emergency
room. Which of the following formula is 54.A 35 years old male was operated for
used for fluid resuscitation incision biopsy of right axillary lymph
node. The procedure was uneventful,
a. Curie after 10 hours of procedure he
b. Barclays 4ml x Body wieght x %TBSA developed bleeding from incision site.
c. Parkland What is likely cause of this
50% in 8 hours 50% in 16 hours
d. Wallace complication
e. Lund & Browder
a. 1˚ hemorrhage
50.How much small intestine can be safely b. 2˚ hemorrhage
resected or bypass without deleterious c. Reactionary hemorrhage
effects d. Non surgical hemorrhage
e. Tertiary hemorrhage
a. 25 %
b. 50 % 55.A patient of 30 years female was
c. 65 % operated for lap-Cholecystectomy in
d. 75 % morning elective list. After 6 hours of
e. 85 % surgery patient deteriorated vitally
with pallor, pulse 130/min weak, BP-
51.Which of the following fluids contain 80 systolic. What is the next step of
potassium management

a. Normal saline a. Reassurance of patient

b. Ringer Lactate b. FAST Scan
c. Dextrose saline c. MRI
d. Dextrose water d. ERCP
e. None e. Blood CBC

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56.Informed consent must always be 61.Mental State examination (MSE)
taken by; includes all of the following except:

a. Staff Nurse a. Appearance

b. House Officer b. Thought
c. Surgeon Operating on Patient c. Affect
d. Medical Officer d. Cognition
e. Anesthetist e. Diagnosis

57.The maximum pressure for 62.Which of the following is a somataform

pneumoperitoneum during laparoscopic disorder?
Cholecystectomy is
a. Pain disorder
a. 10 mmHg b. Depression
b. 15 mmHg 12-15 mmHg c. Malingering
c. 20 mmHg d. Munchausen's syndrome
d. 25 mmHg e. All of the above
e. 30 mmHg
63.Delusional disorder is:
58.During laparoscopy which of the
following gas is used to create a. Unrealistic fixed beliefs that cannot
pneumoperitoneum be changed
b. Thought broadcasting
a. Air c. Hearing of voices
b. CO2 d. Crying spells
c. Oxygen e. Thought withdrawal
d. Nitrous oxide
e. Halothane 64.A false sensory perception in the
absence of external stimulus is:
59.A 30 years old female operated for Para
umbilical hernia on elective list. A a. Hallucination
Redivac drain was placed for any b. Illusion
collection. When this drain should be c. Delusion
removed d. Depression
e. Stress
a. After 24 hrs
b. 02 Days 65.Thalassemia is inherited as
c. 05 Days
d. 07 Days a. Autosomal Recessive
e. No use of drain b. Autosomal Dominant
c. Sexlinked Recessive
60.A 20 years old female underwent d. Sexlinked Dominant
excision biopsy for 2×2 cm left breast e. None of above
lump. Wound is stitched with pro line O
and stitch is removed on day 7. This 66.Peripheral smear of thalassemia can
wound is healed by show

a. 1˚ intension a. Hypochromia
b. 2˚ intension b. Target cells
c. Skin grafting c. Microcytosis
d. Tertiary intension d. Anisocytosis
e. Flap application e. All of the above

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67.Hb electrophoresis in Thalassemia 73.Splerocytisis is inherited as
major shows
a. Autosomal Recessive 25 Hereditary
b. Autosomal Dominant 75 Spherocytosis
a. Absent Hb A2
c. Sex linked Recessive
b. Hb A2 Decreased
d. Sex linked Dominant
c. Hb F les then 10%
e. None of above
d. Elevated Hb A1
e. Hb F more than 90% 74. Sherocytosis is presented in

a. Adult life
68.Which one is not treatment of
b. Neonatal life
thalassemia
c. Infancy
d. Childhood
a. Vit.C
e. None of above
b. Folic cid
c. Oral iron supplements 75. A 4 year old child presented with fever
d. Blood transfusion and epistaxis for 2 weeks. O/E he is
e. Iron chelation febrile with temp 101,pale, bruises on
abdomen and legs and
69.In sickle cell anemia peripheral smear splenomegaly.His cbc shows hb
shows 8g/dl,Tlc 55000,PLT 40000. What is
the next investigation to confirm the
a. Hypochromia diagnosis?
b. Microcytois
a. Hb electrophoresis.
c. Anisocytois
b. Serum Ferritin.
d. Sickle cells
c. Bone Marrow biopsy
e. All of above
d. Blood culture
e. Ct scan Abdomen.
70.Longtime manifestations of sickle cell
76. A 7 year old child is admitted with hx
a. Tissue infarction of weight loss, fever and sweating for 3
b. Gallstones weeks. O/E he is pale, febrile and has
c. Leg ullcers cervical and bilateral axillary
d. Hemosiderosis Lymphadenopathy. He has received
e. All of above oral antibiotics for 2 weeks. What is the
71.G6PD deficiency is inherited as best next step in management?

a. Autosomal Recessive a. Oral antimalarial drugs

b. Autosomal Dominant b. Sputum for AFB
c. Sex linked Recessive c. Lymph node biopsy.
d. Sex linked Dominant d. Bone marrow biopsy
e. None of above e. Intravenous ceftriaxone

77. A known case of ALL is brought to you

72.In G6PD deficiency hemolytic crisis by his parents with complaints of facial
shows puffiness, vomiting and pain
epigastrium and hirsutism. The pt is on
a. Hb less then 5g/d chemotherapy for 8 months. Which
b. Peripheral smear shows Heinz drug is responsible for the symptoms?
bodies
c. Elevated bilirubin a. Methotrexate
d. Hemoglobinurea b. Steroids
e. All of above c. Vincristine.
d. Septran.
e. Etoposide

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78. A 10 month old boy is presented with 82.Risk of having a duchenne muscular
progressive pallor. He is breast fed with dystrophy child to a carrier mother is
no weaning food. Blood picture reveals
microcytic, hypochromic anemia. What a. 50% of sons
is the diagnosis? b. 25% of sons
c. 50% of daughters
a. G6PD deficiency d. 25% of daughters
b. Thalassemia major e. All of above
c. Aplastic anaemia
d. Iron deficiency anemia 83.Which investigation is diagnostic for
e. Hemophilia DMD

79.Which one is the diagnostic test for a. Low Hb

thalassemia major b. High creatinine kinax
c. Reduced dystroplnin in muscle
a. Peripheral smear biopsy
b. Reticulocyte count d. Nerve conduction study
c. Haemoglobin electrophoresis e. Gene analysis
d. Bone marrow examination
e. Coagulation profile 84.Cause of migratory polyarthcritis is

80.A 7 year old boy presented with fever, a. Sepsis

anaemia and multiple bruises. There b. Trauma
was no lymphadenopathy or c. JIA
visceromegaly. Blood picture d. Rheumatic fever
reveals:Hb 4 g/dl, TLC 1600/ e. None of above
cmm,platelets 5000/cmm. What is your
diagnosis 85.Monoartheris in a sick child may be

a. Leukaemia a. Sepsistic artheris

b. Aplastic anaemia b. Rheumatic fever
c. Fanconi anaemia c. JIA
d. Thalassemia d. All of above
e. Thrombocytopenia e. None of above

81.A 4 year old boy presents with 86.Rickets is:

epistaxis. He had URTI 10 days back.
He is now a febrile, active and cheerful.
He has petechial rash over his
abdomen. He is having no
visceromegaly and no
lymphadenopathy. What is the most
important test for diagnosis of this
patient?
a. Failure of mature bone to
mineralize.
b. Failure of mineralization of growing
bone
c. A disease of elderly people.
d. Due to excess of vitamin D.
e. Due to acute diarrhea.

a. Complete blood count 87.Rickets can occur due to:

b. Bone marrow examination
c. Haemoglobin electrophoresis a. Pneumonia
d. Reticulocyte count b. Acute diarrhea
e. Osmolar fragility test c. Dysentery
d. Celiac disease
e. Acute urinary tract infection

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BLOCK N FINAL YEAR MBBS-280423
88.Best site for x-ray for diagnosis of 94.According to WHO, Anemia in
rickets is pregnancy is defined as
a.Ankle joint
b.Wrist joint a.Hb level decreased 12 mg/dl in ist
c.Knee joint trimester
d.Hip joint First trimester: Hb level less than 11.0 b.Hb level decreased 11 mg/dl in ist
e.Chest g/dlSecond trimester: Hb level less than 10.5trimester
g/dlThird trimester: Hb level less than 11.0 c.Hb level decreased 10.5 gm/dl in ist
89.Measles vaccine
g/dlis given trimester
a. I.M d. Hb level decreased 10 gm/dl in ist
b. I.V trimester
c. Subcutaneous e. Hb level decreased 9 gm/dl in ist
d. Intra dermal trimester
e. None of above
95.A 10 years old child present ED in A/E,
90.Development is almost complete by
with history of limping gait, high grade
a. 7 years fever. On examination temperature was
b. 5 years 102˚ F. Localized tenderness just
c. 9 years above knee. Most probably diagnosis
d. 12 years
e. None of above a. Fracture Femur
91.Which of the following is not given by b. Osteosarcoma
I.M injection c. Acute osteomyelitis
d. Rickets
a. Pneumococcal vaccine e. Septic arthritis
b. Hep B
c. HIB 96.A 15 years old male come to
d. Rota virus orthopedics’ OPD with pain & swelling
e. IPV near the knee joint. On examination
92.All of the following imaging modalities temperature is normal; swelling is
use ionizing radiation, EXCEPT: distal part of femur, some movements
of knee joint possible. Blood count is
a. digital radiography
normal. X-rays show radio destructive
b. MRI
lesion distal femur
c. Mammography
d. CT Scan
a. Septic arthritis knee
e. PET Scan
b. Osteosarcoma
93.A 25 years old G3 P2 Al2 at 28 wks of c. Fracture distal femur
pregnancy presented with the C/O easy d. Giant cell tumor
fatigability tiredness and paller. She is e. Acute osteomyelitis
giving history of MUD eating as well.
Investigation show 97.Two weeks old male child present to
Hb 7.8 gm/dl ortho OPD with deformity of feet. Both
MCHC 20 gm/dl feet were inverted and planti flexed.
MCV 68 fl Most probably diagnosis
MCH 26pg/dl
What is the most likely diagnosis? a. Congenital tellepes calcaneo volgus
a. iron deficiency anemia b. Congenital tellepes equino varus
b. B12 c. Pes plamous
c. Folic Acid d. Post polio paralysis of feet
d. Sickle cell anemia e. Neurofibromatosis
e. Thalessemi
clubfoot
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BLOCK N FINAL YEAR MBBS-280423
98. A 1 year old female child was brought 102. A 13 years old girl presented with
to orthopedic OPD. Parents’ deformity of spine. On examination
complaining of limping gait O/E right thoracic spine are curved latterly. X-
leg is shorter then left leg. Right hip rays show scoliosis. On measurement
abduction is limited. Most probably the curve is 50˚. What should be the
diagnosis treatment
For curves greater
a. Congenital dislocation of hip a. Observation than 50 degrees
b. Septic arthritis of hip b. Surgical Stabilization
c. Fracture neck femur c. Braces 20 - 40 Degrees
d. Post polio paralysis of right leg d. None of above
e. Tuberculosis of hip e. Physiotherapy

99.A one day old female child was sent to 103. A 70 years old male presented to
ortho ward from labor room for orthopedic OPD with severe knee joint
orthopedic assessment of limbs. On pain. On examination, it was revealed
examination Barlow’s test is positive in that he has Genue Varum; knees are
both legs. What is the most probable swollen but skin colour is normal and
diagnosis movements are painful. X-rays show
marked reduction of joint space and
a. Fracture neck of femur osteophytes formation. What will be
b. D.D.H diagnosis;
c. CTEV
d. Proximal femoral focal defect a. Rheumatoid arthritis
e. Septic arthritis of hip b. Anky losing spoudylets
c. Osteoarthritis
100. A one day old female child was sent d. Fracture distal femur
to ortho ward from labor room for e. ACL injury
orthopedic assessment of limbs. On
examination Barlow’s test is positive in 104. A 40 years old lady presented with
both legs. What treatment is the best boutonniere (Buttonhole) deformity of
index finger and swan neck deform of
a. Surgery other fingers. Most probable diagnosis
b. Pavlick Harness
c. Hip Spica a. Osteoarthritis
d. Traction b. Rheumatoid arthritis
e. Brace c. SLE
d. Osteoporosis
101. A two day old male child present in e. Gout
ortho OPD. On examination his both
105. A 40 years old lady presented with
feet are deformed and everted with
severe back pain for last 3 months.
planter flexed. What will be the best
Pain worsens at night and not relieved
treatment in this case
with rest. On examination there is
marked tenderness in lower thoracic
a. Surgical correction of deformity
spines slight weakness of both limbs.
b. Serial casting of feet
X-ray shows loss of disc space between
c. Treatment should wait till child is 1
T10 & T11. Most probable diagnosis
year
d. Braces Clubfoot - Serial casting as part of a. Disc herniation
e. Hip spica the ponsetti method b. Tuberculosis of thoracic spine
c. Fracture of thoracic vertebra
Braces are used after serial casting is complete d. Kyphosis
and are worn till 4 years of age
e. Acute phylogenic infection
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BLOCK N FINAL YEAR MBBS-280423
106. A 40 years old lady presented with 110. A 6 years old child with a dry and
severe back pain for last 3 months. xerotic skin, is having positive family
Pain worsen at night and not relieved history of asthma. On examination
with rest. On examination there is there is excoriations and lichenification
marked tenderness in lower thoracic in cubital fossa. The condition can be
spine, slight weakness of both limbs. X- best diagnosed by:
ray shows loss of disc space between a. Clinical evaluation
T10 & T11. Most probable treatment in b. Patch test
this case c. IgE level
d. Skin biopsy
a. Spinal brace e. IgG levels
b. Debridement
111. A 32 years old lady presents in
c. ATT with debridement
autumn season, with a pruritic rash all
d. Surgical stabilization
over the torso but remember an initial
e. Analgesics and rest
solitary large patch with a collarette of
scales. Which of the following is the
107. A 41-year-old man develops itchy,
most likely cause of the rash?
polygonal, violaceous papules on the
a. Secondary syphilis
flexor aspect of his forearms. Some of
b. Lichen planus
these papules have coalesced to form
c. Pityriasis rosea
plaques. What is the most likely
d. Psoriasis
diagnosis?
e. Tinea Corporis
a. lichen planus 112. A 30 years old female having
b. Scabies symmetrical, pruritic, purple papules on
c. Lichen sclerosus the wrists, ankles, shins and umbilical
d. Morphea region. The disease is found to be
e. Psoriasis associated with:
a. Diabetes
108. A seven year old child presenting b. Psoriasis
with recurrent dry scaly macules c. Pemphigus vulgaris
(white, small) on face has: d. Arsenic poisoning
e. Malignant hypertension
a. Post dermal leishmaniasis 113. All of the following are causes of
b. Pityriasis alba erythroderma except?
c. Early vitiligo
a. Psoriasis
d. Leprosy
b. Lichen planus
e. Mycosis fungoides
c. Eczema
d. Pityriasis versicolor
109. A 25 year old women developed
e. Mycosis Fungoides
small itchy wheals after physical
114. A 35 years old male with a
exertion, walking in the sun, eating hot
complaint of fever, enlarged inguinal
spicy food and when she was angry.
lymph nodes and generalized rash
The most likely diagnoses is?
involving palms and soles. He has a
positive history of sexual contact 03
a. Chronic idiopathic urticaria
months back. The causative organism
b. Heat urticaria
of the disease is
c. Solar urticaria
d. Cholinergenic ueticaria a. Entamoeba histolytica
e. Aquageuic usticaria b. Nisseria gonorrhoeae
c. Plasmodium
d. Treponema pallidum
e. Trichophyton Rubrum

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BLOCK N FINAL YEAR MBBS-280423 Macupapular rash in second stage of syphilis
115. A 40 years old male having 118. A man presents with an area of
symmetrical erythematous plaques dermatitis on his left wrist. He thinks
with silvery scales has recently he may be allergic to nickel. Which one
developed the following associated co of the following is the best test to
morbidity: investigate this possibility?
10% patients with
longstanding psoriasis
a. Urticaria develop psoriatic arthritis a. Skin patch test
b. Gingivitis b. Radioallergosorbent test (RAST)
c. Conjunctivitis c. Nickel IgG levels
d. Arthritis d. Skin prick test
e. cholecystitis e. Nickel IgM levels

116. A 17 years old boy living in the 119. What is the most common causative
hostel presented with a history of agent of erythema multiforme (EM)?
severe itching all over . The itcing is
worse at night . He has excoriated skin a. Penicillin and sulphonamides
between fingers and toe webs. On b. Systemic lupus erythematosus
examination there are some itchy c. HSV infection
papules on his genitals. Based on d. Malignancy
history and clinical examination, which e. Pregnancy
of the following is the diagnosis:
120. A 42 years old male patient is
a. Contact dermatitis suffering from psoriasis. The important
b. Pidiculosis diagnostic feature is:
c. Urticaria
d. Scabies a. Crusting
e. Eczema b. Silvery Scales
c. Oozing
117. A 30 years old women presents with d. Erythema
a fixed erythematous scaly, atrophic e. Excoriations
plaque on the face and sun-exposed
areas, telangiectasia ,
hypopigmentation and follicular
plugging are apparent. Examination of
the scalp shows scarring alopecia and
the mouth has erythematous patches.
She also suffers from Raynaud’s
phenomenon. Skin biopsy shows dense
, patchy , dermal lymphocyte
infiltration , epidermal basal layer is
damaged and hyperkeratosis is also
present . What is the most likely
diagnosis?

a. Squamous cell carcinoma

b. Scleroderma
c. Discoid lupus erythmatosus
d. Plaque like psoriasis
e. Bowens disease.

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BLOCK N FINAL YEAR MBBS-280423