Medicine

2009 Medicine Haematology

1.

DIAMS

Elevated serum ferritin, serum iron and percent transferrin saturation are most consistent with the diagnosis of a. Iron deficiency anemia b. Anemia of chronic disease c. Prophyria d. Megaloblastic anemia 2. Most sensitive and specific test for diagnosis of iron deficiency is a. Serum iron levels b. Serum ferritin levels c. Serum transferritin receptor population d. Transferrin saturation 3. All are true regarding anemia of chronic a. Decreased serum Fe b. Decreased ferritin c. Decreased total Fe binding capacity d. Increased bone marrow Fe 4. All are true for sickle cell anemia except a. Pulmonary arterial hypertension b. Fish vertebra c. Leukopenia d. Increased size of heart 5. All are seen is Hemolytic anemia except a. Hemosiderinuria b. Reticulocytosis c. Spherocytosis d. Increased Haptoglobin 6. Splenectomy is most useful in a. Thrombocytopenia b. Hereditary spherocytosis c. H.S. purpura d. Sickle cell anemia 7. Which of the following conditions is associated with Coomb’s positive hemolytic aneima a. Thrombotic thrombocytopenic anemia b. Progressive systemic sclerosis c. Systemic lupus erythematosus d. Polyarteritis nodosa 8. Cause of ITP is a. Vasculitis b. Antibody to vascular epithelium c. Antibody to platelets d. Antibody to clotting factors 9. Platelet transfusion is not indicated in a. Dilutional Thrombocytopenia b. Immunogenic Thrombocytopenia c. Aplastic anemia d. DIC 10. All are true about hemophilia except a. Increased bleeding time b. Decreased factor VIII c. Decreased factor IX d. Increased partial thromboplastin time

Medicine 11. Which is most likely to be increased in Vit. K deficiency a. P.T.T b. P.T c. Platelet count d. Fibrinogen time 12. Most common type of Hodgkin’s lymphoma is a. Nodular sclerosis b. Lymphocyte predominance c. Mixed cellularity d. Lymphocyte depletion 13. Most common type of hodgkin’s lymphoma in India is a. Nodular sclerosis b. Lymphocyte predominance c. Mixed nodulatory d. Lymphocyte depletion 14. The classification proposed by the international Lymphoma study Group for non-Hodgkin’s lymphoma is know as a. Kiel classification b. Real classification c. WHO classification d. Reppaport classification 15. Which is not seen in multiple myeloma a. Anemia b. Increased alkaline phosphatase c. Hypercalcemia d. ↑ed ESR 16. Maximum ESR is seen in a. CHE b. Polycythemia vera c. Multiple myeloma d. Sickle cell anemia 17. While handling a febrile neutropenic patient all are essential except a. Repeated hand washing of hospital person b. While cell infusion c. Prophylactic antibiotic d. Colony stimulating factor for macrophages

Cardiovascular System

18. All of the following heart sounds occur shortly after S2except a. Opening snap b. Pericardial knock c. Ejection click d. Tumor plop 19. ST elevation is seen in all of the following conditions except a. Myocardial infarction b. Coronary artery spasm c. Constrictive pericarditis d. Ventricular aneurysm 20. All are ECG changes in hypokalemia, except a. U wave b. ST segment sagging c. T – wave flattening or inversion d. QT interval prolongation

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1

2009

DIAMS

21. Radiofrequency ablation is done for a. Ventricular tachycardia b. PSVT c. WPW d. Atrial tachycaredia 22. Drug of choice in PSVT is a. Aminodarone b. Lingnocaine c. Quinidine d. Adenosine 23. Kussmaul’s sign is NOT seen in a. Restrictive cardiomyopathy b. Constrictive pericarditis c. Cardiac tamponade d. RV infarct 24. True statement about cardiac myxoma is a. Commonest site is left atrium b. Rarely reoccurs after excision c. Distant metastasis are seen d. More common in females 25. In MI, which enzyme is raised in 4 to 6 hrs. & decreases in 3 to 4 days a. SGOT b. LDH c. CPK d. SGPT 26. Infective endocarditis is least likely to occur in a. Atrial septal defect b. Small ventricular septal defect c. Mitral valve prolapse d. Tetrology of Fallot’s 27. Most common heart valve involved in IV drug user is a. Mitral valve b. Aortic valve c. Pulmonary valve d. Tricuspid valve 28. Osler’s nodes are seen at a. Heart b. Knee joint c. Tip of Palm & Sole d. Anterior abdominal wall 29. Loud first heart sound is heard in a. Mitral stenosis b. MR c. MV prolapse d. Calcified mitral leaflet 30. The most common organism causing infective endocarditis a. Streptococcus viridans b. Streptococcus faecalis c. Coxiella burnetti d. Staphylococcus aureus 31. The normal axis of ECG in adult male is a. –30 to +30 b. –30 to + 110 c. –0 to +180 d. –90 to +90 32. Roth’s spot are seen in a. Subacute bacterial endocarditis

Medicine

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b. Rheumatic fever c. Thromobocytopenic purpura d. None The most common type of congenital heart disease is a. ASD b. VSD c. TOF d. PDA QT interval is shortened in a. Hypocalcemia b. Hypokalemia c. Hypercalcemia d. Hyperkalcemia Hypercalcemia in EGC is diagnosed by a. Increased QT interval b. Decreased QT interval c. Greatly increased PT interval d. Tall “T” waves Pericardial effusion are best diagnosed by a. Ultrasound b. Angiography c. Gallium scan d. Fluoroscopy Centrally acting antihypertensisve drugs are A/E a. Alpha methldopa b. Clonidine c. Guanabenz d. Trimethophan Cannon wave in the JVP is seen in a. Pulmonary stenosis b. Junctional Rhythm c. Tricuspid stenosis d. Pulmonary regurgitation In ECG, Mobitz type 1 heart block is seen as a. Progressie PR interval prolongation b. Static PR interval prolongation c. QRS prolongation d. P wave

Respiratory System

40. Features of restrictive lung disease is a. FEV1/ FVC decreases and compliance decreases b. FEV1/ FVC increases and compliance decreases c. FEV1/ FVC decreases and compliance increases d. FEV1/ FVC increases and compliance decreases 41. All of the following drugs useful in the treatment of a patient with acute bronchial asthma except a. Ipratropium b. Salbutamol c. Montelukast d. Hydrocortisone 42. All are used in bronchial asthma except a. Salbutamol b. Morphine c. Aminophylline

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2

2009

DIAMS

d. Steroid 43. Nosocomial pneumonia is most commonly caused by a. Gram – ve bacilli b. Gram + ve bacilli c. Gram – ve cocci d. Mycoplasma 44. All the following are used in the treatment of Pneumocystis carinii except a. Pentamidine b. Dapsone c. Cotrimoxazole d. Fluoroquinolones 45. All are features of primary tuberculosis a. Pleural effusion b. Consolidation c. Pulmonary fibrosis d. Lymphadenopathy 46. True regarding presentation of primary a. B/L pleural effusion with negative Tuberculin test b. U/L hilar lymphaenopathy c. Sustained chronic pyrexia d. B/L pleural effusion with positive tuberculin test 47. A man presents with fever, wt loss and cough; Mantous reads an induration of 17 x 9 mm; Sputum cytology is negative for AFB. Most likely diagnosis is a. Pulm tuberculosis b. Fungal infection c. Viral infection d. Pneumonia 48. Tuberculous pleural effusion is characterized by all of the following features except effusion a. Harmorrhagic effusion b. Pleural fluid LDH more than 60 % that of serum LDH c. Increased deaminase d. Increased mesothelial cells 49. Most common cause of Mediastinitis is a. Tracheal rupture b. Esophageal rupture c. Drugs d. Idiopathic 50. Most common bronchogenic carcinoma is a. Small cell carcinoma b. Squamous cell carcinoma c. Mixed cell carcinoma d. Adenocarcinoma 51. Commonest type of lung carcinoma in nonsmokers is a. Squamous cell carcinoma b. Adenocarcinoma c. Alveolar cell carcinoma d. Small cell carcinoma 52. A patient presents with secondaries to the adrenals. The most common site of primary is a. Lung

Medicine

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b. Kidney c. Breast d. Stomach Which of the following disease coexist with silicosis a. Sarcoidosis b. Tuberculosis c. Lymphoma d. Rheumatoid arthritis Cotton dust causes one of the following occupational lung disease a. Bagassosis b. Berylliosis c. Silicosis d. Byssinosis Which of the following is not a feature of Kartangener’s syndrome a. Bronchiectasis b. Pancreatic insufficiency c. Sinusitis d. Situs inversus Miliary motting of lung is seen in all except a. Silicosis b. Aspergillosis c. Haemosiderosis d. Tuberculosis Best position to reveal small effusions on chest X- ray is a. AP view b. PA view c. Lateral view d. Lateral decubitus view Stony dull note on percussion is characteristic of a. Pleural effusion b. Consolidation c. Pleurisy d. Tuberculosis cavity Brochoalveolar lavage is beneficial in the evaluation of a. Interstitial lung diseases b. Acute bronchitis c. Bronchopleural fistula d. Pneumothorax Silent chest is seen in a. Very severe asthma b. Chronic bronchitis c. Emphysema d. Bronchiectasis Most common clinical sign of pulmonary embolism is a. Tachypnoea b. Tachycardia c. Cyanosis d. Sweating Tension pneumothorax results in a. Alkalosis b. Increased cardiac output c. Decreased venus return d. Decreased output Most common cause hypoxemia is

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3

2009

DIAMS

a. Lowered insipired oxygen b. Hypoventilation c. Intracardiac shunting d. Ventilation perfusion mistmatch 64. Respiratory alkalosis occurs in a. Diabetic ketosis b. Pyloric stenosis c. Primary aldosteronism d. Excessive ventilation

Kidney and Urinary Tract

65. Most unlikely cause of acute tubular necrosis amongst the following is a. Severe – bacterial – infection b. Massive burn c. Severe crush injury in the foot d. Rupture of aortic aneursym 66. Renal papillary necrosis is almost always associated with one of the following conditions a. Diabetes – mellitus b. Analgesic nephropathy c. Chronic pyelonephritis d. Post streptococcal GN 67. Metabolic complication in CRF include all of the following except a. Hyperkalemia b. Hypophosphatemia c. Hypocalcemia d. Hypokalemia 68. Renal damage due to amphotericin B are all, except a. Azotemia b. Renal tubular acidosis c. Glomerulonephritis d. Hypokalemia 69. All are true of Nephrotic syndrome, except a. RBC casts in urine b. Hypo proteinemia c. Oedema d. Hyperlipidemia 70. True about light microscopy in minimal change disease is a. Loss of foot process seen b. Anti GBM Abs seen c. IgA deposits seen d. No change seen 71. Crescent formation is characteristic of the following glomerular disease a. Minimal change disease b. Rapidly progressive glomerulonephritis c. Focal and segmental glomerulonephritis d. Rapidly non progressive glomerulonephritis 72. IgA nephropathy is seen in a. Membranous glomerulonephritis b. Mesangioproliferative glomerulonephritis c. Focal glomerulonephritis d. Cresentic glomerulonephritis

Medicine 73. Increased IgA deposits are seen in a. Henoch Schonlein Purpura b. Minimal change Glomemlonephritis c. Chronic Pyelonephritis d. Haemolytic uremic syndrome 74. Most common pathological feature in diabetes mellitus is a. Papillary necrosis b. Diffuse glomerulosclerosing c. Renal atherosclerosis d. Chronic pyelonephritis 75. Disease, does not recur in the kidney after renal transplant is a. Alport syndrome b. Amyloidosis c. Good Pasteur;s syndrome d. Diabetic nephropathy 76. All of the following statements are true about Hemolytic uremic syndrome except a. Uraemia b. Hypofibrinogenemia c. Thrombocytopenia d. Positive coomb’s test 77. Most common cause of reanl artery stenosis in young adults in India is a. Atherosclerosis b. Non specific aorto-aortisis c. Fibro muscular dysplasia d. None of the above 78. Medullary cystic disease of the kidney is best diagnosed by a. Ultrasound b. Nuclear scan c. Urography d. Biopsy 79. Adult polycystic kidney is inherited is a. Autosomal-co-dominant b. Autosomal dominant c. Autosomal recessive d. X-linked dominant 80. Charcteristic finding in AGN a. Red cell cast b. Hematuria c. Proteinuria d. Epithelial cells 81. Hematuria, RBC, casts and proteinuria are suggestive of a. Nephritic syndrome b. Renal cell carcinoma c. Acute nephritis d. Chronic renal failure 82. In membranoproliferative glomerulonephritis the charcteristic feature is a. Thickening and splitting of basement membrane b. Nil lesion c. Mesangial cell proliferation d. Fibrin cap 83. What is oliguria

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4

2009

DIAMS a.

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Excretion of less than 300 ml in 24 hrs b. Excretion of less than 500 ml in 24 hrs c. Excretion of less than 300 ml in 12 hrs d. Excretion of less than 100 ml in 24 hrs The term end-stage renal disease (ESRD) is considered appropriate when GFR falls to a. 50% of normal b. 25% of normal c. 10-25% of normal d. 5-10% of normal In chronic renal failure there is a. Decrease anion gap b. Normal anion gap c. Increased anion gap d. Metabolic alkalosis What percentage of cardiac output passes through the kidney normally a. 1 % b. 5 % c. 20 % d. 30 % Uremia occurs when total GFR is reduced by a. 25 % b. 50 % c. 60 % d. 80 % Mosaic pattern of cement line is characteristically seen in a. Hyperparathyroid b. Paget’s disease of bone c. Renal osteodystrophy d. Osteomalacia Autosomal dominant is a. Adult polycystic kidney b. Childhood polycystic disease c. Haemophilia A d. Duchenne muscular dystrophy Fanconi’s syndrome is caused due to a. Gentamicin b. Degraded tetracyclines c. Chromosomal aberrations d. Idiopathic

Gastrointestinal System

91. All are true regarding Plummer Vinson syndrome, except a. Oesophageal web b. Predisposes to malignancy c. Koilonchia d. Common in elderly males 92. The following are predisposing factors for Eophageal carcinoma except a. Plummer Vinson syndrome b. Tylosis palmaris c. Chronic Achalasia d. Benzene therapy

Medicine 93. Adenocarcinoma of esophagus is commonly found in a. Achlasia acardia b. Barret’s oesophagus c. Plummer vinson syndrome d. Chronic smoking 94. Most common site for squamous cell ca. esophagus is a. Upper third b. Middle third c. Lower third d. Gastro – esophageal junction 95. Commonest site of peptic ulcer is a. Ist part of Duodenum b. IInd part of duodenum c. Distal 1/3 of stomach d. Pylorus of the stomach 96. Diagnostic tests for H. Pylori include all of the following except a. Urea – breath test b. Rapid urease test c. Gastric biopsy & Warthin – starry stain d. SAFA test 97. All are used in treatment of Helicobactor pylori, except a. Colloid bismuth b. Cisapride c. Clarihromycin d. Metronisazole 98. In a case of hypertrophic pyloric stenosis, the metabolic disturbance is a. Respiratory alkalosis b. Metabolic acidosis c. Metabolic alkalosis with pseudoxical aciduria d. Metabolic alkalosis with alkaline urine 99. All are complication of ileal resection except a. Megaloblastic anaemia b. Iron deficiency anaemia c. Gastric hypersecretion d. Malabsorption syndrome 100. Massive bleeding per rectum in a 70 yr old patient is due to a. Diverticulosis b. Carcinoma colon c. Colitis d. Polyps 101. In Peutz – Jeghers syndrome, polyps are seen in a. Colon b. Rectum c. Small bowel d. Stomach 102. All the following are causes of Acute Pancreatitis except a. Gall stomes b. Alcohol c. Hemochromatosis d. Hypercalcemia

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5

2009

DIAMS

103. Increased amylase may be seen in all of the following except a. Pancreatic pseudocyst b. Appendicitis c. Perforated peptic ulcer d. Perforated peptic ulcer 104. pH of the gastric acid is a. 1.5 to 2.0 b. 0.5 to 2.5 c. 2.5 to 3.0 d. 3.0 to 3.5 105. Colchicine is used in all except a. Adrenal adenoma b. Amyloidosis c. Familial Mediterranean fever d. Cirrhosis of liver 106. Dumping syndrome is due to a. Vagotomy b. Small stomach c. Hypertonic fluid contents in bowel d. None of the above 107. In celiac sprue there is a deficiency of all except a. Vitamin A b. Vitamin B12 c. Folic acid d. Iron 108. Serum amylase is raised in a. Rubella b. Measles c. Mumps d. Chickenpox 109. Pancreatic insufficiency is best diagnosed by a. Abnormal Schilling test corrected by pancreatic enzyme administration b. Ba meal study c. Amylase levels d. Lipase levels

Liver and Biliary Tract

110. Increased B12 level is seen in all, except a. Cirrhosis b. Primary hepatocellular Ca c. Hepatitis d. Cholestatic jaundice 111. Which of the following hepatitis, viruses have significant perinatal transmission a. Hepatitis E virus b. Hepatitis C virus c. Hepatitis B virus d. Hepatitis A virus 112. Non – parented hepatitis is a. Hepatitis E b. Hep B c. Hep C d. Hep D 113. The most common route of spread in hepatitis E is a. Blood transfusion b. Feco – oral

Medicine c. Intercourse d. IV injection 114. Which hepatitis is most dangerous in pregnancy a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis E 115. Most common type of hepatitis responsible for epidemics in India is a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis E 116. Which of the following enzyme assay is useful to diagnose alcoholism a. SGOT b. SGPT c. Alkaline phosphatase d. Glutamyl aminotransferase 117. In patients with cirrhosis of the liver the site of obstruction in the portal system is in the a. Hepatic vein b. Post sinusoidal c. Extra hepatic portal vein d. Sinusoids 118. What is the most common cause for Budd chiari syndrome a. Right ventricular failure b. PNH c. Valve in hepatic veins d. Polycythemia vera 119. Most common symptom of primary biliary cirrhosis is a. Pruritis b. Abdominal pain c. Jaundice d. Bleeding 120. In patients with acute liver failure, the best prognostic indicator is a. Serum albumin b. Serum alpha feto protein c. Serum bilirubin d. Factor V estimation 121. All the following are features of Wilson’s disease except a. Increased copper content in liver b. Increased cerulolasmin c. Mental changes d. Features of chronic active hepatitis 122. All of the following are risk factors for Hepatocelular carcinoma except a. Hepatitis C infection b. Alcoholism c. Alfatoxins d. Animal fat in diet 123. Dane particle pertains to a. HAV b. HBV c. HCV

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6

2009

DIAMS

d. HDV 124. Antigen which doest not appear in blood in hepatitis B a. HbcAg b. HbeAg c. HbsAg d. None of the above 125. The marker of hepatitis B in the window period is a. HbsAg b. Anti – HBs Ag c. Anti – HBc d. HBs Ag 126. Incubation period of hepatitis B is a. 6 weeks to 6 months b. 6 days to 6 weeks c. 6 months to 6 years d. More than 6 years 127. Following is a cause of unconjugated hyperbilirubinaemia except a. Large haematoma b. Haemolytic anemia c. Megaloblastic anemia d. Rotor’s syndrome 128. The most common cause of hepatocellular carcinoma in India a. Hepatitis A b. Hepatitis B c. Non A Non B hepatitis d. Alcoholic cirrhosis 129. Spider naevi can occur in a. Rheumatoid arthritis b. Cirhossis of the liver c. Pregnancy d. All of the above

Endocrinology

130. All of the following are features of MEN II a, except a. Pituitary tumor b. Pheochromocytoma c. Medullary ca thyroid d. Neuromas 131. All of the following are clinical features of Cushing’s syndrome except a. Insulin resistance b. Menorrhagia c. Violaceous striae d. Centripetal obesity 132. Most common cause of adrenal insufficiency in India is a. Autoimmune b. Surgery c. Steroid withdrawal d. Tuberculosis 133. Which is NOT a clinical feature of Addison’s disease a. Hypoglycemia b. Hyponatremia c. Hypoclacemia d. Hyperkalemia

Medicine 134. Excess Aldosterone is associated with all the following except a. Hypokalemia b. Hyperkalemia c. Sodium retention d. Hypertension 135. Diabetes mellitus is associated with all of the following except a. Encephalopathy b. Myopathy c. Myelopathy d. Myelitis e. Neuropathy 136. Glycosylated haemoglobin percentage which indicates good control of diabetes a. 8% b. 10% c. 15% d. 20% 137. “Hour-glass” vertebrae and “tritiated pelvis” are seen radiologically in a. Thyrotoxicosis b. Myxoedema c. Cretinism d. Hyperparathyroidism 138. Sudden loss of vision in a patient with diabetic retinopathy is due to a. Cataract b. Glaucoma c. Vitreous haemorrhage d. Papilloedema 139. Hashimoto’s thyroiditis all are true except a. Maximum incidence in children b. Neutrophilic infiltration c. Pain d. None of the above 140. Diabetic coma is caused by a. Ketosis b. Hyperglycaemia with hyperosmolar ketosis c. Simple hyperglycaemia d. Hyperkalaemia 141. Most common site of carcinoid is a. Ileum b. Liver c. Rectum d. Appendix 142. Chvostek and Trousseau’s signs positive and hyperreflexia indicate the deficiency of a. Calcium b. Magnesium c. Potassium d. Sodium 143. Obesity lead to all except a. Decrease retardation b. Decrease GH c. Decrease hyperglycaemia d. Decrease growth rate 144. Best antithyroid durg to be used to pregnancy is a. Carbinmazole

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7

2009

DIAMS

Medicine

b. Metrimazole c. Propylthiouracil d. Radioactive I2 145. The chromosomal anomaly in Klinefelter’s syndrome is a. 47 XXY b. 45 XO c. 47 XXX d. 47 XXXX 146. True in Klinefelter syndrome is a. Short stature b. Pituitary adenoma c. Subnormal intellgence d. Breast adenoma 147. Hot flush in menopause is due to a. Low estrogen b. LH surge c. FSH d. Genetic 148. Most common cause of ashermann’s syndrome is a. Trauma b. CuT insertion c. Curettage d. Forceps application 149. Microalbuminuria refers to urinary albumin excretion rate of a. 30-300 mg/24 hour b. 400-600 mg/24 hour c. 700-900 mg/24 hour d. >100 mg/24 hour 150. Short stature with widely spread nipples and webbing of neck is seen in a. Down’s syndrome b. Turner’s syndrome c. Klinetelter’s syndrome d. Edward’s syndrome

Answer Key 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

C B B C D B C C B A B A A B B C

17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32.

B C C D C D C A C A D C A A B A

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33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48.

C C B A D B A D C B A D A B A D

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2009 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82.

DIAMS B D B A B D B B D A A A A C D D D A B C A D B B A B A D B D B A C A

83. A 84. D 85. C 86. C 87. D 88. B 89. A 90. B 91. D 92. D 93. B 94. B 95. A 96. D 97. B 98. C 99. B 100. A 101. C 102. C 103. B 104. A 105. A 106. C 107. B 108. C 109. D 110. D 111. C 112. A 113. B 114. D 115. D 116. A

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Medicine 117. 118. 119. 120. 121. 122. 123. 124. 125. 126. 127. 128. 129. 130. 131. 132. 133. 134. 135. 136. 137. 138. 139. 140. 141. 142. 143. 144. 145. 146. 147. 148. 149. 150.

D D A D B D B A C A D B D A B D C B C, D A D C A B D A D C A C D C A B

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