MediCall book series

[MediCall Book Series] Click Below to Install Pakistan’s #1 Health App MediCall Application C.E.O & Founder : Dr.Tauseef Afridi FCPS Past Papers MEDICINE & ALLIED 01 May2018 Morning (A) 01 May2018 Morning (B) 30 01 May2018 Noon (A) 52 01 May2018 Noon (B) 75 01 May2018 Evening (A) 98 01 May2018 Evening (B) 121 02 May2018 Morning (A) 143 02 May2018 Morning (B) 159 09 March 2018 Evening (A) 173 09 March 2018 Evening (B) 185 08 March 2018 Evening (A) 201 08 March 2018 Evening (B) 223 08 March 2018 Morning (A) 247 07 March 2018 Morning (A) 295 07 March 2018 Morning (B) 313 07 March 2018 Evening (A) 340 07 Sep 2017 Morning (B) 407 1st March 2017 Morning (A) 426 1st March 2017 Morning (B) 447 09 Nov 2016 Evening (A) 466 09 Nov 2016 Evening (B) 488 10 Nov 2016 Evening (A) 509 10 Nov 2016 Evening (B) 526 Parietal layer is sensitive to pain as receptors are present on it and absent on visceral layer 543 SURGERY & ALLIED 547 02 May 2018 Evening (B) 573 01 May 2018 Evening (B) 624 www.theMediCall.com Page 07 Mar 2018 Evening (A) 639 07 Mar 2018 Noon (A) 682 07 Mar 2018 Morning (A) 734 07 Mar 2018 Morning (B) 748 01 Mar 2017 Morning (A) 773 01 Mar 2017 Morning (B) 790 GYNAE 798 01 May 2018 Evening (A) 800 01 May 2018 Morning (A) 838 01 May 2018 Morning (B) 864 08 Mar 2018 Morning (A) 887 08 Mar 2018 Morning (B) 910 07 Mar 2018 Morning (A) 927 07 Mar 2018 Morning (B) 952 07 Mar 2018 Evening (A) 968 07 Mar 2018 Evening (B) 995 EYE 1020 MARCH 2018 EYE Papers 1021 MD / MS Papers MD-MS FEB 2018 1076 MD-MS January 2017 1106 MD-MS May 2016 1136 MD MS Nov 2016 1165 MD-MS October 2017 1194 www.theMediCall.com Page www.theMediCall.com Page MEDICINE & ALLIED ================================================================================= Explanations are written just below the Correct Answer www.Facebook.com/TheMediCall join our Patient Help Group www.Facebook.com/groups/medicallers www.theMediCall.com Page SUBJECT & CHAPTER WISE MCQS AVAILABLE ON APPLICATION Click Below to Install Pakistan’s #1 Health App MediCall Application www.theMediCall.com Page 01 May2018 Morning (A) Q: A Shopkeeper suddenly collapsed in his shop On exam, his pulse was thready BP was 80/60 and Pulse was 120bpm, thready and weak Most likely he suffered from?  Cardiogenic Shock Sustained hypotension (systolic blood pressure (BP) aortic pressure during systole Loudest at heart base radiates to carotids  Q: radiates to LUQ Drug used in diabetic gastropathy  Metoclopramide Metoclopramide:MECHANISM D2 receptor antagonist Increased resting tone, contractility, LES tone, motility Does not influence colon tr port time.CLINICAL USE Diabetic and postsurgery gastroparesis, antiemetic    Omeprazol MgOH sucralphate Q: Man had bp 170/110.He did nothing about it.On his next visit it was 170/100.He ignored again.What are the chances of most common complication in future ?     MI COPD CLD Atherosclerosis In the long run, HTN PREDISPOSES to: Atherosclerosis, LVH, stroke, CHF, renal failure, retinopathy, and aortic dissection Q: Traveler returned from foreign trip.Aftr weeks developed generalyzed lymphadenopathy,hepatospleenomegaly,fever and atypical lymphocytosis Diagnosis?   malaria leishmaniasis Leishmania donovani :Tr mitted by Sandfly, causes Visceral leishmaniasis (kala-azar): spiking fevers, hepatosplenomegaly, pancytopenia   typhoid dengue www.theMediCall.com Page Q: muscle which increase AP diameter of thorax during inspiration  intercostal The anteroposterior diameter is increased by raising the ribs and thrusting the sternum forward through contraction of the intercostal muscles The tr verse diameter is increased byraising the ribs (like bucket handles) through contraction ofthe intercostal muscles    Q: tr versus abdominis scalene posterior scalne anterior Tr ient adhesion molecules are    integrin elastin selectin The weak and tr ient interactions involved in rolling are mediated by the selectin family of adhesion molecules Selectins are receptors expressed on leukocytes and endothelium that contain an extracellular domain that binds sugars (hence the lectin part of the name)  Q: fibrin emphysematous changes are due to deficiency of  α1 anti trypsin Two types of Emphysema are:Centriacinar—associated with smoking.Panacinar—associated with α1-antitrypsin deficiency    Q: ALP fibrin Elastin most comon cause of primary immunodeficiency  SCID Severe combined immunodeficiency (SCID):Several types including defective IL-2R gamma chain (most common, X-linked), adenosine deaminase deficiency (autosomal recessive)    AIDS lymphoma leukemia Q: A new born baby boy died after hour.He had microcephaly and extra finger on medial side of both hands.Diagnosis?  Klinefilter syndrome www.theMediCall.com Page    fracture of parital bone fracture of temporal bone cerebral edema with herniation uncal herniation Compresses ipsilateral CN III (blown pupil, “down-andout” gaze), ipsilateral PCA (contralateral homonymous hemianopia with macular sparing), contralateral crus cerebri at the Kernohan notch (ipsilateral paresis a “false localization” sign) Q: Narrowest part of urethra is:  Anterior meatus Narrowest is anterior meatus, longest is penile, broadest is membranous and widest is prostatic    Q: Penile Bulbous Membranous What is the treatment for ruptured duodenal ulcer  omental repair and lavage omental patch and lavage is traditional management for dudenal ulcer    only lavage and closure primary repair secondary repair Q: Child with noisy breathing relieves when on tummy Stridor present What is the diagnosis?  croup croup is also called barking cough, becomes better when in propped up position    Q: acute tonsillitis acute laryngitis malaria Central Chemoreceptors respond to?    Increase PC02 Decrease P02 Increase PH central chemoreceptors are located near the ventral surface of the medulla close to the site of exit of the 9th and 10th cranial nerves They primarily respond to changes in Hydrogen www.theMediCall.com Page 1209 ion concentration in the adjacent brain ECF Carbon dioxide can cross the blood-brain barrier easily and rapidly and causes changes in brain H+ ion concentration d- Increase temp Q: True Statement about metabolism of brain is?    Take free fatty acid from blood Contain large stores of glycogen 20 % o2 consumption at rest Our brain uses more energy than any other human organ accounting for up to 20 percent of the body's total consumption  Q: 40% o2 consumption at rest Very first response to injury   vasodialation vasoconstriction after the injury the first body mechanism to prevent blood loss in vasoconstriction   swelling edema Q: Child presented with delayed milestones short height specific facial features Murmur grade 4/Q: left parasternal heave, shortness of breath, tachycardia ,basal crepts what is the diagnosis?     wiliam syndrome down syndrome fragile X noonan"s syndrome it is a disorder involving unsual facial characteristics, delayed growth, heart defects at birth,malformation bones.bleeding problems Q: Which amino acid deficiency causes cell injury  Glycine It is a required component in so many functions of the body that a deficiency can result in a wide cellular injury    Tyrosine Adenine Proline www.theMediCall.com Page 1210 Q: a kg child presented with severe dehydration for Diarrhea total fluid required is     300 to 400 ml 700 to 1000 ml 1200 to 1500 ml 1500 to 3000 ml 300ml of fluid is required per kg in a child in severe dehydration So with a child weighing 7kg, fluid requirement is 1500 to 3000ml Q: In dystrophic calcification    calcium is low calcium is high calcium is normal dystrophic calcification Is not directly associated with serum Ca2+ levels (patients are usually normocalcemic deposition in abnormal tissues 2° to injury or necrosis  Q: hypercalciurea is present In hyperacute transplant rejection  preformed antibody against cell are present hyperacute rejection occurs very rapidly within minutes so preformed antibodies are involved    Q: macrophages are involved response occur within months response doesnot occur Regarding epididymus all of the following is true EXCEPT:     Lies in scrotum Covered partly by tunica vaginalis Can be palated easily Supplied by artery to vas deferens Epididymus is supplied by branch of testicular artery Q: Anterior epithelium of cornea is    stratified squamous epithelium stratified columner Stratified squamous non keratinized External / Outer surface of cornea is made of Stratified Non-Keratinised Squamous Epithelium ►Inner layer of cornea → Simple Squamous epithelium www.theMediCall.com Page 1211  Q: simple cuboidal Child with decreased factor 8, diagnosis is?  hemophilia hemophillia is due to the def of factor VIII as a result there is excessive bleeding It is a Xlinked recessive disease,    Q: won vilibrand disease hereditary spherocytosis thalassemia Which one of the following produces Factor VIII   Hepatocytes Kupffer cell Factor VIII is produced by liver sinusoids which are lined by kupffer cells   Q: Bone marrow Spleen Congenital cataract is associated with all EXCEPT    toxoplasmosis galactosemia turner syndrome in turner syndrome, there is no congenital cataract One X chromosome is absent resulting in a infertile female All other mentioned diseases have conigenital cataract  Q: lowe"s syndrome Alveoli are kept dry because of? a.Alveolar macrophages b.Tight junction b/w capillaries c.Surfactants b.Negative interstitial pressure lymphatic capillaries maintain the negative interstitial fluid and keep the alveoli dry www.theMediCall.com Page 1212 Q: HLA DR4 is associated with   SLE RA RA is an autoimmune disorder associated with HLA-DRQ: it is disorder of joints with morning stiffness   Q: grave"s disease DM1 Posterior part of tongue is derived from     fusion of lateral lingualswelling fusion of medial lingual swellings somites 3rd and 4th branchial arches Arches and form posterior 1⁄3 of tongue Muscles formed of 4th arch are: most pharyngeal constrictors cricothyroid, levator veli palatini Q: Radial artery lies  below the tendon of brachioradialis radial artery runs along radial aspect of anterior compartment of forearm under brachioradialis,lateral to flexor carpi ulnaris tendon    below flexor retinabulum lies in medical cubital fossa medial to ulner nerve Q: Patient presented with testicular cancer what should be examined to see involvement of lymphatics     vertical nodes superficial inguinal lymph nodes deep inguinal lymph nodes para-aortic lymph nodes there is a mnemonic TOKU i-e testis ovaries kidneys Ureter…all these drain to paraortic lymph nodes Q: Which structure passes above flexor retinaculum?   radial artery ulner nerve www.theMediCall.com Page 1213  cutaneous branch of median nerve cutaneous branch of median nerve passes above the flerox retinaculum That why in carpel tunel syndrome the sensation of thenar eminance is spared why motor function is compromised as deep branch passes below the retinaculum  Q: deep branch of median nerve HSV remain dormant in   bone marrow nerve ganglion HSV becomes dormant in nevre ganglion and becomes action when the person is immunocompromised Resulting in shingles with severe pain   Q: vesicles bones Structure passing anterior to head of pancreas?    SVC IVC superior mesenteric artey superior mesenteric artery passes infront of uncinate process of head of pancreas And supplies the organs derived from foregut mesentry  Q: inferior mesenteric artery In case of local anaesthesia pain can be decreased if    pH made alkaline thin needle used used with adrenaline while giving anesthesia pain can be decreased with adrenaline due to the constriction of vessels  Q: wide bore needle Viral disease caused by an insect bite  dengue dengue fever is caused by mosquito bite It is a hemorrhagic fever with decreased platelet count  chronic gastritis www.theMediCall.com Page 1214   Q: warts shingles Palatine Tonsils lie between which two structures?     colateral sternocledomastois Superior constrictors of pharynx and inferior constrictors Inferior constrictors of pharynx Palatoglosus arch and palatopharyngeous arch palatine tonsils are located in isthmus of the fauces between palatoglossus and palatopharyngeous, the two arches of soft palate Q: White eye / cornea Cause can be?  retinoblastoma unsual white reflection in pupil is found in retinoblastoma, common congenital tumor    neuroblastoma optic nerve atrophy glaucoma Q: Most common clinical finding/symptom encountered in glycogen storage diseases?   Hepatomegaly & hyperglycemia Hepatomegaly & hypoglycemia Low blood sugar (hypoglycemia) An enlarged liver and a swollen belly are signs of glycogen storage diseases   Q: Hepatomegaly & macroglossia Macroglossia & hypoglycemia Following is not a function of liver?     Lipogenesis Albumin synthesis Cholesterol synthesis Gamma globulin synthesis Gamma-globulin is formed in the germinal centers of lymphatic nodules and in the cytoplasm of mature and immature plasma cells Q: Which organ form peptide that help in bone growth?  Kidney www.theMediCall.com Page 1215  Liver Somatomedins are produced predominantly by the liver when growth hormones In addition to their actions that stimulate growth   Q: Brain Intestine What is Inappropriate about hyperparathyroidism:  There is increase P04 renal absorption in primary hyperparathyroidism, serum phosphate levels are abnormally low as a result of decreased reabsorption of phosphate in the kidney tubules However, this is only present in about 50% of cases This contrasts with secondary hyperparathyroidism, in which serum phosphate levels are generally elevated because of kidney disease    Cause renal stones Cause psychic moans Cause osteoporosis Q: Female who often forget to take OCPs what will be the best contraceptive method you will advise her for to years ?   combined OCP combined vaginal implant the combined vaginal implant that is the best method of contraception if a person forgets to take oral medications It prevents pregnancy for years with a failure rate of only Q: 2%   progesterone only implant Estrogen implants Q: Urethral injury resulting in urine collection in perineum, scrotum and anterior abdominal, the lesion is in:   Penile urethra Bulbous urethra As bulbous part of urethra located in superificial perineal pouch so whenever it rupture, urine first accumulates in superficial perineal pouch, then scrotum and even ascends up in anterior abdominal wall   Membranous urethra Prostatic urethra www.theMediCall.com Page 1216 Q: Patient presented with fever coryza and red bulging tympanic membrane organism involved is?  para influenza A virus parainfluenza virus is common in causing infection of ear and throat With presenting complaints of fever, coryza and ear ache    Q: streptocuccus pneumonia staphylococcus pneumonia nesseria Which can remain in dormant stage for up to 40 years  primary oocyte primary oocyte is stuck at prophase until puberty    Q: secondary oocyte tertiary oocyte Quatery oocyte Best test for Typhoid is  blood culture best diagnostic test for typhoid is blood cultures Culture can be positive in early stages of fever as well    Q: typhi dot stool culture urine RE A polysaccharide structure used to retain plasma volume is     pectin sucrose maltose dextran dextrans are used in hypovolumia to prevent further water loss Used in patient with low BP Q: In post op patient what is correct?    Cough is due to gastroesophageal Reflux oxygen is given in less amount as free radical injury can occur respiratory depression is due to the use of opioids in anesthesia www.theMediCall.com Page 1217 opioids causes respiratory depression and respiratory acidosis due to the accumulation of CO2  Q: patient can work immediately Lactation is regulated by  Prolactin and oxytocin prolactin in involved in the formation of milk and oxytocin is involved in expression of milk    Q: prolactin only oxytocin only fetal cortisol Pinna is made up of?  elastic cartilage PINNA OF ear is made up of elastic cartilage Epiglotis is also made of elastic cartilage    Q: fibrous cartilage both elastic and fibrous hyline cartilage Which statement is true regarding Galactesomia   Low galactose in blood Galactose uridyl transferase deficiency Galactosemia follows an autosomal recessive mode of inheritance that confers a deficiency of Galactose uridyl transferase enzyme responsible for adequate galactose degradation   Q: Glucose transferase deficiency None of above What is the correct sequence of stages of delivery?     external rotation restitution extension internal rotation restitution extension flexion restuition extension engagement Descent flexion internal rotation extension the sequence is engagement ,flexion, descent, rotation, extension, restituition, anterior shoulder delivery, post shoulder delivery www.theMediCall.com Page 1218 Q: A patient presented in the state of shock with decreased cardiac output, decrease venous return and increased total peripheral resistance what is the type of shock ?   cardiogenic shock hypovolumic shockk in hypovolumic shock, there is decreased venous return due to depletion of blood/blood loss, as aresult decreased cardiac output and increased peripheral resistance   Q: neurogenic shock anaphylactic shock Child having nasal lacrimal duct Obstruction probing should be delayed till?   12 months 12 to 18 months as there is high spontaneous rate of remission in 1st yr of life, probing should be delayed uptil 12 to 18 months of age   15 months year Q: Small nodule medial to sternocleidomastoid is present Mild swelling of thyroid present On biopsy of nodule thyroid tissue present.what is the probable diagnosis  ectopic thyroid tissue thyroid gland is the most commonly occuring ectopic gland Common locations are below the tongue, in the cheek and medial to sternocledomastoid muscle    Q: lateral lobe of thyroid ectopic lymph node mets of thyroid cancer Pathognomic of trachoma is  pits and follicles causative organism of trachoma is chamydia trichomatis Which is characterizef by pits and follicles in cornea and conjunctiva respectively    Q: pannus conjunctivitis erythema CA prostate occurs in  peripheral zone www.theMediCall.com Page 1219 prostate carcinoma is commonly present in peripheral zone of prostate and can be palpated as irregular mass on DRE While BPH is palpated as a regular mass    transitional zone superior zone anterior zone Q: Patient with high grade fever and sore throat from days trismus present What is the diagnosis?     abcess acute tonsillitis chronic tonsillitis Quincy quincy is the abcess fromation after acute tonsillitis, distinguishing feature is trismus and is usually drained Q: High fiber diet benefit is     Causes diarrhea Increase predisposition to skin cancer Increase predisposition to lung cancer Increase cholesterol excretion from the body High fiber diet increases cholesterol excretion and reduces blood cholesterol level by its ability to reduce the amount of bile reabsorbed in the intestines Q: Blood testes barrier is formed by?   inhibin sertoli cells blood testes barrier is made of sertoli cells also called as srtoli cell barrier It prevents the transport of various substance and allows only selective substances to cross   Q: spermatogonia interstitial cells which structure form the brush border?   cilia microvilli brush border membrane is made of microvilli In celiac disease autoantobodies are formed against the border causing the flattening of surface.microvilli are minute projections from surface of some cells www.theMediCall.com Page 1220   Q: steriocillia flagella Most common site for squamous cell carcinoma esophagus is? a.Upper and middle third Squamous cell carcinomaoccurs most often in the upper and middle portions of theesophagus b.Lower third c.Gastro-esophageal junction d.None of these Q: Liquid dysphagia is due to ? a.Hypoglossal nerve palsy b.Plummer-vinson syndrome c.Palatal palsy d.Neuromuscular incordination Neuromuscular incordination leads to liquid dysphagia while CA leads to solid dysphagia Q: Regarding cardiac muscle’s action potential, which is correct, most likely   Ventricular muscles resting membrane potential is 70 mv T-wave is ventricular septum reporlarization In ECG, the T wave represents the repolarization, or recovery, of the ventricles The interval from the beginning of the QRS complex to the apex of the T wave is referred to as the absolute refractory period   Q: Atrial muscles have spontaneous depolarization d.RMP of SA node is -90 mv If women accidently exposed to radiation to years back.Which organ is most likely effected    Cervix Fallopian tube Ovaries www.theMediCall.com Page 1221 radiation therapy, and surgery can sometimes damage the ovaries, reducing the reserve supply of eggs When the ovaries are not able to produce eggs or hormones, this is called ovarian failure  Q: Vagina True hermaphroditism is?  XX/XY Etiology of 46,XX/46,XY true hermaphroditismin humans is usually considered to be chimerism Whole-body chimerism can be assumed if two or more geno types are present in non-haematogenous tissues such as skin or gonads or persist in hematogenous tissues    Q: XXY XXX XYY In Patient of hyooyolemic shock after treatementwhat will be decrease  Heart rate Inversely, a reduction in heart rate or stroke volume will lead to a decrease in cardiac output The loss of blood associated with hypovolemic shock causes a reduction in the venous volume, which in turn diminishes the preload, stroke volume and cardiac output    Q: Urine output b.P None of above The most common cause for female pseudo-hermaphroditism is?   Ovarian dysgenesis Congenital adrenal hyperplasia External genitalia is musculinized congenitally when female fetus is exposed to excess androgenic environment Congenital adrenal hyperplasia mostly 21-hydroxylase deficiency is the most common cause Maternal androgen excess due to maternal ovarian tumor or drug intake also causes femalepseudohermaphroditism   Q: Virilising ovarian tumors Exogenous androgen Nervous system affects the  Arterioles www.theMediCall.com Page 1222 arteriole is a small-diameter blood vessel in the microcirculation, Arterioles receive autonomic nervous system innervation and respond to various circulating hormones in order to regulate their diameter    Q: Artery Veins Capillaries Bicarbonate chloride shift in RBC occurs by which protein   Spectrin Band Band protein is a typical polytropic membrane protein and mediates the exchange of the cellular HCO3- with CI- in plasma(chloride shift)  Ankyrin d.None of these Q: 14yrs girl has primary amenorrhea She has normal breast development and secondary sexual characteristics she has short blind ending vagina slight pubic hair and US revealed absent uterus what would be the diagnosis?    Congenital adrenal hyperplasia Chromosomal defect Failure of development of genital tubercle A genital tubercle or phallic tubercle is a body of tissue present in the development of the reproductive system It forms in the ventral, caudal region of mammalian embryos of both sexes, and eventually develops into a primordial pha www.theMediCall.com Page 1223