Sudhurpaschim Loksewa Medical Officer
Click on the Options to reveal answers1. Which of the following conditions is characterized by a "snow storm" appearance on ultrasound (USG)?
Correct Answer: d
2. A 35-year-old G1P0 woman at 39 weeks of gestation presents with a prolonged second stage of labor. Fetal scalp pH is 7.18 and lactate is 5.8 mmol/L. Which of the following is the most accurate predictor of neonatal encephalopathy?
Correct Answer: c
3. Which of the following anti-tuberculosis (ATT) drugs is contraindicated during pregnancy?
Correct Answer: a
4. A 28-year-old G3P2 woman delivers a 4.2 kg baby vaginally. Following delivery, she experiences heavy bleeding (>800 mL) and has a boggy uterus. Her blood pressure is 90/54 mmHg and her pulse is 130 bpm. What is the most likely cause of her postpartum hemorrhage (PPH)?
Correct Answer: d
5. Lovset's maneuver is performed for the:
Correct Answer: d
6. A 35-year-old woman (Para 3) requests a long-term reversible contraceptive method. She has no significant medical history. Which is the most appropriate option?
Correct Answer: b
7. Vomiting is a common feature of the following conditions except:
Correct Answer: d
8. What does HELLP syndrome, a potential complication of eclampsia, stand for?
Correct Answer: b
9. On day 3 of life, a mother complains that her newborn has lost weight. What is the best course of action?
Correct Answer: b
10. Cyanotic congenital heart disease includes all of the following except:
Correct Answer: c
11. A neonate with severe combined immunodeficiency (SCID) undergoes haploidentical hematopoietic stem cell transplant (HSCT) without conditioning. Which immune cell type is expected to reconstitute first post-transplant?
Correct Answer: d
12. What is the recommended duration of antibiotic therapy for native valve bacterial endocarditis?
Correct Answer: c
13. Stranger anxiety normally develops in infants between the ages of:
Correct Answer: b
14. A 7-year-old with sickle cell disease (HbSS) develops recurrent vaso-occlusive crises despite hydroxyurea. Which of the following novel therapies is most effective in reducing hospitalization rates?
Correct Answer: b
15. The hallmark of meningitis in infants is:
Correct Answer: c
16. For most children with enuresis, the only recommended test is:
Correct Answer: a
17. A 9-year-old presents with polyarthritis, elevated ESR, fever, and a prolonged PR interval on ECG, but no evidence of carditis. Which of the following best fits the minor criteria for Rheumatic Fever?
Correct Answer: b
18. A 5-year-old from a rural area presents with night blindness and dry conjunctiva. Bitot's spots are noted on examination. What is the first-line management?
Correct Answer: a
19. Which of the following best describes the typical skin lesion in urticaria?
Correct Answer: b
20. A 40-year-old man with ulcerative colitis refractory to biologics undergoes restorative proctocolectomy. Which J-pouch configuration demonstrates superior functional outcomes in long-term studies?
Correct Answer: a
21. A 7-year-old boy presents with recurrent "targetoid" erythematous plaques on the palms and soles after a Mycoplasma pneumonia infection. What is the most definitive diagnostic test?
Correct Answer: b
22. Which of the following is also known as a "Rodent Ulcer"?
Correct Answer: b
23. A patient presents with confusion, ataxia, and nystagmus two days after alcohol cessation. The most likely diagnosis is:
Correct Answer: c
24. Regarding snake bites in Nepal, which of the following is NOT true?
Correct Answer: a
25. The addition of epinephrine to Lignocaine:
Correct Answer: b
26. A 55-year-old man with CKD presents with nausea, vomiting, and altered mental status. Labs: BUN 110mg/dL, Creatinine 8.5mg/dL, Serum potassium 6.2mmol/L. ECG shows peaked T waves; pH is 7.34. What is the most appropriate next step?
Correct Answer: c
27. A 35-year-old female presents with palpitations, heat intolerance, and weight loss. TSH is undetectable, and free T4 is elevated. Radioactive iodine uptake (RAIU) is diffusely increased. What is the best initial treatment?
Correct Answer: a
28. A 20-year-old female with type 1 diabetes presents with nausea, vomiting, and abdominal pain. Examination shows: BP 90/60, deep rapid breathing (Kussmaul respiration). Urine shows ketones, and blood glucose is 480mg/dL. What is the first priority in management?
Correct Answer: c
29. Evanescent elevations of the skin caused by edema of the dermis are:
Correct Answer: c
30. Which of the following is NOT a symptom of depression?
Correct Answer: d
31. A patient opens eyes to pain, makes incomprehensible sounds, and withdraws from painful stimulus. What is the GCS score?
Correct Answer: d
32. First rank symptoms of schizophrenia include all except:
Correct Answer: a
33. A 60-year-old male with atrial fibrillation on warfarin presents with melena and an INR of 8.5. What is the most appropriate immediate management?
Correct Answer: c
34. An essential feature of nephritic syndrome is:
Correct Answer: d
35. A 30-year-old female presents with fatigue, weight gain, and cold intolerance. TSH is elevated (12 mIU/L) and free T4 is low. She has a history of postpartum hemorrhage. What is the most likely diagnosis?
Correct Answer: c
36. A "bird beak" sign during a barium swallow is a characteristic radiographic feature seen in which disease?
Correct Answer: a
37. What is the initial management step for a hemodynamically unstable UGI bleed?
Correct Answer: b
38. The most common acute presentation of sickle cell anemia is:
Correct Answer: b
39. A 65-year-old male with type 2 diabetes and hypertension presents with progressive fatigue, nausea, and hyperkalemia (K 6.2 mEq/L). Serum creatinine is elevated from baseline. He has been taking lisinopril 20mg daily and spironolactone 25mg daily for 6 months. What is the most likely cause of his acute kidney injury (AKI)?
Correct Answer: c
40. Which of the following is a component of Light's criteria used to distinguish pleural transudate from exudate?
Correct Answer: c
41. The current national protocol for the treatment of drug-susceptible complicated or severe extra-pulmonary TB (CNS-TB, TB pericarditis, musculoskeletal, miliary TB) is:
Correct Answer: c
42. A 40-year-old woman with migraine is prescribed lasmiditan. What is the drug's unique mechanism of action compared to triptans?
Correct Answer: a
43. A young male presents with flaccid bullae and oral erosions. What is the diagnosis?
Correct Answer: c
44. A 70-year-old woman with osteoporosis is prescribed romosozumab. Which of the following is the most serious adverse effect associated with this drug?
Correct Answer: a
45. A 35-year-old HIV-positive man presents with dry cough, fever, and shortness of breath for one week. A chest X-ray shows bilateral ground-glass opacities. His CD4 count is 120 cells/mm³. What is the most likely diagnosis?
Correct Answer: c
46. Wickham’s striae associated with shiny, flat-topped, violaceous papules is a hallmark morphological feature of which of the following?
Correct Answer: b
47. A patient presents with acute abdominal pain that starts around the umbilicus and then shifts and localizes to the right iliac fossa. What is the provisional diagnosis?
Correct Answer: c
48. A 25-year-old male presented with itchy silvery scales on the bilateral elbows and knees which bleed on removal. The diagnosis is:
Correct Answer: d
49. Bonney's test is used to determine:
Correct Answer: b
50. Which of the following dermatophyte infections is most likely to present as a circular, scaly lesion with central clearing on the trunk?
Correct Answer: b
51. A 16-year-old girl presents with a history of sexual assault. The first step in the medico-legal protocol is:
Correct Answer: c
52. What does GESI stand for in the context of Nepal?
Correct Answer: b
53. The "One health approach" has been used to fight against:
Correct Answer: a
54. An entry wound caused by a high-velocity weapon in warfare is generally:
Correct Answer: b
55. The Human Body Organ Transplantation (regulation and prohibition) Act came into force in:
Correct Answer: b
56. A patient dies due to anesthesia overdose in a private hospital. Under the Consumer Protection Act, 2074, what is the maximum compensation the family can claim?
Correct Answer: d
57. Two identical twins will not have the same:
Correct Answer: a
58. Which of the following is the first visible postmortem change after death?
Correct Answer: a
59. "La facies sympathique" is a condition seen in cases of:
Correct Answer: c
60. A suspect claims a gunshot wound was accidental during weapon cleaning. Which forensic finding most refutes this claim?
Correct Answer: b
61. The minimum number of antenatal visits in an uncomplicated pregnancy should be:
Correct Answer: b
62. A city reports a dengue outbreak with rising cases of dengue shock syndrome (CDSS). Which serological finding predicts progression to DSS and should trigger ICU referral?
Correct Answer: d
63. A sudden rise in cholera cases is reported in a Terai district. What is the first step in investigating the outbreak?
Correct Answer: c
64. In a malaria endemic region, a new strategy combines seasonal malaria chemoprevention (SMC) with RTS, S/AS01 vaccination. Which outcome measure is most critical to assess this intervention's public health impact?
Correct Answer: c
65. All of the following are true about incidence except:
Correct Answer: c
66. Which of the following barriers can negatively affect the doctor-patient relationship?
Correct Answer: a
67. Pap Smear screening is an example of:
Correct Answer: c
68. The crude birth rate is calculated using:
Correct Answer: a
69. A community health worker notes a cluster of acute hepatitis linked to contaminated groundwater. PCR testing confirms hepatitis E virus (HEV) genotype 1. Which intervention provides the most effective long-term prevention?
Correct Answer: c
70. Herd immunity refers to:
Correct Answer: b
71. The tendency of colonic carcinoma to metastasize is best assessed by:
Correct Answer: b
72. A 17-year-old presents with a sore throat, high-grade fever, muffled voice, and uvular deviation to the opposite side. What is the next best step in management?
Correct Answer: b
73. The most visually disabling type of cataract is:
Correct Answer: c
74. Which of the following anesthetic agents is contraindicated in patients with hypertension?
Correct Answer: a
75. What is the most common site of osteoporotic fractures?
Correct Answer: c
76. The most common cause of limb amputation in adults is:
Correct Answer: b
77. Which technique is commonly used for caries removal?
Correct Answer: b
78. Carhart's notch is found in:
Correct Answer: a
79. A 65-year-old diabetic presents with center-involving diabetic macular edema (CI-DME) and HbA1C of 7.2%. OCT shows central subfield thickness of 320µm. Which treatment demonstrates superior visual outcomes at 2 years based on the protocol AC trial?
Correct Answer: a
80. Congenital hydrocele is best treated by:
Correct Answer: b
81. Which of the following is NOT a feature of Meniere's disease?
Correct Answer: c
82. A 65-year-old chronic smoker presents with hemoptysis, weight loss, and a central lung mass. Histology shows keratin pearls. What is the most likely diagnosis?
Correct Answer: c
83. Which of the following is usually NOT considered a benefit of minimal access surgery?
Correct Answer: d
84. A 60-year-old woman with stage III colon cancer completes adjuvant FOLFOX. What molecular marker indicates benefit from adding pembrolizumab if recurrence occurs?
Correct Answer: a
85. A 55-year-old male smoker presents with intermittent claudication in the legs. On examination, dorsalis pedis pulses are absent. What is the most likely diagnosis?
Correct Answer: c
86. A 23-year-old male presents with right iliac fossa pain, fever, nausea, and rebound tenderness. His WBC is 13,000/mm³ with 80% neutrophils. What is the most likely Alvarado score range?
Correct Answer: c
87. A 70-year-old man with a 6.2 cm asymptomatic infra-renal AAA and a hostile abdomen (multiple prior laparotomies) is being evaluated for repair. Which approach is supported by the BEST-CLI trial for long-term durability?
Correct Answer: a
88. Which of the following swellings is brilliantly transilluminant?
Correct Answer: a
89. A mid-line neck swelling moving with tongue protrusion and swallowing is a:
Correct Answer: b
90. Slip sign is seen in:
Correct Answer: a
91. The recommended compression-to-ventilation ratio for neonatal resuscitation is:
Correct Answer: c
92. A 30-year-old woman with systemic lupus erythematosus (SLE) presents with avascular necrosis (AVN) of the femoral head. Which of the following genetic polymorphisms is most strongly associated with glucocorticoid-induced AVN in SLE patients?
Correct Answer: a
93. Fracture of necessity include all except:
Correct Answer: d
94. Ludwig's angina most commonly arises from infection of the:
Correct Answer: c
95. A liver biopsy from a patient with hepatocellular carcinoma (HCC) shows a "trabecular > 3 cells thick" pattern. Molecular profiling reveals TERT promoter mutation and CTNNB1 activation. Which of the following is the most likely risk factor for this tumor?
Correct Answer: b
96. Which of the following agents is most commonly used to induce general anesthesia?
Correct Answer: a
97. A 25-year-old woman with recurrent miscarriages is found to have a prolonged PTT that corrects with mixing study. Antiphospholipid antibody testing is negative. Genetic testing reveals a mutation in the ANKRD26 gene. What is the underlying mechanism of her condition?
Correct Answer: c
98. An FNAC report shows granulomas with caseous necrosis in a lymph node aspirate. What is the most likely diagnosis?
Correct Answer: b
99. A dental abscess is best initially managed by:
Correct Answer: b
100. All are the positive signs of pregnancy except:
Correct Answer: a