QP-CMS 2025 PAPER 01-210725

Combined Medical Services Examination -2025 DO NOT OPEN THIS TEST BOOKLET UNTIL YOU ARE TOLD TO DO so T.B.C. : TDSP-O-GMPK Test Booklet Series Serial No. TEST BOOKLET Paper I 0060977 GENERAL MEDICINE AND PEDIATRICS Time Allowed : Two Hours ictacii tie, dso INSTRUCTIONS 1. IMMEDIATELY AFTER THE COMMENCEMENT OF THE EXAMINATION, YOU SHOULD CHECK THAT THIS TEST BOOKLET DOES NOT HAVE ANY UNPRINTED OR TORN OR MISSING PAGES OR ITEMS, ETC. IF SO, GET IT REPLACED BY A COMPLETE TEST BOOKLET. 2. Please note that it is the candidate’s responsibility to encode and fill in the Roll Number and Test Booklet Series A, B, C or D carefully and without any omission or discrepancy at the appropriate places in the OMR Answer Sheet. Any omission/discrepancy will render’ the Answer Sheet liable for rejection. 3. You have to enter your Roll Number on the Test Booklet in the Box provided alongside. DO NOT write anything else on the Test Booklet. 4. This Test Booklet contains 120 items (questions). Each item comprises four responses (answers). You will select the response which you want to mark on the Answer Sheet. In case, you feel that there is more than one correct response, mark the response which you consider the best. In any case, choose ONLY ONE response for each item. 5. You have to mark all your responses ONLY on the separate Answer Sheet provided. See directions in the Answer Sheet. 6. All items carry equal marks. 7. Before you proceed to mark in the Answer Sheet the response to various items in the Test Booklet, you have to fill in some particulars in the Answer Sheet as per instructions sent to you with your Admission Certificate. 8. After you have completed filling in all your responses on the Answer Sheet and the examination has concluded, you should hand over to the Invigilator only the Answer Sheet. You are permitted to také away with you the Test Booklet. 9. Sheets for rough work are appended in the Test Booklet at the end. 10. Penalty for wrong Answers : ; THERE WILL BE PENALTY FOR WRONG ANSWERS MARKED BY A CANDIDATE IN THE OBJECTIVE TYPE QUESTION PAPERS. (i) There are four alternatives for the answer to every question. For each question for which a wrong answer has been given by the candidate, one-third of the marks assigned to that question will be deducted as penalty. (ii) If a candidate gives more than one answer, it will be treated as a wrong answer even if one of the given answers happens to be correct and there will be same penalty as above to that question. (iii) If a question is left blank, i.e., no answer is given by the candidate, there will be no penalty for that question. DO NOT OPEN THIS TEST BOOKLET UNTIL YOU ARE TOLD TO DO SO asoinee IgoibeM bemamou 2C0¢- noitenimnex? GENERAL MEDICINE 1. Which of the following heart sounds are best heard with the bell of stethoscope ? I. Opening snap Il. Systolic click I. Third heart sound IV. Mid diastolic murmur Select the correct answer using the code given below : (a) I and IV (b) Il and III only (c) Wand IV (d) I, Wand I . Consider the following statements for diagnosing ventricular aneurysm in a patient with recent myocardial infarction : L. Paradoxical impulse on chest wall IL. Persistent ST elevation on ECG I. Unusual bulge from cardiac silhouette on X-ray IV. Presence of pulsus paradoxsus Which of the above are correct ? (a) I and II only (b) I and IV (c) I, I and Il (d) I, Ii and IV TDSP-O-GMPK — A 3. Which one of the following statements is correct for subcutaneous nodules in Rheumatic fever ? (a) They are present over flexor aspect of forearm (b) They are painful tender nodules (c) The usual size of these nodules is 3-5 cm (d) They typically appear more than 3weeks after onset of other clinical manifestations . Which one of the following is correct with regard to Carey Coombs murmur ? (a) Soft systolic murmur due to mitral regurgitation (b) Soft mid-diastolic murmur due to mitral valvulitis (c) Harsh early diastolic murmur due to aortic regurgitation (d) Blowing late systolic murmur due to aortic stenosis . Which of the following statements is correct regarding the Opening Snap (OS) in a patient of mitral stenosis ? (a) OS is best heard with the bell of stethoscope (b) Intensity of OS becomes louder when the valve is calcified (c) OS moves closer to the second sound (S2) as the stenosis becomes more severe (d) OS is best heard at the second left intercostal space 6. Which one of the following responses to intravenous adenosine is correctly matched ? Arrhythmia (a) Atrial fibrillation Response Termination (b) Atrio-ventricular — Termination nodal reentrant tachycardia (c) Ventricular — Termination tachycardia and complete recovery (d) Atrial flutter — Termination and complete recovery . Consider the following steps for using a metered dose inhaler (MDI) : I. Incline the head backward to minimize oropharyngeal deposi- tion II. Remove the cap and shake the inhaler Il. Breathe out gently and place the mouthpiece into the mouth IV. Hold the breath for 10 seconds V. Simultaneously, begin a slow deep inspiration, depress the canister and continue to inhale Which one of the following is the correct sequence of using MDI ? (a) I, IL, V,IV (>) I, LIV, U,V (c) I, ULL V,IV (@) IL, LI,1V,v 8. Under the Stepwise Approach to the 10. management of Bronchial Asthma, which one of the following is the correct initial treatment at Step 1 for a patient diagnosed with Asthma ? (a) Low dose inhaled corticosteroid only (b) Low dose inhaled corticosteroid plus oral corticosteroid (c) Low dose inhaled corticosteroid plus long acting anti-muscarinic agents (d) Low dose inhaled corticosteroid plus leukotriene antagonist A 62-year old male chronic smoker has been diagnosed with Chronic Obstructive Pulmonary _ Disease (COPD). On pulmonary function testing, the ratio of Forced Expiratory Volume in 1 second (FEV1) to Forced Vital Capacity (FVC) was 0-6 and FEV1 was 70% of predicted. What is the severity of airflow obstruction in this patient as per GOLD criteria ? (a) StageI —-— Mild (b) Stage II (c) Stage III — Severe — Moderate (d) Stage IV — Very severe Which one of the following correctly denotes the inheritance pattern of cystic fibrosis ? (a) Autosomal Dominant (b) Autosomal Recessive (c) X-linked Dominant (d) X-linked Recessive A — TDSP-O-GMPK il. 12. a3. Which of the following conditions are contraindications for noninvasive positive-pressure ventilation in patients with respiratory failure ? I. Craniofacial abnormalities Il. Significant burns Ill. Respiratory failure with PaCO, of 60 mm Hg IV. Cardiovascular instability Select the correct answer using the code given below : (a) I, I and Ill (b) I, I and IV (c) I, I and IV (d) I, M1 and IV Which one of the following terms denotes the extensive sclerosis of the skin of the chest wall which restricts chest wall movement and is seen as a rare complication of systemic sclerosis ? (a) Flail Chest (b) Hidebound Chest (c) Barrel Chest (d) Pigeon Chest Consider the following pleural fluid analysis : pH - 76 Pleural fluid protein — 0-5 g/dL Serum total protein - 6-5 g/dL Pleural fluid LDH - 100 U/L Serum LDH — 300 U/L TDSP-O-GMPK — A 14. 15. What is the most likely diagnosis ? (a) Pancreatitis (b) Myxedema (c) Sarcoidosis (d) Rheumatoid arthritis ‘Masson Bodies’ formed due to proliferation of immature collagen are a characteristic histopathological finding seen in which of the following conditions ? (a) Lymphocytic Interstitial Pneumonia (b) Cryptogenic Organizing Pneumonia (c) Desquamative Interstitial Pneu- monia (d) Respiratory Bronchiolitis Consider the following statements regarding respiratory function in old age: I. There is increasing ventilation- perfusion mismatch Il. There is increased ventilatory response to hypoxia and hyper- capnia Il. There is a decline in maximum oxygen uptake leading to reduc- tion in cardiorespiratory reserve IV. There is decline in the Forced Expiratory Volume to Forced Vital Capacity ratio (FEVI/FVC) by around 0:2% per year after the forties Which of the statements given above are correct ? (a) I, If and il (b) I, Il and IV (c) U, ll and IV (d) I, Wand IV 16. 17. 18. Which one of the following statements is correct in respect of pulmonary involvement in rheumatoid disease ? (a) Rheumatoid pulmonary nodules are usually asymptomatic and detected incidentally on imaging (b) Rheumatoid pulmonary nodules are often solitary and located near hilum (c) Pleural effusion in these patients is transudative and usually bilateral (d) Combination of pleural effusion and pneumoconiosis in these patients is known as Caplan syndrome Which one of the following conditions is a complication of bacterial pharyn- gitis involving extension of infection into the internal jugular veins leading to thrombosis and metastatic dispersal of the organism ? (a) Cystic Fibrosis (b) Chronic Pulmonary Aspergillosis (c) Lemierre syndrome (d) Wegener’s granulomatosis A 42-year old man with history of alcohol dependency presents with progressive abdominal distension. Abdominal examination reveals a shifting dullness. Which one of the following is the most appropriate drug to relieve this abdominal distension ? 19, 20. 21. (a) Octreotide (b) Propranolol (c) Lactulose (4) Spironolactone Which one of the following is the investigation of choice for diagnosing the presence of stones in the gall- bladder ? (a) Transabdominal ultrasound (b) Erect X ray of abdomen (c) Capsule endoscopy (d) Computed Tomography Which one of the following biologic agents used in the treatment of inflammatory Bowel Disease acts by inhibiting the enzyme ‘Janus Kinase’ ? (a) Infliximab (b) Adalimumab (c) Vedolizumab (d) Tofacitinib Melanosis coli, which occurs due to - long term consumption of stimulant laxatives, presents as brown dis- colouration of colonic mucosa due to deposition of which one of the following pigments ? (a) Melanin (b) Haemosiderin (c) Lipofuscin (d) Haemoglobin A — TDSP-O-GMPK 22. Consider the following with regard to Gilbert Syndrome : 23. 24. I. Autosomal recessive trait of a mutation in gene for UDP- glucuronyl transferase enzyme IL Elevation of unconjugated bili- rubin Il. No stigmata of chronic liver disease other than jaundice IV. Early Liver biopsy recommended in patients with possible Gilbert Syndrome Which of the above are correct ? (a) I and II only (b) II and II only (c) I, Il and Il (d) Wand IV The single most important treatment and prognostic factor in alcohol-related liver disease is (a) N-acetyl cysteine (b) Cessation of alcohol consumption (c) Liver transplantation (d) High dose vitamin E A 40 year old man with a known case of chronic pancreatitis presents to the OPD with complaint of skin pigmentation over the abdomen. The patient gives a history of chronic use of a hot water bottle to relieve the abdominal discomfort. Which one of the following is the most appropriate diagnosis ? TDSP-O-GMPK — A 25. 26. 27. (a) Erythema infectiosum (b) Erythema marginatum (c) Erythema nodosum (d) Erythema ab igne Which one of the following is correct regarding arginine vasopressin antago- nist Tolvaptan ? (a) It is useful in hypovolemic hypo- natremia (b) It antagonises the V, receptor (c) It should be used for at least 1 year (d) It is an oral drug Which one of the following conditions is caused by mutations in the gene that encodes the sodium-potassium- 2-chloride cotransporter (NKCC2), and presents with sodium wasting, hypokalaemia, hypomagnesaemia and hypercalciuria ? (a) Alport syndrome (b) Bartter syndrome (c) Fanconi syndrome (d) Gitelman syndrome A 52 year old male has uncontrolled diabetes. Which one of the following tests will help in early detection of nephropathy ? (a) Blood urea level (b) Serum creatinine level (c) Ultrasonography (d) Urine albumin 28. 29. 30. Autosomal dominant mutations in which one of the following genes may cause focal segmental glomerulosclero- sis associated with abnormal genitalia, Wilm’s tumour and mental retarda- tion ? (a) WTI (b) INF2 (c) LMX1B (d) APOLI1 Kidney damage and Glomerular Filtration Rate (GFR) value between 15-29 mL/min/1-73 m? are found in which stage of Chronic Kidney Disease ? (a) Stage 2 (mild) (b) Stage 3A (mild to moderate) (c) Stage 4 (severe) (d) Stage 5 (kidney failure) Which one of the following hereditary tubulo-interstitial kidney diseases has an autosomal recessive mode of inheritance ? (a) Medullary cystic kidney disease type 1 (b) Medullary cystic kidney disease type 2 _ (€) Nephronophthisis (d) Juvenile hyperuricaemic nephro- pathy 31. 32. Which of the following findings in a patient are suggestive of acute nephritis ? I. Hematuria II. Oliguria Ill. Reduced size of both kidneys IV. Edema Select the correct answer using the code given below : (a) I and II (b) I and IV (c) I and II only (d) I, I and IV A 35 year old male presents with increased urine output. On evaluation, his urinary output was around 4L/day; urinary osmolality was 200 mosmol/L. Which of the following are various differential diagnosis ? I. Psychogenic polydipsia II. Solute diuresis Il. Central diabetes insipidus IV. Nephrogenic diabetes insipidus Select the correct answer using the code given below : (a) I, I and IV (b) I and III only (c) Iand IV (d) I and IV only A — TDSP-O-GMPK 33; 34. 35. Contralateral Homonymous upper quadrantanopia is the type of visual loss seen when the lesion is located at which one of the following anatomical locations ? (a) Frontal lobe (b) Temporal lobe (c) Parietal lobe (4) Occipital lobe Which of the following are clinical features of migraine ? I. It is associated with dilatation of extracranial vessels I. Common migraine is seen without Aura I. Aura is most often visual Select the correct answer using the code given below : (a) I, I and Il (b) I and II only (c) I and II only (d) I and III only A 50 year old man presents with brief episodes of lancinating unilateral facial pain, involving the buccal distribution. Pain is triggered by washing face with cold water. What is the most likely diagnosis ? TDSP-O-GMPK - A 36. a7. (a) Migraine (b) Medication overuse headache (c) Chronic paroxysmal hemicrania (d) Trigeminal neuralgia Which of the following are trigger factors for seizures ? I. Sleep deprivation Il. Missed doses of antiepileptic drugs Il. Recreational drug misuse IV. Physical exhaustion Select the correct answer using the code given below : (a) Il and III only (b) I and IV only (c) I, If and II only (4) 1, U, I and IV Which one of the following childhood epileptic disorders often needs long term treatment with anti epileptic drugs ? (a) Benign neonatal seizures (b) Febrile seizures (c) Benign rolandic epilepsy (d) Juvenile myoclonic epilepsy 38. 39, 40. Which of the following are clinical features of Parkinson’s disease ? I. Reduced eye blinking Il. Drooling of saliva Ill. Soft voice IV. Macrographia Select the correct answer using the code given below : (a) I, Il and Il (b) I, Il and IV (c) I, Ill and IV (d) I, Ill and IV A 35 year female presents with easy fatigability. Investigations show that Hb is 6 g%; Red cell morphology is normocytic normochromic; and reticulocyte production index is 5-5. Which one of the following conditions favours this abnormality ? (a) Iron deficiency anemia (b) Sideroblastic anemia (c) Folate deficiency (d) Intravascular hemolysis A 46 year old lady on vegan diet for a decade presents with chief complaints of tingling and numbness in lower limbs for two months and a history of swaying while walking through narrow corridors. Which one of the following blood tests is advisable for diagnosis in this patient ? (a) Serum protein electrophoresis (b) Anti-gliadin antibodies (c) Vitamin 25(OH) D level (d) Vitamin B12 levels 41. 42. 43. Which one of the following causes low-volume erythrocytosis ? (a) Polycythemia Rubra Vera (b) Exogenous testosterone therapy (c) Gaisbock’s syndrome (d) High altitude First line therapy in chronic phase of chronic myeloid leukemia is (a) Rituximab (b) Thalidomide (c) Imatinib (d) Chlorambucil With regard to management of idiopathic thrombocytopenic purpura, consider the following statements : I. All patients with ITP with platelet count less than 100x109/L should receive high dose of glucocorti- coids I. For patient with spontaneous bleeding, 40 mg of dexametha- sone daily is indicated for 4 days I. Intravenous immunoglobulin can raise the platelet count IV. Life threatening bleeding should be treated with platelet transfusion Which of the statements given above are correct ? (a) I, Il and I (b) IL, Ill and IV (c) I, Ill and IV (d) I, Il and IV A — TDSP-O-GMPK 44. 45. Which of the following drugs cause secondary weight gain ? can I. Insulin Il. Propranolol Il. Orlistat IV. Thyroxine Select the correct answer using the code given below : (a) I, Wand IV (b) I and I (c) U, Il and IV (d) I and II only Under which one of the following conditions, the HPA axis suppression is likely to result in crisis due to adrenal insufficiency following withdrawal of glucocorticoids ? (a) If glucocorticoids have been given by intravenous route for five days (b) If glucocorticoids have been administered orally for one week (c) If glucocorticoids have been prescribed repeatedly within the previous year (d) If the dose is less than equivalent of 5 mg prednisolone per day TDSP-O-GMPK — A 10 46. 47. 48. Wilson’s disease has which of the following inheritance ? (a) X-linked recessive (b) Autosomal dominant (c) Autosomal recessive (d) It is an acquired disease Which of the following can be used for the management of severe hyper- kalaemia ? I. Intravenous calcitonin Il. Intravenous sodium bicarbonate Ill. Oral sodium polystyrene sulphate IV. Intravenous calcium gluconate Select the correct answer using the code given below : (a) I, I and IV (b) I, II and IV (c) I and II only (d) I and IV only Which one of the following conditions can cause euvolaemic hyponatraemia ? (a) Adrenocortical failure (b) Hypothyroidism (c) Nephrotic syndrome (d) Burns 49. Which one among the following 50. 51. 52. vectors transmits the filaria Loa Loa ? (a) Simulium (b) Chrysops (c) Cyclops (d) Culicoides Which of the following is the most favourable prognostic parameter in Bell’s palsy ? (a) Incomplete paralysis in the first week (b) () (d) Mild CSF lymphocytosis Denervation in EMG after 10 days Pain behind the ear Which one of the following groups of drugs is ineffective against gram positive bacteria ? (a) Monobactams (b) Glycopeptides (c) Fluoroquinolones (d) First generation cephalosporins Which one of the following statements is correct regarding leprosy ? (a) Type 1 Leprosy Reaction is also called erythema nodosum lepro- sum 11 S35 54, (b) Type 2 Leprosy Reaction is an immune complex mediated syn- drome called arthus phenomenon (c) ‘Lion face’ appearance is seen in tuberculoid leprosy Nose is the last site of involve- ment in lepromatous leprosy (d) A 56 year old gardener presents with an ulcerative nodule with purulent discharge on his right index finger. He had a prick with a thorn, at the same site around a month back. Which one of the following infections is most likely ? (a) Chromoblastomycosis (b) Mycetoma (c) Phaeohyphomycosis (d) Sporotrichosis A 36 year old man presents with decreased apetite, mouth soreness, diarrhoea and irritability. On examina- tion he has a bright red tongue with a pigmented scaly rash around the neck. Which one of the following food items in his diet has a bearing on his disease ? (a) Rice (b) Wheat (c) Com (d) Fish A — TDSP-O-GMPK 55. 56. Acrodermatitis enteropathica is an autosomal recessive metabolic disorder which affects the absorption of which one of the following micronutrients ? (a) Iodine (b) Zine (c) Iron (d) Selenium Consider the following statements with regard to the treatment of vitamin A deficiency : I. Repeated high doses of retinol can cause liver damage and terato- genicity Il. Acute overdose of vitamin A may lead to increased intracranial pressure and skin desquamation Regular vitamin A supplementa- tion is also recommended for pregnant women even in countries where vitamin A deficiency is not endemic Excessive intake of carotene may cause harmless orange pigmenta- tion of the skin Which of the statements given above are correct ? (a) I, Wand Il (b) I, and IV TDSP-O-GMPK —- A 12 57. 58. (c) I, Wand IV (4) U, Wl and IV Koebner phenomenon is seen in which one of the following conditions ? (a) Psoriasis (b) Acne Vulgaris (c) Bechet’s disease (d) Leprosy Consider the following regarding the human hair growth cycle: I. Anagen is a phase of active hair growth Il. Telogen is a transitional phase mm. Catagen is a resting phase Which of the statements given above is/are correct ? (a) Lonly (b) TI only (c) I and II only (d)_ I, If and Ill 59. Consider the following statements regarding oculocutaneous albinism : I. The disease results from genetic abnormalities leading to destruc- tion of melanocytes I. Type 1 albinism is due to a defect in the tyrosinase gene Ill. Patients may present with poor vision, rotator nystagmus and alternating strabismus IV. Patients are at an increased risk of sunburn or developing skin cancer Which of the statements given above are correct ? (a) I, Wand I (b) I, IandIv (c) I, Wand Iv (d) Il, I and IV 60. A 42 year old man presented with recurrent oral ulcers since one year, episodes of redness of eye and genital ulcers. Which one of the following tests is of diagnostic value ? (a) Mantoux test (b) Drug-sensitivity test (c) Pathergy test (d) Patch test 61. Which of the following joints are commonly affected in osteoarthritis ? I. First metatarsophalangeal joint II. Proximal interphalangeal joint Tl. Ankle joint IV. Sth and 6th cervical vertebrae joint Select the correct answer using the code given below : (a) I and II only (b) III and IV only (c) I, Il and IV only (d) I, Il, Ill and Iv 62. Which of the following are causes of reversible dementia ? I. Hypothyroidism Il. Vitamin B12 deficiency I. Dementia with lewy body IV. Thiamine deficiency Select the correct answer using the code given below : (a) I, Il and Il (b) I, I and IV (c) I, Ill and IV (d) I, Il and IV A — TDSP-O-GMPK 63. Which of the following are clinical features of Fronto-Temporal dementia ? I. Personality change II. Language disturbance Il. Memory may be preserved in early stages IV. Anti-cholinesterases are the drug of choice for treatment Select the correct answer using the code given below : (a) I, I and Il (b) I, If and IV (c) I, Il and IV (d) Il, Ill and IV 64. Which one of the following is the myelinating cell of Central Nervous System ? (a) Astrocyte (b) Microglia (c) Schwann cell (d) Oligodendrocyte 65. Which one of the following is the correct description of Mee’s lines, seen in chronic arsenic poisoning ? (a) Transverse white lines on nails of fingers and toes Transverse red lines on the skin of palms and soles (b) Transverse white lines on the skin of palms and. soles (c) Transverse red lines on the nails of fingers and toes (d) TDSP-O-GMPK - A 14 66. Fomepizole is an antidote used to treat poisoning from which of the following substances ? I. Methanol I. Digoxin Il. Cocaine IV. Ethylene glycol Select the correct answer using the code given below: (a) I and II (b) II and Il (c) Il and IV (d) I and IV 67. The 4A Test is a screening tool for detection of delirium. Which of the following parameters are included in the 4AT tool ? I. Alertness I. Apnoea Il. Abbreviated Mental Test (AMT4) IV. Attention Select the correct answer using the code given below : (a) I, and I (b) I, and IV (c) I, I andIv (d) I, I and IV 68. 69. 70. TA. Which of the following combina- tions of lab test results is indicative of heavy alcohol consumption, with more than 60% sensitivity and specificity ? (a) Gamma _ glutamyl transferase (GGT) > 35 U/L and alkaline phosphatase > 45 U/L (b) Carbohydrate-deficient transferrin (CDT) > 20 U/L and serum uric acid < 7 mg/dL (c) High normal MCV > 91 fL and CDT < 20 U/L (@ GGT>35 U/L and CDT >20U/L What is the antidote for belladonna poisoning ? (a) Physostigmine (b) Amitriptyline (c) Atropine (d) Flumazenil Which one of the following prevents gastrointestinal absorption of thallium ? (a) Calcium carbonate (b) Prussian blue (c) Penicillamine (d) Potassium permanganate A 45 year old farmer came with accidental consumption of a pesticide. He complained of frequent urination and excessive salivation. Which one of the following toxidromes is most likely to be associated with this poisoning ? (a) Serotonergic (b) Cholinergic (c) Adrenergic (d) Hypnotic 15 72. Consider the following regarding Ss salicylate poisoning : I. Arterial pH of 7-25, anion gap of 18 mmol/L Il. Arterial pH of 7-25, anion gap of 10 mmol/L I. pCO, of 20 mm Hg IV. pCO, of 48 mm Hg Which disturbance is likely to be encountered ? (a) I and I (b) I and I (c) Land IV (d) and Iv Which of the following statements are typical for classic heat stroke ? I. Older patient II. Normokalemia Il. Hyponatremia IV. Marked lactic acidosis Select the correct answer using the code given below : (a) I and III (b) I and II (c) Il and IV (d) [and Iv A — TDSP-O-GMPK 74, Which of the following statements are correct regarding Weil’s disease ? L It is caused by a virus named leptospira Il. Acute kidney injury can lead to oliguria in this disease Il. Microscopic agglutination is the investigation of choice IV. Ceftriaxone given parenterally is effective treatment Select the correct answer using the code given below : (a) I, I and Il (b) 1, If and IV (c) I, I and IV (d) I, Il and IV 75. Which of the following are com- ponents of SOFA scoring system ? I. PaO>/FiO, ratio I. Mean arterial pressure Ill. Glasgow coma scale IV. Prothrombin Time with INR Select the correct answer using the code given below : (a) I, I and II (b) I, If and IV (c) I, Il and IV (d) I, Il and IV TDSP-O-GMPK - A 16 76. What are the components to establish the diagnosis of Brain Death ? I. Absent brain stem reflexes I. Apnoea in presence of elevated PCO, Il. Hypothermia IV. Irreversible and unresponsive coma Select the correct answer using the code given below : (a) I, 0 and Il (b) I, Il and IV (c) I, Il and IV (d) I and IV only 77. The most common cause for non- traumatic sub-arachnoid haemorrhage is (a) A-V malformation (b) Saccular aneurysm rupture (c) Extension from primary intra- cerebral haemorrhage (d) Idiopathic 78. Peri-operative respiratory failure is an example of (a) Type I respiratory failure (b) Type II respiratory failure (c) Type Ill respiratory failure (d) Type IV respiratory failure 13: 80. 81. 82. The murmur of mitral regurgitation is best heard at (a) Tricuspid area (b) Aortic area (c) Cardiac apex (d) Pulmonary area A 28 year female presented to emer- gency with fever, agitation and delirium. She was on regular medica- tion of Carbimazole 40 mg daily, but missed her doses for the last 2 days. Which of the following scoring systems would you like to do to assess severity of disease ? (a) DAS 28 score (b) Burch-Wartofsky score (c) Expanded Disability Status Scale (d) Sequential Organ Failure Assess- ment Score Out of the following areas of brain, which area is most commonly affected on brain imaging in Wilson’s disease ? (a) Cerebellum (b) Sub-cortex (c) Thalamus (d) Basal ganglia Which of the following are secondary iron overload conditions ? I. Transfusion related iron load Il. Thalassemia Il. Hepatitis C associated liver disease 17 83. Select the correct answer using the code given below : (a) I, II and Ill (b) I and II only (c) II and III only (d) I and III only Which of the following are features of Alzheimer’s disease ? I. It is a disorder of cerebral cortical function Il. Only short term memory is affected Ill. Patients deny that there is any- thing wrong IV. Depression is commonly present Select the correct answer using the code given below : (a) I, and I (b) I, and IV (c) I, I and IV (d) I, I and Iv . Glymphatics is the lymphatic like structure of which system ? (a) Central Nervous System (b) Respiratory (c) Renal (d) Gastro-intestinal A — TDSP-O-GMPK 85. Which one of the following state- ments is correct in the diagnosis of Giardiasis ? (a) Stool sample at 2-3 days interval should be examined for cysts (b) String test is done to find out cysts of Giardia lamblia (c) Jejunal biopsy samples can show presence of larvae of Giardia lamblia (d) Cystic form of Giardia lamblia remains viable in water upto 1 week only 86. In clinical assessment of an elderly patient, ‘the get up and go test’ is used to evaluate which of the following ? (a) Gait and balance (b) Cognition (c) Driving ability (d) Urinary incontinence 87. Treatment of first choice in acute Gout is (a) Oral Methotrexate (b) Oral Colchicine (c) Allopurinol (d) Sulfasalazine TDSP-O-GMPK - A 18 88. A 56 year male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert intercostals drain. Which one of the following sites is suitable for such a procedure ? (a) Hesselbach’s triangle (b) Petilis triangle (c) Triangle of safety (d) Triangle of auscultation 89. Which one of the following is an antidote for Rivaroxaban and Apixaban, when reversal of anticoagulation is needed due to uncontrolled bleeding ? (a) Idarucizumab (b) Andexanet Alfa (c) Hydroxocobalamin (d) Glucarpidase 90. Which of the following are included in common causes of mediastinal masses in superior and anterior mediastinum ? I. Goitre I. Thymic tumour I. Neurogenic tumour Select the correct answer using the code given below : (a) I and II only (b) I and If only (c) I and III only (d) I, I and Il SI, 92. O38: 94, Which one of the following is used to reverse the anticoagulant effects of Dabigatran ? (a) Glucarpidase (b) Desferrioxamine (c) Idarucizumab (d) Protamine Which one of the following is contra- indication of doing a wireless capsule endoscopy ? (a) Coeliac disease (b) Small bowel stricture (c) Obscure gastrointestinal bleeding (d) Small bowel Crohn’s disease Which one of the following is the causative organism of Erythrasma, a mild, localized and superficial skin infection ? (a) Corynebacterium pseudo tuber- culosis (b) Corynebacterium minutissimum (c) Corynebacterium diphthariae (d) Corynebacterium matruchotii Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction ? 19 95. 96. (a) Sinusoidal — Veno-occlusive disease (b) Pre-hepatic — Portal vein presinusoidal thrombosis (c) Intraheptic — Cirrhosis presinusoidal (d) Post-hepatic — Schistosomiasis post sinusoidal Which one of the following is a secondary cause of headache ? (a) Migraine (b) Tension-type headache (c) Trigeminal autonomic cephalalgia (d) Medication overuse headache A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis ? Adenoma sebaceum in the mid face (a) (b) Erythema nodosum on the skin (c) Kayser-Fleisher in the cormea rings (d) Olser’s nodes at the finger tips A — TDSP-O-GMPK 97. 98. PEDIATRICS Which of the following are causes of secondary immunodeficiency in children ? I. Diphenylhydantoin Il. Severe malnutrition Il. Post-varicella state IV. Nephrotic syndrome Select the correct answer using the code given below : (a) I, If and I (b) I, If and IV (c) I, Il and IV (d) U, I and IV Which of the following statements are correct regarding vaccination routes for children ? I. Hepatitis B vaccine given in del- toid region has reduced efficacy Il. Two vaccines may be given in the same thigh, but separated by 1 inch Separate sites are used when administering a vaccine and an immunoglobulin Two intramuscular vaccines may be given on the same day but in separate limbs TDSP-O-GMPK — A 20 99. 100. Select the answer using the code given below : (a) IW only (b) Land II (c) I and II (d) I and IV A radiopaque density may be noticed in poisoning by which of the following agents ? (a) Phenazopyridine (b) Ethylene glycol (c) Chloroquine (d) Chloral hydrate Which of the following syndromes are caused due to genomic imprinting ? I. Rubinstein Taybi syndrome II. Prader-Willi syndrome Il. Angelman syndrome IV. Edward syndrome Select the correct answer using the code given below : (a) Land I (b) I and I (c) Wand IV (d) Land IV 101. 102. As per POCSO (Protection of Children from Sexual Offences) Act 2012, sexual assault is considered aggravated when I. the abuse involves use of physical violence Il. the abused child is disabled Ill. the abuse is committed by staff of an educational institution IV. the abuse is committed by an immediate family member/first degree relative Which of the above are correct ? (a) IandIV (b) I and II (c) I and I (4) MandIv The mother of a 14-month-old normally developing baby comes to you for feeding advice, Which of the following would be appropriate for her as per the IMNCI (Integrated Management of Neonatal and Childhood Illness) Program ? I. Breastfeed as often as the child wants Il. Keep the child in your lap and feed with your own hands 21 103. Ill. Offer food from the family pot IV. Give 3 to 4 meals each day Select the correct answer using the code given below : (a) I, Mi and IV (b). I, Il and IV (c) 1, Wand WI (d) I, I and IV For a sick child aged 4 years, which of the following are signs of “severe Pneumonia or very severe disease”, as per IMNCI (Integrated Management of Neonatal and Childhood Illness) Program ? I. Fast breathing (Greater than or equal to 40 breaths per minute) I. Child vomits everything Il. Stridor in a calm child IV. Chest indrawing Select the correct answer using the code given below : (a) I and II (6) Ii and I (c) II and IV (d) Il and IV A — TDSP-O-GMPK 104. 105. In a child aged 34 years with an ear problem which one of these situations merits urgent referral to hospital ? (a) Pus seen draining from the ear, and discharge reported for less than 14 days (b) Pus seen draining from the ear, and discharge reported for more than or equal to 14 days (c) Tender swelling behind the ear (d) Pus seen draining from both ears, irrespective of duration Upto 10% of cases of Autism Spectrum Disorder (ASD) may be caused by genetic conditions. Which of the following are known to be associated with ASD ? I. Tuberous sclerosis Il. Fragile X syndrome Il. Prader-Willi syndrome IV. Patau syndrome Select the correct answer using the code given below : (a) Iand 0 (b) I and I (c) Wand (@) Iand IV TDSP-O-GMPK — A 22 106. 107. Which of the following are charac- teristic features of cerebral palsy ? I. Disorder of movement Il. Permanent nature Ill. Progressive course IV. Disorder of posture Select the correct answer using the code given below : (a) I, Il and I (b) I, I and IV (c) Il, II and IV (d) I, I and IV Which of the following are the tools used for classification of spasticity in a child with cerebral palsy ? I. Gross Motor Function Classifica- tion System I. Medical Research Council System Ill. Modified (Connors-II) Connors Scale IV. Modified Ashworth Scale Select the correct answer using the code given below : (a) I and II (b) II and III (c) II and IV (d) I and IV 108. 109. Which of the following medications may be used in a child diagnosed with Attention Deficit Hyperactivity Disorder ? I. Carbamazepine II. Methylphenidate I. Atomoxetine IV. Clonazepam Select the correct answer using the code given below : (a) I and II (b) TI and II (c) Il and IV (d) land IV Which of the following are included as a “Deficiency” under the Rashtriya Bal Swasthya Karyakram (RBSK) ? I. Hypothyroidism I. Vitamin A deficiency Il. Anemia IV. Vitamin D deficiency Select the correct answer using the code given below : (a) |, Wand Il 23 110. (b) I, Il and IV (c) I, I and IV (@) I, Wand Iv Which of the following statements are correct regarding management of hyperkalemia in a child ? I. Intravenous calcium (gluconate or chloride) is given to enhance cellular uptake of potassium Il. Beta adrenergic agonists (salbuta- mol or terbutaline) are used to stabilize myocardial cell mem- brane Regular insulin and glucose given intravenously enhance cellular uptake of potassium Sodium polystyrene sulfonate enhances total body potassium elimination _ Select the answer using the code given below : (a) I and II (b) II and II (c) IandIV (d) Il and IV A — TDSP-O-GMPK 111. Which of the following statements are correct about oral rotavirus vaccines ? I. The storage should be at 2-8°C I. The vaccine should be used within 2 hours of reconstitution or opening Past history of intussusception is a contraindication The vaccine can be given if the baby has ongoing diarrhoea Select the answer using the code given below : (a) Land II (b) If and IV (c) Land Ill (d) Wand IV 412. A child can make a tower of 3 blocks, runs, copies his mother while sweeping and has a vocabulary of 8-10 words. His developmental age is (a) 12 months (b) 15 months (c) 18 months (d) 24 months TDSP-O-GMPK — A 24 113. A child can ride a tricycle, copies a circle, knows name and gender. The developmental age of this child is (a) 2 years (b) 3 years (c) 4 years (d) 5 years 114. A teen boy with birth weight of 2:8 kg is born to a primigravida mother through vaginal delivery and cried immediately after birth. Which of the following statements are correct regarding his initial care after birth ? I. The baby should be initiated on breastfeeding within one hour of birth Il. The baby should be kept in a separate area from the mother The baby should be administered with 0-5 mg of vitamin K intra- muscularly The baby should be thoroughly examined for congenital malfor- mations from head to toe Select the answer using the code given below : (a) I and II (b) I and Ill (c) If and Ill (a) Land IV 115. 116. 17, Which one of the following oral drugs may be used in the management of super-refractory status epilepticus ? (a) Clonazepam (b) Clobazam (c) Lamotrigine (d) Topiramate Which of the following statements are correct regarding the use of benzo- diazepines in the initial management of status epilepticus ? I. Upto two doses may be used 5 minutes apart, if seizures are not controlled Il. For Lorazepam, only a single dose should be used, even if seizures are not controlled Dose of midazolam at this stage is 1-15 pg/kg/min infusion IV. Dose of both lorazepam and midazolam is 0-1 mg/kg Select the answer using the code given below : (a) I and II (b) I and IV (c) I and III (d) I and IV Which of the following statements are correct regarding hypernatremia in children ? I. Diabetes insipidus due to a defi- ciency of antidiuretic hormone (ADH) may cause hypernatremia 25 118. I. Addison disease may be asso- ciated with hypernatremia Ill. Use of boiled skimmed milk can lead to hypernatremia IV. Use of lactulose can lead to hypernatremia Select the answer using the code given below : (a) I, Ill and IV (b) IL, I and Iv (c) I, I and DI (d) I, I and IV Which of the following statements are correct regarding the management of gastrointestinal bleeding in children ? I. Somatostatin or octreotide infu- sion should be given for at least 7 days after stoppage of initial bleeding to prevent rebleeding Il. Endoscopic Sclerotherapy (EST) involves endoscopic injection of N-butyl-2-cyanoacrylate or iso- butyl-2-cyanoacrylate EST has upto 90% efficacy in controlling acute bleeding Following an episode of acute variceal bleeding, all patients should receive secondary prophy- laxis to prevent rebleeding Select the answer using the code given below : (a) I and II (b) I and IIT (c) Il and IV (d) Il and IV A — TDSP-O-GMPK 119. Which of the following are advantages 120. Which of the following are causes of of endotracheal intubation, in a child hypocalcemia in a child ? requiring pediatric advanced life support ? I. Hypomagnesemia I. Inspiratory time can be controlled Il. Hypophosphatemia Il. Positive end-expiratory pressure can be provided wf padres Ill. Metabolic acidosis Ill. Peak expiratory pressure can be controlled IV. Pseudohypoparathyroidism IV. Reduced risk of aspiration of : gastric contents Select the correct answer using the code given below : Select the correct answer using the code given below : (@) Land I (a) I, I and Ill (b) I and Il (b) I, Il and IV (c) I, I and IV (c) I and IV (d) 1, Il and IV (d) and IV TDSP-O-GMPK - A 26 SPACE FOR ROUGH WORK 27 A— TDSP-O-GMPK SPACE FOR ROUGH WORK TDSP-O-GMPK - A 28 SPACE FOR ROUGH WORK 29 & ¬ TDSP-O-GMPK . SPACE FOR ROUGH WORK TDSP-O-GMPK — A 30 SPACE FOR ROUGH WORK 31 A — TDSP-O-GMPK SPACE FOR ROUGH WORK TDSP-O-GMPK — A 32