QP-CMSE-24-PAPER-I-GENERAL-MEDICINE-AND-PEDIATRICS-150724

Combined Medical Services ٣٠۷۰٠٠۰ ବୋ ଗା କୋ ମା ‏ہد‎ DO NOT OPEN THIS TEST BOOKLET UNTIL YOU ARE TOLD TO DO SO T.B.C. : KCSP-A-GMPK = ~ ॥॥ "=" Serial No. TEST BOOKLET Paper-I 1059021 (General Medicine and Pediatrics) Time Allowed : Two Hours Maximum Marks : 250 INSTRUCTIONS 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. 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. 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. 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. You have to mark all your responses ONLY on the separate Answer Sheet provided. See directions in the Answer Sheet. All items carry equal marks. 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. 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 take away with you the Test Booklet. Sheets for rough work are appended in the Test Booklet at the end. Penalty for wrong answers : THERE WILL BE PENALTY FOR WRONG ANSWERS MARKED BY A CANDIDATE IN THE OBJECTIVE TYPE QUESTION PAPERS. ദ There are four alternatives for the answer to every question. For each 27 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 2022 answers happens to be correct and there will be same penalty as above to that question. 011) 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 KCSP-A-GMPK (1-&) KCSP-A-GMPK The height of the Jugular Venous Pulse determined by : (a) Right atrial pressure (b) Right ventricle pressure (c) 1. atrial pressure (ત) 1౬68 ventricle pressure The SA node is situated at the junction of : (a) SVC and RA 00) SVC and LA (০) LAand LV (0) IVC and RA High output cardiac failure is caused by which of the following diseases ? ২ Beri-beri 2. Severe anaemia 3. Thyrotoxicosis Select the correct answer using the code given below : (8) land 2 only (2) 2 9820 8 only (€) ` 1 820 3 only (ଏ) 1,2and3 Reverse splitting of second heart sound is most commonly seen in : (a) ASD (b) Severe MR (c) LBBB (d) Pulmonary hypertension 6. (2-4) Which of the following are major criteria under the Jones Criteria for Acute Rheumatic Fever ? 1. 01070೩ 2. Erythema Marginatum 3. ` ` Subcutaneous Nodules 4, Polyarthralgia Select the correct answer using the code given below: (a) 1,2and3 (0) 1,2and4 ) 1,3and4 (1) 2,3and4 A 70-year-old man with dyspnoea on exertion has been found to have a single second heart sound and a loud diamond-shaped, rough quality systolic murmur best heard at the right 276 intercostal space, radiating to the right carotid artery. Which one of the following is the likely diagnosis ? (a) Patent ductus arteriosus (b) Ventricular septal defect (c) Aortic stenosis (d) Pulmonary stenosis 7. Which one of the following is the appropriate scoring system used to assess the risk of stroke in patients of non-valvular chronic atrial fibrillation on oral anticoagulation ? (a) HAS-BLED യ AMT-4 (০) CURB-65 (१) CHA,DS,VASe 8. Consider the following statements with regard to pulmonary embolism : 1. Unexplained breathlessness is the most common symptom. 2. When congestive heart failure or pneumonia fail to improve despite standard medical treatment, occult pulmonary embolism should 16 considered. 8. Patients with high clinical likelihood of venous thromboembolism should first undergo D-dimer testing alone without obligatory imaging tests. Which of the statements given above are correct ? (a) land 2 only (0) 2 80 3 only (6) land 3 0715 (0) 1, 28043 KCSP-A-GMPK 10. (3-4) Consider the following criteria : 1. Pleural fluid protein : Serum protein ratio > 0:5 2. Pleural fluid LDH : Serum LDH ratio > 0:6 3. Pleural fluid LDH > Two-thirds of the upper limit of normal serum LDH Which of the above criteria, if present in pleural fluid, will indicate an exudate ? (a) land 2 only (0) 2and 3 only (c) land 3 only (0) 1,208 Which of the following statements are correct with regard to clubbing ? 1. It usually affects the fingers symmetrically. 2. It does not involve the toes. 8. It may be associated with malignant lung conditions. 4. It may recede following the lung transplantation in cystic fibrosis. Select the answer using the code given below : (8) 1,2and3 (2) 1, 3 820 4 (©). 2,3and4 (0) 1, 2 8020 4 11. Consider the following statements regarding Lofgren syndrome : 1. It is an acute illness and is more commonly seen in females. 2, It is a clinically distinct phenotype of sarcoidosis characterized by peripheral arthropathy and uveitis. 3. Clinical features include fever, erythema, nodosum and _ bilateral lymphadenopathy. Which of the statements given above are correct ? (৪) land 2 only (2) 2and 3 only (০) 1 and 3 only (1) 1, 2 80१3 12. Which of the following investigations may be used for the diagnosis of pulmonary tuberculosis ? 1: Nucleic acid amplification 2. Culture in Middlebrook medium 3. Light emitting diode fluorescent microscopy with auramine staining 4. Peripheral blood smear Select the correct answer using the code given below : (a) 1,2and3 യ 1, 2 800 4 (০) 1,3and4 (१) 2,3and4 KCSP-A-GMPK 13. 14. 15. (4-A) The distance walked in 6 minutes is an indirect measure of which of the following variables of the ‘BODE Index’ which is used to assess the prognosis in chronic obstructive pulmonary disease ? (a) Body Mass Index (b) Degree of air flow नो ਨਕ (c) Severity of dyspnoea (d) Exercise capacity A 65-year-old female, 8 stone-cutter by occupation had multiple well circumscribed nodular opacities in upper and middle zones - of a chest X-ray along with mediastinal lymph nodes. showing egg-shell calcification. Which one of the following is the most likely etiology ? (a) Byssinosis (0) ১8111003818 (6) Berylliosis (0) 51660518 Which of the following are complications of acute pancreatitis ? ibs Hypoxia 2: Hypercalcemia 3. Hyperglycemia 4. Reduced serum albumin . Select the correct answer using the code given below : (੩) 1,2and3 (2) 1, 3 4820 4 (০) ` 2 820 3 only (વ) 3and4only 16. 17. 18. KCSP-A-GMPK The Gold Standard for diagnosis of Celiac disease is : (a) Endoscopic small bowel biopsy (b) 51001 routine microscopy and culture (c) Abdominal ultrasound (0) Anti-parietal cell antibodies With regard to Helicobacter pylori eradication in peptic ulcer disease, consider the following statements : 1. Proton-pump inhibitor is taken with two antibiotics. 2. Treatment is prescribed for at least 7 days. 3. Treatment of Helicobacter pylori infection leads to vitamin B12 deficiency. 4. Patients requiring long-term NSAIDs should undergo Helicobacter pylori eradication therapy to reduce ulcer risk. Which of the statements given above are correct ? (৪) 1,2and3 യ) 1,2and4 (০ 1,3and4 (d) 2,3and4 Which of the following are precipitating factors for hepatic encephalopathy ? 1. Hypokalemia 2. Septicemia ୫, Increased dietary protein load Select the correct answer using the code given below : (a) 1 820 2 only (0) 2 920 3 only (6) land 3 only (ત) 1,2and3 19. 20. 21. (5-&) Which one of the following statements is correct regarding Upper Gastro Intestinal Bleeding (UGIB) ? (a) Esophageal varices are the most common cause. (b) Eradication of Helicobacter pylori in patients with bleeding ulcers decreases the rebleeding rates to less than 5%. (c) Patients with cardiovascular disease who are on aspirin for secondary prevention should not restart their aspirin. (d) Transjugular Intrahepatic Portosystemic Shunt (TIPS) should be considered as only after hospitalization for therapy one week of acute variceal bleeding. Crigler-Najjar syndrome Type-I is inherited as an: (a) Autosomal recessive disorder (b) Autosomal dominant disorder (6) X-linked recessive disorder (d) X-linked dominant disorder Whipple’s disease is characterized by the infiltration of small intestinal mucosa by ‘foamy’ macrophages. Which one of the following histological characteristically used to stain them ? stains is (a) Sudan Black-B (b) Gentian violet (c) Methylene blue (d) Periodic acid Schiff 22. Poorly absorbed antibiotics are often used 23. When the serum ascites to albumin gradient (SAAG) is less than 1.1 gm/dL, then which of the following causes of ascites may be considered ? 1 Infection 2. Malignancy 3. Cardiac ascites 4. Portal hypertension Select the correct answer using the code given below : (a) 1,3and4 (2) land 2 only (€) 3and4only (0) 1,2and3 24. A sigmoid configuration along with tapering beak-like deformity at the lower esophageal sphincter on barium swallow is a feature of : (a) Diffuse esophageal spasm (0) Squamous cell carcinoma of esophagus (০) Achalasia cardia (1) Barret’s esophagus KCSP-A-GMPK adjunctive therapies in patients with hepatic encephalopathy. These may include : (೩) Tenofovir or Telbivudine (0) 500509૫7717 or Velpatasur (6) Levofloxacin or Clarithromycin (0) Neomycin or Rifaximin 25. Consider the following findings in urine examination of suspected haematuria : Dipstick test is Urine Etiology positive for microscopy following component A: Myoglobinuria | 2 : White 0: Glomerular blood bleeding cells 1 : Hematuria E:Nored |1 Intravascular cells hemolysis 0: Hemoglobinuria | ए : Red cell |I: Rhabdomyolysis casts 26. (6-A) Which one of the following triplets is correctly matched ? (a) B,F,G 0(6 (9) ~. 9, 0 Cf ‏کے‎ Which of the following statements are correct regarding anti-glomerular basement membrane disease ? Ls It is a rare autoimmune disease which presents ઘડ rapidly progressive glomerulonephritis. 2. Antibodies are formed against 03 chain of type 4 collagen GBM. 3. The ૦3 chain is expressed in basement membrane of glomerulus and the retina. 4. The disease may be associated with retinal hemorrhage when it is known as Goodpasture syndrome. Select the answer using the code given below : (೩) land 2 only (b) 2,3 and 4 only (6) 1,3 and 4 only (0) 1,2,3and4 27. Which of the following are poor prognostic indictators in glomerular disease ? 1. ‘Female sex 2. Hypertension 3. Persistent and severe proteinuria 4. Elevated creatinine levels at presentation Select the correct answer using the code given below : (a) 18700 3 only യ) 2800 4 only (6) 2, 8 and 4 only (0) 1,2,3and4 28. Which of the following are indications for a renal biopsy ? > Chronic kidney disease of uncertain etiology 2. Nephritic syndrome 3. Uncontrolled severe hypertension 4. Renal transplant dysfunction Select the correct answer using the code given below : (a) 1,208 (0) 1, 2 4300 4 (c) 1, 3 8020 4 (0) 2, 3 820 4 KCSP-A-GMPK (3 29. 30. 31. -A) Which of the following is the correct range of Glomerular Filtration Rate (GFR) for Stage 2 chronic kidney disease ? (a) 60 - 89 mL/min/1-73 m? (1) 45-59 mL/min/-73 पण (6) 30 - 44 mL/min/-73 m? (૧) 15 - 29 mL/min/1-73 112 A diagnosis of polycystic ovary syndrome requires the presence of which of the following clinical features ? 1 Menstrual irregularity 2. Clinical or biochemical androgen excess 3. Multiple cysts in the ovaries 4. BMI < 18:5 kg/m? Select the correct answer using the code given below : (a) 1,2and3 (2) 2, 3 820 4 (c) 1,3and4 (0) 1,2and4 A young male presented with recent onset urethral discharge On examination, the discharge was profuse and 200 _ 6780೩. purulent. Microscopy of smears from the discharge revealed Gram-negative diplococci. What is the likely diagnosis ? (a) Genital herpes (b) Chlamydia (6) Gonorrhoea (d) Syphilis ૭2. ૭૩. KCSP-A-GMPK A 40-year-old female with nephritic proteinuria is found to have low serum complement levels. Which of the following can be the likely etiology ? ‎Systemic lupus erythematosus‏ ا ‎2. Post-infectious glomerulonephritis ‎3. त endocarditis ‎4. Mesangio-capillary glomerulonephritis ‎Select the correct answer using the code given ‎below : ‎(8) land 2 only (0) 3and4only (€) 1,2and3 ‎(6) 1,2,3and4 ‎Consider the following clinical features : 2 Hypomimia ‎2. Dysphonia ‎3. Festination gait ‎4. Cogwheel rigidity ‎Which of the features given above are ‎generally present in Parkinsonism ? (a) 1,2,3and4 ‎(2) 1,2 and 4 only ‎(6) 8876440117 ‎(0) 1, 2 and 3 only ‎34. Circuits between the basal ganglia and the ‎35. ‎(8-4) ‎motor cortex constitute the extra pyramidal system which controls muscle tone, body posture and the initiation of movement. Lesions of the extra pyramidal system present clinically with : ‎(a) Tremor and rigidity ‎_ (2) Seizures ‎(c) Urinary incontinence ‎(d) Muscle wasting ‎Consider the following statements regarding Transient Global Amnesia (TGA) : ‎1. TGA mainly affects middle aged persons who present with abrupt, discrete loss of anterograde memory lasting for few hours. ‎2. During the episode, the patients are unable to record new memories resulting in repetitive questioning. ‎3. Consciousness is impaired during the episode and the patient is unable to perform even simple motor functions. ‎4. After 4 ¬ 6 hours, memory function and behaviour return to normal but the patient has complete and persistent amnesia for the duration of the episode. ‎Which of the statements given above are correct ? ‎(8) 1,2and3 (0) 1,2and4 (০ 1,3and4 (0) 2, 8 8100 4 Contralateral homonymous lower ‎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 (d) Occipital lobe 37. Which of the following correctly describes the primary position of the right eye in right ‏8و‎ ‎cranial nerve palsy 7 (a) Downwards and outwards (0) Downwards and inwards (c) Upwards and outwards (d) Upwards and inwards 38. Consider the following statements regarding cluster headache : 1. The headaches are periodic, beginning at the same time for weeks at a stretch. 2. Patients experience severe, unilateral periorbital pain which typically lasts from 30 - 90 minutes. 3. The headache is accompanied with autonomic features such as ipsilateral tearing, nasal congestion and conjunctival injection. 4. Subcutaneous injection of Sumatriptan or inhalation of 100% oxygen may be beneficial in halting acute attacks. Which of the statements given above are correct ? (8) 3and4only (2) 1 810 2 only (0 1,2and3 (0) 1, 2, 3 800 4 KCSP-A-GMPK 39. 40. 41. (9-A) A 22-year-old lady presented with complaint of chronic daily headache. She has prior history of migraine but increasingly unrelieved with analgesics. She has history of using Sumatriptan almost daily since the last three weeks. What is the most likely diagnosis ? (a) Sub-arachnoid hemorrhage (b) Cluster headache (c) Medication overuse headache (d) Trigeminal neuralgia Consider the following with regard to trigger factors for seizures : £ 1. ‘Flickering lights 2. Recreational drug misuse 3. Non-compliance to treatment with antiepileptic drugs 4. Sleep deprivation Which of the factors given above are correct ? (a) land 2 0015 (0) 1,2,3and4 (০) 2೩/6 3 only (1) 3and4only A 75-year-old man presented with temporal headache, jaw pain, exacerbated by chewing and talking. Which one of the following investigations will most likely help in diagnosis ? (a) Temporal artery biopsy (b) Electromyography (c) MRI of the brain (d) Carotid colour Doppler 42. The Rai staging system and Binet 43. 45. KCSP-A-GMPK system are the two widely used staging systems used for staging which of the following hematological malignancies ? (a) Acute Myeloid Leukemia (b) Chronic Myeloid Leukemia (০) | Acute Lymphoid Leukemia (1) Chronic Lymphocytic Leukemia Patients suffering from which of the following conditions commonly present for several years in the dermatology OPD with eczematous or dermatitis skin lesions before being finally diagnosed with a T-cell lymphoma ? (a) Mycosis fungoides (b) Psoriasis (c) Acne vulgaris (d) Onychomycosis Which of the anticoagulant ? following is an’ oral (8) Dabigatran (b) Heparin (6) Fondaparinux (0) 8178117617. A 39-year-old female presents with severe autoimmune hemolytic anemia. Which of the following should be the initial step in its management ? (8) Prednisolone (0) Rituximab (c) Emergency splenectomy (0) Plasmapheresis 46. 47. (10-൧2) Which one of the following is a cause of Secondary Hyperaldosteronism ? (8) Adrenal adenoma secreting aldosterone (b) Idiopathic bilateral adrenal hyperplasia (6) 11-deoxycorticosterone secreting adrenal tumour (d) Inadequate renal perfusion due to renal artery stenosis Which one of the following diseases is characterized by destructive lymphoid infiltration of the thyroid gland leading to fibrosis and enlargement of the thyroid gland with an increased risk of developing thyroid lymphoma ? (೩) 0০ Quervain’s Thyroiditis (0) Multinodular Goitre (©) Riedel’s thyroiditis (વ) Hashimoto’s thyroiditis A 52-year-old male diabetic presents with recurrent episodes of hypoglycemia. On examination, Pulse 84 beats/minute, BP 160/100 mm Hg, Chest and CVS examination unremarkable. Which of the should ৮০ following antihypertensive avoided in this patient ? (೩) Propranolol (0) Telmisartan (€) Torsemide (d) Amlodipine 49. 50. KCSP-A-GMPK Which of the following are correct regarding Cortisol ? 1. Levels are highest in the morning on waking. 2. Cortisol falls dramatically during an illness. 8. More than 95% circulating cortisol is protein bound. 4. 11 is the major glucocorticoid in humans and can also activate mineralocorticoid receptors. Select the answer using the code given below : (a) 1,3and4 യ 2, 3 200 4 (০) land 3 only (0) land 2 only A patient presents with history of ‘bones, stones and abdominal groans’ — due to generalised aches and pains and renal Which 15 the discriminatory blood investigation ? calculus ८०८. most (a) Parathyroid hormone assay -(b) Thyroid function tests (free T3, free T4, |. TSH) (০) Cortisol levels (d) Insulin and C-peptide levels 51. 52. 53. (144A) 3. Radioiodine 15 With regards to treatment of thyrotoxicosis of Grave’s disease, consider the following - statements : 1. Propylthiouracil 15 suitable in breastfeeding patients. 2. Large goitre is an indication for thyroidectomy. recommended 10 management in pregnancy. 4. Agranulocytosis is a complication associated with carbimazole. Which of the statements given above are correct ? (a) 1,2and3 (0) 2, 3 4800 4 (6) 1,2and4 (૧) 1, 3 ஊக்க With regard to management of hypothyroidism, consider the following statements : 1. Treatment is with levothyroxine replacement. 5 It is taken as a single daily dose. 3. Average dose is 1-6 pgm/kg/day. 4. Full dose per weight should be started in those with coronary artery disease. Which of the statements given above are correct ? (a) 1,2and3 (0) 2,3and4 (c) 1,2and4 (ત) 1,3and4 Which of the following glucose lowering agent can be given as an injectable drug ? (a) Pioglitazone (b) Metformin (6) 81৮৪৪110017) (१) Semaglutide 55. 56. KCSP-A-GMPK Which of the seen in Diabetic Retinopathy on examination ? following findings are 2: Microaneurysm 2. . Dot and blot hemorrhage 3. Retinal thickening 4. Neovascularization Select the correct answer using the code given below : (a) (b) (০) (d) 1, 2 and 3 1, 2 ੨00 4 1,3 and 4 2,3 and 4 Which one of the following disorders are caused by enzymatic defects in the heme biosynthesis pathway ? (a) (b) Porphyrias Myelodysplastic syndrome ০) (d) Hemophilias Plasma cell disorders Which of the following is an inhibitor of the NPC1L1, responsible for the absorption of dietary and intestinal mucosal transporter biliary cholesterol ? (a). Atorvastatin (b) Fenofibrate (c) Metformin (ଏ) Ezetimibe 57. 59. (12-A) Which one of the following is the most appropriate initial treatment for management of severe hypercalcemia ? (a) Intravenous infusion of pamidronate (b) Oral phosphate supplementation (c) Intravenous infusion of normal saline (d) Hemodialysis Which of the following are used in calculating the serum osmolality ? 1, Serum sodium 2: Glucose 3. Calcium 4. Blood urea nitrogen Select the correct answer using the code given below : (8) 1,2and3 യ) 1,2and4 (€ 1,8and4 (1) 2, 3 800 4 A ‘slapped cheek’ rash is characteristically seen in which of the following infections ? (a) Measles (0) Rubella (c) Chickenpox (d) Erythema infectiosum Which of the following pharmacological agents can 16 used for the treatment of visceral Leishmaniasis ? 10 Pentavalent antimonials 2. Amphotericin છ 3. Spiramycin 4. Paromomycin Select the correct answer using the code given below : (8) 1,2and3 (9) 1, 2 8020 4 (০) 1, 3 8०१4 (0) 2, 8 8० 4 61. 62. KCSP-A-GMPK The Sabin-Feldman dye test is an indirect fluorescent antibody test which is used to detect antibodies against which of the following organisms ? (a) Toxoplasma gondii (b) Leishmania donovani (6) ` Coxiella burnetii (d) Trypanosoma cruzi Cat-scratch disease is caused by infection of which of the following organisms ? (a) Chlamydia trachomitis (b) Coxiella burnetii (c) Trypanosoma cruzi (d) Bartonella henselae Which among the following is the first intermediate 105 for the parasitic fluke Clonorchis sinensis ? (a) Dog യ) Snail (€) Encysts on vegetation (d) Sheep A calabar swelling, which is a short-lived, inflammatory, oedematous swelling close to a limb joint, is characteristically seen in infection caused by which of the following nematodes ? (೩) Onchocerca volvulus (0) Mansonella perstans (6) Loa loa (0) Brugia malayi 67. (13-A) An ophthalmologist may observe ‘Snowflake’ deposits on the edges of the cornea, in a patient infected with which of the following filarial worms ? (a) Brugia malayi യ) Loa loa (€) Mansonella perstans (0) (07807006700 volvulus Which among the following are hepatobiliary ` flukes (trematodes) ? પ Clonorchis sinensis 2. Mansonella perstans 3. Fasciola hepatica 4. Opisthorchis felineus Select the correct answer using the code given . below : (a) 1,2and3 (2) 1,2and4 (০) 1,380 4 (0) 2 8 4 Which among the following parasitic helminths is a nematode and has zoonotic transmission ? (೩) Taenia saginata (2) Trichinella spiralis (c) Fasciola hepatica (0) Fasciolopsis buski 68. 69. . KCSP-A-GMPK Which of the following are correct with to BCG vaccination? ৷ 1. 115 a live-attenuated vaccine. 2. It is administered by intramuscular injection. 3. It is derived from Mycobacterium bovis. 4, It is highly immunogenic. Select the answer using the code given below : (8) 1,2and3 (2) 2,3 80 4 (c) 1, 3 80 4 (0) 1, 2 8020 4 Which of the following immunizations are recommended for persons infected with HIV ? 1. Hepatitis B vaccine 2. Influenza virus vaccine 9. ` ` Pneumococcal vaccine Select the correct answer using the code given below : (8) land 2 only (2) 2880 3 only (౧ land 3 only (1) 1,2and3 70. 71. 72. (14-^) Consider the following statements with regard to Vitamin D deficiency : 4. Vitamin D deficiency is common in northern latitudes. മു Vitamin D deficiency is more likely to develop in people with dark skin. 8: Exposure to UV light is advisable in patients with Vitamin D deficiency. Which of the statements given above are correct ? (৪) land 2only (2) 2and8 only (০) land 3 only ദ 1,2and3 Which one of the following statements is characteristic of Purpura fulminans ? (a) Non-hemorrhagic bullae usually present over extremities. (b) Present as large ecchymosis with irregular shapes. (€) Auto-immune disorder and _ never associated with any infection. (0) Asplenic patients are protected and do not develop this disease. An elderly male presents with papular lesions on his face. The papules are with pearly telangiectatic border on sun-damaged skin. The likely diagnosis is : (a) Squamous cell carcinoma (b) . Melanoma (€) Basal cell carcinoma (d) Actinic keratosis 73. Allergic contact dermatitis is a manifestation | 76. of : (a) Type 1 hypersensitivity (b) Type 2 hypersensitivity (c) Type 3 hypersensitivity (0) Type 4 hypersensitivity 74. Which one of the following is an example of non-scarring alopecia ? (a) Linear scleroderma nT. (b) Cutaneous metastases (€) 16102010 effluvium (d) Sarcoidosis 75. Which of the following statements are correct in respect of scabies ? ५ Male mite 5067000108 scabiei are commonly transferred from an infected person to a non-infected person. 2. Norwegian scabies occur in immunodeficient patients. 3. Permethrin cream (5%) is used for treatment. 4. Pruritus intensifies at night and after | 78. hot shower. Select the answer using the code given below : (a) 1,2and3 (0) 1,2and4 (€) 1,3and4 (0) 2, 3 and4 KCSP-A-GMPK (15-A) 32 Heberden’s nodes are present mainly in : (a) Rheumatoid arthritis (b) Osteoarthritis (c) Psoriatic arthritis (१) Gouty arthritis A patient developed difficulty in standing from a seated position, walking up steps, squatting and lifting arms overhead. Chronic therapy with which of the following drugs is likely to result in such presentation ? (a) Acetaminophen യ) Fexofenadine (c) Glucocorticoids (d) Metformin Hemorrhagic cystisis is a serious side effect of : (a) Leflunomide (b) Mycophenolate mofetil (c) ` Cyclophosphamide (d) Methotrexate 79. Schober’s test is used in the assessment which one of the following clinical conditions ? (a) Rheumatoid arthritis (b) Systemic Lupus Erythematosus (c) Ankylosing Spondylitis (0) Psoriasis 80. Urate crystals are described as having the following shape : (a) Short and stout (0) Long and needle-like (c) Small and triangular (d) Large and rhomboid 81, Anti-citrullinated peptide antibody is useful in diagnosis of : (8) Rheumatoid arthritis (0) Sjogren’s syndrome (c) Scleroderma (d) Systemic Lupus Erythematosus 82. Which one of the following antibodies is commonly associated with Drug-induced Lupus ? (a) = Anti-centromere antibody ` (0) Anti-Jo-1 antibody (౧ Anti-histone antibody (त) Anti-RNP antibody KCSP-A-GMPK (16-A) Long term treatment of bipolar disorder with lithium carbonate can cause which of the following adverse effects ? 12 Weight loss 2, Hypothyroidism 3. Increased levels of parathyroid hormone 4. Nephrogenic diabetes insipidus Select the correct answer using the code given below : (a) 1,2and3 യ 128৫4 (0 14 (ଏ) 2,3and4 Which of the following antidepressant drugs act by inhibition of monoamine oxidase ? 13 Phenelzine 2. Tranylcypromine 9. Dosulepin 4. ` Moclobemide Select the correct answer using the code given below : (8) 1,2and3 (2) 1,28 4 (০ 1,3and4 (ଏ) 2, 3 4 85. Which of the following are selective serotonin | 87. re-uptake inhibitors ? $ जि Escitalopram 2. Amitriptyline 3. Fluoxetine 4. Sertraline Select the correct answer using the code given below : (a) 1,2and3 (2) 1,204 (০) 1, 3 त 4 (0) 2, 8 4 86. Which of the following are First Rank Symptoms of acute schizophrenia? 1. Auditory hallucinations 2. Broadcasting of thoughts 3. Delusional perceptions 4. Delirium Select the correct answer using the code given below : ഭ 1,2and3 02) 1,2and4 (c) 1,3and4 (0) 2,3 4 KCSP-A-GMPK (17-A) Consider the following statements regarding Wernicke-Korsakoff syndrome : 3 It is a rare complication of chronic alcohol characterised by opthalmoplegia, ataxia and delirium. misuse There is damage to the mammillary bodies and dorsomedial nuclei of thalamus. The underlying cause is deficiency of Vitamin B12 (Cobalamin). The syndrome can also arise due to malabsorption or protracted vomiting. Select the correct answer using the code given below : (8) 1,2and3 (0) 1, 2 80 4 (6) 1, 3 820 4 (0) 2, 3 804 Which of the following are inherited causes of dementia ? 1. Alzheimer’s disease 2. Huntington’s disease 3. Wilson’s disease 4, Punch-drunk syndrome Select the correct answer using the code given below : (a) (b) (८) (d) 1, 2 and3 1, 2 and 4 1, 3 and 4 2, 3 and 4 89. Which of the following are classified 91. Which of the following are causes of acquired mood-stabilising psychotropic drugs ? systemic amyloidosis ? శ్‌ కై ‏ا ا‎ 1. Tuberculosis 2 Multiple myeloma 2. ‘Valproate 3. Untreated rheumatoid arthritis 3. Lamotrigine 4, Chronic osteomyelitis Select the correct answer using the code given i ಡೆ Select the correct answer using the code given below : ಜ್‌ (3) ` 1 810 2 only (৪) 2and 3 only (2) 2 820 3 only 00) 1 800 4 01119 (০) ` 1 &10 3 only (6) ` 2, 8 त 4 only (0) 1,2,3and4 ৫) 1,2and3 92. Which of the following statements are correct 90. Which of the following are correct regardin డ్‌ : with regard to glucose homeostasis 7 acetaminophen ? 1. ` Insulin level rises postprandially. ९ < It does not interfere with platelet : 2. Major portion of postprandial glucose is function. used by skeletal muscle. 2. 1६15 toxic to the liver in high doses. थ... glucose iH Bey 3. It is a non-narcotic analgesic. insulin-dependent manner. < ਨ 4. Glucagon is secreted during exercise. Select the answer using the code given below : Select the answer using the code given below : (8) land 2only (a) 1,2and3 (2) 2and 3 only (0) 1,284 (০) land 3 only (€) 1,8and4 कत (4) 2, 3 8064 KCSP-A-GMPK (18-A) 93. Consider the following pancreatic hormones : 1. Insulin . 2. 19196 amyloid polypeptide or amylin ૭. Glucagon 4, Somatostatin Which of the above is/are secreted by beta cells of the pancreatic islets ? (৪) 10017 യ 2and3 (¢) land2 (0) 1 820 4 94, Consider the following statements regarding Acute Respiratory Distress Syndrome (ARDS) : 1 Exudative phase lasts from day 7 to day 21 after exposure to a precipitating risk factor. 2. Proliferative phase is characterised by proliferation of type II pneumocytes. 8. 17% tidal volume ventilation (6 mL/kg body weight) has significantly lower mortality in management as compared to high tidal volume ventilation (12 mL/kg body weight). 4. PaO,/FiO, క 100 mm Hg is classified as severe AIDS. Which of the statements given above are correct ? (8) 1,2and3 (2) 2, 3 820 4 (૦ 1,3and4 (0) 1, 2 204 KCSP-A-GMPK (19-A) Consider the following statements regarding organophosphate-induced delayed polyneuropathy (OPIDN) : 1. ` [£ 18 a rare complication and occurs 2 - 3 weeks after acute exposure. 2. It is a feature of poisoning with certain organophosphorus compounds such as triorthocresyl phosphate. 8; Inhibition of acetylcholinesterase causes motor polyneuropathy with no evidence of sensory loss. 4. There is no specific therapy although regular physiotherapy may limit deformity caused by muscle wasting. Which of the statements given above are correct ? (8) land 2 only (0) 1,2and3 (9 1,284 (1) 2, 3 800 4 Consider the following statements regarding paracetamol toxicity : 1. Toxicity is caused by an intermediate reactive metabolite that binds covalently to cellular proteins causing cell death. 2. Antidotes for paracetamol act by replenishing hepatic glutathione and should be administered to all patients with acute poisoning. 3. Intravenous acetyl cysteine is a highly efficacious antidote if administered within 8 hours of the overdose. 4. Methionine may be used as an alternative antidote but it is less effective than acetyl cysteine. Which of the statements given above are correct ? ୮ (a) 1 200 4 01119 (2) 1, 2 820 3 only (€) 2, 3 ৪700 4 only (4) 1, 2, 8 04 97. 98. KCSP-A-GMPK Which one of the following statements 15 correct regarding _ physiology breastfeeding ? (a) Prolactin is responsible for ejection of milk from the glands. യ Night feeding 15 important ୮୦୮ maintaining prolactin reflex. (€) Oxytocin is responsible for milk secretion by the alveolar epithelial cells. (d) Oxytocin is secreted by the anterior pituitary. Which one of the following fine motor milestones will appear ahead of others ? (a) Copies a cross യു Copies a circle (6) Draws a circle (d) Draws across In case of hypertensive emergency in a child, blood pressure should be reduced by up to : (a) 10% over the first 8 hours (2) 15% over the first 8 hours (6) 10% in the first hour (1) 15% in the first hour (20 - 100. At what cut-off respiratory rate will you 101. 102. . Management of which A) consider “fast breathing” in a 2-year-old child ? (a) 260 per minute (b) ટ 50 per minute (€) 240 per minute (4) > 80 per minute Which of the following are used in the management of hyperkalemia ? ந்‌, 10% calcium gluconate intravenously 2. ` Regular insulin and intravenous glucose 3. Nebulized ipratropium bromide 4. = Intravenous sodium bicarbonate Select the correct answer using the code given below : (a) 1,2and3 (2) 1,2and4 (c). . 1, 3 and4 (1) 2, 3 844 Nebulized salbutamol is used 10 the of the following electrolyte abnormality ? (a) Hypernatremia (b) Hyperkalemia (c) Hyponatremia (d) Hypomagnesemia 103. 104. (8) 1,2and3 യ 1,2and4 (০) 3 8100 4 01119 (१) 2, 8 800 4 KCSP-A-GMPK (21- Which of the following are correct regarding activities under the Weekly Iron and Folic Acid Supplementation (WIFS) programme ? 2 Administration of supervised weekly iron-folic acid supplements of 100 mg elemental iron and 500 பூத folic acid 2. Administration of supervised weekly iron-folic acid supplements of 60 mg elemental iron and 0.5 mg folic acid 3. Biannual de-worming with albenzadole 4, Annual de-worming with albendazole Select the answer using the code given below : (8) land4 (0) 103 (০) 28004 (1) 2and3 Under the Integrated Management of Neonatal and Childhood Illness, caretakers are advised to return immediately to a health facility, if 1. Any sick child 15 not able to drink or breast feed. 2. Fast breathing or difficult breathing, in a child who has no pneumonia 3. Blood in stool, in a child with diarrhoea 4. Conjunctivitis in a child with measles Select the correct answer using the code given below : 105. 106. A) Which of the following statements are correct regarding the fluid management of pediatric inpatients with burn injuries ? 1. The Parkland formula estimates the amount of fluid to be replaced over 24 hours. 2. Volume of fluid (mL) = 4 mL x Weight (kg) x Total body surface area burn(%). 3. Additional maintenance fluid therapy is also to be given to the child. 4. Half of the resuscitation volume should be given over 6 hours and the remaining half over the next 18 hours. Select the answer using code given below : (a) 1,2and4 യ 1, 2803 (9 1, 3 810 4 (1) 2,804 Whole Bowel Irrigation (WBI) as a method of gastrointestinal decontamination is useful for poisoning with : (a) Alcohol (b) Iron (c) Kerosene (d) Organophosphorus 107. 108. (8) 1,2and3 യു 1,2and4 (©) 1,3and4 (0) 2,3and4 KCSP-A-GMPK (22 - To prevent recurrence, expectant | with a previous fetus with neural tube defect should receive folic acid daily at the dose of : (8) 4ug (b) 400 ug (০) 4mg 0) 400mg Consider the following statements regarding non-invasive prenatal screening (NIPS) for high aneuploidies : screening risk pregnancies for ¢ 8 It is carried out on maternal blood. 2. 1६158 done before 10 weeks gestation. 3. 1 has a negative predictive value of about 98%. 4. Invasive testing 15 needed णि confirmation of a positive test. Which of the statements given above are correct ? 109. The risk of Down syndrome is 100% in the 110. 111. A) offspring, if : (a) Mother only is the carrier of balanced translocation (b) Father only is the carrier of balanced translocation (c) Both parents are carriers of balanced translocation (0) Either parent is a carrier of translocation between two chromosome 21 Which of the following are examples of genomic imprinting ? 1. Angelman syndrome 2, Williams syndrome 3. Prader-Willi syndrome 4, DiGeorge syndrome Select the correct answer using the code given below : (8) land3 00) 12042 () 2and3 (0) 2800 4 Poisoning with which of the following drugs causes hypothermia ? (a) Digoxin (b) Chlorpromazine (c) Iron (0) Alcohol 112. 113. 114. (a) Primary apnea (b) Secondary apnea (c) Tertiary apnea (0) Cardiorespiratory arrest KCSP-A-GMPK (23- Consider the following pairs : Urine colour Possible causative agent in a child with suspected poisoning 1. Pink - Cephalosporin 2. Brown - Chloroquine 3. Greenish blue - Phenazopyridine 4. Red-orange - Amitriptyline How many of the pairs given above are correctly matched ? (a) Only one pair (b) Only two pairs (c) Only three pairs (0) 41 four pairs Consider the following agents and the cardiac effects in case of overdose or poisoning : ۴ Prolonged PR interval - Lithium 2 Prolonged QTc interval -- Amiodarone 3. Wide QRS complex — Kerosene ingestion 4, Tachycardia — Organophosphates How many of the pairs given above are correctly matched ? (8) Only one pair (0) Only two pairs (c) Only three pairs (4) All four pairs If a baby does not begin breathing in response to tactile stimulation, then the baby is assumed to be in : 115. 116. A) Consider the following conditions : Response to tactile Bott) Siege Tone ti > Rate |Pressure stimulation| A Yes Normal| Normal | Normal | 8 | Yes Falling | Normal | Decreasing 6 No Falling | Falling | Decreasing [7 | No Rising | Normal | Normal Primary apnea in a neonate is characterized by which one of the above conditions ? (a) A (0) 8 (^. 08 ५) D Consider the following statements about human breast milk : 1٢ 75% of breast milk content is water. 2 Breast milk is poor in taurine and cysteine. 3. Breast milk is particularly rich ‘in omega 2 and omega 6 fatty acids. 4. High lactose content of breast milk helps in absorption of calcium. Which of the statements given above are correct ? (a) 1,3and4 (0) 1 820 4 only (6) land 3 only (વ) 3and4only १17. 118. KCSP-A-GMPK Which of the following are signs of good attachment during breastfeeding ? 3 The baby’s nose is at the level of the nipple. 2. The baby’s mouth is wide open. 3. The baby’s chin touches the breast. 4. The baby’s lower lip is everted. Select the correct answer using the code given below : (a) 1,2and3 00) 2,3 and4 (c) 1,3and4 (1) 1,2and4 A 6-year-old boy has recently started telling his full name, although he cannot recite a poem. His Developmental Quotient (DQ) in the language sphere is : (a) 33% (b) 50% (c) 66% (1) 83% (248 119. 120. A) Consider the following statements : 1. Hepatitis 8 vaccine has reduced efficacy, if administered intramuscularly. 2. The maximum time allowed between reconstitution of MMR vaccine and use is 30 minutes. ૭. Maternal antibodies do not interfere with cellular immune response to BCG vaccine. 4. DTwP is preferred to DTaP for primary immunization in most children. Which of the statements given above are correct ? (8) land2 0) land3 (6) 29004 (0) ৪৪004 Rotavirus vaccination is avoided during an episode of diarrhoea because (a) 11 might compromise uptake of vaccine (0) it could trigger an episode 08 intussusception (c) Rotavirus vaccine is a live vaccine and hence may cause rotavirus diarrhoea and worsen the diarrhoeal episode (d) vomiting is a significant adverse effect of Rotavirus vaccine SPACE FOR ROUGH WORK KCSP-A-GMPK (25-A) SPACE FOR ROUGH WORK KCSP-A-GMPK (26 - ^) SPACE FOR ROUGH WORK KCSP-A-GMPK (27-A) SPACE FOR ROUGH WORK KCSP-A-GMPK (28-A)