Mock PE1_240520_082515.pdf

Paper 1 1. Which one of the following leukocytes secrete heparin A. Eosinophil B. Basophil C. Monocytes D. Lymphocytes 2. The WBC that is involved in cell mediated immune response is A.Eosinophils B.Basophils C.T-lymphocyte D.B-lymphocyte 3. Which one of the following prot...

Paper 1 1. Which one of the following leukocytes secrete heparin A. Eosinophil B. Basophil C. Monocytes D. Lymphocytes 2. The WBC that is involved in cell mediated immune response is A.Eosinophils B.Basophils C.T-lymphocyte D.B-lymphocyte 3. Which one of the following proteins facilitates clot retraction A. Albumin B. Globulin C. Fibrinogen D. Thrombosthenin ✅ 4. Which one of the following factors is necessary to convert fibrinogen to fibrin? A. Thrombin B. Prothrombin C.Thromboplastin D. Fibrin stabilizing factor 5. Which one of the following types of haemoglobin contains gamma chain? A. Haemoglobin A B. Haemoglobin A2 C. Haemoglobin F D. Haemoglobin H ✅ 6. Carbon dioxide binds with haemoglobin to form A. Carbaminohaemoglobin B. Carboxyhemoglobin C. Oxyhaemoglobin D. Methaemoglobin 7. A 25 year old man with complained of facial puffiness and swellings in the leg and ankle was diagnosed with nephrotic syndrome. Which of the following plasma protein is decreased at the early phase of the disease? A. albumin B. alpha2 Globulin C. beta Globulin D. Immunoglobulin 8. Which of the following is negative acute phase protein? A. Transferrin B. C reactive protein C. Fibrinogen D. Alpha-1-antitrypsin 9. Which are the most probable causes of lymphocytic leukocytosis? A. Viral infection B. Parasitic infection C. Fungal infection D. Bacterial infection 10. Which of the following is the disease associated with the formation of defective lysosomal granules and poor chemotaxis? ✅️ A. Myeloperoxidase deficiency B. Chediak Higashi syndrome C. Chronic granulomatous disease D. Leukocyte adhesion deficiency 11. Which of the following are the principle cellular components of granulation tissue? A. Plasma cells and fat cells ✅ B. Myofibroblasts and eosinophilsb C. Fibroblast and endothelial cells D. Neutrophils and smooth muscle cells 12. A 6 year old girl was brought into the ER after an automobile accident. Physical examination showed multiple wounds and cbc showed normocytic normochromic anemia. Which of the following indices is most helpful in defining the patient’s anemia as normocytic? A. hematocrit B. haemoglobin C. RBC count D. mean corpuscular volume 13. Which one of the following is the most common cause of agranulocytosis? A. Drug toxicity B. Kostmann syndrome C. Myelodysplastic syndrome D. Acquired idiopathic neutropenia 14. Which of the chromosomal translocations is most likely to be found on cytogenetic analysis of a patient with chronic myeloid leukaemia? A. t(8;21) B. t(9;22) C. t(12;21) D. t(15;17) 15. A young healthy girl develops gingival bleeding and multiple non palpable petechiae on both legs following a bout of common cold. On physical examination, her lymph node, liver, spleen were not enlarged, and major joints were normal. The most likely diagnosis is A. Glycoprotein IIa/IIIb deficiency B. Von Willebrand disease C. Disseminated intravascular coagulopathy D. Idiopathic thrombocytic purpura 16. Which following associated with development of eosinophilia A. Typhoid B. Strongyloidiasis C. HPV infection D. Cryptococcal infection 17. A 49 year-old woman appeared pale with complaints of dizziness and headache. Her peripheral blood smear shows microcytic and hypochromic red blood cells. Which of the following is the best treatment option for this patient? A. Vitamin B12 B. Erythropoietin C. Iron supplement D. Folic acid 18. The laboratory report of a 18-year-old female with anaemia are as follows MCV: 70fl (normal: 70-94fl) MCH: 22pg (normal: 27-32pg) MCHC: 30g/dl (normal: 31-35 g/dl) Based on this finding, which one of the following is most likely diagnosis A. Folic acid deficiency anaemia B. Iron deficiency anaemia C. B12 deficiency anaemia D. Pernicious anaemia 19. Flat bony projection from lateral end of scapula: A. Coracoid process B. Acromion process C. Coronoid process D. Spinous process 20. A 19-year-old man is brought to the emergency department after dislocating his shoulder while playing football. Following treatment of the dislocation, he cannot initiate the abduction of his arm. An MRI of the shoulder shows a torn muscle. Which muscle was most likely damaged by injury? A. Teres major B. Coracobrachialis C. Supraspinatus D. Pectoralis major 21. Artery located at the floor of the anatomical snuff box A. Ulnar artery B. Radial artery C. Anterior interosseous artery D. Posterior interosseous artery 22. Wrist joint is a synovial joint that is ✅️ A. ball and socket B. ellipsoid C. hinge D. plane 23. Largest tarsal bone of foot is A. Calcaneus B. Talus C. Cuboid D. Navicular 24. A 34 y/o power lifter, difficulty in walking,physical examination reveal that there is a problem in unlocking the knee joint to allow flexion of the leg, which muscle is affected A. Rectus femoris B. Popliteus C. Biceps femoris D. Gastrocnemius 25. What is the branch of the femoral artery? A. Pudendal B. Inferior Gluteal C. profunda femoris D. Superior Gluteal 26.Feature of female type of bony pelvis is A. wider subpubic angle B. less prominent preauricular sulcus C. heart shaped pelvic inlet D. more prominent muscular attachment 27. Which of the following muscles is attached to the pterygoid fovea of mandible? A. Masseter B. Medial pterygoid muscle C. Lateral pterygoid muscle D. Temporalis 28. Middle ear communicates with nasopharynx through A. Foramen ovale B. Foramen spinosum C. Auditory tube D. Aditus to mastoid antrum 29. Sarcomere is a contractile unit of muscle fibres between two successive A. Z Line B. H Line C. B Line D. A Line 30. The role of troponin-tropomyosin complex in muscle contractile response is to A. Provide maximum elastic tension B. Cover the binding site on actin filament in resting state C. Prevent sodium from triggering muscle contraction D. Excite activity of power stroke 31. At the skeletal neuromuscular junction, a nerve impulse arrival cause A. Na+ reflux into presynaptic terminal B. Ca++ efflux into presynaptic terminal. C. Release of acetylcholine into synaptic cleft. D. Opening of Ca+ channels in post synaptic terminal 32. Which of the following diagnostic screening test would help to differentiate gout and septic arthritis A. Radiograph of kidney B. Ultrasound of the joint C. Synovial fluid analysis D. Estimation of serum calcium concentration 33. Which of the following is required as a fuel for high-intensity activity? A. Glucose in anaerobic activity B. Glucose in aerobic activity C. Fat in anaerobic activity D. Fat in aerobic activity 34. Match the glucose deficiency types with the correct deficient enzymes A. Type ll Muscle phosphorylase B. Type lV Branching enzyme C. Type l Alpha-1,4-Glucosidase D. Type lll Glucose-6-phosphatase 35. A 23 year-old girl presented to the emergency department with a 24 hour history of fever and swollen left knee. She was treated for food poisoning 3 weeks ago. Blood investigation revealed that she has raised ESR and CRP. Gram staining and cultures of fibrous fluid aspiration are negative. What is the diagnosis? A. Psoriatic arthritis B. Septic arthritis C. Reactive arthritis D. Rheumatoid arthritis 36. A 35 year-old lady presented with white raised lesion in the oral cavity.The gram staining showed large yeast cell with pseudohyphae. What is the causative agent? A. Candida albicans B. Cryptococcus neoformans C. Pseudomonas aeruginosa D. Staphylococcus aureus 37. After a road traffic accident, the victim's lower limb was swollen, painful and crepitus is felt on examination. The wound was foul smelling, the gram stain of pus revealed gram positive bacilli. The pathogen is A. Clostridium Tetani B. Clostridium Difficile C. Clostridium Botulinum D. Clostridium Perfringens 38. 17 y/o male present with nocturnal pain in his left leg. The pain is relieved by aspirin. X ray shown round, radiolucent in his left tibia with central mineralisation, surrounded by thickened bone.The size of lesion is approximately 1.2 diameter. Which is the following diagnosis? A. Enchondroma B. Giant cell tumor C. Osteochondroma D. Osteoid osteoma 39. A premature baby has cyanosis, heart murmur on auscultation. A 2D doppler echocardiogram detects a patent ductus arteriosus. Which drug is the best to close the duct? A. Aspirin B. Indomethacin C. Celecoxib D. Ketolorac 40. A 56 year old woman presented with the complaints of pain in multiple joints, worse in her hands and feet with significant morning stiffness. The patient has a positive family history of such complaints. She was prescribed a drug which is folic acid antagonist. The drug is A. Diclofenac B. Allopurinol C. Methotrexate D. Methyl prednisone ✅ 41. The musculi pectinati is present in A. Anterior wall of left atrium B. Infundibulum of right ventricle C. Aortic vestibule of left ventricle D. Septal wall of right atrium 42. Which one Of the following components of the conducting system of heart is located near the opening of superior vena cava? A. SAV B. AVN C. Right bundle branch D. Left bundle branch 43. Which of the following is the remnant of ligaments arteriosus? ✅️ A. Truncus arteriosus B. Ductus arteriosus C. Sinus arteriosus D. 44. Ventricular pressure increases and reaches maximum during A. Atrial systole B. Ventricular filling C. Isovolumetric contraction D. Ventricular ejection 45. The component of cardiac tissue with highest propagation velocity is A. Atrial muscle B. Ventricle muscle C. Av node D. Purkinje fibres 46. The jugular venous pressure reflects pressure changes in A. Left atrium B. Left ventricle C. Coronary sinus D. Right atrium 47. What is the hallmark feature of myocardial infarction in ECG? A. Absence of Q wave B. Appearance of Q wave C. Elevation of ST segment in area of the infarct D. Depression of ST segment in area of infarct 48. Which apoprotein present in VLDL serves as an activator for lipoprotein lipase? A. Apo B100 ✅ B. Apo B48 C. Apo CII D. Apo E 49. A 56 year-old man presents with a very high level of serum cholesterol. According to the results of the screening test, the px has high LDL cholesterol (440mg/dl) but normal LDL receptors. Which of the following is the cause of the increased LDL cholesterol in this case? A. Mutation Apo E B. Defective Apo B100  C. Defective Lipoprotein lipase D. Abnormal concentration of VLDL 50. A 48 year old man presents to the outpatient department complaining of chest pain radiating to his left arm. He was prescribed nitroglycerin tablets. The nitric oxide released from this drug relieves pain by activating A. Adenylate cyclase B. Guanylyl cyclase C. Xanthine oxidase D. NADPH oxidase 51. A 34 year old man was sent to the emergency department due to accidental ingestion of organophosphate insecticide. On examination, he was found to have dilated pupils, tremor. What is the drug suitable for the treatment? A. Aspirin B. Physostigmine C. Flumazenil D. Atropine 52. Which of the following drugs and its indication is correctly paired? A. Salbutamol - neurogenic shock B. Dobutamine - nasal decongestion C. Adrenaline - anaphylactic shock D. Xylometazoline - cardiac failure 53. Which of the following adverse effects can be seen in a patient taking simvastatin? A. Hypotension B. Bradycardia C. Hypoglycemia D. Myopathy 54. Patient on heparin therapy for deep vein thrombosis develops life-threatening bleeding,which of the following is for managing bleeding caused by heparin. A. Vitamin K B. Aminocaproic acid C. Protamine sulphate D. Tranexamic acid 55. A 40 year old patient with unstable angina was given clopidogrel. The clopidogrel was given as prophylactic treatment. Clopidogrel is used to block A. ADP receptor B. GP IIb/IIIa receptor C. Thrombin receptor D. 56. Which of the following mechanisms best describe pedal edema in a healthy patient who was long-standing? A. Hypoalbuminemia B. Lymphatic obstruction C. Increased hydrostatic pressure D. Secondary aldosteronism 57. Which of the following is considered an early sign of atherosclerosis? A. Increased serum lipid levels B. Formation of foam cells in arterial walls C. Chest discomfort D. Hypertension 58. Which of the following is the pacemaker for respiration? A. Apneustic center B. Pneumotaxic center C. Prebotzinger complex D. Ventral respiratory group of neuron 59. Parietal pleura is developed from A. Head mesenchyme B. Intermediate mesoderm C. Lateral plate somatic mesoderm D. Lateral plate splanchnic mesoderm 60. Which of the following nerves are likely to be injured while removing any foreign body from the piriform fossa of laryngopharynx? A. Superior laryngeal B. Recurrent laryngeal C. Internal laryngeal D. Glossopharyngeal 61. Which of the following is the powerful stimulus for peripheral chemoreceptor? A. Metabolic alkalosis no B. Respiratory alkalosis C. Decrease in PO2 in blood D. Decrease in PCO2 in blood 62. Pattern of oxygen-hemoglobin dissociation curve A. Sigmoidal B. Linear C. Parabolic D. Exponential 63. The rate of gas diffusion is inversely proportional to the A. Diffusion coefficient of the gas B. Difference between the pressure gradient of the gas C. Thickness of the pulmonary membrane  D. Surface area of the pulmonary membrane 64. Pulmonary surfactant increases A. Lung compliance B. Pulmonary blood flow C. Pulmonary venous pressure D. The surface tension of the fluid lining alveolar walls 65. Which of the following antitubercular drug inhibits the synthesis of mycolic acid A.ISONIAZID B.RIFAMPICIN C.ETHAMBUTOL D.STREPTOMYCIN 66. Identify the acid base disorder ph:7.55 pco2:52 mm Hco3:40 meq/Hg A. metabolic acidosis B. metabolic alkalosis C. respiratory acidosis D. respiratory alkalosis 67. Identify the acid base disorders Ph:7.5 pco2: 48 mm Hco3 33 meq/Hg A. partially compensated metabolic alkalosis B. partially compensated metabolic acidosis C. fully compensated metabolic acidosis D. fully compensated metabolic alkalosis 68. A 6 year old boy with a history of recurrent pneumonia was diagnosed with cystic fibrosis. Laboratory investigation revealed a gram negative rod and oxidase positive. What is the most likely causative organism? A. Haemophilus Influenzae B. Pseudomonas aeruginosa C. Bordetella pertussis D. Legionella pneumophilia 69. An 8 month old Infant presented with fever, running nose, hoarseness of voice, bark-like cough Clinically diagnosed as tracheobronchitis (croup). What is the most likely causative organism? A. Adenovirus B. Coxsackie virus C. Parainfluenza virus D. Rhinovirus virus 70. Histopathological feature of ARDS of lungs. A. Hyaline membrane lining alveoli  B. Goblet cell… C. Endothelial cell… D. Dense… 71. Keratin pearl is the characteristic histological feature of A. adenocarcinoma B. Squamous cell carcinoma C. Small cell carcinoma D. Large cell carcinoma 72. A 21 year old medical student faced a seasonal allergy before PE. Name drug for management. Fexofenadine 73.Which of the following nerves carries general sensation from the 2/3 of the tongue A. Lingual B. Hypoglossal C. Glossopharyngeal D. Chorda tympani 74. Enterokinase is used for the conversion of A. Lactose to sucrose B. pepsinogen to pepsin C. Trypsinogen to trypsin D. Polypeptide to peptide 75. Which of the following arteries supply the derivatives of the midgut A. celiac B. splenic C. superior mesenteric D. inferior mesenteric 76. Function of bile salt A. Emulsification B. Activate lipase C. Inhibition lipid absorption D. Cofactor of cholesteryl ester 77. During an emergency splenectomy, a surgeon accidentally tore the gastrosplenic ligament and its content. Which artery is most likely to be damaged in this event? A. Splenic B. Left gastric C. Right gastric D. Short gastric 78. Which of the following binds with vitamin B12 and favours its absorption through the lumen of the small intestine? A. Hephaestin  B. Intrinsic factor C. Transcobalamin-1 D. Specific binding protein R 79. Male with retrosternal chest pain associated with acute MI, lab diagnosis reveals increased serum troponin I & cardiac enzyme. What happens in the affected area? A. Increase formation of lactate B. Increase use of ketone bodies C. Increase fatty acid oxidation D. Increase conversion of pyruvate to acetyl coA 80. A mother stated that her 4-month-old infant presented with irritation and lethargy. The laboratory tests showed that the infant’s serum glucose and ketone levels are low. The geneticist suspected that the infant had a mutation in a gene that codes for medium-chain acyl CoA dehydrogenase. Which metabolic pathway is affected in the patient ? A. Alpha oxidation B. Beta oxidation C. Omega oxidation D. Peroxisomal fatty acid oxidation 81. A 35 year old man presented to the emergency department complaining of nausea and vomiting after a Jamaican meal that contained toxin hypoglycin A. Which enzyme is inhibited? A. Tyrosinase B. Acyl CoA dehydrogenase C. Carnitine acyl transferase D. Propionyl CoA carboxylase 82. A 35 year old female returning from central America is having symptoms of fever, dysentery, and right upper quadrant pain. CT scan shows abscess. Aspiration is done. What is the most likely causative infection organism? A. Balantidium coli B. Giardia lamblia C. Entamoeba histolytica D. Cryptosporidium hominis 83. An elderly patient comes in with a virus infection. Electron microscopy shows star-like morphology. What types of virus infected in this patient? A. Astrovirus B. Adenovirus C. Norovirus D. Sapovirus 84. Which of the following is a histopathological findings of liver cirrhosis? A. Presence of fat globules B. Nodular regeneration and fibrosis C. Peri-portal necrosis and peripheral cholestasis  D. Scattered single cell necrosis and eosinophilic bodies 85. A patient with a history of haemophilia A and repeated blood transfusion develop chronic hepatitis. Which are the organisms that will cause the most? A. hepatitis A virus B. hepatitis C virus C. hepatitis D virus D. hepatitis E virus 86. Mr X,80 years old,has taken lactulose to prevent hepatic encephalopathy.How MOA of lactulose to prevent hepatic encephalopathy. A. Osmotic action to increase water reabsorption B. Stimulates myenteric neurons to enhance gut peristalsis C. Increase the water excretion from body D. Kills microorganisms responsible for hepatic encephalopathy 87. Antiemetic drug used during chemotherapy? Ans: Ondansetron 88. Which dura mater separates the cerebral hemispheres? A. falx cerebri B. falx cerebelli C. diaphragma sellae D. tentorium cerebelli 89. The 12th cranial nerve rootlets emerge from A. Ventral part of pons B. Ponto medullary junction C. Between pyramid and olive of medulla D. Between olive and inferior cerebellar peduncle 90. Which of the following fibres pass through the middle cerebellar peduncles? A. Pontocerebellar B. Vestibulocerebellar C. Anterior spinocerebellar D. Posterior spinocerebellar 91. The fibers passing through the genu of corpus callosum is A. Tapetum B. Forceps major C. Forceps minor D. Habenular fibres 92. The ventral corticospinal tract controls A. Speaking B. Drawing C. Fine skilled movements like writing  D. Gross voluntary movements like walking 93. Tract involved in regulating distal limbs muscle movement A. Tectospinal B. Reticulospinal C. ventral corticospinal D. Lateral corticospinal 94. Which of the sign observed in Parkinson's disease? A. Aphasia B. Ataxia gait C. Shuffling gait D. Intention tremor 95. Depletion of which neurotransmitter in nigrostriatal projection of basal ganglia leads to Parkinson disease A. GABA B. dopamine C. glutamate D. acetylcholine 96. Based on the theory “dorsal root is sensory and ventral root is motor” what is it called A. All or none law B. Law of projection C. Bell magendie law D. Webber-fechner law 97. Receptor inverse stretch reflex A. Muscle spindle B. Golgi tendon organs C. Static intrafusal D. Dynamic intrafusal 98.Major thalamic nuclei that receives most of the sensory afferent from the body is A. pulvinar B. anterior group C. ventroanterior D. lateral ventroposterior 99. Which of the following transmitter substance is released by inhibitory interneuron in the spinal cord? A. Glycine B. Nitric acid C. Acetylcholine D. Norepinephrine 100. Which one of the following sensation is carried by lateral spinothalamic tract? A. Vibration  B. Fine touch C. Temperature D. Prioreception 101. Which taste bud is carried by the tip of the tongue? A. Sweet B. Sour C. Salty D. Bitter 102. Which of the diseases results in meningitis caused by encapsulated yeast? A. Candidiasis B. Cryptococcosis C. Coccidioidomycosis D. Histoplasmosis 103.What are the viruses that enter the central nervous system by retrograde axonal transport of peripheral nerves ? A. Rabies virus B. Adenovirus C. Herpes simplex virus D. Vesiculovirus 104. 9 year old girl was evaluated for headache, dizziness over the last month. CT scan revealed solitary midline, partially cystic cerebellar lesion. The mass was surgically removed. Microscopic examination revealed elongated bipolar cells with fibrillar processes and Rosenthal fibres. Likely diagnosis is A. Neuroblastoma B. Medulloblastoma C. Ependymoma D. Pilocytic astrocytoma 105. 30 year old man, morphine addiction. What is the treatment for morphine addiction A. Methadone B. Naloxone C. Pethidine D. Clonidine 106. Which of the following drug acts to facilitate GABA mediated chloride influx ? A. Diazepam B. Phenytoin C. Morphine D. Carbamazepine 107. Which of the antiepileptic drugs cause gingival hyperplasia? A. Carbamazepine B. Phenytoin  C. Diazepam D. Valproic Acid 108. Pituicytes are present in A. Pars Distalis B. Pars Nervosa C. Pars Intermedia D. Pars Tuberalis 109. Fertilisation occurs in: A. Cervical canal B. Ampulla of the uterine tube C. Isthmus of the uterine tube D. Infundibulum of the uterine tube 110. Ejaculatory ducts open into A. Penile urethra B. Prostatic urethra C. Membranous urethra D. Neck of urinary bladder 111. Which will decrease in aldosterone deficiency? A. Urine volume B. Blood volume C. Plasma osmolarity D. Plasma potassium level 112. Pheochromocytoma predominantly secretes A. Serotonin B. Dopamine C. Norepinephrine D. Epinephrine 113. Which of the following controls secretion of testosterone in Leydig cells? A. Oestrogen B. Progesterone C. FSH D. LH 114. Which of the following phases of the uterine cycle corresponds with the ovarian luteal phase? A. Follicular B. Secretory C. Menstrual D. Proliferative 115. Crucial difference for primitive gonads into testes. A. Inhibin  B. Triacylglyceride C. AMH D. Spy gene 116.The common abnormality associated with dysfunction of posterior pituitary is A. Type 1 diabetes ✅ B. Type 2 diabetes C. Diabetes insipidus D. Gestational diabetes 117. Which of the following is a potent stimulator of insulin secretion? A. Glucagon B. epinephrine C. norepinephrine D. somatostatin 118. Which of the following is the feature of hyperthyroidism? A. Weight Gain B. Cold intolerance C. Positive nitrogen balance D. Increased basal rate 119. A 34 year old woman is diagnosed with pheochromocytoma. Which of the following is predominantly found in the urine sample A. ALA B. HIAA C. VMA D. FIGlu 120. What are the screening method for hypercortisolism A. Urinary free cortisol B. Dexamethasone suppression test C. Adreno-corticotrophic hormone D. Corticotrophin releasing hormone 121. Which of the following antidiabetic drugs are euglycemic A. Glipizide B. Sitagliptin C. Metformin D. Repaglinide 122. Biopsy of a painless lesion featuring unilateral lump in the testis of an adolescent boy revealed a disorderly mixture of various well differentiated structures such as cartilage,bone and glandular tissue.Which of the following tumours is consistent with these findings? A. Teratoma B. Seminoma C. Yolk sac tumour D. Embryonal carcinoma 123. What is the anterior relation of left ureter A. left colic vessel B. left psoas major C. bifurcation of aorta D. root of mesentery 124. The penile urethra is a structure that arises from A. Pronephros B. Mesonephros C. Urogenital sinus D. Urogenital ridge 125. Which of the following mediates voluntary control on the urinary bladder? A. Vagus nerve B. Somatic S 2,3,4 C. Sympathetic L 2,3,4 D. Parasympathetic S2,3,4 126. In nephron maximum reabsorption of water occurs in A. Proximal tubule B. Distal convulated tubule C. Descending limb of loop of henle D. Thick ascending limb of loop of henle 127. Which one of the following secreted in proximal and distal renal tubule A. K+ B. H+ C. Inulin D. Creatinine 128. Under normal condition complete reabsorption of filtered glucose occurs in A. distal tubule B. proximal tubule C. ascending limb of loop of Henle D. descending limb of loop of Henle 129. In urinalysis which indicates UTI ? A. Albumin B. Glucose C. Bilirubin D. Leukocytes 130. Which one of the following pathogens is associated with sterile pyuria? A. Escherichia Coli B. Proteus mirabilis  C. Pseudomonas aeruginosa D. Mycobacterium tuberculosis 131. Which of the following is type 1 rapid glomerulonephritis? a) Lupus nephritis b) IgA nephropathy c) Goodpasture syndrome d) Post streptococcal nephritis Which of the following drugs is effective in status epilepticus?- Carbamazepine 132. 40 year old lady complains of occasional palpitations. Examination of her pulse shows a heart rate of 120 beats per minute with irregularly irregular rhythm. Which one of the following is the most likely diagnosis? a) Supraventricular tachycardia b) Atrial fibrillation c) Atrial flutter d) Complete heart block 133. Patient with High intracranial pressure. Which drug ? A. Manitol B. Furosemide C. Hydrochlorothiazide D. Spironolactone 133. A male patient was admitted to the intensive care unit with metabolic alkalosis. Which drug? A. Mannitol B. Furosemide C. Indapamide D.Acetazolamide 134. Which of the following glomerular lesion is characteristically seen in renal biopsy for a pt with long-standing DM ? A. Crescent formation B. Segmental glomerulosclerosis C. Focal mesangial proliferation D. Enlarged and hypercellular glomeruli 135. Pott’s spine is caused by A. Treponima pallidum B. Haemophilus influenzae C. Mycobacterium tuberculosis D. Escherichia coli 136. The presence of Aschoff bodies on histopathologic examination is diagnostic of A. Myocardial Infarction  B. Rheumatic Heart disease C. Infective endocarditis D. Congestive h9. 138. Autopsy on body of 78 years old male who died suddenly reveal rupture aneurysm in abdominal aorta proximal to bifurcation. It fill with thrombus. What is most probable cause? A) Hypertension B) Atherosclerosis C) Marfan syndrome D) Syphilitic infection 139. Cell that secretes toxic oxygen reactants that can lead to tissue damage. A. Mast cell B. B lymphocyte C. T lymphocyte D. Macrophage 140. The "nutmeg liver" pattern is observed in the gross appearance of the liver is characteristics A.malnutrition B.Chronic renal failure C. Portal vein thrombosis D. Congestive heart failure 141. A 50 year old male was discharged after recovery from Myocardial infarction. The resident doctor instructed to prescribe the follow up treatment for secondary prophylaxis of myocardial infarction. Which one of the following drug prescribed for secondary prophylaxis of myocardial infarction? A. Aspirin B. Diclofenac C. Magnesium D. Vitamin K 142-144: STIs (i only rmb some organisms) A. Candida albicans B. Chlamydia trachomatis C. Haemophilus ducreyi D. Human papillomavirus E. Herpes simplex virus F. Treponema pallidum G. Hepatitis B virus 142. Patient presented painless- external genitalia-Spirochetes observed. Treponema Pallidum 143. Patient presented with vesicles on external genitalia. Tzanck smear revealed giant multinucleated cells. HSV 144. Irregular warty growth is seen on the shaft of penis. Biopsy of the lesion shows koilocytes. HPV 145-147: Infective endocarditis A. Escherichia Coli B. Bortenella henselae C. Cardiobacterium hominis D. Haemophilus parainfluenza E. Klebsiella pneumoniae F. Staphylococcus aureus G. Staphylococcus epidermidis H. Streptococcus viridans 145. A gram positive coccus which was catalase & coagulase positive, was isolated from blood culture of a 55 years old man with a prosthetic heart valve. A (Staphylococcus aureus) 146. The blood culture of a 3 year old boy with clinical evidence of bacterial endocarditis reveals gram-positive coccus, alpha-hemolytic on blood agar and negative catalase test. H（Streptococcus viridans） 147. Vesicle Lesion on penis, pneumonia (previously), gram negative, encapsulated, non-motile 148-150: options (choose 3) A. Anergy B. Clonal tolerance C. Clonal deletion D. Central tolerance E. Peripheral deletion F. Self- tolerance G. Immune privilage 148.Reduction or lack of an immune response to a specific antigen. 149. Self-reactive T cells become functionally unresponsive or are deleted after encountering self-antigens outside of the thymus. 150. The process of removing self-reactive T and B cells by apoptosis. Paper 2 1. A previously healthy 65 year old woman presented to her primary care physician with increased fatigue and weakness.She recently began experiencing shortness of breath during routine physical activity. She had no family history of anaemia, unusual dietary habits. On physical examination, she had pallor and tachycardia. The laboratory results were as follows: Complete blood count: Hb: 6.6 g/dL (13.5 - 17.5 g/dL) Hematocrit: 27% (41-51%) RDW: 21.5 (11.6 - 14.6) MCV: 68 µm3 (80 - 100) MCHC: 24.4 g/dL (31 - 36 g/dL) Reticulocyte: 0.7% (0.5 - 1.5%) Leukocytes: 8100 m3 (4500 - 11000) Serum iron concentration: 20 mg/dL (50 -100mg/dL) Transferrin saturation: 5% (20 - 50) Serum ferritin: 12 mg/ml (23 - 336) TIBC: 400 (250 - 370) a) Most likely diagnosis. (Type of anaemia) of this patient based on the presentation and lab test results. (1 mark) b) Describe THREE causes of the above mentioned type of anaemia. (1.5 marks) c) Describe the morphological changes that will be observed in the examination of peripheral blood smear of this patient (1.5 marks) d) Explain the reason why she felt shortness of breath (3 marks) e) State any TWO further investigations jneeded for this patient to find the underlying cause of the above condition. (1 mark) f) State the storage form of iron in the body. (0.5 marks) g) Serum iron is reduced in this patient. For this, iron supplementation is given. State any two iron preparations which will be suitable for this patient. (1 mark) h) State any two significant adverse side effects of the given iron therapy. (0.5 marks) 2. A 52-year-old man presents to the Emergency Department with severe right knee pain. The patient reported that he had two similar previous episodes with the same symptoms lasting to 4-5 days. On examination, his right knee was swollen, warm, red, and tender. The synovial (joint) fluid examination revealed needle-shaped crystals. The patient was prescribed colchicine and NSAID to relieve acute severe pain. a) State the diagnosis of this patient’s condition. (0.5m) b) Explain any 3 biochemical basis of this patient’s disease condition. (3m) c) Examination findings of the patient’s right knee are suggestive of acute inflammation. Explain the vascular events of acute inflammation. (1m) d) State the movements of the knee joint. (1m) e) Describe any six ligaments of the knee joint. (3m) f) State the action of colchicine in this case and state any two of its adverse effects. (1.5m) 3. A 67 year old man with chronic ischemic heart disease was admitted for acute severe breathlessness. The physical examination findings were acutely ill-appearing, dyspnoea, raised JVP, displaced apex beat to 6th intercostal space lateral to mid clavicular line, S3 gallop with systolic murmur and bilateral basal crepitation. Echocardiography shows decreased left ventricular ejection fraction (35%) with diminished wall motion. The patient was given immediate drug therapy with intravenous furosemide, oral spironolactone, ramipril (ACEI) followed by continuous monitoring for clinical improvement. a) State the significance of the following physical examination findings (clinical signs): i) Raised JVP ii) Bilateral basal crepitation b) Define murmur and physiological basis of systolic murmur (2m) c) State the diagnosis of the above clinical condition. d) List four causes of the above clinical condition. (1m) e) Describe Ejection Fraction(EF) and its normal value at rest. f) Role of ramipril in the management of the above clinical condition. g) Histology of cardiac muscle. 4. A 27 year old man presented with a 6 week history of coughing, breathlessness and malaise. He complained of fever which he felt was more in the evenings. he had lost 4 kg of body weight in 4 weeks and complained of blood in his sputum over the last week. He also complained of loss of appetite. His chest X-ray showed cavitary lesions in the right upper lobe. 4(a) State 2 investigations that can be done to confirm the patient's diagnosis using the sputum sample. 4(b) Histopathological features of the biopsy of the lesion. 4(c) Describe the normal lung histology. 4(d) Describe the work of breathing. 4(e) State the type of hypersensitivity reaction of this patient. The patient was prescribed rifampicin, INH, pyrazinamide, ethambutol and vitamin B6. The patient complains of orange-red coloured urine. 4(f) Why does the patient have orange-red coloured urine? 4(g) State the common side effects of ethambutol. 4(h) State the reason why vitamin B6 is prescribed. 5. A 45 year old man presented with a 6 month history of intermittent upper abdominal pain that was worse shortly after taking aspirin and was relieved after taking antacid. Upper git endoscopy revealed 2 cm ulcer in the antrum along the lesser curvature of the stomach. Histopathology of biopsy specimens revealed gastric peptic ulcers. 5a) Explain how pain was worsened after taking aspirin (1m) 5b) Explain role of proton pump inhibitor in this case (1m) 5c) List four common risk factor for development peptic ulcer disease (1m) 5d) List laboratory test to identify cause of peptic ulcer (0.5m) 5e) Describe parts of stomach (2m) 5f) Describe gross and microscopic features of classic peptic ulcer (2m) 5g) State gastric mucosal barriers (1.5m) 5h) State two possible complications of gastric peptic ulcer (1m) 6. A 14 years old girl presents with abdominal pain, vomiting, deep and sighing respiration. On further questioning of her parents, she was found to have polydipsia, polyuria, polyphagia and weight loss of 8 Ib. Urinalysis performed by the clinic showed presences of glucose and ketones. Finger - stick blood glucose was 530 mg/dL. She was admitted to the Medical Unit diagnosed with diabetes ketoacidosis. 6a) State the type of DM present in this case. Justified your answer. (1 mark) 6b) Describe the aetiopathogenesis of the above mentioned type of diabetes mellitus. (2 mark) 6c) State any 2 ketone bodies found in this case. (1 mark) 6d) Explain the reason for the production of the ketone bodies in this case. (1 mark) 6e) Describe the mechanisms of action of insulin on skeletal muscle. (3 mark) 6f) State the blood test that measures average blood glucose level for the past 3 months. (0.5 mark) 6g) State FOUR indication of insulin and the mode of administration of insulin in this case. (1.0 mark+0.5 mark=1.5marks) 7. A 6 years old boy evaluated for a one-week history of facial swelling, which recently progressed to whole-body swelling. He has otherwise been in his usual state of good health. Physical examination revealed facial oedema and pitting oedema in both legs, blood pressure: 136/72 mmHg, pulse: 68 beat/minute, respiratory rate 20 breaths/minute. Urinalysis reveals massive proteinuria (4.2 mg/day) with the presence of fatty casts. The initial blood tests revealed Hypoalbuminemia and hyperlipidemia. The boy was admitted to hospital for a diagnosis of Nephrotic syndrome. A kidney biopsy was performed after admission. a) State diagnostic criteria of nephrotic syndrome present in this patient. (1m) b) Explain the pathophysiology of oedema in this patient. (2m) c) State most common cause of nephrotic syndrome in children. (1m) d) Describe expected light microscopic and electron microscopic findings of kidney biopsy in this patient. (2m) e) Describe the histology of normal kidney. (2m) f) Describe the normal composition of the glomerular filtration. (2m) 8. A 46-year old lady had a 6 months history of vaginal discharge and post coital bleeding. She has smoked 1 pack of cigarettes per day for 20 years. She reported that she has had abnormal pap smear test results in the past. The speculum examination shows a 2-cm irregular fungating mass on the anterior lip of the cervix. The biopsy was performed that showed invasive squamous cell carcinoma cervix. 8(a) Identify risk factors of carcinoma cervix present in this patient. (1m) 8(b) Her abnormal pap smear test results in the past can be pre-malignant lesion. State the pre-malignant lesions of the carcinoma cervix. (1m) 8(c) State the virus which has a high oncogenic risk for the development of cervical cancer. (1m) 8(d) State TWO laboratory tests to detect this oncogenic virus infection.(1m) 8(e) Explain the oncogenic effects of the above virus. (1m) 8(f) State the parts and normal position of the uterus.(2m) 8(g) State the lymphatic drainage of the uterus.(1m) 8(h) Describe the microscopic features of squamous cell carcinoma.(1m) 9. A 45 year old woman presented to her primary care physician with fatigue, weight gain, and cold intolerance. Physical examination showed enlarged thyroid gland (goiter), coarse skin and bradycardia. Her thyroid function tests show elevated TSH levels and low levels of total T3 & T4. 9(a) State the reason for elevated serum TSH level in this case. (1m) 9(b) State the action of thyroxine on carbohydrates & fat metabolism. (3m) 9(c) Explain the histological features of normal thyroid gland. (4m) 9(d) Biopsy of enlarged thyroid gland findings and additional laboratory tests results supports diagnosis of Hashimoto’ thyroiditis. Explain the microscopical features of Hashimoto's thyroiditis. (1.5m) 9(e) State one more additional test to support the UN diagnosis of Hashimoto's thyroiditis. (Besides a biopsy) (0.5m) 10. A 9-year-old boy was being brought to the hospital by his mother with headache, drowsiness and high fever for the past 2 days. 7 days ago, he was treated by a local doctor for an infection in the left ear. On examination, he was febrile, drowsy and found to have the features of meningeal irritation. The medical officer suspects meningitis and a lumbar puncture was performed. The CSF is turbid in appearance and being sent for routine analysis and culture & direct antibody sensitivity test. 10(a) State the level to perform lumbar puncture to obtain CSF in this patient. 10(b) Describe the meningeal layers of spinal cord. 10 c) State the most possible route of transmission of microorganism into central nervous system for this boy. 10 (d) State 2 possible causative organism at bacterial meningitis in this 9 year old boy. 10 (e) CSF Analysis acute bacterial meningitis aseptic (Viral) meningitis pressure & appearance /Colour CSF WBC count & cell type CSF protein CSF glucose 10(f) State 2 features of meningeal irritation. 10 (g) State how the anterior hypothalamus plays a role in body temperature regulation.