Download UPSC CMS Paper I 2020 Question Paper with Answer Key

Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?

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(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation
2.

--- Content provided by FirstRanker.com ---

An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin
(b) Glimepiride

--- Content provided by FirstRanker.com ---

(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body

--- Content provided by FirstRanker.com ---

habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome

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(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina

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(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

--- Content provided by FirstRanker.com ---

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

--- Content provided by FirstRanker.com ---

6.
Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation

--- Content provided by FirstRanker.com ---

(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

FirstRanker.com - FirstRanker's Choice

--- Content provided by FirstRanker.com ---

Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?

--- Content provided by FirstRanker.com ---

(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation
2.

--- Content provided by FirstRanker.com ---

An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin
(b) Glimepiride

--- Content provided by FirstRanker.com ---

(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body

--- Content provided by FirstRanker.com ---

habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome

--- Content provided by FirstRanker.com ---

(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina

--- Content provided by FirstRanker.com ---

(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

--- Content provided by FirstRanker.com ---

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

--- Content provided by FirstRanker.com ---

6.
Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation

--- Content provided by FirstRanker.com ---

(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

7.

--- Content provided by FirstRanker.com ---

In an ECG recording, P wave is produced by:

(a) Atrial depolarisation
(b) Atrial repolarisation
(c) Ventricular depolarisation

--- Content provided by FirstRanker.com ---

(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

--- Content provided by FirstRanker.com ---

(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine
9.

--- Content provided by FirstRanker.com ---

Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine
(b) Azilsartan
(c) Aliskiren

--- Content provided by FirstRanker.com ---

(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

(a) Aortic regurgitation

--- Content provided by FirstRanker.com ---

(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis
11.
Signet-ring sign on CT-chest is suggestive of:

--- Content provided by FirstRanker.com ---

(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis
12.

--- Content provided by FirstRanker.com ---

Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent
(b) Moderate persistent
(c) Severe persistent

--- Content provided by FirstRanker.com ---

(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation

--- Content provided by FirstRanker.com ---

(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study
FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020

--- Content provided by FirstRanker.com ---

Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?
(a) Ventricular fibrillation

--- Content provided by FirstRanker.com ---

(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation
2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for

--- Content provided by FirstRanker.com ---

follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin
(b) Glimepiride
(c) Enalapril

--- Content provided by FirstRanker.com ---

(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,

--- Content provided by FirstRanker.com ---

joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome
(c) Marfan?s syndrome

--- Content provided by FirstRanker.com ---

(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina
(b) To evaluate stable angina

--- Content provided by FirstRanker.com ---

(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

--- Content provided by FirstRanker.com ---

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

--- Content provided by FirstRanker.com ---

6.
Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation
(b) Hypothyroidism

--- Content provided by FirstRanker.com ---

(c) Hypertension
(d) Acute myocardial infarction

7.
In an ECG recording, P wave is produced by:

--- Content provided by FirstRanker.com ---

(a) Atrial depolarisation
(b) Atrial repolarisation
(c) Ventricular depolarisation
(d) Ventricular repolarisation

--- Content provided by FirstRanker.com ---

8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

(a) DC Cardioversion

--- Content provided by FirstRanker.com ---

(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine
9.
Which one of the following drugs is a Direct Renin Inhibitor?

--- Content provided by FirstRanker.com ---

(a) Benedipine
(b) Azilsartan
(c) Aliskiren
(d) Lisinopril

--- Content provided by FirstRanker.com ---

10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

(a) Aortic regurgitation
(b) Thyrotoxicosis

--- Content provided by FirstRanker.com ---

(c) Patent ductus arteriosus
(d) Aortic stenosis
11.
Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis

--- Content provided by FirstRanker.com ---

(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis
12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it

--- Content provided by FirstRanker.com ---

is:
(a) Mild persistent
(b) Moderate persistent
(c) Severe persistent
(d) Very severe persistent

--- Content provided by FirstRanker.com ---

13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation
(b) CT-chest

--- Content provided by FirstRanker.com ---

(c) Lung biopsy
(d) DNA sequencing study
14.
Which one of the following antigens is commonly associated with causation of Farmer?s
lung?

--- Content provided by FirstRanker.com ---

(a) Penicillium
(b) Actinomycetes
(c) Aspergillus
(d) Candida
15.

--- Content provided by FirstRanker.com ---

The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

(a) INH resistance
(b) Rifampicin resistance

--- Content provided by FirstRanker.com ---

(c) Multi drug resistance
(d) Ethambutol resistance
16.
The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia

--- Content provided by FirstRanker.com ---

(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism
17.
The most frequent symptom in respiratory diseases is:

--- Content provided by FirstRanker.com ---

(a) Breathlessness
(b) Chest pain
(c) Hemoptysis
(d) Cough
18.

--- Content provided by FirstRanker.com ---

A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

(a) Albuterol

--- Content provided by FirstRanker.com ---

(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate
19.
Consider the following statements with regard to respiratory examination:

--- Content provided by FirstRanker.com ---

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma

--- Content provided by FirstRanker.com ---

4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?
(a) 1 and 3
(b) 2 and 4 only

--- Content provided by FirstRanker.com ---

(c) 1, 2 and 4
(d) 2, 3 and 4
FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I

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1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex

--- Content provided by FirstRanker.com ---

(c) Atrial flutter
(d) Atrial fibrillation
2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the

--- Content provided by FirstRanker.com ---

most likely cause?
(a) Aspirin
(b) Glimepiride
(c) Enalapril
(d) Atorvastatin

--- Content provided by FirstRanker.com ---

3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following

--- Content provided by FirstRanker.com ---

diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation

--- Content provided by FirstRanker.com ---

4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization

--- Content provided by FirstRanker.com ---

(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism

--- Content provided by FirstRanker.com ---

(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

6.

--- Content provided by FirstRanker.com ---

Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension

--- Content provided by FirstRanker.com ---

(d) Acute myocardial infarction

7.
In an ECG recording, P wave is produced by:

--- Content provided by FirstRanker.com ---

(a) Atrial depolarisation
(b) Atrial repolarisation
(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.

--- Content provided by FirstRanker.com ---

Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

(a) DC Cardioversion
(b) Injection Lignocaine

--- Content provided by FirstRanker.com ---

(c) Injection Amiodarone
(d) Injection Adenosine
9.
Which one of the following drugs is a Direct Renin Inhibitor?

--- Content provided by FirstRanker.com ---

(a) Benedipine
(b) Azilsartan
(c) Aliskiren
(d) Lisinopril
10.

--- Content provided by FirstRanker.com ---

All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus

--- Content provided by FirstRanker.com ---

(d) Aortic stenosis
11.
Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis

--- Content provided by FirstRanker.com ---

(c) Aspergilloma
(d) Sarcoidosis
12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:

--- Content provided by FirstRanker.com ---

(a) Mild persistent
(b) Moderate persistent
(c) Severe persistent
(d) Very severe persistent
13.

--- Content provided by FirstRanker.com ---

An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy

--- Content provided by FirstRanker.com ---

(d) DNA sequencing study
14.
Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium

--- Content provided by FirstRanker.com ---

(b) Actinomycetes
(c) Aspergillus
(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of

--- Content provided by FirstRanker.com ---

which of the following?

(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance

--- Content provided by FirstRanker.com ---

(d) Ethambutol resistance
16.
The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD

--- Content provided by FirstRanker.com ---

(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism
17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness

--- Content provided by FirstRanker.com ---

(b) Chest pain
(c) Hemoptysis
(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma

--- Content provided by FirstRanker.com ---

by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

(a) Albuterol
(b) Anti-leukotrienes

--- Content provided by FirstRanker.com ---

(c) Aminophylline
(d) Magnesium sulfate
19.
Consider the following statements with regard to respiratory examination:

--- Content provided by FirstRanker.com ---

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

--- Content provided by FirstRanker.com ---

Which of the above statements are correct?
(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4

--- Content provided by FirstRanker.com ---

(d) 2, 3 and 4
20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection

--- Content provided by FirstRanker.com ---

(c) SLE
(d) Meig syndrome
21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite

--- Content provided by FirstRanker.com ---

(b) It decreases gastric emptying
(c) It increases acid secretion
(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?

--- Content provided by FirstRanker.com ---

(a) Lactose intolerance
(b) Mucosal inflammation
(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.

--- Content provided by FirstRanker.com ---

The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score
(b) APACHE score
(c) MELD score
(d) Metavir score

--- Content provided by FirstRanker.com ---

24.
The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein

--- Content provided by FirstRanker.com ---

(d) 70 % hepatic artery and 30 % portal vein
25.
All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis

--- Content provided by FirstRanker.com ---

(b) IgA nephropathy
(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I
1.

--- Content provided by FirstRanker.com ---

A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter

--- Content provided by FirstRanker.com ---

(d) Atrial fibrillation
2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?

--- Content provided by FirstRanker.com ---

(a) Aspirin
(b) Glimepiride
(c) Enalapril
(d) Atorvastatin
3.

--- Content provided by FirstRanker.com ---

A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?

--- Content provided by FirstRanker.com ---

(a) Takayasu?s arteritis
(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.

--- Content provided by FirstRanker.com ---

All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs

--- Content provided by FirstRanker.com ---

5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy

--- Content provided by FirstRanker.com ---

(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

6.
Which one of the following is NOT a common cause of atrial fibrillation?

--- Content provided by FirstRanker.com ---

(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

--- Content provided by FirstRanker.com ---

7.
In an ECG recording, P wave is produced by:

(a) Atrial depolarisation

--- Content provided by FirstRanker.com ---

(b) Atrial repolarisation
(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular

--- Content provided by FirstRanker.com ---

tachycardia?

(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone

--- Content provided by FirstRanker.com ---

(d) Injection Adenosine
9.
Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine

--- Content provided by FirstRanker.com ---

(b) Azilsartan
(c) Aliskiren
(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

--- Content provided by FirstRanker.com ---

(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis

--- Content provided by FirstRanker.com ---

11.
Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma

--- Content provided by FirstRanker.com ---

(d) Sarcoidosis
12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent

--- Content provided by FirstRanker.com ---

(b) Moderate persistent
(c) Severe persistent
(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and

--- Content provided by FirstRanker.com ---

bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study

--- Content provided by FirstRanker.com ---

14.
Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium
(b) Actinomycetes

--- Content provided by FirstRanker.com ---

(c) Aspergillus
(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

--- Content provided by FirstRanker.com ---

(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance

--- Content provided by FirstRanker.com ---

16.
The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma

--- Content provided by FirstRanker.com ---

(d) Severe pulmonary thromboembolism
17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain

--- Content provided by FirstRanker.com ---

(c) Hemoptysis
(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the

--- Content provided by FirstRanker.com ---

prescription?

(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline

--- Content provided by FirstRanker.com ---

(d) Magnesium sulfate
19.
Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of

--- Content provided by FirstRanker.com ---

interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

--- Content provided by FirstRanker.com ---

Which of the above statements are correct?
(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4

--- Content provided by FirstRanker.com ---

20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection
(c) SLE

--- Content provided by FirstRanker.com ---

(d) Meig syndrome
21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying

--- Content provided by FirstRanker.com ---

(c) It increases acid secretion
(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance

--- Content provided by FirstRanker.com ---

(b) Mucosal inflammation
(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:

--- Content provided by FirstRanker.com ---

(a) Child Pugh score
(b) APACHE score
(c) MELD score
(d) Metavir score
24.

--- Content provided by FirstRanker.com ---

The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein

--- Content provided by FirstRanker.com ---

25.
All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy

--- Content provided by FirstRanker.com ---

(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

26.
Consider the following statements with regard to oral aphthous ulcers:

1. They are superficial and painful
2. They may occur in women just prior to menstruation

--- Content provided by FirstRanker.com ---

3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases
4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

Which of the above statements are correct?

--- Content provided by FirstRanker.com ---

(a) 1 and 4 only
(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4

--- Content provided by FirstRanker.com ---

27.
Which one of the following statements about Barrett?s Oesophagus is NOT correct?

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar

--- Content provided by FirstRanker.com ---

cells
(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

--- Content provided by FirstRanker.com ---

28.
The most common cause of acute hepatitis outbreaks in India is:

(a) Hepatitis E
(b) Hepatitis C

--- Content provided by FirstRanker.com ---

(c) Hepatitis B
(d) Hepatitis A

29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is

--- Content provided by FirstRanker.com ---

characteristically seen in which one of the following conditions?

(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus

--- Content provided by FirstRanker.com ---

(d) Barrett?s oesophagus
30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

--- Content provided by FirstRanker.com ---

(a) Unexplained vitamin B12 deficiency
(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

--- Content provided by FirstRanker.com ---

FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the

--- Content provided by FirstRanker.com ---

following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation

--- Content provided by FirstRanker.com ---

2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin

--- Content provided by FirstRanker.com ---

(b) Glimepiride
(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The

--- Content provided by FirstRanker.com ---

chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis

--- Content provided by FirstRanker.com ---

(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:

--- Content provided by FirstRanker.com ---

(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.

--- Content provided by FirstRanker.com ---

Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy

--- Content provided by FirstRanker.com ---

(d) Right Ventricular Infarction

6.
Which one of the following is NOT a common cause of atrial fibrillation?

--- Content provided by FirstRanker.com ---

(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

--- Content provided by FirstRanker.com ---

7.
In an ECG recording, P wave is produced by:

(a) Atrial depolarisation
(b) Atrial repolarisation

--- Content provided by FirstRanker.com ---

(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

--- Content provided by FirstRanker.com ---

(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine

--- Content provided by FirstRanker.com ---

9.
Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine
(b) Azilsartan

--- Content provided by FirstRanker.com ---

(c) Aliskiren
(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

--- Content provided by FirstRanker.com ---

(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis
11.

--- Content provided by FirstRanker.com ---

Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis

--- Content provided by FirstRanker.com ---

12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent
(b) Moderate persistent

--- Content provided by FirstRanker.com ---

(c) Severe persistent
(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:

--- Content provided by FirstRanker.com ---

(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study
14.

--- Content provided by FirstRanker.com ---

Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium
(b) Actinomycetes
(c) Aspergillus

--- Content provided by FirstRanker.com ---

(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

--- Content provided by FirstRanker.com ---

(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance
16.

--- Content provided by FirstRanker.com ---

The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism

--- Content provided by FirstRanker.com ---

17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain
(c) Hemoptysis

--- Content provided by FirstRanker.com ---

(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

--- Content provided by FirstRanker.com ---

(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate

--- Content provided by FirstRanker.com ---

19.
Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis

--- Content provided by FirstRanker.com ---

2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?

--- Content provided by FirstRanker.com ---

(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4
20.

--- Content provided by FirstRanker.com ---

All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection
(c) SLE
(d) Meig syndrome

--- Content provided by FirstRanker.com ---

21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion

--- Content provided by FirstRanker.com ---

(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation

--- Content provided by FirstRanker.com ---

(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score

--- Content provided by FirstRanker.com ---

(b) APACHE score
(c) MELD score
(d) Metavir score
24.
The blood supply of liver consists of:

--- Content provided by FirstRanker.com ---

(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.

--- Content provided by FirstRanker.com ---

All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus

--- Content provided by FirstRanker.com ---

(d) Cryoglobulinaemia

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

26.

--- Content provided by FirstRanker.com ---

Consider the following statements with regard to oral aphthous ulcers:

1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases

--- Content provided by FirstRanker.com ---

4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

Which of the above statements are correct?

--- Content provided by FirstRanker.com ---

(a) 1 and 4 only
(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.

--- Content provided by FirstRanker.com ---

Which one of the following statements about Barrett?s Oesophagus is NOT correct?

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells

--- Content provided by FirstRanker.com ---

(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.

--- Content provided by FirstRanker.com ---

The most common cause of acute hepatitis outbreaks in India is:

(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B

--- Content provided by FirstRanker.com ---

(d) Hepatitis A

29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

--- Content provided by FirstRanker.com ---

(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus

--- Content provided by FirstRanker.com ---

30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency

--- Content provided by FirstRanker.com ---

(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

31.

--- Content provided by FirstRanker.com ---

What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL

--- Content provided by FirstRanker.com ---

(d) 13 to 14 gm/dL
32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease

--- Content provided by FirstRanker.com ---

(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:

--- Content provided by FirstRanker.com ---

(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.

--- Content provided by FirstRanker.com ---

Consider the following statements in relation to an adult patient:

1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

--- Content provided by FirstRanker.com ---

Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only

--- Content provided by FirstRanker.com ---

(d) 1, 2 and 3

35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis

--- Content provided by FirstRanker.com ---

(b) Pyelonephritis
(c) Renal stone disease
(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history

--- Content provided by FirstRanker.com ---

of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

--- Content provided by FirstRanker.com ---

(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis

--- Content provided by FirstRanker.com ---

FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the

--- Content provided by FirstRanker.com ---

following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation

--- Content provided by FirstRanker.com ---

2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin

--- Content provided by FirstRanker.com ---

(b) Glimepiride
(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The

--- Content provided by FirstRanker.com ---

chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis

--- Content provided by FirstRanker.com ---

(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:

--- Content provided by FirstRanker.com ---

(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.

--- Content provided by FirstRanker.com ---

Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy

--- Content provided by FirstRanker.com ---

(d) Right Ventricular Infarction

6.
Which one of the following is NOT a common cause of atrial fibrillation?

--- Content provided by FirstRanker.com ---

(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

--- Content provided by FirstRanker.com ---

7.
In an ECG recording, P wave is produced by:

(a) Atrial depolarisation
(b) Atrial repolarisation

--- Content provided by FirstRanker.com ---

(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

--- Content provided by FirstRanker.com ---

(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine

--- Content provided by FirstRanker.com ---

9.
Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine
(b) Azilsartan

--- Content provided by FirstRanker.com ---

(c) Aliskiren
(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

--- Content provided by FirstRanker.com ---

(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis
11.

--- Content provided by FirstRanker.com ---

Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis

--- Content provided by FirstRanker.com ---

12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent
(b) Moderate persistent

--- Content provided by FirstRanker.com ---

(c) Severe persistent
(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:

--- Content provided by FirstRanker.com ---

(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study
14.

--- Content provided by FirstRanker.com ---

Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium
(b) Actinomycetes
(c) Aspergillus

--- Content provided by FirstRanker.com ---

(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

--- Content provided by FirstRanker.com ---

(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance
16.

--- Content provided by FirstRanker.com ---

The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism

--- Content provided by FirstRanker.com ---

17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain
(c) Hemoptysis

--- Content provided by FirstRanker.com ---

(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

--- Content provided by FirstRanker.com ---

(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate

--- Content provided by FirstRanker.com ---

19.
Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis

--- Content provided by FirstRanker.com ---

2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?

--- Content provided by FirstRanker.com ---

(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4
20.

--- Content provided by FirstRanker.com ---

All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection
(c) SLE
(d) Meig syndrome

--- Content provided by FirstRanker.com ---

21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion

--- Content provided by FirstRanker.com ---

(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation

--- Content provided by FirstRanker.com ---

(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score

--- Content provided by FirstRanker.com ---

(b) APACHE score
(c) MELD score
(d) Metavir score
24.
The blood supply of liver consists of:

--- Content provided by FirstRanker.com ---

(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.

--- Content provided by FirstRanker.com ---

All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus

--- Content provided by FirstRanker.com ---

(d) Cryoglobulinaemia

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

26.

--- Content provided by FirstRanker.com ---

Consider the following statements with regard to oral aphthous ulcers:

1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases

--- Content provided by FirstRanker.com ---

4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

Which of the above statements are correct?

--- Content provided by FirstRanker.com ---

(a) 1 and 4 only
(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.

--- Content provided by FirstRanker.com ---

Which one of the following statements about Barrett?s Oesophagus is NOT correct?

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells

--- Content provided by FirstRanker.com ---

(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.

--- Content provided by FirstRanker.com ---

The most common cause of acute hepatitis outbreaks in India is:

(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B

--- Content provided by FirstRanker.com ---

(d) Hepatitis A

29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

--- Content provided by FirstRanker.com ---

(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus

--- Content provided by FirstRanker.com ---

30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency

--- Content provided by FirstRanker.com ---

(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

31.

--- Content provided by FirstRanker.com ---

What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL

--- Content provided by FirstRanker.com ---

(d) 13 to 14 gm/dL
32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease

--- Content provided by FirstRanker.com ---

(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:

--- Content provided by FirstRanker.com ---

(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.

--- Content provided by FirstRanker.com ---

Consider the following statements in relation to an adult patient:

1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

--- Content provided by FirstRanker.com ---

Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only

--- Content provided by FirstRanker.com ---

(d) 1, 2 and 3

35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis

--- Content provided by FirstRanker.com ---

(b) Pyelonephritis
(c) Renal stone disease
(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history

--- Content provided by FirstRanker.com ---

of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

--- Content provided by FirstRanker.com ---

(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis

--- Content provided by FirstRanker.com ---

37.
Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

(a) Higher dietary calcium increases risk

--- Content provided by FirstRanker.com ---

(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.

--- Content provided by FirstRanker.com ---

He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis

--- Content provided by FirstRanker.com ---

(d) Viral encephalitis
39.
Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac

--- Content provided by FirstRanker.com ---

(c) Thiamine
(d) Prednisdone
40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe

--- Content provided by FirstRanker.com ---

(b) Non dominant parietal lobe
(c) Frontal lobe
(d) Non dominant temporal lobe

41.

--- Content provided by FirstRanker.com ---

Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome
(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome

--- Content provided by FirstRanker.com ---

42.
A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:
(a) Left 3
rd

--- Content provided by FirstRanker.com ---

nerve palsy
(b) Left 6
th
nerve palsy
(c) Right 4

--- Content provided by FirstRanker.com ---

th
nerve palsy
(d) Right 3
rd
nerve palsy

--- Content provided by FirstRanker.com ---

43.
All of the following are features of Cauda Equina syndrome EXCEPT:

(a) Low back pain
(b) Lower limb areflexia

--- Content provided by FirstRanker.com ---

(c) Loss of bladder function
(d) Extensor plantar response

FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020

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Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?
(a) Ventricular fibrillation

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(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation
2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for

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follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin
(b) Glimepiride
(c) Enalapril

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(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,

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joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome
(c) Marfan?s syndrome

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(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina
(b) To evaluate stable angina

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(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

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(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

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6.
Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation
(b) Hypothyroidism

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(c) Hypertension
(d) Acute myocardial infarction

7.
In an ECG recording, P wave is produced by:

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(a) Atrial depolarisation
(b) Atrial repolarisation
(c) Ventricular depolarisation
(d) Ventricular repolarisation

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8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

(a) DC Cardioversion

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(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine
9.
Which one of the following drugs is a Direct Renin Inhibitor?

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(a) Benedipine
(b) Azilsartan
(c) Aliskiren
(d) Lisinopril

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10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

(a) Aortic regurgitation
(b) Thyrotoxicosis

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(c) Patent ductus arteriosus
(d) Aortic stenosis
11.
Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis

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(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis
12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it

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is:
(a) Mild persistent
(b) Moderate persistent
(c) Severe persistent
(d) Very severe persistent

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13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation
(b) CT-chest

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(c) Lung biopsy
(d) DNA sequencing study
14.
Which one of the following antigens is commonly associated with causation of Farmer?s
lung?

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(a) Penicillium
(b) Actinomycetes
(c) Aspergillus
(d) Candida
15.

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The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

(a) INH resistance
(b) Rifampicin resistance

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(c) Multi drug resistance
(d) Ethambutol resistance
16.
The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia

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(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism
17.
The most frequent symptom in respiratory diseases is:

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(a) Breathlessness
(b) Chest pain
(c) Hemoptysis
(d) Cough
18.

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A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

(a) Albuterol

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(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate
19.
Consider the following statements with regard to respiratory examination:

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1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma

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4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?
(a) 1 and 3
(b) 2 and 4 only

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(c) 1, 2 and 4
(d) 2, 3 and 4
20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction

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(b) Fungal infection
(c) SLE
(d) Meig syndrome
21.
Which one of the following is NOT true about Ghrelin?

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(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion
(d) Fasting increases its secretion
22.

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Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation
(c) Bile acid secretory defects
(d) Pancreatic dysfunction

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23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score
(b) APACHE score
(c) MELD score

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(d) Metavir score
24.
The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery

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(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.
All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:

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(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

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26.
Consider the following statements with regard to oral aphthous ulcers:

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1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases
4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

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Which of the above statements are correct?

(a) 1 and 4 only
(b) 2 and 3 only

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(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.
Which one of the following statements about Barrett?s Oesophagus is NOT correct?

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(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells
(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells

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(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.
The most common cause of acute hepatitis outbreaks in India is:

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(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B
(d) Hepatitis A

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29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

(a) Menetrier?s disease

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(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus
30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-

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gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency
(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding

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(d) Acute glomerulonephritis

31.
What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?

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(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL
(d) 13 to 14 gm/dL
32.

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Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease
(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic

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(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:
(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria

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(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.
Consider the following statements in relation to an adult patient:

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1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

Which of the statements given above are correct?

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(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only
(d) 1, 2 and 3

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35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis
(b) Pyelonephritis
(c) Renal stone disease

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(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history
of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C

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3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

(a) Renal biopsy is rarely required for making diagnosis

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(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis
37.
Which one of the following statements is NOT correct regarding the risk factors for

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nephrolithiasis?

(a) Higher dietary calcium increases risk
(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk

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(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.
He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?

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(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis
(d) Viral encephalitis
39.

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Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac
(c) Thiamine
(d) Prednisdone

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40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe
(b) Non dominant parietal lobe
(c) Frontal lobe

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(d) Non dominant temporal lobe

41.
Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome

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(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome
42.
A patient on looking forward was found to have his right eye deviated downwards and

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outwards with pupil dilated. He is suffering from:
(a) Left 3
rd
nerve palsy
(b) Left 6

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th
nerve palsy
(c) Right 4
th
nerve palsy

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(d) Right 3
rd
nerve palsy
43.
All of the following are features of Cauda Equina syndrome EXCEPT:

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(a) Low back pain
(b) Lower limb areflexia
(c) Loss of bladder function
(d) Extensor plantar response

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44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On
examination, he had resting tremor, bradykinesia, rigidity and postural instability. This
patient is suffering most likely from:

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(a) Parkinson?s disease
(b) Vascular dementia
(c) Alzheimer?s disease
(d) Frunto temporal dementia

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45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and
turns. Heal-Shin test is normal. Which one of the following is most likely disorder?
(a) Cerebellar ataxia

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(b) Sensory ataxia
(c) Frontal gait disorder
(d) Parkinson?s disease
46.
Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following

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EXCEPT:
(a) Bradycardia
(b) Hypertension
(c) Irregular respiration
(d) Hypothermia

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47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.
Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture
(LP) and a day later reports worsening of headache. Which one of the following features is

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NOT consistent with diagnosis of ?Post-LP? headache?

(a) Post-LP headache usually begins within 48 hours
(b) Post-LP headache worsens in sitting position
(c) Post-LP headache is most severe upon waking up

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(d) Post-LP headache may improve with caffeine intake
48.
Which one of the following investigations is NOT appropriate in a case of recurrent
thrombosis?
(a) Antiphospholipid antibodies

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(b) Bcr-Abl assay
(c) Protein C and S assays
(d) Antithrombin level
49.
All of the following are causes of reactive thrombocytosis, EXCEPT:

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(a) Hemolytic anemia
(b) Megaloblastic anemia
(c) Post splenectomy
(d) Chronic inflammatory disorders

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FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I
1.

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A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter

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(d) Atrial fibrillation
2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?

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(a) Aspirin
(b) Glimepiride
(c) Enalapril
(d) Atorvastatin
3.

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A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?

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(a) Takayasu?s arteritis
(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.

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All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs

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5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy

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(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

6.
Which one of the following is NOT a common cause of atrial fibrillation?

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(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

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7.
In an ECG recording, P wave is produced by:

(a) Atrial depolarisation

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(b) Atrial repolarisation
(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular

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tachycardia?

(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone

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(d) Injection Adenosine
9.
Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine

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(b) Azilsartan
(c) Aliskiren
(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

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(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis

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11.
Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma

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(d) Sarcoidosis
12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent

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(b) Moderate persistent
(c) Severe persistent
(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and

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bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study

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14.
Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium
(b) Actinomycetes

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(c) Aspergillus
(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

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(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance

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16.
The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma

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(d) Severe pulmonary thromboembolism
17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain

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(c) Hemoptysis
(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the

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prescription?

(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline

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(d) Magnesium sulfate
19.
Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of

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interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

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Which of the above statements are correct?
(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4

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20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection
(c) SLE

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(d) Meig syndrome
21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying

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(c) It increases acid secretion
(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance

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(b) Mucosal inflammation
(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:

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(a) Child Pugh score
(b) APACHE score
(c) MELD score
(d) Metavir score
24.

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The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein

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25.
All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy

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(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

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26.
Consider the following statements with regard to oral aphthous ulcers:

1. They are superficial and painful
2. They may occur in women just prior to menstruation

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3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases
4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

Which of the above statements are correct?

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(a) 1 and 4 only
(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4

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27.
Which one of the following statements about Barrett?s Oesophagus is NOT correct?

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar

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cells
(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

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28.
The most common cause of acute hepatitis outbreaks in India is:

(a) Hepatitis E
(b) Hepatitis C

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(c) Hepatitis B
(d) Hepatitis A

29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is

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characteristically seen in which one of the following conditions?

(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus

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(d) Barrett?s oesophagus
30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

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(a) Unexplained vitamin B12 deficiency
(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

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31.
What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL

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(c) 12 to 13 gm/dL
(d) 13 to 14 gm/dL
32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?

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(a) Adynamic bone disease
(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.

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All of the following statements about adult polycystic kidney disease are true, EXCEPT:
(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm

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34.
Consider the following statements in relation to an adult patient:

1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day

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3. Polyuria is defined as urine volume in excess of 3 litre per day

Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only

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(c) 1 and 2 only
(d) 1, 2 and 3

35.
White cell casts in urine examination are strongly suggestive of:

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(a) Nephritis
(b) Pyelonephritis
(c) Renal stone disease
(d) Papillitis
36.

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A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history
of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is

--- Content provided by FirstRanker.com ---

NOT correct about management for this condition?

(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive

--- Content provided by FirstRanker.com ---

(d) Immunosuppressants are to be used for crescentic glomerulonephritis
37.
Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

--- Content provided by FirstRanker.com ---

(a) Higher dietary calcium increases risk
(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk
38.

--- Content provided by FirstRanker.com ---

A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.
He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis
(b) Tubercular meningitis

--- Content provided by FirstRanker.com ---

(c) Pyogenic (bacterial) meningitis
(d) Viral encephalitis
39.
Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine

--- Content provided by FirstRanker.com ---

(b) Aceclofenac
(c) Thiamine
(d) Prednisdone
40.
Constructional skills is a function of which lobe?

--- Content provided by FirstRanker.com ---

(a) Dominant temporal lobe
(b) Non dominant parietal lobe
(c) Frontal lobe
(d) Non dominant temporal lobe

--- Content provided by FirstRanker.com ---

41.
Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome
(b) Millard Gubler syndrome
(c) Claude syndrome

--- Content provided by FirstRanker.com ---

(d) Parinaud syndrome
42.
A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:
(a) Left 3

--- Content provided by FirstRanker.com ---

rd
nerve palsy
(b) Left 6
th
nerve palsy

--- Content provided by FirstRanker.com ---

(c) Right 4
th
nerve palsy
(d) Right 3
rd

--- Content provided by FirstRanker.com ---

nerve palsy
43.
All of the following are features of Cauda Equina syndrome EXCEPT:

(a) Low back pain

--- Content provided by FirstRanker.com ---

(b) Lower limb areflexia
(c) Loss of bladder function
(d) Extensor plantar response

44.

--- Content provided by FirstRanker.com ---

A 68-year old male presented in OPD with complaints of progressive small handwriting. On
examination, he had resting tremor, bradykinesia, rigidity and postural instability. This
patient is suffering most likely from:

(a) Parkinson?s disease

--- Content provided by FirstRanker.com ---

(b) Vascular dementia
(c) Alzheimer?s disease
(d) Frunto temporal dementia
45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with

--- Content provided by FirstRanker.com ---

imbalance, comprising short strides, shuffling along the floor and difficulty with starts and
turns. Heal-Shin test is normal. Which one of the following is most likely disorder?
(a) Cerebellar ataxia
(b) Sensory ataxia
(c) Frontal gait disorder

--- Content provided by FirstRanker.com ---

(d) Parkinson?s disease
46.
Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following
EXCEPT:
(a) Bradycardia

--- Content provided by FirstRanker.com ---

(b) Hypertension
(c) Irregular respiration
(d) Hypothermia

47.

--- Content provided by FirstRanker.com ---

A 35 year old man presents with history of low grade fever and headache for last five weeks.
Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture
(LP) and a day later reports worsening of headache. Which one of the following features is
NOT consistent with diagnosis of ?Post-LP? headache?

--- Content provided by FirstRanker.com ---

(a) Post-LP headache usually begins within 48 hours
(b) Post-LP headache worsens in sitting position
(c) Post-LP headache is most severe upon waking up
(d) Post-LP headache may improve with caffeine intake
48.

--- Content provided by FirstRanker.com ---

Which one of the following investigations is NOT appropriate in a case of recurrent
thrombosis?
(a) Antiphospholipid antibodies
(b) Bcr-Abl assay
(c) Protein C and S assays

--- Content provided by FirstRanker.com ---

(d) Antithrombin level
49.
All of the following are causes of reactive thrombocytosis, EXCEPT:
(a) Hemolytic anemia
(b) Megaloblastic anemia

--- Content provided by FirstRanker.com ---

(c) Post splenectomy
(d) Chronic inflammatory disorders


50.

--- Content provided by FirstRanker.com ---

Cryoprecipitate cannot be used for treatment of which one of the following conditions?
(a) Von Willebrand disease
(b) Hypofibrinogenemia
(c) Hemophilia?B
(d) Hemphilia?A

--- Content provided by FirstRanker.com ---

51.
Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic
anaemia. The disorder is inherited as an:

(a) Autosomal recessive trait

--- Content provided by FirstRanker.com ---

(b) X-linked recessive trait
(c) Autosomal dominant trait
(d) X-linked dominant trait
52.
Sickle cell disease may be associated with any of the following EXCEPT:

--- Content provided by FirstRanker.com ---

(a) Acute chest syndrome
(b) Aplastic crisis
(c) Splenic sequestration crisis
(d) Conn?s syndrome

--- Content provided by FirstRanker.com ---

53.
Fever with splenomegaly and lymphadenopathy can be seen in
(a) Infectious mononucleosis
(b) Chronic leukaemia

--- Content provided by FirstRanker.com ---

(c) Both infectious mononucleosis and chronic leukaemia
(d) Neither infectious mononucleosis nor chronic leukaemia
54.
Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:

--- Content provided by FirstRanker.com ---

(a) Haemoglobin X disease
(b) Haemoglobin H disease
(c) Haemoglobin F disease
(d) Hydrops fetalis
55.

--- Content provided by FirstRanker.com ---

Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?
(a) It is a clonal malignancy of haematopoetic stem
(b) Risk of developing CML is increased in monozygotic turns
(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

FirstRanker.com - FirstRanker's Choice

--- Content provided by FirstRanker.com ---

Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?

--- Content provided by FirstRanker.com ---

(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation
2.

--- Content provided by FirstRanker.com ---

An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin
(b) Glimepiride

--- Content provided by FirstRanker.com ---

(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body

--- Content provided by FirstRanker.com ---

habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome

--- Content provided by FirstRanker.com ---

(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina

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(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

--- Content provided by FirstRanker.com ---

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

--- Content provided by FirstRanker.com ---

6.
Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation

--- Content provided by FirstRanker.com ---

(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

7.

--- Content provided by FirstRanker.com ---

In an ECG recording, P wave is produced by:

(a) Atrial depolarisation
(b) Atrial repolarisation
(c) Ventricular depolarisation

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(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

--- Content provided by FirstRanker.com ---

(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine
9.

--- Content provided by FirstRanker.com ---

Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine
(b) Azilsartan
(c) Aliskiren

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(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

(a) Aortic regurgitation

--- Content provided by FirstRanker.com ---

(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis
11.
Signet-ring sign on CT-chest is suggestive of:

--- Content provided by FirstRanker.com ---

(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis
12.

--- Content provided by FirstRanker.com ---

Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent
(b) Moderate persistent
(c) Severe persistent

--- Content provided by FirstRanker.com ---

(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation

--- Content provided by FirstRanker.com ---

(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study
14.
Which one of the following antigens is commonly associated with causation of Farmer?s

--- Content provided by FirstRanker.com ---

lung?
(a) Penicillium
(b) Actinomycetes
(c) Aspergillus
(d) Candida

--- Content provided by FirstRanker.com ---

15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

(a) INH resistance

--- Content provided by FirstRanker.com ---

(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance
16.
The most common cause of chronic type II respiratory failure is:

--- Content provided by FirstRanker.com ---

(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism
17.

--- Content provided by FirstRanker.com ---

The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain
(c) Hemoptysis
(d) Cough

--- Content provided by FirstRanker.com ---

18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

--- Content provided by FirstRanker.com ---

(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate
19.

--- Content provided by FirstRanker.com ---

Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation

--- Content provided by FirstRanker.com ---

3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?
(a) 1 and 3

--- Content provided by FirstRanker.com ---

(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4
20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:

--- Content provided by FirstRanker.com ---

(a) SVC obstruction
(b) Fungal infection
(c) SLE
(d) Meig syndrome
21.

--- Content provided by FirstRanker.com ---

Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion
(d) Fasting increases its secretion

--- Content provided by FirstRanker.com ---

22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation
(c) Bile acid secretory defects

--- Content provided by FirstRanker.com ---

(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score
(b) APACHE score

--- Content provided by FirstRanker.com ---

(c) MELD score
(d) Metavir score
24.
The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein

--- Content provided by FirstRanker.com ---

(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.
All of the following conditions are associated with Glomerulonephritis with low complement

--- Content provided by FirstRanker.com ---

level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

26.
Consider the following statements with regard to oral aphthous ulcers:

--- Content provided by FirstRanker.com ---

1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases
4. They are pre-malignant and progress over few years to squamous cell carcinoma of

--- Content provided by FirstRanker.com ---

the oral cavity

Which of the above statements are correct?

(a) 1 and 4 only

--- Content provided by FirstRanker.com ---

(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.
Which one of the following statements about Barrett?s Oesophagus is NOT correct?

--- Content provided by FirstRanker.com ---

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells
(c) Normal columnar cells lining the lower oesophagus are replaced by squamous

--- Content provided by FirstRanker.com ---

cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.
The most common cause of acute hepatitis outbreaks in India is:

--- Content provided by FirstRanker.com ---

(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B
(d) Hepatitis A

--- Content provided by FirstRanker.com ---

29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

--- Content provided by FirstRanker.com ---

(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus
30.

--- Content provided by FirstRanker.com ---

Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency
(b) Idiopathic thrombocytopenic purpura

--- Content provided by FirstRanker.com ---

(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

31.
What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney

--- Content provided by FirstRanker.com ---

disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL
(d) 13 to 14 gm/dL

--- Content provided by FirstRanker.com ---

32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease
(b) Tumoral calcinosis

--- Content provided by FirstRanker.com ---

(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:
(a) It is inherited as autosomal dominant trait

--- Content provided by FirstRanker.com ---

(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.
Consider the following statements in relation to an adult patient:

--- Content provided by FirstRanker.com ---

1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

--- Content provided by FirstRanker.com ---

Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only
(d) 1, 2 and 3

--- Content provided by FirstRanker.com ---

35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis
(b) Pyelonephritis

--- Content provided by FirstRanker.com ---

(c) Renal stone disease
(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history
of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for

--- Content provided by FirstRanker.com ---

low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

--- Content provided by FirstRanker.com ---

(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis
37.

--- Content provided by FirstRanker.com ---

Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

(a) Higher dietary calcium increases risk
(b) Higher animal protein intake increases risk

--- Content provided by FirstRanker.com ---

(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.
He has history of fever and headache for the preceding 3 days. The CSF examination is

--- Content provided by FirstRanker.com ---

unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis
(d) Viral encephalitis

--- Content provided by FirstRanker.com ---

39.
Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac
(c) Thiamine

--- Content provided by FirstRanker.com ---

(d) Prednisdone
40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe
(b) Non dominant parietal lobe

--- Content provided by FirstRanker.com ---

(c) Frontal lobe
(d) Non dominant temporal lobe

41.
Vertical gaze palsy with convergence retraction nystagmus is seen in:

--- Content provided by FirstRanker.com ---

(a) Weber syndrome
(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome
42.

--- Content provided by FirstRanker.com ---

A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:
(a) Left 3
rd
nerve palsy

--- Content provided by FirstRanker.com ---

(b) Left 6
th
nerve palsy
(c) Right 4
th

--- Content provided by FirstRanker.com ---

nerve palsy
(d) Right 3
rd
nerve palsy
43.

--- Content provided by FirstRanker.com ---

All of the following are features of Cauda Equina syndrome EXCEPT:

(a) Low back pain
(b) Lower limb areflexia
(c) Loss of bladder function

--- Content provided by FirstRanker.com ---

(d) Extensor plantar response

44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On
examination, he had resting tremor, bradykinesia, rigidity and postural instability. This

--- Content provided by FirstRanker.com ---

patient is suffering most likely from:

(a) Parkinson?s disease
(b) Vascular dementia
(c) Alzheimer?s disease

--- Content provided by FirstRanker.com ---

(d) Frunto temporal dementia
45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and
turns. Heal-Shin test is normal. Which one of the following is most likely disorder?

--- Content provided by FirstRanker.com ---

(a) Cerebellar ataxia
(b) Sensory ataxia
(c) Frontal gait disorder
(d) Parkinson?s disease
46.

--- Content provided by FirstRanker.com ---

Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following
EXCEPT:
(a) Bradycardia
(b) Hypertension
(c) Irregular respiration

--- Content provided by FirstRanker.com ---

(d) Hypothermia

47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.
Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture

--- Content provided by FirstRanker.com ---

(LP) and a day later reports worsening of headache. Which one of the following features is
NOT consistent with diagnosis of ?Post-LP? headache?

(a) Post-LP headache usually begins within 48 hours
(b) Post-LP headache worsens in sitting position

--- Content provided by FirstRanker.com ---

(c) Post-LP headache is most severe upon waking up
(d) Post-LP headache may improve with caffeine intake
48.
Which one of the following investigations is NOT appropriate in a case of recurrent
thrombosis?

--- Content provided by FirstRanker.com ---

(a) Antiphospholipid antibodies
(b) Bcr-Abl assay
(c) Protein C and S assays
(d) Antithrombin level
49.

--- Content provided by FirstRanker.com ---

All of the following are causes of reactive thrombocytosis, EXCEPT:
(a) Hemolytic anemia
(b) Megaloblastic anemia
(c) Post splenectomy
(d) Chronic inflammatory disorders

--- Content provided by FirstRanker.com ---

50.
Cryoprecipitate cannot be used for treatment of which one of the following conditions?
(a) Von Willebrand disease

--- Content provided by FirstRanker.com ---

(b) Hypofibrinogenemia
(c) Hemophilia?B
(d) Hemphilia?A
51.
Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic

--- Content provided by FirstRanker.com ---

anaemia. The disorder is inherited as an:

(a) Autosomal recessive trait
(b) X-linked recessive trait
(c) Autosomal dominant trait

--- Content provided by FirstRanker.com ---

(d) X-linked dominant trait
52.
Sickle cell disease may be associated with any of the following EXCEPT:

(a) Acute chest syndrome

--- Content provided by FirstRanker.com ---

(b) Aplastic crisis
(c) Splenic sequestration crisis
(d) Conn?s syndrome

53.

--- Content provided by FirstRanker.com ---

Fever with splenomegaly and lymphadenopathy can be seen in
(a) Infectious mononucleosis
(b) Chronic leukaemia
(c) Both infectious mononucleosis and chronic leukaemia
(d) Neither infectious mononucleosis nor chronic leukaemia

--- Content provided by FirstRanker.com ---

54.
Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:
(a) Haemoglobin X disease
(b) Haemoglobin H disease

--- Content provided by FirstRanker.com ---

(c) Haemoglobin F disease
(d) Hydrops fetalis
55.
Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?
(a) It is a clonal malignancy of haematopoetic stem

--- Content provided by FirstRanker.com ---

(b) Risk of developing CML is increased in monozygotic turns
(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

56.
Diagnostic criteria of multiple myeloma includes which of the following?

--- Content provided by FirstRanker.com ---

1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary M protein
3. Skeletal lytic lesions
4. Skeletal blastic lesions

--- Content provided by FirstRanker.com ---

Select the correct answer using the code given below:
(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4
(d) 2, 3 and 4

--- Content provided by FirstRanker.com ---

57.
The most predominant type of serum immunoglobulin involved in patients with plasma cell
disorder is:
(a) Ig G
(b) Ig A

--- Content provided by FirstRanker.com ---

(c) Ig D
(d) Light chains
58.
Which one of the following statements is NOT true regarding the thyroid function/disorder in
pregnancy?

--- Content provided by FirstRanker.com ---

(a) There is an increase in the metabolism of thyroxine by placenta
(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy
(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in
pregnancy
(d) Impaired cognitive impairment may be seen in the offspring of mother with

--- Content provided by FirstRanker.com ---

subclinical hypothyroidism

59.
Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?
(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL

--- Content provided by FirstRanker.com ---

(b) HbA1c ? 6.5 %
(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test
(d) Fasting plasma glucose ? 110 mg/dL
60.
A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight

--- Content provided by FirstRanker.com ---

gain, hair loss, tiredness and weakness. What will be the investigation of choice?
(a) FSH & LH level
(b) Estrogen level
(c) Free T
3

--- Content provided by FirstRanker.com ---

and free T
4
level
(d) Free T
4

--- Content provided by FirstRanker.com ---

and TSH level

--- Content provided by FirstRanker.com ---

FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020

--- Content provided by FirstRanker.com ---

Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?
(a) Ventricular fibrillation

--- Content provided by FirstRanker.com ---

(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation
2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for

--- Content provided by FirstRanker.com ---

follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin
(b) Glimepiride
(c) Enalapril

--- Content provided by FirstRanker.com ---

(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,

--- Content provided by FirstRanker.com ---

joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome
(c) Marfan?s syndrome

--- Content provided by FirstRanker.com ---

(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina
(b) To evaluate stable angina

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(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

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(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

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6.
Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation
(b) Hypothyroidism

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(c) Hypertension
(d) Acute myocardial infarction

7.
In an ECG recording, P wave is produced by:

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(a) Atrial depolarisation
(b) Atrial repolarisation
(c) Ventricular depolarisation
(d) Ventricular repolarisation

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8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

(a) DC Cardioversion

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(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine
9.
Which one of the following drugs is a Direct Renin Inhibitor?

--- Content provided by FirstRanker.com ---

(a) Benedipine
(b) Azilsartan
(c) Aliskiren
(d) Lisinopril

--- Content provided by FirstRanker.com ---

10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

(a) Aortic regurgitation
(b) Thyrotoxicosis

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(c) Patent ductus arteriosus
(d) Aortic stenosis
11.
Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis

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(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis
12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it

--- Content provided by FirstRanker.com ---

is:
(a) Mild persistent
(b) Moderate persistent
(c) Severe persistent
(d) Very severe persistent

--- Content provided by FirstRanker.com ---

13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation
(b) CT-chest

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(c) Lung biopsy
(d) DNA sequencing study
14.
Which one of the following antigens is commonly associated with causation of Farmer?s
lung?

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(a) Penicillium
(b) Actinomycetes
(c) Aspergillus
(d) Candida
15.

--- Content provided by FirstRanker.com ---

The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

(a) INH resistance
(b) Rifampicin resistance

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(c) Multi drug resistance
(d) Ethambutol resistance
16.
The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia

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(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism
17.
The most frequent symptom in respiratory diseases is:

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(a) Breathlessness
(b) Chest pain
(c) Hemoptysis
(d) Cough
18.

--- Content provided by FirstRanker.com ---

A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

(a) Albuterol

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(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate
19.
Consider the following statements with regard to respiratory examination:

--- Content provided by FirstRanker.com ---

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma

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4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?
(a) 1 and 3
(b) 2 and 4 only

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(c) 1, 2 and 4
(d) 2, 3 and 4
20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction

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(b) Fungal infection
(c) SLE
(d) Meig syndrome
21.
Which one of the following is NOT true about Ghrelin?

--- Content provided by FirstRanker.com ---

(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion
(d) Fasting increases its secretion
22.

--- Content provided by FirstRanker.com ---

Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation
(c) Bile acid secretory defects
(d) Pancreatic dysfunction

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23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score
(b) APACHE score
(c) MELD score

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(d) Metavir score
24.
The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery

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(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.
All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:

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(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

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--- Content provided by FirstRanker.com ---

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26.
Consider the following statements with regard to oral aphthous ulcers:

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1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases
4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

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Which of the above statements are correct?

(a) 1 and 4 only
(b) 2 and 3 only

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(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.
Which one of the following statements about Barrett?s Oesophagus is NOT correct?

--- Content provided by FirstRanker.com ---

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells
(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells

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(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.
The most common cause of acute hepatitis outbreaks in India is:

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(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B
(d) Hepatitis A

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29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

(a) Menetrier?s disease

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(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus
30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-

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gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency
(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding

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(d) Acute glomerulonephritis

31.
What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?

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(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL
(d) 13 to 14 gm/dL
32.

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Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease
(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic

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(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:
(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria

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(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.
Consider the following statements in relation to an adult patient:

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1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

Which of the statements given above are correct?

--- Content provided by FirstRanker.com ---

(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only
(d) 1, 2 and 3

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35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis
(b) Pyelonephritis
(c) Renal stone disease

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(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history
of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C

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3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

(a) Renal biopsy is rarely required for making diagnosis

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(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis
37.
Which one of the following statements is NOT correct regarding the risk factors for

--- Content provided by FirstRanker.com ---

nephrolithiasis?

(a) Higher dietary calcium increases risk
(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk

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(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.
He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?

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(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis
(d) Viral encephalitis
39.

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Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac
(c) Thiamine
(d) Prednisdone

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40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe
(b) Non dominant parietal lobe
(c) Frontal lobe

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(d) Non dominant temporal lobe

41.
Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome

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(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome
42.
A patient on looking forward was found to have his right eye deviated downwards and

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outwards with pupil dilated. He is suffering from:
(a) Left 3
rd
nerve palsy
(b) Left 6

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th
nerve palsy
(c) Right 4
th
nerve palsy

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(d) Right 3
rd
nerve palsy
43.
All of the following are features of Cauda Equina syndrome EXCEPT:

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(a) Low back pain
(b) Lower limb areflexia
(c) Loss of bladder function
(d) Extensor plantar response

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44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On
examination, he had resting tremor, bradykinesia, rigidity and postural instability. This
patient is suffering most likely from:

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(a) Parkinson?s disease
(b) Vascular dementia
(c) Alzheimer?s disease
(d) Frunto temporal dementia

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45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and
turns. Heal-Shin test is normal. Which one of the following is most likely disorder?
(a) Cerebellar ataxia

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(b) Sensory ataxia
(c) Frontal gait disorder
(d) Parkinson?s disease
46.
Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following

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EXCEPT:
(a) Bradycardia
(b) Hypertension
(c) Irregular respiration
(d) Hypothermia

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47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.
Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture
(LP) and a day later reports worsening of headache. Which one of the following features is

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NOT consistent with diagnosis of ?Post-LP? headache?

(a) Post-LP headache usually begins within 48 hours
(b) Post-LP headache worsens in sitting position
(c) Post-LP headache is most severe upon waking up

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(d) Post-LP headache may improve with caffeine intake
48.
Which one of the following investigations is NOT appropriate in a case of recurrent
thrombosis?
(a) Antiphospholipid antibodies

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(b) Bcr-Abl assay
(c) Protein C and S assays
(d) Antithrombin level
49.
All of the following are causes of reactive thrombocytosis, EXCEPT:

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(a) Hemolytic anemia
(b) Megaloblastic anemia
(c) Post splenectomy
(d) Chronic inflammatory disorders

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50.
Cryoprecipitate cannot be used for treatment of which one of the following conditions?
(a) Von Willebrand disease
(b) Hypofibrinogenemia

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(c) Hemophilia?B
(d) Hemphilia?A
51.
Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic
anaemia. The disorder is inherited as an:

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(a) Autosomal recessive trait
(b) X-linked recessive trait
(c) Autosomal dominant trait
(d) X-linked dominant trait

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52.
Sickle cell disease may be associated with any of the following EXCEPT:

(a) Acute chest syndrome
(b) Aplastic crisis

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(c) Splenic sequestration crisis
(d) Conn?s syndrome

53.
Fever with splenomegaly and lymphadenopathy can be seen in

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(a) Infectious mononucleosis
(b) Chronic leukaemia
(c) Both infectious mononucleosis and chronic leukaemia
(d) Neither infectious mononucleosis nor chronic leukaemia
54.

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Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:
(a) Haemoglobin X disease
(b) Haemoglobin H disease
(c) Haemoglobin F disease

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(d) Hydrops fetalis
55.
Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?
(a) It is a clonal malignancy of haematopoetic stem
(b) Risk of developing CML is increased in monozygotic turns

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(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

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--- Content provided by FirstRanker.com ---

56.
Diagnostic criteria of multiple myeloma includes which of the following?

1. Increased malignant plasma cells in the bone marrow

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2. Serum and/or urinary M protein
3. Skeletal lytic lesions
4. Skeletal blastic lesions

Select the correct answer using the code given below:

--- Content provided by FirstRanker.com ---

(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4
(d) 2, 3 and 4
57.

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The most predominant type of serum immunoglobulin involved in patients with plasma cell
disorder is:
(a) Ig G
(b) Ig A
(c) Ig D

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(d) Light chains
58.
Which one of the following statements is NOT true regarding the thyroid function/disorder in
pregnancy?
(a) There is an increase in the metabolism of thyroxine by placenta

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(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy
(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in
pregnancy
(d) Impaired cognitive impairment may be seen in the offspring of mother with
subclinical hypothyroidism

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59.
Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?
(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL
(b) HbA1c ? 6.5 %

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(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test
(d) Fasting plasma glucose ? 110 mg/dL
60.
A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight
gain, hair loss, tiredness and weakness. What will be the investigation of choice?

--- Content provided by FirstRanker.com ---

(a) FSH & LH level
(b) Estrogen level
(c) Free T
3
and free T

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4
level
(d) Free T
4
and TSH level

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

61.
Consider the following statements about erectile dysfunction in diabetic males:

--- Content provided by FirstRanker.com ---

1. It affects 60 % of males
2. Its common cause is an underlying neuro-vascular pathology
3. It may be aggravated by beta-adrenergic agonist drugs
4. Endocrine disorders like hyperprolactinemia may cause it

--- Content provided by FirstRanker.com ---

Which of the statements given above are true?
(a) 1 and 2
(b) 2 and 3
(c) 2 and 4
(d) 3 and 4

--- Content provided by FirstRanker.com ---

62.
All of the following can cause Hyperprolactinemia, EXCEPT:
(a) Craniopharyngioma
(b) Hyperthyroidism
(c) Stress

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(d) Chronic renal failure
63.
All of the following can be seen in a case of thyrotoxicosis, EXCEPT:
(a) Atrial fibrillation
(b) Periodic paralysis

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(c) Deafness
(d) Osteoporosis
64.
Which one of the following hormones acts via the receptor tyrosine kinase?
(a) FSH

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(b) TSH
(c) IGF-1
(d) PTH
65.
Consider the following disorders as constituent of Multiple Endocrine Neoplasia Type 2a

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(MEN 2a):

1. Primary Hyperparathyroidism
2. Pituitary tumours
3. Medullary carcinoma of thyroid

--- Content provided by FirstRanker.com ---

4. Pheochromocytoma

Which of the above are correct?:

(a) 1, 2 and 4

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(b) 1, 2 and 3
(c) 1, 3 and 4
(d) 2, 3 and 4

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FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I

--- Content provided by FirstRanker.com ---

1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex

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(c) Atrial flutter
(d) Atrial fibrillation
2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the

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most likely cause?
(a) Aspirin
(b) Glimepiride
(c) Enalapril
(d) Atorvastatin

--- Content provided by FirstRanker.com ---

3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following

--- Content provided by FirstRanker.com ---

diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation

--- Content provided by FirstRanker.com ---

4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization

--- Content provided by FirstRanker.com ---

(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism

--- Content provided by FirstRanker.com ---

(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

6.

--- Content provided by FirstRanker.com ---

Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension

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(d) Acute myocardial infarction

7.
In an ECG recording, P wave is produced by:

--- Content provided by FirstRanker.com ---

(a) Atrial depolarisation
(b) Atrial repolarisation
(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.

--- Content provided by FirstRanker.com ---

Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

(a) DC Cardioversion
(b) Injection Lignocaine

--- Content provided by FirstRanker.com ---

(c) Injection Amiodarone
(d) Injection Adenosine
9.
Which one of the following drugs is a Direct Renin Inhibitor?

--- Content provided by FirstRanker.com ---

(a) Benedipine
(b) Azilsartan
(c) Aliskiren
(d) Lisinopril
10.

--- Content provided by FirstRanker.com ---

All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus

--- Content provided by FirstRanker.com ---

(d) Aortic stenosis
11.
Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis

--- Content provided by FirstRanker.com ---

(c) Aspergilloma
(d) Sarcoidosis
12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:

--- Content provided by FirstRanker.com ---

(a) Mild persistent
(b) Moderate persistent
(c) Severe persistent
(d) Very severe persistent
13.

--- Content provided by FirstRanker.com ---

An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy

--- Content provided by FirstRanker.com ---

(d) DNA sequencing study
14.
Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium

--- Content provided by FirstRanker.com ---

(b) Actinomycetes
(c) Aspergillus
(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of

--- Content provided by FirstRanker.com ---

which of the following?

(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance

--- Content provided by FirstRanker.com ---

(d) Ethambutol resistance
16.
The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD

--- Content provided by FirstRanker.com ---

(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism
17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness

--- Content provided by FirstRanker.com ---

(b) Chest pain
(c) Hemoptysis
(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma

--- Content provided by FirstRanker.com ---

by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

(a) Albuterol
(b) Anti-leukotrienes

--- Content provided by FirstRanker.com ---

(c) Aminophylline
(d) Magnesium sulfate
19.
Consider the following statements with regard to respiratory examination:

--- Content provided by FirstRanker.com ---

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

--- Content provided by FirstRanker.com ---

Which of the above statements are correct?
(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4

--- Content provided by FirstRanker.com ---

(d) 2, 3 and 4
20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection

--- Content provided by FirstRanker.com ---

(c) SLE
(d) Meig syndrome
21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite

--- Content provided by FirstRanker.com ---

(b) It decreases gastric emptying
(c) It increases acid secretion
(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?

--- Content provided by FirstRanker.com ---

(a) Lactose intolerance
(b) Mucosal inflammation
(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.

--- Content provided by FirstRanker.com ---

The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score
(b) APACHE score
(c) MELD score
(d) Metavir score

--- Content provided by FirstRanker.com ---

24.
The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein

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(d) 70 % hepatic artery and 30 % portal vein
25.
All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis

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(b) IgA nephropathy
(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

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26.
Consider the following statements with regard to oral aphthous ulcers:

1. They are superficial and painful

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2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases
4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

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Which of the above statements are correct?

(a) 1 and 4 only
(b) 2 and 3 only
(c) 1, 2 and 3 only

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(d) 1, 2, 3 and 4
27.
Which one of the following statements about Barrett?s Oesophagus is NOT correct?

(a) It is a pre-malignant condition

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(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells
(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

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28.
The most common cause of acute hepatitis outbreaks in India is:

(a) Hepatitis E

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(b) Hepatitis C
(c) Hepatitis B
(d) Hepatitis A

29.

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Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

(a) Menetrier?s disease
(b) Boerhaave?s syndrome

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(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus
30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

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(a) Unexplained vitamin B12 deficiency
(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

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31.
What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?
(a) 8 to 10 gm/dL

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(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL
(d) 13 to 14 gm/dL
32.
Which one of the following complications of chronic kidney disease is observed in patients

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with low parathyroid hormone levels?
(a) Adynamic bone disease
(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic
(d) Calciphylaxis

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33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:
(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age

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(d) It is associated with Berry aneurysm
34.
Consider the following statements in relation to an adult patient:

1. Oliguria is defined as passage of urine less than 300 ml per day

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2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

Which of the statements given above are correct?
(a) 1 and 3 only

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(b) 2 and 3 only
(c) 1 and 2 only
(d) 1, 2 and 3

35.

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White cell casts in urine examination are strongly suggestive of:
(a) Nephritis
(b) Pyelonephritis
(c) Renal stone disease
(d) Papillitis

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36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history
of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C
3

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and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection

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(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis
37.
Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

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(a) Higher dietary calcium increases risk
(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk

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38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.
He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis

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(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis
(d) Viral encephalitis
39.
Drug of choice for the treatment of Trigeminal Neuralgia is:

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(a) Carbamazepine
(b) Aceclofenac
(c) Thiamine
(d) Prednisdone
40.

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Constructional skills is a function of which lobe?
(a) Dominant temporal lobe
(b) Non dominant parietal lobe
(c) Frontal lobe
(d) Non dominant temporal lobe

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41.
Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome
(b) Millard Gubler syndrome

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(c) Claude syndrome
(d) Parinaud syndrome
42.
A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:

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(a) Left 3
rd
nerve palsy
(b) Left 6
th

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nerve palsy
(c) Right 4
th
nerve palsy
(d) Right 3

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rd
nerve palsy
43.
All of the following are features of Cauda Equina syndrome EXCEPT:

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(a) Low back pain
(b) Lower limb areflexia
(c) Loss of bladder function
(d) Extensor plantar response

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44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On
examination, he had resting tremor, bradykinesia, rigidity and postural instability. This
patient is suffering most likely from:

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(a) Parkinson?s disease
(b) Vascular dementia
(c) Alzheimer?s disease
(d) Frunto temporal dementia
45.

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An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and
turns. Heal-Shin test is normal. Which one of the following is most likely disorder?
(a) Cerebellar ataxia
(b) Sensory ataxia

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(c) Frontal gait disorder
(d) Parkinson?s disease
46.
Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following
EXCEPT:

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(a) Bradycardia
(b) Hypertension
(c) Irregular respiration
(d) Hypothermia

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47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.
Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture
(LP) and a day later reports worsening of headache. Which one of the following features is
NOT consistent with diagnosis of ?Post-LP? headache?

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(a) Post-LP headache usually begins within 48 hours
(b) Post-LP headache worsens in sitting position
(c) Post-LP headache is most severe upon waking up
(d) Post-LP headache may improve with caffeine intake

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48.
Which one of the following investigations is NOT appropriate in a case of recurrent
thrombosis?
(a) Antiphospholipid antibodies
(b) Bcr-Abl assay

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(c) Protein C and S assays
(d) Antithrombin level
49.
All of the following are causes of reactive thrombocytosis, EXCEPT:
(a) Hemolytic anemia

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(b) Megaloblastic anemia
(c) Post splenectomy
(d) Chronic inflammatory disorders

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50.
Cryoprecipitate cannot be used for treatment of which one of the following conditions?
(a) Von Willebrand disease
(b) Hypofibrinogenemia
(c) Hemophilia?B

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(d) Hemphilia?A
51.
Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic
anaemia. The disorder is inherited as an:

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(a) Autosomal recessive trait
(b) X-linked recessive trait
(c) Autosomal dominant trait
(d) X-linked dominant trait
52.

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Sickle cell disease may be associated with any of the following EXCEPT:

(a) Acute chest syndrome
(b) Aplastic crisis
(c) Splenic sequestration crisis

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(d) Conn?s syndrome

53.
Fever with splenomegaly and lymphadenopathy can be seen in
(a) Infectious mononucleosis

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(b) Chronic leukaemia
(c) Both infectious mononucleosis and chronic leukaemia
(d) Neither infectious mononucleosis nor chronic leukaemia
54.
Every individual carries four alpha gene alleles. Deletion of three alleles leads to

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development of:
(a) Haemoglobin X disease
(b) Haemoglobin H disease
(c) Haemoglobin F disease
(d) Hydrops fetalis

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55.
Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?
(a) It is a clonal malignancy of haematopoetic stem
(b) Risk of developing CML is increased in monozygotic turns
(c) CML is defined by presence of BCR-ABL 1 fusion gene

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(d) 10 year survival with TKI therapy is 85%

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56.
Diagnostic criteria of multiple myeloma includes which of the following?

1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary M protein

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3. Skeletal lytic lesions
4. Skeletal blastic lesions

Select the correct answer using the code given below:
(a) 1, 2 and 3

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(b) 1, 3 and 4
(c) 1, 2 and 4
(d) 2, 3 and 4
57.
The most predominant type of serum immunoglobulin involved in patients with plasma cell

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disorder is:
(a) Ig G
(b) Ig A
(c) Ig D
(d) Light chains

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58.
Which one of the following statements is NOT true regarding the thyroid function/disorder in
pregnancy?
(a) There is an increase in the metabolism of thyroxine by placenta
(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy

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(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in
pregnancy
(d) Impaired cognitive impairment may be seen in the offspring of mother with
subclinical hypothyroidism

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59.
Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?
(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL
(b) HbA1c ? 6.5 %
(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test

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(d) Fasting plasma glucose ? 110 mg/dL
60.
A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight
gain, hair loss, tiredness and weakness. What will be the investigation of choice?
(a) FSH & LH level

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(b) Estrogen level
(c) Free T
3
and free T
4

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level
(d) Free T
4
and TSH level

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61.
Consider the following statements about erectile dysfunction in diabetic males:

1. It affects 60 % of males

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2. Its common cause is an underlying neuro-vascular pathology
3. It may be aggravated by beta-adrenergic agonist drugs
4. Endocrine disorders like hyperprolactinemia may cause it

Which of the statements given above are true?

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(a) 1 and 2
(b) 2 and 3
(c) 2 and 4
(d) 3 and 4
62.

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All of the following can cause Hyperprolactinemia, EXCEPT:
(a) Craniopharyngioma
(b) Hyperthyroidism
(c) Stress
(d) Chronic renal failure

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63.
All of the following can be seen in a case of thyrotoxicosis, EXCEPT:
(a) Atrial fibrillation
(b) Periodic paralysis
(c) Deafness

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(d) Osteoporosis
64.
Which one of the following hormones acts via the receptor tyrosine kinase?
(a) FSH
(b) TSH

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(c) IGF-1
(d) PTH
65.
Consider the following disorders as constituent of Multiple Endocrine Neoplasia Type 2a
(MEN 2a):

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1. Primary Hyperparathyroidism
2. Pituitary tumours
3. Medullary carcinoma of thyroid
4. Pheochromocytoma

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Which of the above are correct?:

(a) 1, 2 and 4
(b) 1, 2 and 3

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(c) 1, 3 and 4
(d) 2, 3 and 4

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66.
Consider the following statements with regard to Graves? ophthalmopathy :

1. Proptosis is often asymmetric and can even appear to be unilateral

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2. It is a clinical diagnosis
3. Worsening of symptoms upon glucocorticoid withdrawal is common
4. Radiation therapy is very effective in treatment

Which of the above statements are correct?

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(a) 1 and 2 only
(b) 1, 2 and 3
(c) 2, 3 and 4
(d) 1 and 4 only

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67.
All of the following are common aetiologies of delirium EXCEPT:
(a) Hyperthyroidism
(b) Hypothyroidism
(c) Hyperparathyroidism

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(d) Hypoparathyroidism
68.
Key anthropometric measurements important for evaluating the degree of obesity are:

(a) Weight, height and waist circumference

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(b) Weight, height and hip circumference
(c) Weight, height and mid-thigh circumference
(d) Weight, height and chest circumference
69.
What is the minimum BMI (Body Mass Index) recommended for considering adjuvant

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pharmacologic treatment in obesity with comorbidity?
(a) 23 kg/m
2

(b) 25 kg/m

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2

(c) 27 kg/m
2

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(d) 30 kg/m
2

70.
A young medical student while working in HIV ward got pricked accidently on the finger by

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a syringe needle which was used to draw blood from a patient. Patient?s infection status is not
known. Which one of the following therapeutic interventions will be the best interest of this
student?
(a) To start Dolultegravir immediately
(b) To wash wound with soap and water and start Emtricitabine

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(c) To give Dolutegravir + Tenofovir + Emtricitabine
(d) To give Dolutegravir + Tenofovir + Emtricitabine + HBV Immunoglobulin
71.
Cryptococcal infection is acquired through:
(a) Inhalation route

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(b) Bite of Culex mosquito
(c) Direct skin contact
(d) Ingestion of spores

FirstRanker.com - FirstRanker's Choice

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Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?

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(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation
2.

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An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin
(b) Glimepiride

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(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body

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habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome

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(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina

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(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

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(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

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6.
Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation

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(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

7.

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In an ECG recording, P wave is produced by:

(a) Atrial depolarisation
(b) Atrial repolarisation
(c) Ventricular depolarisation

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(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

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(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine
9.

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Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine
(b) Azilsartan
(c) Aliskiren

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(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

(a) Aortic regurgitation

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(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis
11.
Signet-ring sign on CT-chest is suggestive of:

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(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis
12.

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Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent
(b) Moderate persistent
(c) Severe persistent

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(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation

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(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study
14.
Which one of the following antigens is commonly associated with causation of Farmer?s

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lung?
(a) Penicillium
(b) Actinomycetes
(c) Aspergillus
(d) Candida

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15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

(a) INH resistance

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(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance
16.
The most common cause of chronic type II respiratory failure is:

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(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism
17.

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The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain
(c) Hemoptysis
(d) Cough

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18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

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(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate
19.

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Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation

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3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?
(a) 1 and 3

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(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4
20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:

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(a) SVC obstruction
(b) Fungal infection
(c) SLE
(d) Meig syndrome
21.

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Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion
(d) Fasting increases its secretion

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22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation
(c) Bile acid secretory defects

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(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score
(b) APACHE score

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(c) MELD score
(d) Metavir score
24.
The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein

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(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.
All of the following conditions are associated with Glomerulonephritis with low complement

--- Content provided by FirstRanker.com ---

level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

26.
Consider the following statements with regard to oral aphthous ulcers:

--- Content provided by FirstRanker.com ---

1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases
4. They are pre-malignant and progress over few years to squamous cell carcinoma of

--- Content provided by FirstRanker.com ---

the oral cavity

Which of the above statements are correct?

(a) 1 and 4 only

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(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.
Which one of the following statements about Barrett?s Oesophagus is NOT correct?

--- Content provided by FirstRanker.com ---

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells
(c) Normal columnar cells lining the lower oesophagus are replaced by squamous

--- Content provided by FirstRanker.com ---

cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.
The most common cause of acute hepatitis outbreaks in India is:

--- Content provided by FirstRanker.com ---

(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B
(d) Hepatitis A

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29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

--- Content provided by FirstRanker.com ---

(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus
30.

--- Content provided by FirstRanker.com ---

Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency
(b) Idiopathic thrombocytopenic purpura

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(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

31.
What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney

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disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL
(d) 13 to 14 gm/dL

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32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease
(b) Tumoral calcinosis

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(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:
(a) It is inherited as autosomal dominant trait

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(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.
Consider the following statements in relation to an adult patient:

--- Content provided by FirstRanker.com ---

1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

--- Content provided by FirstRanker.com ---

Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only
(d) 1, 2 and 3

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35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis
(b) Pyelonephritis

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(c) Renal stone disease
(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history
of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for

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low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

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(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis
37.

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Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

(a) Higher dietary calcium increases risk
(b) Higher animal protein intake increases risk

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(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.
He has history of fever and headache for the preceding 3 days. The CSF examination is

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unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis
(d) Viral encephalitis

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39.
Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac
(c) Thiamine

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(d) Prednisdone
40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe
(b) Non dominant parietal lobe

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(c) Frontal lobe
(d) Non dominant temporal lobe

41.
Vertical gaze palsy with convergence retraction nystagmus is seen in:

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(a) Weber syndrome
(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome
42.

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A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:
(a) Left 3
rd
nerve palsy

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(b) Left 6
th
nerve palsy
(c) Right 4
th

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nerve palsy
(d) Right 3
rd
nerve palsy
43.

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All of the following are features of Cauda Equina syndrome EXCEPT:

(a) Low back pain
(b) Lower limb areflexia
(c) Loss of bladder function

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(d) Extensor plantar response

44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On
examination, he had resting tremor, bradykinesia, rigidity and postural instability. This

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patient is suffering most likely from:

(a) Parkinson?s disease
(b) Vascular dementia
(c) Alzheimer?s disease

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(d) Frunto temporal dementia
45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and
turns. Heal-Shin test is normal. Which one of the following is most likely disorder?

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(a) Cerebellar ataxia
(b) Sensory ataxia
(c) Frontal gait disorder
(d) Parkinson?s disease
46.

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Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following
EXCEPT:
(a) Bradycardia
(b) Hypertension
(c) Irregular respiration

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(d) Hypothermia

47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.
Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture

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(LP) and a day later reports worsening of headache. Which one of the following features is
NOT consistent with diagnosis of ?Post-LP? headache?

(a) Post-LP headache usually begins within 48 hours
(b) Post-LP headache worsens in sitting position

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(c) Post-LP headache is most severe upon waking up
(d) Post-LP headache may improve with caffeine intake
48.
Which one of the following investigations is NOT appropriate in a case of recurrent
thrombosis?

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(a) Antiphospholipid antibodies
(b) Bcr-Abl assay
(c) Protein C and S assays
(d) Antithrombin level
49.

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All of the following are causes of reactive thrombocytosis, EXCEPT:
(a) Hemolytic anemia
(b) Megaloblastic anemia
(c) Post splenectomy
(d) Chronic inflammatory disorders

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50.
Cryoprecipitate cannot be used for treatment of which one of the following conditions?
(a) Von Willebrand disease

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(b) Hypofibrinogenemia
(c) Hemophilia?B
(d) Hemphilia?A
51.
Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic

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anaemia. The disorder is inherited as an:

(a) Autosomal recessive trait
(b) X-linked recessive trait
(c) Autosomal dominant trait

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(d) X-linked dominant trait
52.
Sickle cell disease may be associated with any of the following EXCEPT:

(a) Acute chest syndrome

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(b) Aplastic crisis
(c) Splenic sequestration crisis
(d) Conn?s syndrome

53.

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Fever with splenomegaly and lymphadenopathy can be seen in
(a) Infectious mononucleosis
(b) Chronic leukaemia
(c) Both infectious mononucleosis and chronic leukaemia
(d) Neither infectious mononucleosis nor chronic leukaemia

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54.
Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:
(a) Haemoglobin X disease
(b) Haemoglobin H disease

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(c) Haemoglobin F disease
(d) Hydrops fetalis
55.
Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?
(a) It is a clonal malignancy of haematopoetic stem

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(b) Risk of developing CML is increased in monozygotic turns
(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

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56.
Diagnostic criteria of multiple myeloma includes which of the following?

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1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary M protein
3. Skeletal lytic lesions
4. Skeletal blastic lesions

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Select the correct answer using the code given below:
(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4
(d) 2, 3 and 4

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57.
The most predominant type of serum immunoglobulin involved in patients with plasma cell
disorder is:
(a) Ig G
(b) Ig A

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(c) Ig D
(d) Light chains
58.
Which one of the following statements is NOT true regarding the thyroid function/disorder in
pregnancy?

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(a) There is an increase in the metabolism of thyroxine by placenta
(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy
(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in
pregnancy
(d) Impaired cognitive impairment may be seen in the offspring of mother with

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subclinical hypothyroidism

59.
Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?
(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL

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(b) HbA1c ? 6.5 %
(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test
(d) Fasting plasma glucose ? 110 mg/dL
60.
A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight

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gain, hair loss, tiredness and weakness. What will be the investigation of choice?
(a) FSH & LH level
(b) Estrogen level
(c) Free T
3

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and free T
4
level
(d) Free T
4

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and TSH level

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61.
Consider the following statements about erectile dysfunction in diabetic males:

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1. It affects 60 % of males
2. Its common cause is an underlying neuro-vascular pathology
3. It may be aggravated by beta-adrenergic agonist drugs
4. Endocrine disorders like hyperprolactinemia may cause it

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Which of the statements given above are true?
(a) 1 and 2
(b) 2 and 3
(c) 2 and 4

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(d) 3 and 4
62.
All of the following can cause Hyperprolactinemia, EXCEPT:
(a) Craniopharyngioma
(b) Hyperthyroidism

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(c) Stress
(d) Chronic renal failure
63.
All of the following can be seen in a case of thyrotoxicosis, EXCEPT:
(a) Atrial fibrillation

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(b) Periodic paralysis
(c) Deafness
(d) Osteoporosis
64.
Which one of the following hormones acts via the receptor tyrosine kinase?

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(a) FSH
(b) TSH
(c) IGF-1
(d) PTH
65.

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Consider the following disorders as constituent of Multiple Endocrine Neoplasia Type 2a
(MEN 2a):

1. Primary Hyperparathyroidism
2. Pituitary tumours

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3. Medullary carcinoma of thyroid
4. Pheochromocytoma

Which of the above are correct?:

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(a) 1, 2 and 4
(b) 1, 2 and 3
(c) 1, 3 and 4
(d) 2, 3 and 4

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66.
Consider the following statements with regard to Graves? ophthalmopathy :

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1. Proptosis is often asymmetric and can even appear to be unilateral
2. It is a clinical diagnosis
3. Worsening of symptoms upon glucocorticoid withdrawal is common
4. Radiation therapy is very effective in treatment

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Which of the above statements are correct?

(a) 1 and 2 only
(b) 1, 2 and 3

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(c) 2, 3 and 4
(d) 1 and 4 only
67.
All of the following are common aetiologies of delirium EXCEPT:
(a) Hyperthyroidism

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(b) Hypothyroidism
(c) Hyperparathyroidism
(d) Hypoparathyroidism
68.
Key anthropometric measurements important for evaluating the degree of obesity are:

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(a) Weight, height and waist circumference
(b) Weight, height and hip circumference
(c) Weight, height and mid-thigh circumference
(d) Weight, height and chest circumference

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69.
What is the minimum BMI (Body Mass Index) recommended for considering adjuvant
pharmacologic treatment in obesity with comorbidity?
(a) 23 kg/m
2

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(b) 25 kg/m
2

(c) 27 kg/m

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2

(d) 30 kg/m
2

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70.
A young medical student while working in HIV ward got pricked accidently on the finger by
a syringe needle which was used to draw blood from a patient. Patient?s infection status is not
known. Which one of the following therapeutic interventions will be the best interest of this
student?

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(a) To start Dolultegravir immediately
(b) To wash wound with soap and water and start Emtricitabine
(c) To give Dolutegravir + Tenofovir + Emtricitabine
(d) To give Dolutegravir + Tenofovir + Emtricitabine + HBV Immunoglobulin
71.

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Cryptococcal infection is acquired through:
(a) Inhalation route
(b) Bite of Culex mosquito
(c) Direct skin contact
(d) Ingestion of spores

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72.
Which one of the following is NOT appropriate treatment for Echinococcus granulosus and
hydatid disease?
(a) Albendazole 400 mg twice in a day for 3 months

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(b) Diethylcarbamazine 2 mg/kg thrice in a day for 12 days
(c) PAIR (percutaneous puncture, aspiration, injection of scolicide, reaspiration)
(d) Praziquantel (20 mg/kg twice daily for 14 days)
73.
Which one of the following infections is NOT amenable to post-exposure prophylaxis with

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specific immunoglobulins?
(a) Hepatitis B
(b) HIV
(c) Tetanus
(d) Rabies

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74.
Echinocandins are a class of:
(a) Antiviral agents
(b) Antiparasitic agents
(c) Antitubercular agents

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(d) Antifungal agents
75.
Recommended first time drug for initial treatment of tuberculosis include all EXCEPT:
(a) Isoniazid
(b) Rifampin

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(c) Ethambutol
(d) Ethionamide
76.
The most frequent adverse reaction of significance among people treated for drug-susceptible
tuberculosis is:

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(a) Colitis
(b) Hepatitis
(c) Cystitis
(d) Enteritis
77.

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All adult patients in whom anti-tubercular treatment is being started should undergo baseline
assessment of:
(a) Complete blood count
(b) Liver function test
(c) Lipid profile

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(d) Pulmonary function test
78.
A 30 year old male presents with fever, headache, anorexia, nausea, vomiting and diarrhoea.
On examination tongue is coated with abdominal tenderness, soft splenomegaly, relative
bradycardia and rose spots rash. The most likely diagnosis is:

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(a) Malaria fever
(b) Enteric fever
(c) Leptospirosis
(d) Dengue fever

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FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I
1.

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A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter

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(d) Atrial fibrillation
2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?

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(a) Aspirin
(b) Glimepiride
(c) Enalapril
(d) Atorvastatin
3.

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A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?

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(a) Takayasu?s arteritis
(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.

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All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs

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5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy

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(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

6.
Which one of the following is NOT a common cause of atrial fibrillation?

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(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

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7.
In an ECG recording, P wave is produced by:

(a) Atrial depolarisation

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(b) Atrial repolarisation
(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular

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tachycardia?

(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone

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(d) Injection Adenosine
9.
Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine

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(b) Azilsartan
(c) Aliskiren
(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

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(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis

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11.
Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma

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(d) Sarcoidosis
12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent

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(b) Moderate persistent
(c) Severe persistent
(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and

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bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study

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14.
Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium
(b) Actinomycetes

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(c) Aspergillus
(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

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(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance

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16.
The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma

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(d) Severe pulmonary thromboembolism
17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain

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(c) Hemoptysis
(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the

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prescription?

(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline

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(d) Magnesium sulfate
19.
Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of

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interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

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Which of the above statements are correct?
(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4

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20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection
(c) SLE

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(d) Meig syndrome
21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying

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(c) It increases acid secretion
(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance

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(b) Mucosal inflammation
(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:

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(a) Child Pugh score
(b) APACHE score
(c) MELD score
(d) Metavir score
24.

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The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein

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25.
All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy

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(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

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26.
Consider the following statements with regard to oral aphthous ulcers:

1. They are superficial and painful
2. They may occur in women just prior to menstruation

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3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases
4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

Which of the above statements are correct?

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(a) 1 and 4 only
(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4

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27.
Which one of the following statements about Barrett?s Oesophagus is NOT correct?

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar

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cells
(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

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28.
The most common cause of acute hepatitis outbreaks in India is:

(a) Hepatitis E
(b) Hepatitis C

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(c) Hepatitis B
(d) Hepatitis A

29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is

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characteristically seen in which one of the following conditions?

(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus

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(d) Barrett?s oesophagus
30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

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(a) Unexplained vitamin B12 deficiency
(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

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31.
What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL

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(c) 12 to 13 gm/dL
(d) 13 to 14 gm/dL
32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?

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(a) Adynamic bone disease
(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.

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All of the following statements about adult polycystic kidney disease are true, EXCEPT:
(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm

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34.
Consider the following statements in relation to an adult patient:

1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day

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3. Polyuria is defined as urine volume in excess of 3 litre per day

Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only

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(c) 1 and 2 only
(d) 1, 2 and 3

35.
White cell casts in urine examination are strongly suggestive of:

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(a) Nephritis
(b) Pyelonephritis
(c) Renal stone disease
(d) Papillitis
36.

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A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history
of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is

--- Content provided by FirstRanker.com ---

NOT correct about management for this condition?

(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive

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(d) Immunosuppressants are to be used for crescentic glomerulonephritis
37.
Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

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(a) Higher dietary calcium increases risk
(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk
38.

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A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.
He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis
(b) Tubercular meningitis

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(c) Pyogenic (bacterial) meningitis
(d) Viral encephalitis
39.
Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine

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(b) Aceclofenac
(c) Thiamine
(d) Prednisdone
40.
Constructional skills is a function of which lobe?

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(a) Dominant temporal lobe
(b) Non dominant parietal lobe
(c) Frontal lobe
(d) Non dominant temporal lobe

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41.
Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome
(b) Millard Gubler syndrome
(c) Claude syndrome

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(d) Parinaud syndrome
42.
A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:
(a) Left 3

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rd
nerve palsy
(b) Left 6
th
nerve palsy

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(c) Right 4
th
nerve palsy
(d) Right 3
rd

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nerve palsy
43.
All of the following are features of Cauda Equina syndrome EXCEPT:

(a) Low back pain

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(b) Lower limb areflexia
(c) Loss of bladder function
(d) Extensor plantar response

44.

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A 68-year old male presented in OPD with complaints of progressive small handwriting. On
examination, he had resting tremor, bradykinesia, rigidity and postural instability. This
patient is suffering most likely from:

(a) Parkinson?s disease

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(b) Vascular dementia
(c) Alzheimer?s disease
(d) Frunto temporal dementia
45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with

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imbalance, comprising short strides, shuffling along the floor and difficulty with starts and
turns. Heal-Shin test is normal. Which one of the following is most likely disorder?
(a) Cerebellar ataxia
(b) Sensory ataxia
(c) Frontal gait disorder

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(d) Parkinson?s disease
46.
Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following
EXCEPT:
(a) Bradycardia

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(b) Hypertension
(c) Irregular respiration
(d) Hypothermia

47.

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A 35 year old man presents with history of low grade fever and headache for last five weeks.
Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture
(LP) and a day later reports worsening of headache. Which one of the following features is
NOT consistent with diagnosis of ?Post-LP? headache?

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(a) Post-LP headache usually begins within 48 hours
(b) Post-LP headache worsens in sitting position
(c) Post-LP headache is most severe upon waking up
(d) Post-LP headache may improve with caffeine intake
48.

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Which one of the following investigations is NOT appropriate in a case of recurrent
thrombosis?
(a) Antiphospholipid antibodies
(b) Bcr-Abl assay
(c) Protein C and S assays

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(d) Antithrombin level
49.
All of the following are causes of reactive thrombocytosis, EXCEPT:
(a) Hemolytic anemia
(b) Megaloblastic anemia

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(c) Post splenectomy
(d) Chronic inflammatory disorders


50.

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Cryoprecipitate cannot be used for treatment of which one of the following conditions?
(a) Von Willebrand disease
(b) Hypofibrinogenemia
(c) Hemophilia?B
(d) Hemphilia?A

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51.
Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic
anaemia. The disorder is inherited as an:

(a) Autosomal recessive trait

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(b) X-linked recessive trait
(c) Autosomal dominant trait
(d) X-linked dominant trait
52.
Sickle cell disease may be associated with any of the following EXCEPT:

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(a) Acute chest syndrome
(b) Aplastic crisis
(c) Splenic sequestration crisis
(d) Conn?s syndrome

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53.
Fever with splenomegaly and lymphadenopathy can be seen in
(a) Infectious mononucleosis
(b) Chronic leukaemia

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(c) Both infectious mononucleosis and chronic leukaemia
(d) Neither infectious mononucleosis nor chronic leukaemia
54.
Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:

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(a) Haemoglobin X disease
(b) Haemoglobin H disease
(c) Haemoglobin F disease
(d) Hydrops fetalis
55.

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Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?
(a) It is a clonal malignancy of haematopoetic stem
(b) Risk of developing CML is increased in monozygotic turns
(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

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56.

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Diagnostic criteria of multiple myeloma includes which of the following?

1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary M protein
3. Skeletal lytic lesions

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4. Skeletal blastic lesions

Select the correct answer using the code given below:
(a) 1, 2 and 3
(b) 1, 3 and 4

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(c) 1, 2 and 4
(d) 2, 3 and 4
57.
The most predominant type of serum immunoglobulin involved in patients with plasma cell
disorder is:

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(a) Ig G
(b) Ig A
(c) Ig D
(d) Light chains
58.

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Which one of the following statements is NOT true regarding the thyroid function/disorder in
pregnancy?
(a) There is an increase in the metabolism of thyroxine by placenta
(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy
(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in

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pregnancy
(d) Impaired cognitive impairment may be seen in the offspring of mother with
subclinical hypothyroidism

59.

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Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?
(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL
(b) HbA1c ? 6.5 %
(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test
(d) Fasting plasma glucose ? 110 mg/dL

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60.
A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight
gain, hair loss, tiredness and weakness. What will be the investigation of choice?
(a) FSH & LH level
(b) Estrogen level

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(c) Free T
3
and free T
4
level

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(d) Free T
4
and TSH level

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61.
Consider the following statements about erectile dysfunction in diabetic males:

1. It affects 60 % of males
2. Its common cause is an underlying neuro-vascular pathology

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3. It may be aggravated by beta-adrenergic agonist drugs
4. Endocrine disorders like hyperprolactinemia may cause it

Which of the statements given above are true?
(a) 1 and 2

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(b) 2 and 3
(c) 2 and 4
(d) 3 and 4
62.
All of the following can cause Hyperprolactinemia, EXCEPT:

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(a) Craniopharyngioma
(b) Hyperthyroidism
(c) Stress
(d) Chronic renal failure
63.

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All of the following can be seen in a case of thyrotoxicosis, EXCEPT:
(a) Atrial fibrillation
(b) Periodic paralysis
(c) Deafness
(d) Osteoporosis

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64.
Which one of the following hormones acts via the receptor tyrosine kinase?
(a) FSH
(b) TSH
(c) IGF-1

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(d) PTH
65.
Consider the following disorders as constituent of Multiple Endocrine Neoplasia Type 2a
(MEN 2a):

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1. Primary Hyperparathyroidism
2. Pituitary tumours
3. Medullary carcinoma of thyroid
4. Pheochromocytoma

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Which of the above are correct?:

(a) 1, 2 and 4
(b) 1, 2 and 3
(c) 1, 3 and 4

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(d) 2, 3 and 4

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66.
Consider the following statements with regard to Graves? ophthalmopathy :

1. Proptosis is often asymmetric and can even appear to be unilateral
2. It is a clinical diagnosis

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3. Worsening of symptoms upon glucocorticoid withdrawal is common
4. Radiation therapy is very effective in treatment

Which of the above statements are correct?

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(a) 1 and 2 only
(b) 1, 2 and 3
(c) 2, 3 and 4
(d) 1 and 4 only
67.

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All of the following are common aetiologies of delirium EXCEPT:
(a) Hyperthyroidism
(b) Hypothyroidism
(c) Hyperparathyroidism
(d) Hypoparathyroidism

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68.
Key anthropometric measurements important for evaluating the degree of obesity are:

(a) Weight, height and waist circumference
(b) Weight, height and hip circumference

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(c) Weight, height and mid-thigh circumference
(d) Weight, height and chest circumference
69.
What is the minimum BMI (Body Mass Index) recommended for considering adjuvant
pharmacologic treatment in obesity with comorbidity?

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(a) 23 kg/m
2

(b) 25 kg/m
2

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(c) 27 kg/m
2

(d) 30 kg/m

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2

70.
A young medical student while working in HIV ward got pricked accidently on the finger by
a syringe needle which was used to draw blood from a patient. Patient?s infection status is not

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known. Which one of the following therapeutic interventions will be the best interest of this
student?
(a) To start Dolultegravir immediately
(b) To wash wound with soap and water and start Emtricitabine
(c) To give Dolutegravir + Tenofovir + Emtricitabine

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(d) To give Dolutegravir + Tenofovir + Emtricitabine + HBV Immunoglobulin
71.
Cryptococcal infection is acquired through:
(a) Inhalation route
(b) Bite of Culex mosquito

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(c) Direct skin contact
(d) Ingestion of spores

72.
Which one of the following is NOT appropriate treatment for Echinococcus granulosus and

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hydatid disease?
(a) Albendazole 400 mg twice in a day for 3 months
(b) Diethylcarbamazine 2 mg/kg thrice in a day for 12 days
(c) PAIR (percutaneous puncture, aspiration, injection of scolicide, reaspiration)
(d) Praziquantel (20 mg/kg twice daily for 14 days)

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73.
Which one of the following infections is NOT amenable to post-exposure prophylaxis with
specific immunoglobulins?
(a) Hepatitis B
(b) HIV

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(c) Tetanus
(d) Rabies
74.
Echinocandins are a class of:
(a) Antiviral agents

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(b) Antiparasitic agents
(c) Antitubercular agents
(d) Antifungal agents
75.
Recommended first time drug for initial treatment of tuberculosis include all EXCEPT:

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(a) Isoniazid
(b) Rifampin
(c) Ethambutol
(d) Ethionamide
76.

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The most frequent adverse reaction of significance among people treated for drug-susceptible
tuberculosis is:
(a) Colitis
(b) Hepatitis
(c) Cystitis

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(d) Enteritis
77.
All adult patients in whom anti-tubercular treatment is being started should undergo baseline
assessment of:
(a) Complete blood count

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(b) Liver function test
(c) Lipid profile
(d) Pulmonary function test
78.
A 30 year old male presents with fever, headache, anorexia, nausea, vomiting and diarrhoea.

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On examination tongue is coated with abdominal tenderness, soft splenomegaly, relative
bradycardia and rose spots rash. The most likely diagnosis is:

(a) Malaria fever
(b) Enteric fever

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(c) Leptospirosis
(d) Dengue fever

79.
The extrapulmonary sites most commonly involved in tuberculosis are all EXCEPT:

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(a) Lymph node TB
(b) Genitourinary TB
(c) Skeletal TB
(d) Skull TB
80.

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Which of the following is NOT a clinical feature of Botulism?
(a) Impaired alertness
(b) Dysphagia
(c) Diplopia
(d) Ptosis

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81.
Post exposure prophylaxis (PEP) for HIV should contain:
(a) 2 antiretroviral drugs administered for 4 weeks
(b) 2 antiretroviral drugs administered for 6 weeks
(c) 3 antiretroviral drugs administered for 4 weeks

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(d) 3 antiretroviral drugs administered for 6 weeks
82.
Paralytic rabies is characterized by:
(a) Maculopapular rash
(b) Flaccid muscle weakness

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(c) Spastic muscle weakness
(d) Hyperexcitability and facial weakness
83.
All of the following are seen in Marasmus EXCEPT:

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(a) Reduced triceps skinfold
(b) Reduced mid arm circumference
(c) Protein wasting
(d) Decreased body mass index
84.

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A 20 year young lady presents with high grade fever for five days and palpable purpura over
extremities. She is found to be confused, with presence of neck stiffness. Which of the
following is the most likely diagnosis?
(a) Disseminated intravascular coagulation
(b) Acute meningococcemia

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(c) Antiphospholipid antibody syndrome
(d) Thrombotic thrombocytopenic purpura
85.
Fibroblast Growth Factor 23 (FGF 23) is increased in which one of the following conditions?
(a) Osteomalacia

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(b) Osteoporosis
(c) Paget?s disease
(d) Renal Osteodystrophy

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FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020

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Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?
(a) Ventricular fibrillation

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(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation
2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for

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follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin
(b) Glimepiride
(c) Enalapril

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(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,

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joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome
(c) Marfan?s syndrome

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(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina
(b) To evaluate stable angina

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(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

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(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

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6.
Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation
(b) Hypothyroidism

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(c) Hypertension
(d) Acute myocardial infarction

7.
In an ECG recording, P wave is produced by:

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(a) Atrial depolarisation
(b) Atrial repolarisation
(c) Ventricular depolarisation
(d) Ventricular repolarisation

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8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

(a) DC Cardioversion

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(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine
9.
Which one of the following drugs is a Direct Renin Inhibitor?

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(a) Benedipine
(b) Azilsartan
(c) Aliskiren
(d) Lisinopril

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10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

(a) Aortic regurgitation
(b) Thyrotoxicosis

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(c) Patent ductus arteriosus
(d) Aortic stenosis
11.
Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis

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(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis
12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it

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is:
(a) Mild persistent
(b) Moderate persistent
(c) Severe persistent
(d) Very severe persistent

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13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation
(b) CT-chest

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(c) Lung biopsy
(d) DNA sequencing study
14.
Which one of the following antigens is commonly associated with causation of Farmer?s
lung?

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(a) Penicillium
(b) Actinomycetes
(c) Aspergillus
(d) Candida
15.

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The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

(a) INH resistance
(b) Rifampicin resistance

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(c) Multi drug resistance
(d) Ethambutol resistance
16.
The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia

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(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism
17.
The most frequent symptom in respiratory diseases is:

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(a) Breathlessness
(b) Chest pain
(c) Hemoptysis
(d) Cough
18.

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A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

(a) Albuterol

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(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate
19.
Consider the following statements with regard to respiratory examination:

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1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma

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4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?
(a) 1 and 3
(b) 2 and 4 only

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(c) 1, 2 and 4
(d) 2, 3 and 4
20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction

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(b) Fungal infection
(c) SLE
(d) Meig syndrome
21.
Which one of the following is NOT true about Ghrelin?

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(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion
(d) Fasting increases its secretion
22.

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Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation
(c) Bile acid secretory defects
(d) Pancreatic dysfunction

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23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score
(b) APACHE score
(c) MELD score

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(d) Metavir score
24.
The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery

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(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.
All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:

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(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

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--- Content provided by FirstRanker.com ---

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26.
Consider the following statements with regard to oral aphthous ulcers:

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1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases
4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

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Which of the above statements are correct?

(a) 1 and 4 only
(b) 2 and 3 only

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(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.
Which one of the following statements about Barrett?s Oesophagus is NOT correct?

--- Content provided by FirstRanker.com ---

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells
(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells

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(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.
The most common cause of acute hepatitis outbreaks in India is:

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(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B
(d) Hepatitis A

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29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

(a) Menetrier?s disease

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(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus
30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-

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gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency
(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding

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(d) Acute glomerulonephritis

31.
What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?

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(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL
(d) 13 to 14 gm/dL
32.

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Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease
(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic

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(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:
(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria

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(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.
Consider the following statements in relation to an adult patient:

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1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

Which of the statements given above are correct?

--- Content provided by FirstRanker.com ---

(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only
(d) 1, 2 and 3

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35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis
(b) Pyelonephritis
(c) Renal stone disease

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(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history
of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C

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3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

(a) Renal biopsy is rarely required for making diagnosis

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(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis
37.
Which one of the following statements is NOT correct regarding the risk factors for

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nephrolithiasis?

(a) Higher dietary calcium increases risk
(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk

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(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.
He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?

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(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis
(d) Viral encephalitis
39.

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Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac
(c) Thiamine
(d) Prednisdone

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40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe
(b) Non dominant parietal lobe
(c) Frontal lobe

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(d) Non dominant temporal lobe

41.
Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome

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(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome
42.
A patient on looking forward was found to have his right eye deviated downwards and

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outwards with pupil dilated. He is suffering from:
(a) Left 3
rd
nerve palsy
(b) Left 6

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th
nerve palsy
(c) Right 4
th
nerve palsy

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(d) Right 3
rd
nerve palsy
43.
All of the following are features of Cauda Equina syndrome EXCEPT:

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(a) Low back pain
(b) Lower limb areflexia
(c) Loss of bladder function
(d) Extensor plantar response

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44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On
examination, he had resting tremor, bradykinesia, rigidity and postural instability. This
patient is suffering most likely from:

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(a) Parkinson?s disease
(b) Vascular dementia
(c) Alzheimer?s disease
(d) Frunto temporal dementia

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45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and
turns. Heal-Shin test is normal. Which one of the following is most likely disorder?
(a) Cerebellar ataxia

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(b) Sensory ataxia
(c) Frontal gait disorder
(d) Parkinson?s disease
46.
Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following

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EXCEPT:
(a) Bradycardia
(b) Hypertension
(c) Irregular respiration
(d) Hypothermia

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47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.
Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture
(LP) and a day later reports worsening of headache. Which one of the following features is

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NOT consistent with diagnosis of ?Post-LP? headache?

(a) Post-LP headache usually begins within 48 hours
(b) Post-LP headache worsens in sitting position
(c) Post-LP headache is most severe upon waking up

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(d) Post-LP headache may improve with caffeine intake
48.
Which one of the following investigations is NOT appropriate in a case of recurrent
thrombosis?
(a) Antiphospholipid antibodies

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(b) Bcr-Abl assay
(c) Protein C and S assays
(d) Antithrombin level
49.
All of the following are causes of reactive thrombocytosis, EXCEPT:

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(a) Hemolytic anemia
(b) Megaloblastic anemia
(c) Post splenectomy
(d) Chronic inflammatory disorders

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50.
Cryoprecipitate cannot be used for treatment of which one of the following conditions?
(a) Von Willebrand disease
(b) Hypofibrinogenemia

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(c) Hemophilia?B
(d) Hemphilia?A
51.
Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic
anaemia. The disorder is inherited as an:

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(a) Autosomal recessive trait
(b) X-linked recessive trait
(c) Autosomal dominant trait
(d) X-linked dominant trait

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52.
Sickle cell disease may be associated with any of the following EXCEPT:

(a) Acute chest syndrome
(b) Aplastic crisis

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(c) Splenic sequestration crisis
(d) Conn?s syndrome

53.
Fever with splenomegaly and lymphadenopathy can be seen in

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(a) Infectious mononucleosis
(b) Chronic leukaemia
(c) Both infectious mononucleosis and chronic leukaemia
(d) Neither infectious mononucleosis nor chronic leukaemia
54.

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Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:
(a) Haemoglobin X disease
(b) Haemoglobin H disease
(c) Haemoglobin F disease

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(d) Hydrops fetalis
55.
Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?
(a) It is a clonal malignancy of haematopoetic stem
(b) Risk of developing CML is increased in monozygotic turns

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(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

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56.
Diagnostic criteria of multiple myeloma includes which of the following?

1. Increased malignant plasma cells in the bone marrow

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2. Serum and/or urinary M protein
3. Skeletal lytic lesions
4. Skeletal blastic lesions

Select the correct answer using the code given below:

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(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4
(d) 2, 3 and 4
57.

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The most predominant type of serum immunoglobulin involved in patients with plasma cell
disorder is:
(a) Ig G
(b) Ig A
(c) Ig D

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(d) Light chains
58.
Which one of the following statements is NOT true regarding the thyroid function/disorder in
pregnancy?
(a) There is an increase in the metabolism of thyroxine by placenta

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(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy
(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in
pregnancy
(d) Impaired cognitive impairment may be seen in the offspring of mother with
subclinical hypothyroidism

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59.
Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?
(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL
(b) HbA1c ? 6.5 %

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(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test
(d) Fasting plasma glucose ? 110 mg/dL
60.
A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight
gain, hair loss, tiredness and weakness. What will be the investigation of choice?

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(a) FSH & LH level
(b) Estrogen level
(c) Free T
3
and free T

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4
level
(d) Free T
4
and TSH level

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61.
Consider the following statements about erectile dysfunction in diabetic males:

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1. It affects 60 % of males
2. Its common cause is an underlying neuro-vascular pathology
3. It may be aggravated by beta-adrenergic agonist drugs
4. Endocrine disorders like hyperprolactinemia may cause it

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Which of the statements given above are true?
(a) 1 and 2
(b) 2 and 3
(c) 2 and 4
(d) 3 and 4

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62.
All of the following can cause Hyperprolactinemia, EXCEPT:
(a) Craniopharyngioma
(b) Hyperthyroidism
(c) Stress

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(d) Chronic renal failure
63.
All of the following can be seen in a case of thyrotoxicosis, EXCEPT:
(a) Atrial fibrillation
(b) Periodic paralysis

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(c) Deafness
(d) Osteoporosis
64.
Which one of the following hormones acts via the receptor tyrosine kinase?
(a) FSH

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(b) TSH
(c) IGF-1
(d) PTH
65.
Consider the following disorders as constituent of Multiple Endocrine Neoplasia Type 2a

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(MEN 2a):

1. Primary Hyperparathyroidism
2. Pituitary tumours
3. Medullary carcinoma of thyroid

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4. Pheochromocytoma

Which of the above are correct?:

(a) 1, 2 and 4

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(b) 1, 2 and 3
(c) 1, 3 and 4
(d) 2, 3 and 4

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66.
Consider the following statements with regard to Graves? ophthalmopathy :

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1. Proptosis is often asymmetric and can even appear to be unilateral
2. It is a clinical diagnosis
3. Worsening of symptoms upon glucocorticoid withdrawal is common
4. Radiation therapy is very effective in treatment

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Which of the above statements are correct?

(a) 1 and 2 only
(b) 1, 2 and 3
(c) 2, 3 and 4

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(d) 1 and 4 only
67.
All of the following are common aetiologies of delirium EXCEPT:
(a) Hyperthyroidism
(b) Hypothyroidism

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(c) Hyperparathyroidism
(d) Hypoparathyroidism
68.
Key anthropometric measurements important for evaluating the degree of obesity are:

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(a) Weight, height and waist circumference
(b) Weight, height and hip circumference
(c) Weight, height and mid-thigh circumference
(d) Weight, height and chest circumference
69.

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What is the minimum BMI (Body Mass Index) recommended for considering adjuvant
pharmacologic treatment in obesity with comorbidity?
(a) 23 kg/m
2

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(b) 25 kg/m
2

(c) 27 kg/m
2

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(d) 30 kg/m
2

70.

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A young medical student while working in HIV ward got pricked accidently on the finger by
a syringe needle which was used to draw blood from a patient. Patient?s infection status is not
known. Which one of the following therapeutic interventions will be the best interest of this
student?
(a) To start Dolultegravir immediately

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(b) To wash wound with soap and water and start Emtricitabine
(c) To give Dolutegravir + Tenofovir + Emtricitabine
(d) To give Dolutegravir + Tenofovir + Emtricitabine + HBV Immunoglobulin
71.
Cryptococcal infection is acquired through:

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(a) Inhalation route
(b) Bite of Culex mosquito
(c) Direct skin contact
(d) Ingestion of spores

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72.
Which one of the following is NOT appropriate treatment for Echinococcus granulosus and
hydatid disease?
(a) Albendazole 400 mg twice in a day for 3 months
(b) Diethylcarbamazine 2 mg/kg thrice in a day for 12 days

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(c) PAIR (percutaneous puncture, aspiration, injection of scolicide, reaspiration)
(d) Praziquantel (20 mg/kg twice daily for 14 days)
73.
Which one of the following infections is NOT amenable to post-exposure prophylaxis with
specific immunoglobulins?

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(a) Hepatitis B
(b) HIV
(c) Tetanus
(d) Rabies
74.

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Echinocandins are a class of:
(a) Antiviral agents
(b) Antiparasitic agents
(c) Antitubercular agents
(d) Antifungal agents

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75.
Recommended first time drug for initial treatment of tuberculosis include all EXCEPT:
(a) Isoniazid
(b) Rifampin
(c) Ethambutol

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(d) Ethionamide
76.
The most frequent adverse reaction of significance among people treated for drug-susceptible
tuberculosis is:
(a) Colitis

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(b) Hepatitis
(c) Cystitis
(d) Enteritis
77.
All adult patients in whom anti-tubercular treatment is being started should undergo baseline

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assessment of:
(a) Complete blood count
(b) Liver function test
(c) Lipid profile
(d) Pulmonary function test

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78.
A 30 year old male presents with fever, headache, anorexia, nausea, vomiting and diarrhoea.
On examination tongue is coated with abdominal tenderness, soft splenomegaly, relative
bradycardia and rose spots rash. The most likely diagnosis is:

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(a) Malaria fever
(b) Enteric fever
(c) Leptospirosis
(d) Dengue fever

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79.
The extrapulmonary sites most commonly involved in tuberculosis are all EXCEPT:
(a) Lymph node TB
(b) Genitourinary TB
(c) Skeletal TB

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(d) Skull TB
80.
Which of the following is NOT a clinical feature of Botulism?
(a) Impaired alertness
(b) Dysphagia

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(c) Diplopia
(d) Ptosis
81.
Post exposure prophylaxis (PEP) for HIV should contain:
(a) 2 antiretroviral drugs administered for 4 weeks

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(b) 2 antiretroviral drugs administered for 6 weeks
(c) 3 antiretroviral drugs administered for 4 weeks
(d) 3 antiretroviral drugs administered for 6 weeks
82.
Paralytic rabies is characterized by:

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(a) Maculopapular rash
(b) Flaccid muscle weakness
(c) Spastic muscle weakness
(d) Hyperexcitability and facial weakness
83.

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All of the following are seen in Marasmus EXCEPT:

(a) Reduced triceps skinfold
(b) Reduced mid arm circumference
(c) Protein wasting

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(d) Decreased body mass index
84.
A 20 year young lady presents with high grade fever for five days and palpable purpura over
extremities. She is found to be confused, with presence of neck stiffness. Which of the
following is the most likely diagnosis?

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(a) Disseminated intravascular coagulation
(b) Acute meningococcemia
(c) Antiphospholipid antibody syndrome
(d) Thrombotic thrombocytopenic purpura
85.

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Fibroblast Growth Factor 23 (FGF 23) is increased in which one of the following conditions?
(a) Osteomalacia
(b) Osteoporosis
(c) Paget?s disease
(d) Renal Osteodystrophy

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86.
Which of the following crystals are deposited in a case of pseudogout?
(a) Monosodium urate
(b) Calcium phosphate
(c) Cholestrol crystals

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(d) Calcium pyrophosphate dehydrate (CPPD)
87.
Which of the following features are associated with poor prognosis in Diffuse Cutaneous
Systemic Sclerosis?

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1. Older age
2. A high gas transfer factor for carbon monoxide (TLCO)
3. Proteinuria
4. Diffuse skin disease

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Select the correct answer using the code given below:
(a) 1, 2 and 4
(b) 3 and 4 only
(c) 1, 3 and 4
(d) 1, 2 and 3

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88.
Which of the following statements regarding pegloticase are correct?

1. It is enzyme conjugate

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2. It is useful in chronic Gout management
3. The main adverse effects are infusion reactions and development of antibodies

Select the correct answer using the code given below:
(a) 1 and 2 only

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(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
89.
The most common cause of sensorineural hearing loss in adults is:

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(a) Otosclerosis
(b) Meniere?s disease
(c) Presbycusis
(d) Meningitis
90.

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A 50-year old male presents with dizziness. Which one of the following clinical findings does
NOT favour a central cause?
(a) Poor saccades
(b) Gaze evoked nystagmus
(c) Inhibition by visual fixation

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(d) Presence of diplopia, dysarthria

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FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the

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following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation

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2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin

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(b) Glimepiride
(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The

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chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis

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(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:

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(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.

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Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy

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(d) Right Ventricular Infarction

6.
Which one of the following is NOT a common cause of atrial fibrillation?

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(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

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7.
In an ECG recording, P wave is produced by:

(a) Atrial depolarisation
(b) Atrial repolarisation

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(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

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(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine

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9.
Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine
(b) Azilsartan

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(c) Aliskiren
(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

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(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis
11.

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Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis

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12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent
(b) Moderate persistent

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(c) Severe persistent
(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:

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(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study
14.

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Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium
(b) Actinomycetes
(c) Aspergillus

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(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

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(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance
16.

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The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism

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17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain
(c) Hemoptysis

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(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

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(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate

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19.
Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis

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2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?

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(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4
20.

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All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection
(c) SLE
(d) Meig syndrome

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21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion

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(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation

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(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score

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(b) APACHE score
(c) MELD score
(d) Metavir score
24.
The blood supply of liver consists of:

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(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.

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All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus

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(d) Cryoglobulinaemia

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

26.

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Consider the following statements with regard to oral aphthous ulcers:

1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases

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4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

Which of the above statements are correct?

--- Content provided by FirstRanker.com ---

(a) 1 and 4 only
(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.

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Which one of the following statements about Barrett?s Oesophagus is NOT correct?

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells

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(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.

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The most common cause of acute hepatitis outbreaks in India is:

(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B

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(d) Hepatitis A

29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

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(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus

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30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency

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(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

31.

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What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL

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(d) 13 to 14 gm/dL
32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease

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(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:

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(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.

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Consider the following statements in relation to an adult patient:

1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

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Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only

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(d) 1, 2 and 3

35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis

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(b) Pyelonephritis
(c) Renal stone disease
(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history

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of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

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(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis

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37.
Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

(a) Higher dietary calcium increases risk

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(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.

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He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis

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(d) Viral encephalitis
39.
Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac

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(c) Thiamine
(d) Prednisdone
40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe

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(b) Non dominant parietal lobe
(c) Frontal lobe
(d) Non dominant temporal lobe

41.

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Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome
(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome

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42.
A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:
(a) Left 3
rd

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nerve palsy
(b) Left 6
th
nerve palsy
(c) Right 4

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th
nerve palsy
(d) Right 3
rd
nerve palsy

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43.
All of the following are features of Cauda Equina syndrome EXCEPT:

(a) Low back pain
(b) Lower limb areflexia

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(c) Loss of bladder function
(d) Extensor plantar response

44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On

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examination, he had resting tremor, bradykinesia, rigidity and postural instability. This
patient is suffering most likely from:

(a) Parkinson?s disease
(b) Vascular dementia

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(c) Alzheimer?s disease
(d) Frunto temporal dementia
45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and

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turns. Heal-Shin test is normal. Which one of the following is most likely disorder?
(a) Cerebellar ataxia
(b) Sensory ataxia
(c) Frontal gait disorder
(d) Parkinson?s disease

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46.
Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following
EXCEPT:
(a) Bradycardia
(b) Hypertension

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(c) Irregular respiration
(d) Hypothermia

47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.

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Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture
(LP) and a day later reports worsening of headache. Which one of the following features is
NOT consistent with diagnosis of ?Post-LP? headache?

(a) Post-LP headache usually begins within 48 hours

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(b) Post-LP headache worsens in sitting position
(c) Post-LP headache is most severe upon waking up
(d) Post-LP headache may improve with caffeine intake
48.
Which one of the following investigations is NOT appropriate in a case of recurrent

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thrombosis?
(a) Antiphospholipid antibodies
(b) Bcr-Abl assay
(c) Protein C and S assays
(d) Antithrombin level

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49.
All of the following are causes of reactive thrombocytosis, EXCEPT:
(a) Hemolytic anemia
(b) Megaloblastic anemia
(c) Post splenectomy

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(d) Chronic inflammatory disorders


50.
Cryoprecipitate cannot be used for treatment of which one of the following conditions?

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(a) Von Willebrand disease
(b) Hypofibrinogenemia
(c) Hemophilia?B
(d) Hemphilia?A
51.

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Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic
anaemia. The disorder is inherited as an:

(a) Autosomal recessive trait
(b) X-linked recessive trait

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(c) Autosomal dominant trait
(d) X-linked dominant trait
52.
Sickle cell disease may be associated with any of the following EXCEPT:

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(a) Acute chest syndrome
(b) Aplastic crisis
(c) Splenic sequestration crisis
(d) Conn?s syndrome

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53.
Fever with splenomegaly and lymphadenopathy can be seen in
(a) Infectious mononucleosis
(b) Chronic leukaemia
(c) Both infectious mononucleosis and chronic leukaemia

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(d) Neither infectious mononucleosis nor chronic leukaemia
54.
Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:
(a) Haemoglobin X disease

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(b) Haemoglobin H disease
(c) Haemoglobin F disease
(d) Hydrops fetalis
55.
Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?

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(a) It is a clonal malignancy of haematopoetic stem
(b) Risk of developing CML is increased in monozygotic turns
(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

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56.
Diagnostic criteria of multiple myeloma includes which of the following?

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1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary M protein
3. Skeletal lytic lesions
4. Skeletal blastic lesions

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Select the correct answer using the code given below:
(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4

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(d) 2, 3 and 4
57.
The most predominant type of serum immunoglobulin involved in patients with plasma cell
disorder is:
(a) Ig G

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(b) Ig A
(c) Ig D
(d) Light chains
58.
Which one of the following statements is NOT true regarding the thyroid function/disorder in

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pregnancy?
(a) There is an increase in the metabolism of thyroxine by placenta
(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy
(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in
pregnancy

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(d) Impaired cognitive impairment may be seen in the offspring of mother with
subclinical hypothyroidism

59.
Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?

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(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL
(b) HbA1c ? 6.5 %
(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test
(d) Fasting plasma glucose ? 110 mg/dL
60.

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A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight
gain, hair loss, tiredness and weakness. What will be the investigation of choice?
(a) FSH & LH level
(b) Estrogen level
(c) Free T

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3
and free T
4
level
(d) Free T

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4
and TSH level

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61.

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Consider the following statements about erectile dysfunction in diabetic males:

1. It affects 60 % of males
2. Its common cause is an underlying neuro-vascular pathology
3. It may be aggravated by beta-adrenergic agonist drugs

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4. Endocrine disorders like hyperprolactinemia may cause it

Which of the statements given above are true?
(a) 1 and 2
(b) 2 and 3

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(c) 2 and 4
(d) 3 and 4
62.
All of the following can cause Hyperprolactinemia, EXCEPT:
(a) Craniopharyngioma

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(b) Hyperthyroidism
(c) Stress
(d) Chronic renal failure
63.
All of the following can be seen in a case of thyrotoxicosis, EXCEPT:

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(a) Atrial fibrillation
(b) Periodic paralysis
(c) Deafness
(d) Osteoporosis
64.

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Which one of the following hormones acts via the receptor tyrosine kinase?
(a) FSH
(b) TSH
(c) IGF-1
(d) PTH

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65.
Consider the following disorders as constituent of Multiple Endocrine Neoplasia Type 2a
(MEN 2a):

1. Primary Hyperparathyroidism

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2. Pituitary tumours
3. Medullary carcinoma of thyroid
4. Pheochromocytoma

Which of the above are correct?:

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(a) 1, 2 and 4
(b) 1, 2 and 3
(c) 1, 3 and 4
(d) 2, 3 and 4

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66.

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Consider the following statements with regard to Graves? ophthalmopathy :

1. Proptosis is often asymmetric and can even appear to be unilateral
2. It is a clinical diagnosis
3. Worsening of symptoms upon glucocorticoid withdrawal is common

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4. Radiation therapy is very effective in treatment

Which of the above statements are correct?

(a) 1 and 2 only

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(b) 1, 2 and 3
(c) 2, 3 and 4
(d) 1 and 4 only
67.
All of the following are common aetiologies of delirium EXCEPT:

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(a) Hyperthyroidism
(b) Hypothyroidism
(c) Hyperparathyroidism
(d) Hypoparathyroidism
68.

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Key anthropometric measurements important for evaluating the degree of obesity are:

(a) Weight, height and waist circumference
(b) Weight, height and hip circumference
(c) Weight, height and mid-thigh circumference

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(d) Weight, height and chest circumference
69.
What is the minimum BMI (Body Mass Index) recommended for considering adjuvant
pharmacologic treatment in obesity with comorbidity?
(a) 23 kg/m

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2

(b) 25 kg/m
2

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(c) 27 kg/m
2

(d) 30 kg/m
2

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70.
A young medical student while working in HIV ward got pricked accidently on the finger by
a syringe needle which was used to draw blood from a patient. Patient?s infection status is not
known. Which one of the following therapeutic interventions will be the best interest of this

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student?
(a) To start Dolultegravir immediately
(b) To wash wound with soap and water and start Emtricitabine
(c) To give Dolutegravir + Tenofovir + Emtricitabine
(d) To give Dolutegravir + Tenofovir + Emtricitabine + HBV Immunoglobulin

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71.
Cryptococcal infection is acquired through:
(a) Inhalation route
(b) Bite of Culex mosquito
(c) Direct skin contact

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(d) Ingestion of spores

72.
Which one of the following is NOT appropriate treatment for Echinococcus granulosus and
hydatid disease?

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(a) Albendazole 400 mg twice in a day for 3 months
(b) Diethylcarbamazine 2 mg/kg thrice in a day for 12 days
(c) PAIR (percutaneous puncture, aspiration, injection of scolicide, reaspiration)
(d) Praziquantel (20 mg/kg twice daily for 14 days)
73.

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Which one of the following infections is NOT amenable to post-exposure prophylaxis with
specific immunoglobulins?
(a) Hepatitis B
(b) HIV
(c) Tetanus

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(d) Rabies
74.
Echinocandins are a class of:
(a) Antiviral agents
(b) Antiparasitic agents

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(c) Antitubercular agents
(d) Antifungal agents
75.
Recommended first time drug for initial treatment of tuberculosis include all EXCEPT:
(a) Isoniazid

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(b) Rifampin
(c) Ethambutol
(d) Ethionamide
76.
The most frequent adverse reaction of significance among people treated for drug-susceptible

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tuberculosis is:
(a) Colitis
(b) Hepatitis
(c) Cystitis
(d) Enteritis

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77.
All adult patients in whom anti-tubercular treatment is being started should undergo baseline
assessment of:
(a) Complete blood count
(b) Liver function test

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(c) Lipid profile
(d) Pulmonary function test
78.
A 30 year old male presents with fever, headache, anorexia, nausea, vomiting and diarrhoea.
On examination tongue is coated with abdominal tenderness, soft splenomegaly, relative

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bradycardia and rose spots rash. The most likely diagnosis is:

(a) Malaria fever
(b) Enteric fever
(c) Leptospirosis

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(d) Dengue fever

79.
The extrapulmonary sites most commonly involved in tuberculosis are all EXCEPT:
(a) Lymph node TB

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(b) Genitourinary TB
(c) Skeletal TB
(d) Skull TB
80.
Which of the following is NOT a clinical feature of Botulism?

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(a) Impaired alertness
(b) Dysphagia
(c) Diplopia
(d) Ptosis
81.

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Post exposure prophylaxis (PEP) for HIV should contain:
(a) 2 antiretroviral drugs administered for 4 weeks
(b) 2 antiretroviral drugs administered for 6 weeks
(c) 3 antiretroviral drugs administered for 4 weeks
(d) 3 antiretroviral drugs administered for 6 weeks

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82.
Paralytic rabies is characterized by:
(a) Maculopapular rash
(b) Flaccid muscle weakness
(c) Spastic muscle weakness

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(d) Hyperexcitability and facial weakness
83.
All of the following are seen in Marasmus EXCEPT:

(a) Reduced triceps skinfold

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(b) Reduced mid arm circumference
(c) Protein wasting
(d) Decreased body mass index
84.
A 20 year young lady presents with high grade fever for five days and palpable purpura over

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extremities. She is found to be confused, with presence of neck stiffness. Which of the
following is the most likely diagnosis?
(a) Disseminated intravascular coagulation
(b) Acute meningococcemia
(c) Antiphospholipid antibody syndrome

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(d) Thrombotic thrombocytopenic purpura
85.
Fibroblast Growth Factor 23 (FGF 23) is increased in which one of the following conditions?
(a) Osteomalacia
(b) Osteoporosis

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(c) Paget?s disease
(d) Renal Osteodystrophy

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86.
Which of the following crystals are deposited in a case of pseudogout?
(a) Monosodium urate

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(b) Calcium phosphate
(c) Cholestrol crystals
(d) Calcium pyrophosphate dehydrate (CPPD)
87.
Which of the following features are associated with poor prognosis in Diffuse Cutaneous

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Systemic Sclerosis?

1. Older age
2. A high gas transfer factor for carbon monoxide (TLCO)
3. Proteinuria

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4. Diffuse skin disease

Select the correct answer using the code given below:
(a) 1, 2 and 4
(b) 3 and 4 only

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(c) 1, 3 and 4
(d) 1, 2 and 3

88.
Which of the following statements regarding pegloticase are correct?

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1. It is enzyme conjugate
2. It is useful in chronic Gout management
3. The main adverse effects are infusion reactions and development of antibodies

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Select the correct answer using the code given below:
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3

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89.
The most common cause of sensorineural hearing loss in adults is:
(a) Otosclerosis
(b) Meniere?s disease
(c) Presbycusis

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(d) Meningitis
90.
A 50-year old male presents with dizziness. Which one of the following clinical findings does
NOT favour a central cause?
(a) Poor saccades

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(b) Gaze evoked nystagmus
(c) Inhibition by visual fixation
(d) Presence of diplopia, dysarthria

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91.
A young primigravida with 11 weeks pregnancy presents with sudden onset pain and
swelling of left lower limb. Homan?s sign is positive. Duplex ultrasonogram shows non-

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compressibility of veins in the affected region, with absent flow. The drug of choice for
treatment is:
(a) Enoxaparin
(b) Amoxycillin?Clavulanic acid
(c) Warfarin

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(d) Limb elevation only
92.
All of the following are clinical features of hypovolaemic shock EXCEPT:
(a) Cold clammy skin
(b) Bradycardia

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(c) Hypotension
(d) Oliguria
93.
Which one of the following is most appropriate to describe classic heat stroke?
(a) Patients core body temperature rises above 44?C with headache, nausea and loss of

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consciousness
(b) Patients core body temperature rises above 40 ?C with muscle tremors, confusion,
loss of consciousness and loss of sweating
(c) Patients core body temperature rises above 38 ?C with increased sweating,
tachypnoea, tachycardia and loss of consciousness

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(d) Patients core body temperature is above 40 ?C with disorientation, increased
sweating, peripheral vasodilation, tachycardia and loss of consciousness
94.
Which of the following is NOT a priority in the initial management of shock from venomous
snake?

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(a) Aggressive volume resuscitation
(b) Vasopressor support
(c) Anti-venom administration
(d) All of these are undertaken simultaneously

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95.
Which one of the following is NOT an appropriate criterion for diagnosis of Systemic
Inflammatory Response Syndrome (SIRS)?
(a) Respiratory rate > 20/mm

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(b) Heart rate > 90/min
(c) Total leucocyte count > 16 ? 10
9
per Litre
(d) Temperature > 38

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0
C

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the

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following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation

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2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin

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(b) Glimepiride
(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The

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chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis

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(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:

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(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.

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Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy

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(d) Right Ventricular Infarction

6.
Which one of the following is NOT a common cause of atrial fibrillation?

--- Content provided by FirstRanker.com ---

(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

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7.
In an ECG recording, P wave is produced by:

(a) Atrial depolarisation
(b) Atrial repolarisation

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(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

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(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine

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9.
Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine
(b) Azilsartan

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(c) Aliskiren
(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

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(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis
11.

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Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis

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12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent
(b) Moderate persistent

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(c) Severe persistent
(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:

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(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study
14.

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Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium
(b) Actinomycetes
(c) Aspergillus

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(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

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(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance
16.

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The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism

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17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain
(c) Hemoptysis

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(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

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(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate

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19.
Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis

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2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?

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(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4
20.

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All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection
(c) SLE
(d) Meig syndrome

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21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion

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(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation

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(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score

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(b) APACHE score
(c) MELD score
(d) Metavir score
24.
The blood supply of liver consists of:

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(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.

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All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus

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(d) Cryoglobulinaemia

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26.

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Consider the following statements with regard to oral aphthous ulcers:

1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases

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4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

Which of the above statements are correct?

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(a) 1 and 4 only
(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.

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Which one of the following statements about Barrett?s Oesophagus is NOT correct?

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells

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(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.

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The most common cause of acute hepatitis outbreaks in India is:

(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B

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(d) Hepatitis A

29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

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(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus

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30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency

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(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

31.

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What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL

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(d) 13 to 14 gm/dL
32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease

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(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:

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(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.

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Consider the following statements in relation to an adult patient:

1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

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Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only

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(d) 1, 2 and 3

35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis

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(b) Pyelonephritis
(c) Renal stone disease
(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history

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of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

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(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis

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37.
Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

(a) Higher dietary calcium increases risk

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(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.

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He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis

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(d) Viral encephalitis
39.
Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac

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(c) Thiamine
(d) Prednisdone
40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe

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(b) Non dominant parietal lobe
(c) Frontal lobe
(d) Non dominant temporal lobe

41.

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Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome
(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome

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42.
A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:
(a) Left 3
rd

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nerve palsy
(b) Left 6
th
nerve palsy
(c) Right 4

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th
nerve palsy
(d) Right 3
rd
nerve palsy

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43.
All of the following are features of Cauda Equina syndrome EXCEPT:

(a) Low back pain
(b) Lower limb areflexia

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(c) Loss of bladder function
(d) Extensor plantar response

44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On

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examination, he had resting tremor, bradykinesia, rigidity and postural instability. This
patient is suffering most likely from:

(a) Parkinson?s disease
(b) Vascular dementia

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(c) Alzheimer?s disease
(d) Frunto temporal dementia
45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and

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turns. Heal-Shin test is normal. Which one of the following is most likely disorder?
(a) Cerebellar ataxia
(b) Sensory ataxia
(c) Frontal gait disorder
(d) Parkinson?s disease

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46.
Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following
EXCEPT:
(a) Bradycardia
(b) Hypertension

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(c) Irregular respiration
(d) Hypothermia

47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.

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Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture
(LP) and a day later reports worsening of headache. Which one of the following features is
NOT consistent with diagnosis of ?Post-LP? headache?

(a) Post-LP headache usually begins within 48 hours

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(b) Post-LP headache worsens in sitting position
(c) Post-LP headache is most severe upon waking up
(d) Post-LP headache may improve with caffeine intake
48.
Which one of the following investigations is NOT appropriate in a case of recurrent

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thrombosis?
(a) Antiphospholipid antibodies
(b) Bcr-Abl assay
(c) Protein C and S assays
(d) Antithrombin level

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49.
All of the following are causes of reactive thrombocytosis, EXCEPT:
(a) Hemolytic anemia
(b) Megaloblastic anemia
(c) Post splenectomy

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(d) Chronic inflammatory disorders


50.
Cryoprecipitate cannot be used for treatment of which one of the following conditions?

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(a) Von Willebrand disease
(b) Hypofibrinogenemia
(c) Hemophilia?B
(d) Hemphilia?A
51.

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Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic
anaemia. The disorder is inherited as an:

(a) Autosomal recessive trait
(b) X-linked recessive trait

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(c) Autosomal dominant trait
(d) X-linked dominant trait
52.
Sickle cell disease may be associated with any of the following EXCEPT:

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(a) Acute chest syndrome
(b) Aplastic crisis
(c) Splenic sequestration crisis
(d) Conn?s syndrome

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53.
Fever with splenomegaly and lymphadenopathy can be seen in
(a) Infectious mononucleosis
(b) Chronic leukaemia
(c) Both infectious mononucleosis and chronic leukaemia

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(d) Neither infectious mononucleosis nor chronic leukaemia
54.
Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:
(a) Haemoglobin X disease

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(b) Haemoglobin H disease
(c) Haemoglobin F disease
(d) Hydrops fetalis
55.
Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?

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(a) It is a clonal malignancy of haematopoetic stem
(b) Risk of developing CML is increased in monozygotic turns
(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

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56.
Diagnostic criteria of multiple myeloma includes which of the following?

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1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary M protein
3. Skeletal lytic lesions
4. Skeletal blastic lesions

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Select the correct answer using the code given below:
(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4

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(d) 2, 3 and 4
57.
The most predominant type of serum immunoglobulin involved in patients with plasma cell
disorder is:
(a) Ig G

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(b) Ig A
(c) Ig D
(d) Light chains
58.
Which one of the following statements is NOT true regarding the thyroid function/disorder in

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pregnancy?
(a) There is an increase in the metabolism of thyroxine by placenta
(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy
(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in
pregnancy

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(d) Impaired cognitive impairment may be seen in the offspring of mother with
subclinical hypothyroidism

59.
Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?

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(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL
(b) HbA1c ? 6.5 %
(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test
(d) Fasting plasma glucose ? 110 mg/dL
60.

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A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight
gain, hair loss, tiredness and weakness. What will be the investigation of choice?
(a) FSH & LH level
(b) Estrogen level
(c) Free T

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3
and free T
4
level
(d) Free T

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4
and TSH level

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61.

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Consider the following statements about erectile dysfunction in diabetic males:

1. It affects 60 % of males
2. Its common cause is an underlying neuro-vascular pathology
3. It may be aggravated by beta-adrenergic agonist drugs

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4. Endocrine disorders like hyperprolactinemia may cause it

Which of the statements given above are true?
(a) 1 and 2
(b) 2 and 3

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(c) 2 and 4
(d) 3 and 4
62.
All of the following can cause Hyperprolactinemia, EXCEPT:
(a) Craniopharyngioma

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(b) Hyperthyroidism
(c) Stress
(d) Chronic renal failure
63.
All of the following can be seen in a case of thyrotoxicosis, EXCEPT:

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(a) Atrial fibrillation
(b) Periodic paralysis
(c) Deafness
(d) Osteoporosis
64.

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Which one of the following hormones acts via the receptor tyrosine kinase?
(a) FSH
(b) TSH
(c) IGF-1
(d) PTH

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65.
Consider the following disorders as constituent of Multiple Endocrine Neoplasia Type 2a
(MEN 2a):

1. Primary Hyperparathyroidism

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2. Pituitary tumours
3. Medullary carcinoma of thyroid
4. Pheochromocytoma

Which of the above are correct?:

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(a) 1, 2 and 4
(b) 1, 2 and 3
(c) 1, 3 and 4
(d) 2, 3 and 4

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66.

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Consider the following statements with regard to Graves? ophthalmopathy :

1. Proptosis is often asymmetric and can even appear to be unilateral
2. It is a clinical diagnosis
3. Worsening of symptoms upon glucocorticoid withdrawal is common

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4. Radiation therapy is very effective in treatment

Which of the above statements are correct?

(a) 1 and 2 only

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(b) 1, 2 and 3
(c) 2, 3 and 4
(d) 1 and 4 only
67.
All of the following are common aetiologies of delirium EXCEPT:

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(a) Hyperthyroidism
(b) Hypothyroidism
(c) Hyperparathyroidism
(d) Hypoparathyroidism
68.

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Key anthropometric measurements important for evaluating the degree of obesity are:

(a) Weight, height and waist circumference
(b) Weight, height and hip circumference
(c) Weight, height and mid-thigh circumference

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(d) Weight, height and chest circumference
69.
What is the minimum BMI (Body Mass Index) recommended for considering adjuvant
pharmacologic treatment in obesity with comorbidity?
(a) 23 kg/m

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2

(b) 25 kg/m
2

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(c) 27 kg/m
2

(d) 30 kg/m
2

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70.
A young medical student while working in HIV ward got pricked accidently on the finger by
a syringe needle which was used to draw blood from a patient. Patient?s infection status is not
known. Which one of the following therapeutic interventions will be the best interest of this

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student?
(a) To start Dolultegravir immediately
(b) To wash wound with soap and water and start Emtricitabine
(c) To give Dolutegravir + Tenofovir + Emtricitabine
(d) To give Dolutegravir + Tenofovir + Emtricitabine + HBV Immunoglobulin

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71.
Cryptococcal infection is acquired through:
(a) Inhalation route
(b) Bite of Culex mosquito
(c) Direct skin contact

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(d) Ingestion of spores

72.
Which one of the following is NOT appropriate treatment for Echinococcus granulosus and
hydatid disease?

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(a) Albendazole 400 mg twice in a day for 3 months
(b) Diethylcarbamazine 2 mg/kg thrice in a day for 12 days
(c) PAIR (percutaneous puncture, aspiration, injection of scolicide, reaspiration)
(d) Praziquantel (20 mg/kg twice daily for 14 days)
73.

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Which one of the following infections is NOT amenable to post-exposure prophylaxis with
specific immunoglobulins?
(a) Hepatitis B
(b) HIV
(c) Tetanus

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(d) Rabies
74.
Echinocandins are a class of:
(a) Antiviral agents
(b) Antiparasitic agents

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(c) Antitubercular agents
(d) Antifungal agents
75.
Recommended first time drug for initial treatment of tuberculosis include all EXCEPT:
(a) Isoniazid

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(b) Rifampin
(c) Ethambutol
(d) Ethionamide
76.
The most frequent adverse reaction of significance among people treated for drug-susceptible

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tuberculosis is:
(a) Colitis
(b) Hepatitis
(c) Cystitis
(d) Enteritis

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77.
All adult patients in whom anti-tubercular treatment is being started should undergo baseline
assessment of:
(a) Complete blood count
(b) Liver function test

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(c) Lipid profile
(d) Pulmonary function test
78.
A 30 year old male presents with fever, headache, anorexia, nausea, vomiting and diarrhoea.
On examination tongue is coated with abdominal tenderness, soft splenomegaly, relative

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bradycardia and rose spots rash. The most likely diagnosis is:

(a) Malaria fever
(b) Enteric fever
(c) Leptospirosis

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(d) Dengue fever

79.
The extrapulmonary sites most commonly involved in tuberculosis are all EXCEPT:
(a) Lymph node TB

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(b) Genitourinary TB
(c) Skeletal TB
(d) Skull TB
80.
Which of the following is NOT a clinical feature of Botulism?

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(a) Impaired alertness
(b) Dysphagia
(c) Diplopia
(d) Ptosis
81.

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Post exposure prophylaxis (PEP) for HIV should contain:
(a) 2 antiretroviral drugs administered for 4 weeks
(b) 2 antiretroviral drugs administered for 6 weeks
(c) 3 antiretroviral drugs administered for 4 weeks
(d) 3 antiretroviral drugs administered for 6 weeks

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82.
Paralytic rabies is characterized by:
(a) Maculopapular rash
(b) Flaccid muscle weakness
(c) Spastic muscle weakness

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(d) Hyperexcitability and facial weakness
83.
All of the following are seen in Marasmus EXCEPT:

(a) Reduced triceps skinfold

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(b) Reduced mid arm circumference
(c) Protein wasting
(d) Decreased body mass index
84.
A 20 year young lady presents with high grade fever for five days and palpable purpura over

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extremities. She is found to be confused, with presence of neck stiffness. Which of the
following is the most likely diagnosis?
(a) Disseminated intravascular coagulation
(b) Acute meningococcemia
(c) Antiphospholipid antibody syndrome

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(d) Thrombotic thrombocytopenic purpura
85.
Fibroblast Growth Factor 23 (FGF 23) is increased in which one of the following conditions?
(a) Osteomalacia
(b) Osteoporosis

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(c) Paget?s disease
(d) Renal Osteodystrophy

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86.
Which of the following crystals are deposited in a case of pseudogout?
(a) Monosodium urate

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(b) Calcium phosphate
(c) Cholestrol crystals
(d) Calcium pyrophosphate dehydrate (CPPD)
87.
Which of the following features are associated with poor prognosis in Diffuse Cutaneous

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Systemic Sclerosis?

1. Older age
2. A high gas transfer factor for carbon monoxide (TLCO)
3. Proteinuria

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4. Diffuse skin disease

Select the correct answer using the code given below:
(a) 1, 2 and 4
(b) 3 and 4 only

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(c) 1, 3 and 4
(d) 1, 2 and 3

88.
Which of the following statements regarding pegloticase are correct?

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1. It is enzyme conjugate
2. It is useful in chronic Gout management
3. The main adverse effects are infusion reactions and development of antibodies

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Select the correct answer using the code given below:
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3

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89.
The most common cause of sensorineural hearing loss in adults is:
(a) Otosclerosis
(b) Meniere?s disease
(c) Presbycusis

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(d) Meningitis
90.
A 50-year old male presents with dizziness. Which one of the following clinical findings does
NOT favour a central cause?
(a) Poor saccades

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(b) Gaze evoked nystagmus
(c) Inhibition by visual fixation
(d) Presence of diplopia, dysarthria

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91.
A young primigravida with 11 weeks pregnancy presents with sudden onset pain and
swelling of left lower limb. Homan?s sign is positive. Duplex ultrasonogram shows non-

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compressibility of veins in the affected region, with absent flow. The drug of choice for
treatment is:
(a) Enoxaparin
(b) Amoxycillin?Clavulanic acid
(c) Warfarin

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(d) Limb elevation only
92.
All of the following are clinical features of hypovolaemic shock EXCEPT:
(a) Cold clammy skin
(b) Bradycardia

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(c) Hypotension
(d) Oliguria
93.
Which one of the following is most appropriate to describe classic heat stroke?
(a) Patients core body temperature rises above 44?C with headache, nausea and loss of

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consciousness
(b) Patients core body temperature rises above 40 ?C with muscle tremors, confusion,
loss of consciousness and loss of sweating
(c) Patients core body temperature rises above 38 ?C with increased sweating,
tachypnoea, tachycardia and loss of consciousness

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(d) Patients core body temperature is above 40 ?C with disorientation, increased
sweating, peripheral vasodilation, tachycardia and loss of consciousness
94.
Which of the following is NOT a priority in the initial management of shock from venomous
snake?

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(a) Aggressive volume resuscitation
(b) Vasopressor support
(c) Anti-venom administration
(d) All of these are undertaken simultaneously

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95.
Which one of the following is NOT an appropriate criterion for diagnosis of Systemic
Inflammatory Response Syndrome (SIRS)?
(a) Respiratory rate > 20/mm

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(b) Heart rate > 90/min
(c) Total leucocyte count > 16 ? 10
9
per Litre
(d) Temperature > 38

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0
C

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96.
All of the following predispose to Acute Respiratory Distress Syndrome EXCEPT:
(a) Acute Pancreatitis
(b) Toxic gas inhalation
(c) Aspiration of gastric contents

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(d) Severe Bronchial asthma
97.
An 8 year old child has consumed a few tablets of a drug that were being taken by his mother
on a regular basis. Following this the child develops gastric necrosis, acidosis, shock and
hepatic necrosis. Which is the most likely drug?

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(a) Multivitamins
(b) Calcium carbonate
(c) Folic acid
(d) Iron
98.

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A newborn weighing 1.5 kg at birth presents at 6 hours of age with lethargy, weak and high
pitched cry and difficulty in feeding. What is the next step in management?

(a) Estimation of blood sugar
(b) Estimation of serum calcium

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(c) Supplementary oxygen
(d) Bedside electrocardiogram

99.
In a child with acute organophosphorus poisoning, which one of the following drugs will act

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as anti-sialogogue and peripheral parasympatholytic agent?

(a) Carbamates
(b) Atropine
(c) Benzodiazepine

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(d) Pralidoxime
100.
A 6-year old child needs to undergo a central Catheter placement for total parental nutrition.
The procedure is likely to evoke pain and anxiety. Which of the following is the most
appropriate drug for sedation and analgesia in this child?

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(a) Chloral hydrate
(b) Midozolam
(c) Propofol
(d) Ketamine

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101.
Which one of the following is the drug of choice in a child presenting with supraventricular
tachycardia?

(a) Atropine

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(b) Lidocaine
(c) Adenosine
(d) Nalaxone

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FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the

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following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation

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2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin

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(b) Glimepiride
(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The

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chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis

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(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:

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(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.

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Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy

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(d) Right Ventricular Infarction

6.
Which one of the following is NOT a common cause of atrial fibrillation?

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(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

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7.
In an ECG recording, P wave is produced by:

(a) Atrial depolarisation
(b) Atrial repolarisation

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(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

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(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine

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9.
Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine
(b) Azilsartan

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(c) Aliskiren
(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

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(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis
11.

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Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis

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12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent
(b) Moderate persistent

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(c) Severe persistent
(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:

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(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study
14.

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Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium
(b) Actinomycetes
(c) Aspergillus

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(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

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(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance
16.

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The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism

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17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain
(c) Hemoptysis

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(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

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(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate

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19.
Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis

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2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?

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(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4
20.

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All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection
(c) SLE
(d) Meig syndrome

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21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion

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(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation

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(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score

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(b) APACHE score
(c) MELD score
(d) Metavir score
24.
The blood supply of liver consists of:

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(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.

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All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus

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(d) Cryoglobulinaemia

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26.

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Consider the following statements with regard to oral aphthous ulcers:

1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases

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4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

Which of the above statements are correct?

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(a) 1 and 4 only
(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.

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Which one of the following statements about Barrett?s Oesophagus is NOT correct?

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells

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(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.

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The most common cause of acute hepatitis outbreaks in India is:

(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B

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(d) Hepatitis A

29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

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(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus

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30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency

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(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

31.

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What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL

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(d) 13 to 14 gm/dL
32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease

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(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:

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(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.

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Consider the following statements in relation to an adult patient:

1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

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Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only

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(d) 1, 2 and 3

35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis

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(b) Pyelonephritis
(c) Renal stone disease
(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history

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of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

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(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis

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37.
Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

(a) Higher dietary calcium increases risk

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(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.

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He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis

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(d) Viral encephalitis
39.
Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac

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(c) Thiamine
(d) Prednisdone
40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe

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(b) Non dominant parietal lobe
(c) Frontal lobe
(d) Non dominant temporal lobe

41.

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Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome
(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome

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42.
A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:
(a) Left 3
rd

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nerve palsy
(b) Left 6
th
nerve palsy
(c) Right 4

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th
nerve palsy
(d) Right 3
rd
nerve palsy

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43.
All of the following are features of Cauda Equina syndrome EXCEPT:

(a) Low back pain
(b) Lower limb areflexia

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(c) Loss of bladder function
(d) Extensor plantar response

44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On

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examination, he had resting tremor, bradykinesia, rigidity and postural instability. This
patient is suffering most likely from:

(a) Parkinson?s disease
(b) Vascular dementia

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(c) Alzheimer?s disease
(d) Frunto temporal dementia
45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and

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turns. Heal-Shin test is normal. Which one of the following is most likely disorder?
(a) Cerebellar ataxia
(b) Sensory ataxia
(c) Frontal gait disorder
(d) Parkinson?s disease

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46.
Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following
EXCEPT:
(a) Bradycardia
(b) Hypertension

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(c) Irregular respiration
(d) Hypothermia

47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.

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Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture
(LP) and a day later reports worsening of headache. Which one of the following features is
NOT consistent with diagnosis of ?Post-LP? headache?

(a) Post-LP headache usually begins within 48 hours

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(b) Post-LP headache worsens in sitting position
(c) Post-LP headache is most severe upon waking up
(d) Post-LP headache may improve with caffeine intake
48.
Which one of the following investigations is NOT appropriate in a case of recurrent

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thrombosis?
(a) Antiphospholipid antibodies
(b) Bcr-Abl assay
(c) Protein C and S assays
(d) Antithrombin level

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49.
All of the following are causes of reactive thrombocytosis, EXCEPT:
(a) Hemolytic anemia
(b) Megaloblastic anemia
(c) Post splenectomy

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(d) Chronic inflammatory disorders


50.
Cryoprecipitate cannot be used for treatment of which one of the following conditions?

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(a) Von Willebrand disease
(b) Hypofibrinogenemia
(c) Hemophilia?B
(d) Hemphilia?A
51.

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Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic
anaemia. The disorder is inherited as an:

(a) Autosomal recessive trait
(b) X-linked recessive trait

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(c) Autosomal dominant trait
(d) X-linked dominant trait
52.
Sickle cell disease may be associated with any of the following EXCEPT:

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(a) Acute chest syndrome
(b) Aplastic crisis
(c) Splenic sequestration crisis
(d) Conn?s syndrome

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53.
Fever with splenomegaly and lymphadenopathy can be seen in
(a) Infectious mononucleosis
(b) Chronic leukaemia
(c) Both infectious mononucleosis and chronic leukaemia

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(d) Neither infectious mononucleosis nor chronic leukaemia
54.
Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:
(a) Haemoglobin X disease

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(b) Haemoglobin H disease
(c) Haemoglobin F disease
(d) Hydrops fetalis
55.
Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?

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(a) It is a clonal malignancy of haematopoetic stem
(b) Risk of developing CML is increased in monozygotic turns
(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

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56.
Diagnostic criteria of multiple myeloma includes which of the following?

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1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary M protein
3. Skeletal lytic lesions
4. Skeletal blastic lesions

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Select the correct answer using the code given below:
(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4

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(d) 2, 3 and 4
57.
The most predominant type of serum immunoglobulin involved in patients with plasma cell
disorder is:
(a) Ig G

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(b) Ig A
(c) Ig D
(d) Light chains
58.
Which one of the following statements is NOT true regarding the thyroid function/disorder in

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pregnancy?
(a) There is an increase in the metabolism of thyroxine by placenta
(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy
(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in
pregnancy

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(d) Impaired cognitive impairment may be seen in the offspring of mother with
subclinical hypothyroidism

59.
Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?

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(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL
(b) HbA1c ? 6.5 %
(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test
(d) Fasting plasma glucose ? 110 mg/dL
60.

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A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight
gain, hair loss, tiredness and weakness. What will be the investigation of choice?
(a) FSH & LH level
(b) Estrogen level
(c) Free T

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3
and free T
4
level
(d) Free T

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4
and TSH level

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61.

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Consider the following statements about erectile dysfunction in diabetic males:

1. It affects 60 % of males
2. Its common cause is an underlying neuro-vascular pathology
3. It may be aggravated by beta-adrenergic agonist drugs

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4. Endocrine disorders like hyperprolactinemia may cause it

Which of the statements given above are true?
(a) 1 and 2
(b) 2 and 3

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(c) 2 and 4
(d) 3 and 4
62.
All of the following can cause Hyperprolactinemia, EXCEPT:
(a) Craniopharyngioma

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(b) Hyperthyroidism
(c) Stress
(d) Chronic renal failure
63.
All of the following can be seen in a case of thyrotoxicosis, EXCEPT:

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(a) Atrial fibrillation
(b) Periodic paralysis
(c) Deafness
(d) Osteoporosis
64.

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Which one of the following hormones acts via the receptor tyrosine kinase?
(a) FSH
(b) TSH
(c) IGF-1
(d) PTH

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65.
Consider the following disorders as constituent of Multiple Endocrine Neoplasia Type 2a
(MEN 2a):

1. Primary Hyperparathyroidism

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2. Pituitary tumours
3. Medullary carcinoma of thyroid
4. Pheochromocytoma

Which of the above are correct?:

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(a) 1, 2 and 4
(b) 1, 2 and 3
(c) 1, 3 and 4
(d) 2, 3 and 4

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66.

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Consider the following statements with regard to Graves? ophthalmopathy :

1. Proptosis is often asymmetric and can even appear to be unilateral
2. It is a clinical diagnosis
3. Worsening of symptoms upon glucocorticoid withdrawal is common

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4. Radiation therapy is very effective in treatment

Which of the above statements are correct?

(a) 1 and 2 only

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(b) 1, 2 and 3
(c) 2, 3 and 4
(d) 1 and 4 only
67.
All of the following are common aetiologies of delirium EXCEPT:

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(a) Hyperthyroidism
(b) Hypothyroidism
(c) Hyperparathyroidism
(d) Hypoparathyroidism
68.

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Key anthropometric measurements important for evaluating the degree of obesity are:

(a) Weight, height and waist circumference
(b) Weight, height and hip circumference
(c) Weight, height and mid-thigh circumference

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(d) Weight, height and chest circumference
69.
What is the minimum BMI (Body Mass Index) recommended for considering adjuvant
pharmacologic treatment in obesity with comorbidity?
(a) 23 kg/m

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2

(b) 25 kg/m
2

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(c) 27 kg/m
2

(d) 30 kg/m
2

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70.
A young medical student while working in HIV ward got pricked accidently on the finger by
a syringe needle which was used to draw blood from a patient. Patient?s infection status is not
known. Which one of the following therapeutic interventions will be the best interest of this

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student?
(a) To start Dolultegravir immediately
(b) To wash wound with soap and water and start Emtricitabine
(c) To give Dolutegravir + Tenofovir + Emtricitabine
(d) To give Dolutegravir + Tenofovir + Emtricitabine + HBV Immunoglobulin

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71.
Cryptococcal infection is acquired through:
(a) Inhalation route
(b) Bite of Culex mosquito
(c) Direct skin contact

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(d) Ingestion of spores

72.
Which one of the following is NOT appropriate treatment for Echinococcus granulosus and
hydatid disease?

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(a) Albendazole 400 mg twice in a day for 3 months
(b) Diethylcarbamazine 2 mg/kg thrice in a day for 12 days
(c) PAIR (percutaneous puncture, aspiration, injection of scolicide, reaspiration)
(d) Praziquantel (20 mg/kg twice daily for 14 days)
73.

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Which one of the following infections is NOT amenable to post-exposure prophylaxis with
specific immunoglobulins?
(a) Hepatitis B
(b) HIV
(c) Tetanus

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(d) Rabies
74.
Echinocandins are a class of:
(a) Antiviral agents
(b) Antiparasitic agents

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(c) Antitubercular agents
(d) Antifungal agents
75.
Recommended first time drug for initial treatment of tuberculosis include all EXCEPT:
(a) Isoniazid

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(b) Rifampin
(c) Ethambutol
(d) Ethionamide
76.
The most frequent adverse reaction of significance among people treated for drug-susceptible

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tuberculosis is:
(a) Colitis
(b) Hepatitis
(c) Cystitis
(d) Enteritis

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77.
All adult patients in whom anti-tubercular treatment is being started should undergo baseline
assessment of:
(a) Complete blood count
(b) Liver function test

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(c) Lipid profile
(d) Pulmonary function test
78.
A 30 year old male presents with fever, headache, anorexia, nausea, vomiting and diarrhoea.
On examination tongue is coated with abdominal tenderness, soft splenomegaly, relative

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bradycardia and rose spots rash. The most likely diagnosis is:

(a) Malaria fever
(b) Enteric fever
(c) Leptospirosis

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(d) Dengue fever

79.
The extrapulmonary sites most commonly involved in tuberculosis are all EXCEPT:
(a) Lymph node TB

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(b) Genitourinary TB
(c) Skeletal TB
(d) Skull TB
80.
Which of the following is NOT a clinical feature of Botulism?

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(a) Impaired alertness
(b) Dysphagia
(c) Diplopia
(d) Ptosis
81.

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Post exposure prophylaxis (PEP) for HIV should contain:
(a) 2 antiretroviral drugs administered for 4 weeks
(b) 2 antiretroviral drugs administered for 6 weeks
(c) 3 antiretroviral drugs administered for 4 weeks
(d) 3 antiretroviral drugs administered for 6 weeks

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82.
Paralytic rabies is characterized by:
(a) Maculopapular rash
(b) Flaccid muscle weakness
(c) Spastic muscle weakness

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(d) Hyperexcitability and facial weakness
83.
All of the following are seen in Marasmus EXCEPT:

(a) Reduced triceps skinfold

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(b) Reduced mid arm circumference
(c) Protein wasting
(d) Decreased body mass index
84.
A 20 year young lady presents with high grade fever for five days and palpable purpura over

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extremities. She is found to be confused, with presence of neck stiffness. Which of the
following is the most likely diagnosis?
(a) Disseminated intravascular coagulation
(b) Acute meningococcemia
(c) Antiphospholipid antibody syndrome

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(d) Thrombotic thrombocytopenic purpura
85.
Fibroblast Growth Factor 23 (FGF 23) is increased in which one of the following conditions?
(a) Osteomalacia
(b) Osteoporosis

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(c) Paget?s disease
(d) Renal Osteodystrophy

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86.
Which of the following crystals are deposited in a case of pseudogout?
(a) Monosodium urate

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(b) Calcium phosphate
(c) Cholestrol crystals
(d) Calcium pyrophosphate dehydrate (CPPD)
87.
Which of the following features are associated with poor prognosis in Diffuse Cutaneous

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Systemic Sclerosis?

1. Older age
2. A high gas transfer factor for carbon monoxide (TLCO)
3. Proteinuria

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4. Diffuse skin disease

Select the correct answer using the code given below:
(a) 1, 2 and 4
(b) 3 and 4 only

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(c) 1, 3 and 4
(d) 1, 2 and 3

88.
Which of the following statements regarding pegloticase are correct?

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1. It is enzyme conjugate
2. It is useful in chronic Gout management
3. The main adverse effects are infusion reactions and development of antibodies

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Select the correct answer using the code given below:
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3

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89.
The most common cause of sensorineural hearing loss in adults is:
(a) Otosclerosis
(b) Meniere?s disease
(c) Presbycusis

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(d) Meningitis
90.
A 50-year old male presents with dizziness. Which one of the following clinical findings does
NOT favour a central cause?
(a) Poor saccades

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(b) Gaze evoked nystagmus
(c) Inhibition by visual fixation
(d) Presence of diplopia, dysarthria

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91.
A young primigravida with 11 weeks pregnancy presents with sudden onset pain and
swelling of left lower limb. Homan?s sign is positive. Duplex ultrasonogram shows non-

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compressibility of veins in the affected region, with absent flow. The drug of choice for
treatment is:
(a) Enoxaparin
(b) Amoxycillin?Clavulanic acid
(c) Warfarin

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(d) Limb elevation only
92.
All of the following are clinical features of hypovolaemic shock EXCEPT:
(a) Cold clammy skin
(b) Bradycardia

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(c) Hypotension
(d) Oliguria
93.
Which one of the following is most appropriate to describe classic heat stroke?
(a) Patients core body temperature rises above 44?C with headache, nausea and loss of

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consciousness
(b) Patients core body temperature rises above 40 ?C with muscle tremors, confusion,
loss of consciousness and loss of sweating
(c) Patients core body temperature rises above 38 ?C with increased sweating,
tachypnoea, tachycardia and loss of consciousness

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(d) Patients core body temperature is above 40 ?C with disorientation, increased
sweating, peripheral vasodilation, tachycardia and loss of consciousness
94.
Which of the following is NOT a priority in the initial management of shock from venomous
snake?

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(a) Aggressive volume resuscitation
(b) Vasopressor support
(c) Anti-venom administration
(d) All of these are undertaken simultaneously

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95.
Which one of the following is NOT an appropriate criterion for diagnosis of Systemic
Inflammatory Response Syndrome (SIRS)?
(a) Respiratory rate > 20/mm

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(b) Heart rate > 90/min
(c) Total leucocyte count > 16 ? 10
9
per Litre
(d) Temperature > 38

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0
C

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96.
All of the following predispose to Acute Respiratory Distress Syndrome EXCEPT:
(a) Acute Pancreatitis
(b) Toxic gas inhalation
(c) Aspiration of gastric contents

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(d) Severe Bronchial asthma
97.
An 8 year old child has consumed a few tablets of a drug that were being taken by his mother
on a regular basis. Following this the child develops gastric necrosis, acidosis, shock and
hepatic necrosis. Which is the most likely drug?

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(a) Multivitamins
(b) Calcium carbonate
(c) Folic acid
(d) Iron
98.

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A newborn weighing 1.5 kg at birth presents at 6 hours of age with lethargy, weak and high
pitched cry and difficulty in feeding. What is the next step in management?

(a) Estimation of blood sugar
(b) Estimation of serum calcium

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(c) Supplementary oxygen
(d) Bedside electrocardiogram

99.
In a child with acute organophosphorus poisoning, which one of the following drugs will act

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as anti-sialogogue and peripheral parasympatholytic agent?

(a) Carbamates
(b) Atropine
(c) Benzodiazepine

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(d) Pralidoxime
100.
A 6-year old child needs to undergo a central Catheter placement for total parental nutrition.
The procedure is likely to evoke pain and anxiety. Which of the following is the most
appropriate drug for sedation and analgesia in this child?

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(a) Chloral hydrate
(b) Midozolam
(c) Propofol
(d) Ketamine

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101.
Which one of the following is the drug of choice in a child presenting with supraventricular
tachycardia?

(a) Atropine

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(b) Lidocaine
(c) Adenosine
(d) Nalaxone

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102.
Which one of the following drugs is used in cardiopulmonary resuscitation for pulseless
ventricular fibrillation?

(a) Atropine

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(b) Adenosine
(c) Lidocaine
(d) Amiodarone
103.
Which one of the following is a sign of good attachment during breastfeeding?

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(a) The baby?s nose is at the level of the nipple
(b) The baby?s chin touches the breast
(c) Most of the nipple is in the mouth and the lower areola is visible
(d) The baby?s lower lip is inverted
104.

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Which one of the following signs is NOT included as an indicator of a vigorous baby
immediately after delivery of an infant born through meconium strained liquor?
(a) Pink colour
(b) Strong respiratory efforts
(c) Good muscle tone

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(d) Active movements of the baby
105.
All are true for a Cephalohematoma in a newborn EXCEPT:
(a) It is located over the parietal bones in the subcutaneous plane
(b) It may be associated with hyperbilirubinemia

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(c) It increases in size in the first 12?24 hours
(d) It can take 3?6 weeks to resolve
106.
Which of the following sick neonates can be started on ?Minimal Enteral Feeding?, if
hemodynamically stable?

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(a) Septic neonate with sclerema
(b) Neonate with necrotizing enterocolitis (NEC)
(c) Neonate on mechanical ventilation
(d) Symptomatic hypoglycaemia
107.

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Which one of the following drugs is contraindicated in a mother who is breastfeeding her
infant?
(a) Bromocriptine
(b) Chlorpromazine
(c) Acyclovir

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(d) Morphine
108.
A term neonate presents with tachypnea on day 1 after birth. The chest X-ray reveals
hyperexpanded lung fields, prominent vascular markings, and prominent interlobar fissure.
Which of the following is the most probable diagnosis?

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(a) Congenital lobar emphysema
(b) Diaphragmatic hernia
(c) Transient tachypnea of the newborn
(d) Tracheoesophageal fistula

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FirstRanker.com - FirstRanker's Choice
Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the

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following Arrhythmia is most likely?
(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation

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2.
An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin

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(b) Glimepiride
(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The

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chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body
habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis

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(b) Raynaud?s syndrome
(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:

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(a) To confirm the diagnosis of angina
(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.

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Kussmaul?s sign is present in all of the following conditions, EXCEPT:

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy

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(d) Right Ventricular Infarction

6.
Which one of the following is NOT a common cause of atrial fibrillation?

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(a) Mitral regurgitation
(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

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7.
In an ECG recording, P wave is produced by:

(a) Atrial depolarisation
(b) Atrial repolarisation

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(c) Ventricular depolarisation
(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

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(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine

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9.
Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine
(b) Azilsartan

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(c) Aliskiren
(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

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(a) Aortic regurgitation
(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis
11.

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Signet-ring sign on CT-chest is suggestive of:
(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis

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12.
Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent
(b) Moderate persistent

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(c) Severe persistent
(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:

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(a) 24 hour fecal fat-estimation
(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study
14.

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Which one of the following antigens is commonly associated with causation of Farmer?s
lung?
(a) Penicillium
(b) Actinomycetes
(c) Aspergillus

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(d) Candida
15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

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(a) INH resistance
(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance
16.

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The most common cause of chronic type II respiratory failure is:
(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism

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17.
The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain
(c) Hemoptysis

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(d) Cough
18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

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(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate

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19.
Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis

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2. Whispered pectoriloquy is characteristic of lung consolidation
3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?

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(a) 1 and 3
(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4
20.

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All of the following are the causes of exudative Pleural Effusion, EXCEPT:
(a) SVC obstruction
(b) Fungal infection
(c) SLE
(d) Meig syndrome

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21.
Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion

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(d) Fasting increases its secretion
22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation

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(c) Bile acid secretory defects
(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score

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(b) APACHE score
(c) MELD score
(d) Metavir score
24.
The blood supply of liver consists of:

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(a) 50 % hepatic artery and 50 % portal vein
(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.

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All of the following conditions are associated with Glomerulonephritis with low complement
level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus

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(d) Cryoglobulinaemia

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26.

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Consider the following statements with regard to oral aphthous ulcers:

1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases

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4. They are pre-malignant and progress over few years to squamous cell carcinoma of
the oral cavity

Which of the above statements are correct?

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(a) 1 and 4 only
(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.

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Which one of the following statements about Barrett?s Oesophagus is NOT correct?

(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells

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(c) Normal columnar cells lining the lower oesophagus are replaced by squamous
cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.

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The most common cause of acute hepatitis outbreaks in India is:

(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B

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(d) Hepatitis A

29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

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(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus

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30.
Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency

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(b) Idiopathic thrombocytopenic purpura
(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

31.

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What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney
disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL

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(d) 13 to 14 gm/dL
32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease

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(b) Tumoral calcinosis
(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:

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(a) It is inherited as autosomal dominant trait
(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.

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Consider the following statements in relation to an adult patient:

1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

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Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only

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(d) 1, 2 and 3

35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis

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(b) Pyelonephritis
(c) Renal stone disease
(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history

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of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for
low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

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(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis

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37.
Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

(a) Higher dietary calcium increases risk

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(b) Higher animal protein intake increases risk
(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.

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He has history of fever and headache for the preceding 3 days. The CSF examination is
unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis

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(d) Viral encephalitis
39.
Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac

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(c) Thiamine
(d) Prednisdone
40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe

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(b) Non dominant parietal lobe
(c) Frontal lobe
(d) Non dominant temporal lobe

41.

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Vertical gaze palsy with convergence retraction nystagmus is seen in:
(a) Weber syndrome
(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome

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42.
A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:
(a) Left 3
rd

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nerve palsy
(b) Left 6
th
nerve palsy
(c) Right 4

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th
nerve palsy
(d) Right 3
rd
nerve palsy

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43.
All of the following are features of Cauda Equina syndrome EXCEPT:

(a) Low back pain
(b) Lower limb areflexia

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(c) Loss of bladder function
(d) Extensor plantar response

44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On

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examination, he had resting tremor, bradykinesia, rigidity and postural instability. This
patient is suffering most likely from:

(a) Parkinson?s disease
(b) Vascular dementia

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(c) Alzheimer?s disease
(d) Frunto temporal dementia
45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and

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turns. Heal-Shin test is normal. Which one of the following is most likely disorder?
(a) Cerebellar ataxia
(b) Sensory ataxia
(c) Frontal gait disorder
(d) Parkinson?s disease

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46.
Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following
EXCEPT:
(a) Bradycardia
(b) Hypertension

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(c) Irregular respiration
(d) Hypothermia

47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.

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Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture
(LP) and a day later reports worsening of headache. Which one of the following features is
NOT consistent with diagnosis of ?Post-LP? headache?

(a) Post-LP headache usually begins within 48 hours

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(b) Post-LP headache worsens in sitting position
(c) Post-LP headache is most severe upon waking up
(d) Post-LP headache may improve with caffeine intake
48.
Which one of the following investigations is NOT appropriate in a case of recurrent

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thrombosis?
(a) Antiphospholipid antibodies
(b) Bcr-Abl assay
(c) Protein C and S assays
(d) Antithrombin level

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49.
All of the following are causes of reactive thrombocytosis, EXCEPT:
(a) Hemolytic anemia
(b) Megaloblastic anemia
(c) Post splenectomy

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(d) Chronic inflammatory disorders


50.
Cryoprecipitate cannot be used for treatment of which one of the following conditions?

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(a) Von Willebrand disease
(b) Hypofibrinogenemia
(c) Hemophilia?B
(d) Hemphilia?A
51.

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Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic
anaemia. The disorder is inherited as an:

(a) Autosomal recessive trait
(b) X-linked recessive trait

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(c) Autosomal dominant trait
(d) X-linked dominant trait
52.
Sickle cell disease may be associated with any of the following EXCEPT:

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(a) Acute chest syndrome
(b) Aplastic crisis
(c) Splenic sequestration crisis
(d) Conn?s syndrome

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53.
Fever with splenomegaly and lymphadenopathy can be seen in
(a) Infectious mononucleosis
(b) Chronic leukaemia
(c) Both infectious mononucleosis and chronic leukaemia

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(d) Neither infectious mononucleosis nor chronic leukaemia
54.
Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:
(a) Haemoglobin X disease

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(b) Haemoglobin H disease
(c) Haemoglobin F disease
(d) Hydrops fetalis
55.
Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?

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(a) It is a clonal malignancy of haematopoetic stem
(b) Risk of developing CML is increased in monozygotic turns
(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

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56.
Diagnostic criteria of multiple myeloma includes which of the following?

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1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary M protein
3. Skeletal lytic lesions
4. Skeletal blastic lesions

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Select the correct answer using the code given below:
(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4

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(d) 2, 3 and 4
57.
The most predominant type of serum immunoglobulin involved in patients with plasma cell
disorder is:
(a) Ig G

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(b) Ig A
(c) Ig D
(d) Light chains
58.
Which one of the following statements is NOT true regarding the thyroid function/disorder in

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pregnancy?
(a) There is an increase in the metabolism of thyroxine by placenta
(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy
(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in
pregnancy

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(d) Impaired cognitive impairment may be seen in the offspring of mother with
subclinical hypothyroidism

59.
Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?

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(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL
(b) HbA1c ? 6.5 %
(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test
(d) Fasting plasma glucose ? 110 mg/dL
60.

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A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight
gain, hair loss, tiredness and weakness. What will be the investigation of choice?
(a) FSH & LH level
(b) Estrogen level
(c) Free T

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3
and free T
4
level
(d) Free T

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4
and TSH level

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61.

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Consider the following statements about erectile dysfunction in diabetic males:

1. It affects 60 % of males
2. Its common cause is an underlying neuro-vascular pathology
3. It may be aggravated by beta-adrenergic agonist drugs

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4. Endocrine disorders like hyperprolactinemia may cause it

Which of the statements given above are true?
(a) 1 and 2
(b) 2 and 3

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(c) 2 and 4
(d) 3 and 4
62.
All of the following can cause Hyperprolactinemia, EXCEPT:
(a) Craniopharyngioma

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(b) Hyperthyroidism
(c) Stress
(d) Chronic renal failure
63.
All of the following can be seen in a case of thyrotoxicosis, EXCEPT:

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(a) Atrial fibrillation
(b) Periodic paralysis
(c) Deafness
(d) Osteoporosis
64.

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Which one of the following hormones acts via the receptor tyrosine kinase?
(a) FSH
(b) TSH
(c) IGF-1
(d) PTH

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65.
Consider the following disorders as constituent of Multiple Endocrine Neoplasia Type 2a
(MEN 2a):

1. Primary Hyperparathyroidism

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2. Pituitary tumours
3. Medullary carcinoma of thyroid
4. Pheochromocytoma

Which of the above are correct?:

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(a) 1, 2 and 4
(b) 1, 2 and 3
(c) 1, 3 and 4
(d) 2, 3 and 4

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66.

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Consider the following statements with regard to Graves? ophthalmopathy :

1. Proptosis is often asymmetric and can even appear to be unilateral
2. It is a clinical diagnosis
3. Worsening of symptoms upon glucocorticoid withdrawal is common

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4. Radiation therapy is very effective in treatment

Which of the above statements are correct?

(a) 1 and 2 only

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(b) 1, 2 and 3
(c) 2, 3 and 4
(d) 1 and 4 only
67.
All of the following are common aetiologies of delirium EXCEPT:

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(a) Hyperthyroidism
(b) Hypothyroidism
(c) Hyperparathyroidism
(d) Hypoparathyroidism
68.

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Key anthropometric measurements important for evaluating the degree of obesity are:

(a) Weight, height and waist circumference
(b) Weight, height and hip circumference
(c) Weight, height and mid-thigh circumference

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(d) Weight, height and chest circumference
69.
What is the minimum BMI (Body Mass Index) recommended for considering adjuvant
pharmacologic treatment in obesity with comorbidity?
(a) 23 kg/m

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2

(b) 25 kg/m
2

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(c) 27 kg/m
2

(d) 30 kg/m
2

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70.
A young medical student while working in HIV ward got pricked accidently on the finger by
a syringe needle which was used to draw blood from a patient. Patient?s infection status is not
known. Which one of the following therapeutic interventions will be the best interest of this

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student?
(a) To start Dolultegravir immediately
(b) To wash wound with soap and water and start Emtricitabine
(c) To give Dolutegravir + Tenofovir + Emtricitabine
(d) To give Dolutegravir + Tenofovir + Emtricitabine + HBV Immunoglobulin

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71.
Cryptococcal infection is acquired through:
(a) Inhalation route
(b) Bite of Culex mosquito
(c) Direct skin contact

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(d) Ingestion of spores

72.
Which one of the following is NOT appropriate treatment for Echinococcus granulosus and
hydatid disease?

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(a) Albendazole 400 mg twice in a day for 3 months
(b) Diethylcarbamazine 2 mg/kg thrice in a day for 12 days
(c) PAIR (percutaneous puncture, aspiration, injection of scolicide, reaspiration)
(d) Praziquantel (20 mg/kg twice daily for 14 days)
73.

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Which one of the following infections is NOT amenable to post-exposure prophylaxis with
specific immunoglobulins?
(a) Hepatitis B
(b) HIV
(c) Tetanus

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(d) Rabies
74.
Echinocandins are a class of:
(a) Antiviral agents
(b) Antiparasitic agents

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(c) Antitubercular agents
(d) Antifungal agents
75.
Recommended first time drug for initial treatment of tuberculosis include all EXCEPT:
(a) Isoniazid

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(b) Rifampin
(c) Ethambutol
(d) Ethionamide
76.
The most frequent adverse reaction of significance among people treated for drug-susceptible

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tuberculosis is:
(a) Colitis
(b) Hepatitis
(c) Cystitis
(d) Enteritis

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77.
All adult patients in whom anti-tubercular treatment is being started should undergo baseline
assessment of:
(a) Complete blood count
(b) Liver function test

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(c) Lipid profile
(d) Pulmonary function test
78.
A 30 year old male presents with fever, headache, anorexia, nausea, vomiting and diarrhoea.
On examination tongue is coated with abdominal tenderness, soft splenomegaly, relative

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bradycardia and rose spots rash. The most likely diagnosis is:

(a) Malaria fever
(b) Enteric fever
(c) Leptospirosis

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(d) Dengue fever

79.
The extrapulmonary sites most commonly involved in tuberculosis are all EXCEPT:
(a) Lymph node TB

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(b) Genitourinary TB
(c) Skeletal TB
(d) Skull TB
80.
Which of the following is NOT a clinical feature of Botulism?

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(a) Impaired alertness
(b) Dysphagia
(c) Diplopia
(d) Ptosis
81.

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Post exposure prophylaxis (PEP) for HIV should contain:
(a) 2 antiretroviral drugs administered for 4 weeks
(b) 2 antiretroviral drugs administered for 6 weeks
(c) 3 antiretroviral drugs administered for 4 weeks
(d) 3 antiretroviral drugs administered for 6 weeks

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82.
Paralytic rabies is characterized by:
(a) Maculopapular rash
(b) Flaccid muscle weakness
(c) Spastic muscle weakness

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(d) Hyperexcitability and facial weakness
83.
All of the following are seen in Marasmus EXCEPT:

(a) Reduced triceps skinfold

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(b) Reduced mid arm circumference
(c) Protein wasting
(d) Decreased body mass index
84.
A 20 year young lady presents with high grade fever for five days and palpable purpura over

--- Content provided by FirstRanker.com ---

extremities. She is found to be confused, with presence of neck stiffness. Which of the
following is the most likely diagnosis?
(a) Disseminated intravascular coagulation
(b) Acute meningococcemia
(c) Antiphospholipid antibody syndrome

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(d) Thrombotic thrombocytopenic purpura
85.
Fibroblast Growth Factor 23 (FGF 23) is increased in which one of the following conditions?
(a) Osteomalacia
(b) Osteoporosis

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(c) Paget?s disease
(d) Renal Osteodystrophy

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86.
Which of the following crystals are deposited in a case of pseudogout?
(a) Monosodium urate

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(b) Calcium phosphate
(c) Cholestrol crystals
(d) Calcium pyrophosphate dehydrate (CPPD)
87.
Which of the following features are associated with poor prognosis in Diffuse Cutaneous

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Systemic Sclerosis?

1. Older age
2. A high gas transfer factor for carbon monoxide (TLCO)
3. Proteinuria

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4. Diffuse skin disease

Select the correct answer using the code given below:
(a) 1, 2 and 4
(b) 3 and 4 only

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(c) 1, 3 and 4
(d) 1, 2 and 3

88.
Which of the following statements regarding pegloticase are correct?

--- Content provided by FirstRanker.com ---

1. It is enzyme conjugate
2. It is useful in chronic Gout management
3. The main adverse effects are infusion reactions and development of antibodies

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Select the correct answer using the code given below:
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3

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89.
The most common cause of sensorineural hearing loss in adults is:
(a) Otosclerosis
(b) Meniere?s disease
(c) Presbycusis

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(d) Meningitis
90.
A 50-year old male presents with dizziness. Which one of the following clinical findings does
NOT favour a central cause?
(a) Poor saccades

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(b) Gaze evoked nystagmus
(c) Inhibition by visual fixation
(d) Presence of diplopia, dysarthria

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91.
A young primigravida with 11 weeks pregnancy presents with sudden onset pain and
swelling of left lower limb. Homan?s sign is positive. Duplex ultrasonogram shows non-

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compressibility of veins in the affected region, with absent flow. The drug of choice for
treatment is:
(a) Enoxaparin
(b) Amoxycillin?Clavulanic acid
(c) Warfarin

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(d) Limb elevation only
92.
All of the following are clinical features of hypovolaemic shock EXCEPT:
(a) Cold clammy skin
(b) Bradycardia

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(c) Hypotension
(d) Oliguria
93.
Which one of the following is most appropriate to describe classic heat stroke?
(a) Patients core body temperature rises above 44?C with headache, nausea and loss of

--- Content provided by FirstRanker.com ---

consciousness
(b) Patients core body temperature rises above 40 ?C with muscle tremors, confusion,
loss of consciousness and loss of sweating
(c) Patients core body temperature rises above 38 ?C with increased sweating,
tachypnoea, tachycardia and loss of consciousness

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(d) Patients core body temperature is above 40 ?C with disorientation, increased
sweating, peripheral vasodilation, tachycardia and loss of consciousness
94.
Which of the following is NOT a priority in the initial management of shock from venomous
snake?

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(a) Aggressive volume resuscitation
(b) Vasopressor support
(c) Anti-venom administration
(d) All of these are undertaken simultaneously

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95.
Which one of the following is NOT an appropriate criterion for diagnosis of Systemic
Inflammatory Response Syndrome (SIRS)?
(a) Respiratory rate > 20/mm

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(b) Heart rate > 90/min
(c) Total leucocyte count > 16 ? 10
9
per Litre
(d) Temperature > 38

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0
C

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96.
All of the following predispose to Acute Respiratory Distress Syndrome EXCEPT:
(a) Acute Pancreatitis
(b) Toxic gas inhalation
(c) Aspiration of gastric contents

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(d) Severe Bronchial asthma
97.
An 8 year old child has consumed a few tablets of a drug that were being taken by his mother
on a regular basis. Following this the child develops gastric necrosis, acidosis, shock and
hepatic necrosis. Which is the most likely drug?

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(a) Multivitamins
(b) Calcium carbonate
(c) Folic acid
(d) Iron
98.

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A newborn weighing 1.5 kg at birth presents at 6 hours of age with lethargy, weak and high
pitched cry and difficulty in feeding. What is the next step in management?

(a) Estimation of blood sugar
(b) Estimation of serum calcium

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(c) Supplementary oxygen
(d) Bedside electrocardiogram

99.
In a child with acute organophosphorus poisoning, which one of the following drugs will act

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as anti-sialogogue and peripheral parasympatholytic agent?

(a) Carbamates
(b) Atropine
(c) Benzodiazepine

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(d) Pralidoxime
100.
A 6-year old child needs to undergo a central Catheter placement for total parental nutrition.
The procedure is likely to evoke pain and anxiety. Which of the following is the most
appropriate drug for sedation and analgesia in this child?

--- Content provided by FirstRanker.com ---

(a) Chloral hydrate
(b) Midozolam
(c) Propofol
(d) Ketamine

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101.
Which one of the following is the drug of choice in a child presenting with supraventricular
tachycardia?

(a) Atropine

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(b) Lidocaine
(c) Adenosine
(d) Nalaxone

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102.
Which one of the following drugs is used in cardiopulmonary resuscitation for pulseless
ventricular fibrillation?

(a) Atropine

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(b) Adenosine
(c) Lidocaine
(d) Amiodarone
103.
Which one of the following is a sign of good attachment during breastfeeding?

--- Content provided by FirstRanker.com ---

(a) The baby?s nose is at the level of the nipple
(b) The baby?s chin touches the breast
(c) Most of the nipple is in the mouth and the lower areola is visible
(d) The baby?s lower lip is inverted
104.

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Which one of the following signs is NOT included as an indicator of a vigorous baby
immediately after delivery of an infant born through meconium strained liquor?
(a) Pink colour
(b) Strong respiratory efforts
(c) Good muscle tone

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(d) Active movements of the baby
105.
All are true for a Cephalohematoma in a newborn EXCEPT:
(a) It is located over the parietal bones in the subcutaneous plane
(b) It may be associated with hyperbilirubinemia

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(c) It increases in size in the first 12?24 hours
(d) It can take 3?6 weeks to resolve
106.
Which of the following sick neonates can be started on ?Minimal Enteral Feeding?, if
hemodynamically stable?

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(a) Septic neonate with sclerema
(b) Neonate with necrotizing enterocolitis (NEC)
(c) Neonate on mechanical ventilation
(d) Symptomatic hypoglycaemia
107.

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Which one of the following drugs is contraindicated in a mother who is breastfeeding her
infant?
(a) Bromocriptine
(b) Chlorpromazine
(c) Acyclovir

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(d) Morphine
108.
A term neonate presents with tachypnea on day 1 after birth. The chest X-ray reveals
hyperexpanded lung fields, prominent vascular markings, and prominent interlobar fissure.
Which of the following is the most probable diagnosis?

--- Content provided by FirstRanker.com ---

(a) Congenital lobar emphysema
(b) Diaphragmatic hernia
(c) Transient tachypnea of the newborn
(d) Tracheoesophageal fistula

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109.
A pre-school boy can go upstairs on alternate feet and has also started copying a circle. How
many blocks should he be able to build a tower with, without toppling over?

(a) 5

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(b) 7
(c) 9
(d) More than 10

110.

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Which one of the following drugs is the antidote for benzodiazepine poisoning?

(a) Flumazenil
(b) Atropine
(c) Naloxone

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(d) Pralidoxime aldoxime methiodide

111.
A 3-year old child develops severe respiratory distress after inhalation of fumes arising from
burning plastic. The child is started on supportive ventilation. Which one of the following

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antidotes needs to be given?
(a) Hydroxycobalamin
(b) Amylnitrate
(c) Sodium nitrite
(d) N-acetyl cysteine

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112.
A child has an incurving of the little finger. What is this condition known as?
(a) Camptodactyly
(b) Brachydactyly
(c) Partial cutaneous syndactyly

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(d) Clinodactyly
113.
A 4-week old infant presents with repeated episodes of non-bilious vomiting since 7 days.
The infant seems active and hungry after the vomiting. Examination reveals an olive-shaped
mass in the epigartrium. Which metabolic abnormality is expected in this infant?

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(a) Hyperchloremia
(b) Metabolic alkalosis
(c) Hyperkalemia
(d) Hyponatramia
114.

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Which one of the following is the correct dose and route of administration of hepatitis B
vaccine in children?

(a) 0.5 mL dose with 10 microgram of antigen subcutaneously
(b) 0.5 mL dose with 10 microgram of antigen intramuscularly

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(c) 1 mL dose with 5 microgram of antigen subcutaneously
(d) 1 mL dose with 5 microgram of antigen intramuscularly


FirstRanker.com - FirstRanker's Choice

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Combined Medical Services Examination-2020
Paper-I
1.
A chronic alcoholic develops a paroxysm of palpitations after alcohol binge. Which of the
following Arrhythmia is most likely?

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(a) Ventricular fibrillation
(b) Ventricular premature complex
(c) Atrial flutter
(d) Atrial fibrillation
2.

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An elderly-man with history of Diabetes mellitus and Coronary Artery Disease comes for
follow-up, with complaints of muscle pains. Which one of the following drugs could be the
most likely cause?
(a) Aspirin
(b) Glimepiride

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(c) Enalapril
(d) Atorvastatin
3.
A 40-year old lady comes to outdoor clinic with complaints of sudden onset chest pain. The
chest X-ray shows bilateral Pneumothorax. Examination reveals abnormalities of body

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habitus-including long arms, legs and finger (arachnodactyly), scoliosis, high arched palate,
joint hypermobility, and a pansystolic murmur at cardiac apex. Which one of the following
diseases is most likely?
(a) Takayasu?s arteritis
(b) Raynaud?s syndrome

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(c) Marfan?s syndrome
(d) Rheumatic heart disease-Mitral regurgitation
4.
All of the following are indications for treadmill testing/exercise-testing EXCEPT:
(a) To confirm the diagnosis of angina

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(b) To evaluate stable angina
(c) To assess outcome after coronary revascularization
(d) To evaluate the treatment efficacy of antianginal drugs
5.
Kussmaul?s sign is present in all of the following conditions, EXCEPT:

--- Content provided by FirstRanker.com ---

(a) Massive Pulmonary Embolism
(b) Restrictive Cardiomyopathy
(c) Hypertrophic Cardiomyopathy
(d) Right Ventricular Infarction

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6.
Which one of the following is NOT a common cause of atrial fibrillation?

(a) Mitral regurgitation

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(b) Hypothyroidism
(c) Hypertension
(d) Acute myocardial infarction

7.

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In an ECG recording, P wave is produced by:

(a) Atrial depolarisation
(b) Atrial repolarisation
(c) Ventricular depolarisation

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(d) Ventricular repolarisation
8.
Which one of the following modalities is NOT used in the treatment of ventricular
tachycardia?

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(a) DC Cardioversion
(b) Injection Lignocaine
(c) Injection Amiodarone
(d) Injection Adenosine
9.

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Which one of the following drugs is a Direct Renin Inhibitor?

(a) Benedipine
(b) Azilsartan
(c) Aliskiren

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(d) Lisinopril
10.
All of the following are causes of systolic hypertension with wide pulse pressure EXCEPT:

(a) Aortic regurgitation

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(b) Thyrotoxicosis
(c) Patent ductus arteriosus
(d) Aortic stenosis
11.
Signet-ring sign on CT-chest is suggestive of:

--- Content provided by FirstRanker.com ---

(a) Bronchiectasis
(b) Active alveolitis
(c) Aspergilloma
(d) Sarcoidosis
12.

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Oral corticosteroids are best introduced in the treatment of chronic bronchial asthma when it
is:
(a) Mild persistent
(b) Moderate persistent
(c) Severe persistent

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(d) Very severe persistent
13.
An 18-year old male has insulin dependent diabetes, with malabsorption syndrome and
bilateral upper lobe bronchiectasis. A diagnostic work-up will include all EXCEPT:
(a) 24 hour fecal fat-estimation

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(b) CT-chest
(c) Lung biopsy
(d) DNA sequencing study
14.
Which one of the following antigens is commonly associated with causation of Farmer?s

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lung?
(a) Penicillium
(b) Actinomycetes
(c) Aspergillus
(d) Candida

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15.
The Gene X-pert test used for MTB detection has the additional advantage of detection of
which of the following?

(a) INH resistance

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(b) Rifampicin resistance
(c) Multi drug resistance
(d) Ethambutol resistance
16.
The most common cause of chronic type II respiratory failure is:

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(a) Severe pneumonia
(b) Severe COPD
(c) Severe bronchial asthma
(d) Severe pulmonary thromboembolism
17.

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The most frequent symptom in respiratory diseases is:
(a) Breathlessness
(b) Chest pain
(c) Hemoptysis
(d) Cough

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18.
A 26-year old young lady attends medical emergency and is labelled as acute severe asthma
by the emergency physician. Which one of the following is unlikely to be a part of the
prescription?

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(a) Albuterol
(b) Anti-leukotrienes
(c) Aminophylline
(d) Magnesium sulfate
19.

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Consider the following statements with regard to respiratory examination:

1. Change in note, when patient phonates ?EEE? (Egophony) is characteristic of
interstitial fibrosis
2. Whispered pectoriloquy is characteristic of lung consolidation

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3. Monophonic wheeze is characteristic of asthma
4. Hyper-resonant note on percussion is characteristic of pnemothorax

Which of the above statements are correct?
(a) 1 and 3

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(b) 2 and 4 only
(c) 1, 2 and 4
(d) 2, 3 and 4
20.
All of the following are the causes of exudative Pleural Effusion, EXCEPT:

--- Content provided by FirstRanker.com ---

(a) SVC obstruction
(b) Fungal infection
(c) SLE
(d) Meig syndrome
21.

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Which one of the following is NOT true about Ghrelin?
(a) It stimulates appetite
(b) It decreases gastric emptying
(c) It increases acid secretion
(d) Fasting increases its secretion

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22.
Fecal elastase test is used for diagnosing which one of the following conditions?
(a) Lactose intolerance
(b) Mucosal inflammation
(c) Bile acid secretory defects

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(d) Pancreatic dysfunction
23.
The recent classification system for listing a patient as a candidate for liver transplantation is:
(a) Child Pugh score
(b) APACHE score

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(c) MELD score
(d) Metavir score
24.
The blood supply of liver consists of:
(a) 50 % hepatic artery and 50 % portal vein

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(b) 80 % portal vein and 20 % hepatic artery
(c) 80 % hepatic artery and 20 % portal vein
(d) 70 % hepatic artery and 30 % portal vein
25.
All of the following conditions are associated with Glomerulonephritis with low complement

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level, EXCEPT:
(a) Subacute bacterial endocarditis
(b) IgA nephropathy
(c) Systemic lupus erythematosus
(d) Cryoglobulinaemia

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--- Content provided by FirstRanker.com ---

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26.
Consider the following statements with regard to oral aphthous ulcers:

--- Content provided by FirstRanker.com ---

1. They are superficial and painful
2. They may occur in women just prior to menstruation
3. Oral glucocorticoids may be needed for the treatment of severe, recurrent cases
4. They are pre-malignant and progress over few years to squamous cell carcinoma of

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the oral cavity

Which of the above statements are correct?

(a) 1 and 4 only

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(b) 2 and 3 only
(c) 1, 2 and 3 only
(d) 1, 2, 3 and 4
27.
Which one of the following statements about Barrett?s Oesophagus is NOT correct?

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(a) It is a pre-malignant condition
(b) Normal squamous cells lining the lower oesophagus are replaced by columnar
cells
(c) Normal columnar cells lining the lower oesophagus are replaced by squamous

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cells
(d) It is an adaptive response to chronic gastro-oesophageal reflux

28.
The most common cause of acute hepatitis outbreaks in India is:

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(a) Hepatitis E
(b) Hepatitis C
(c) Hepatitis B
(d) Hepatitis A

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29.
Spontaneous oesophageal perforation after a bout of forceful vomiting or retching is
characteristically seen in which one of the following conditions?

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(a) Menetrier?s disease
(b) Boerhaave?s syndrome
(c) Achalasia of the oesophagus
(d) Barrett?s oesophagus
30.

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Eradication of helicobacter pylori infection may prove beneficial in the following extra-
gastric disorders EXCEPT:

(a) Unexplained vitamin B12 deficiency
(b) Idiopathic thrombocytopenic purpura

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(c) Iron deficiency anaemia without gastro-intestinal bleeding
(d) Acute glomerulonephritis

31.
What is the target blood Hemoglobin level when treating anaemia in Stage-4 chronic kidney

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disease patient?
(a) 8 to 10 gm/dL
(b) 10 to 12 gm/dL
(c) 12 to 13 gm/dL
(d) 13 to 14 gm/dL

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32.
Which one of the following complications of chronic kidney disease is observed in patients
with low parathyroid hormone levels?
(a) Adynamic bone disease
(b) Tumoral calcinosis

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(c) Osteitis fibrosa cystic
(d) Calciphylaxis
33.
All of the following statements about adult polycystic kidney disease are true, EXCEPT:
(a) It is inherited as autosomal dominant trait

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(b) It is usually associated with marked proteinuria
(c) It is usually associated with systematic hypertension, from young age
(d) It is associated with Berry aneurysm
34.
Consider the following statements in relation to an adult patient:

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1. Oliguria is defined as passage of urine less than 300 ml per day
2. Anuria is said to exist when less than 50 ml urine is passed per day
3. Polyuria is defined as urine volume in excess of 3 litre per day

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Which of the statements given above are correct?
(a) 1 and 3 only
(b) 2 and 3 only
(c) 1 and 2 only
(d) 1, 2 and 3

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35.
White cell casts in urine examination are strongly suggestive of:
(a) Nephritis
(b) Pyelonephritis

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(c) Renal stone disease
(d) Papillitis
36.
A 13-year old boy presents with hematuria, oliguria, edema and hypertension. He has history
of sore throat two weeks prior to presentation. Laboratory investigations are remarkable for

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low C
3
and increased titres of ASO and antiDNase. Which one of the following statements is
NOT correct about management for this condition?

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(a) Renal biopsy is rarely required for making diagnosis
(b) Antibiotic treatment is given for streptococcal infection
(c) Treatment is largely supportive
(d) Immunosuppressants are to be used for crescentic glomerulonephritis
37.

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Which one of the following statements is NOT correct regarding the risk factors for
nephrolithiasis?

(a) Higher dietary calcium increases risk
(b) Higher animal protein intake increases risk

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(c) Higher dietary potassium intake lowers risk
(d) Lower urine citrate increases the risk
38.
A 60-year old patient is admitted in emergency with seizure, aphasia and altered sensorium.
He has history of fever and headache for the preceding 3 days. The CSF examination is

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unremarkable. What would be the probable diagnosis?
(a) Multiple sclerosis
(b) Tubercular meningitis
(c) Pyogenic (bacterial) meningitis
(d) Viral encephalitis

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39.
Drug of choice for the treatment of Trigeminal Neuralgia is:
(a) Carbamazepine
(b) Aceclofenac
(c) Thiamine

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(d) Prednisdone
40.
Constructional skills is a function of which lobe?
(a) Dominant temporal lobe
(b) Non dominant parietal lobe

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(c) Frontal lobe
(d) Non dominant temporal lobe

41.
Vertical gaze palsy with convergence retraction nystagmus is seen in:

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(a) Weber syndrome
(b) Millard Gubler syndrome
(c) Claude syndrome
(d) Parinaud syndrome
42.

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A patient on looking forward was found to have his right eye deviated downwards and
outwards with pupil dilated. He is suffering from:
(a) Left 3
rd
nerve palsy

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(b) Left 6
th
nerve palsy
(c) Right 4
th

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nerve palsy
(d) Right 3
rd
nerve palsy
43.

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All of the following are features of Cauda Equina syndrome EXCEPT:

(a) Low back pain
(b) Lower limb areflexia
(c) Loss of bladder function

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(d) Extensor plantar response

44.
A 68-year old male presented in OPD with complaints of progressive small handwriting. On
examination, he had resting tremor, bradykinesia, rigidity and postural instability. This

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patient is suffering most likely from:

(a) Parkinson?s disease
(b) Vascular dementia
(c) Alzheimer?s disease

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(d) Frunto temporal dementia
45.
An elderly patient presents with abnormal gait. He has a wide base freezing gait with
imbalance, comprising short strides, shuffling along the floor and difficulty with starts and
turns. Heal-Shin test is normal. Which one of the following is most likely disorder?

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(a) Cerebellar ataxia
(b) Sensory ataxia
(c) Frontal gait disorder
(d) Parkinson?s disease
46.

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Cushing reflex, seen in conditions of raised intra cranial pressure includes all of the following
EXCEPT:
(a) Bradycardia
(b) Hypertension
(c) Irregular respiration

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(d) Hypothermia

47.
A 35 year old man presents with history of low grade fever and headache for last five weeks.
Clinical examination is remarkable for signs of meningismus. He undergoes lumbar puncture

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(LP) and a day later reports worsening of headache. Which one of the following features is
NOT consistent with diagnosis of ?Post-LP? headache?

(a) Post-LP headache usually begins within 48 hours
(b) Post-LP headache worsens in sitting position

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(c) Post-LP headache is most severe upon waking up
(d) Post-LP headache may improve with caffeine intake
48.
Which one of the following investigations is NOT appropriate in a case of recurrent
thrombosis?

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(a) Antiphospholipid antibodies
(b) Bcr-Abl assay
(c) Protein C and S assays
(d) Antithrombin level
49.

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All of the following are causes of reactive thrombocytosis, EXCEPT:
(a) Hemolytic anemia
(b) Megaloblastic anemia
(c) Post splenectomy
(d) Chronic inflammatory disorders

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50.
Cryoprecipitate cannot be used for treatment of which one of the following conditions?
(a) Von Willebrand disease

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(b) Hypofibrinogenemia
(c) Hemophilia?B
(d) Hemphilia?A
51.
Pyruvate kinase deficiency results in deficiency of ATP production and a chronic haemolytic

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anaemia. The disorder is inherited as an:

(a) Autosomal recessive trait
(b) X-linked recessive trait
(c) Autosomal dominant trait

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(d) X-linked dominant trait
52.
Sickle cell disease may be associated with any of the following EXCEPT:

(a) Acute chest syndrome

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(b) Aplastic crisis
(c) Splenic sequestration crisis
(d) Conn?s syndrome

53.

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Fever with splenomegaly and lymphadenopathy can be seen in
(a) Infectious mononucleosis
(b) Chronic leukaemia
(c) Both infectious mononucleosis and chronic leukaemia
(d) Neither infectious mononucleosis nor chronic leukaemia

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54.
Every individual carries four alpha gene alleles. Deletion of three alleles leads to
development of:
(a) Haemoglobin X disease
(b) Haemoglobin H disease

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(c) Haemoglobin F disease
(d) Hydrops fetalis
55.
Which one of the following is NOT true regarding Chronic Myeloid Leukaemia (CML)?
(a) It is a clonal malignancy of haematopoetic stem

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(b) Risk of developing CML is increased in monozygotic turns
(c) CML is defined by presence of BCR-ABL 1 fusion gene
(d) 10 year survival with TKI therapy is 85%

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56.
Diagnostic criteria of multiple myeloma includes which of the following?

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1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary M protein
3. Skeletal lytic lesions
4. Skeletal blastic lesions

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Select the correct answer using the code given below:
(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4
(d) 2, 3 and 4

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57.
The most predominant type of serum immunoglobulin involved in patients with plasma cell
disorder is:
(a) Ig G
(b) Ig A

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(c) Ig D
(d) Light chains
58.
Which one of the following statements is NOT true regarding the thyroid function/disorder in
pregnancy?

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(a) There is an increase in the metabolism of thyroxine by placenta
(b) Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy
(c) Levothyroxine replacement therapy dose should be decreased by 30?50% early in
pregnancy
(d) Impaired cognitive impairment may be seen in the offspring of mother with

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subclinical hypothyroidism

59.
Which one of the following is NOT the criterion for the diagnosis of Diabetes mellitus?
(a) Symptoms of diabetes and random plasma sugar concentration ? 200 mg/dL

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(b) HbA1c ? 6.5 %
(c) 2-hours plasma glucose ? 200 mg/dL during an oral glucose tolerance test
(d) Fasting plasma glucose ? 110 mg/dL
60.
A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight

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gain, hair loss, tiredness and weakness. What will be the investigation of choice?
(a) FSH & LH level
(b) Estrogen level
(c) Free T
3

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and free T
4
level
(d) Free T
4

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and TSH level

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61.
Consider the following statements about erectile dysfunction in diabetic males:

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1. It affects 60 % of males
2. Its common cause is an underlying neuro-vascular pathology
3. It may be aggravated by beta-adrenergic agonist drugs
4. Endocrine disorders like hyperprolactinemia may cause it

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Which of the statements given above are true?
(a) 1 and 2
(b) 2 and 3
(c) 2 and 4

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(d) 3 and 4
62.
All of the following can cause Hyperprolactinemia, EXCEPT:
(a) Craniopharyngioma
(b) Hyperthyroidism

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(c) Stress
(d) Chronic renal failure
63.
All of the following can be seen in a case of thyrotoxicosis, EXCEPT:
(a) Atrial fibrillation

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(b) Periodic paralysis
(c) Deafness
(d) Osteoporosis
64.
Which one of the following hormones acts via the receptor tyrosine kinase?

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(a) FSH
(b) TSH
(c) IGF-1
(d) PTH
65.

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Consider the following disorders as constituent of Multiple Endocrine Neoplasia Type 2a
(MEN 2a):

1. Primary Hyperparathyroidism
2. Pituitary tumours

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3. Medullary carcinoma of thyroid
4. Pheochromocytoma

Which of the above are correct?:

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(a) 1, 2 and 4
(b) 1, 2 and 3
(c) 1, 3 and 4
(d) 2, 3 and 4

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66.
Consider the following statements with regard to Graves? ophthalmopathy :

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1. Proptosis is often asymmetric and can even appear to be unilateral
2. It is a clinical diagnosis
3. Worsening of symptoms upon glucocorticoid withdrawal is common
4. Radiation therapy is very effective in treatment

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Which of the above statements are correct?

(a) 1 and 2 only
(b) 1, 2 and 3

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(c) 2, 3 and 4
(d) 1 and 4 only
67.
All of the following are common aetiologies of delirium EXCEPT:
(a) Hyperthyroidism

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(b) Hypothyroidism
(c) Hyperparathyroidism
(d) Hypoparathyroidism
68.
Key anthropometric measurements important for evaluating the degree of obesity are:

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(a) Weight, height and waist circumference
(b) Weight, height and hip circumference
(c) Weight, height and mid-thigh circumference
(d) Weight, height and chest circumference

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69.
What is the minimum BMI (Body Mass Index) recommended for considering adjuvant
pharmacologic treatment in obesity with comorbidity?
(a) 23 kg/m
2

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(b) 25 kg/m
2

(c) 27 kg/m

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2

(d) 30 kg/m
2

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70.
A young medical student while working in HIV ward got pricked accidently on the finger by
a syringe needle which was used to draw blood from a patient. Patient?s infection status is not
known. Which one of the following therapeutic interventions will be the best interest of this
student?

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(a) To start Dolultegravir immediately
(b) To wash wound with soap and water and start Emtricitabine
(c) To give Dolutegravir + Tenofovir + Emtricitabine
(d) To give Dolutegravir + Tenofovir + Emtricitabine + HBV Immunoglobulin
71.

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Cryptococcal infection is acquired through:
(a) Inhalation route
(b) Bite of Culex mosquito
(c) Direct skin contact
(d) Ingestion of spores

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72.
Which one of the following is NOT appropriate treatment for Echinococcus granulosus and
hydatid disease?
(a) Albendazole 400 mg twice in a day for 3 months

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(b) Diethylcarbamazine 2 mg/kg thrice in a day for 12 days
(c) PAIR (percutaneous puncture, aspiration, injection of scolicide, reaspiration)
(d) Praziquantel (20 mg/kg twice daily for 14 days)
73.
Which one of the following infections is NOT amenable to post-exposure prophylaxis with

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specific immunoglobulins?
(a) Hepatitis B
(b) HIV
(c) Tetanus
(d) Rabies

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74.
Echinocandins are a class of:
(a) Antiviral agents
(b) Antiparasitic agents
(c) Antitubercular agents

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(d) Antifungal agents
75.
Recommended first time drug for initial treatment of tuberculosis include all EXCEPT:
(a) Isoniazid
(b) Rifampin

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(c) Ethambutol
(d) Ethionamide
76.
The most frequent adverse reaction of significance among people treated for drug-susceptible
tuberculosis is:

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(a) Colitis
(b) Hepatitis
(c) Cystitis
(d) Enteritis
77.

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All adult patients in whom anti-tubercular treatment is being started should undergo baseline
assessment of:
(a) Complete blood count
(b) Liver function test
(c) Lipid profile

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(d) Pulmonary function test
78.
A 30 year old male presents with fever, headache, anorexia, nausea, vomiting and diarrhoea.
On examination tongue is coated with abdominal tenderness, soft splenomegaly, relative
bradycardia and rose spots rash. The most likely diagnosis is:

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(a) Malaria fever
(b) Enteric fever
(c) Leptospirosis
(d) Dengue fever

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79.
The extrapulmonary sites most commonly involved in tuberculosis are all EXCEPT:
(a) Lymph node TB
(b) Genitourinary TB

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(c) Skeletal TB
(d) Skull TB
80.
Which of the following is NOT a clinical feature of Botulism?
(a) Impaired alertness

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(b) Dysphagia
(c) Diplopia
(d) Ptosis
81.
Post exposure prophylaxis (PEP) for HIV should contain:

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(a) 2 antiretroviral drugs administered for 4 weeks
(b) 2 antiretroviral drugs administered for 6 weeks
(c) 3 antiretroviral drugs administered for 4 weeks
(d) 3 antiretroviral drugs administered for 6 weeks
82.

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Paralytic rabies is characterized by:
(a) Maculopapular rash
(b) Flaccid muscle weakness
(c) Spastic muscle weakness
(d) Hyperexcitability and facial weakness

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83.
All of the following are seen in Marasmus EXCEPT:

(a) Reduced triceps skinfold
(b) Reduced mid arm circumference

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(c) Protein wasting
(d) Decreased body mass index
84.
A 20 year young lady presents with high grade fever for five days and palpable purpura over
extremities. She is found to be confused, with presence of neck stiffness. Which of the

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following is the most likely diagnosis?
(a) Disseminated intravascular coagulation
(b) Acute meningococcemia
(c) Antiphospholipid antibody syndrome
(d) Thrombotic thrombocytopenic purpura

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85.
Fibroblast Growth Factor 23 (FGF 23) is increased in which one of the following conditions?
(a) Osteomalacia
(b) Osteoporosis
(c) Paget?s disease

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(d) Renal Osteodystrophy

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86.
Which of the following crystals are deposited in a case of pseudogout?
(a) Monosodium urate
(b) Calcium phosphate

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(c) Cholestrol crystals
(d) Calcium pyrophosphate dehydrate (CPPD)
87.
Which of the following features are associated with poor prognosis in Diffuse Cutaneous
Systemic Sclerosis?

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1. Older age
2. A high gas transfer factor for carbon monoxide (TLCO)
3. Proteinuria
4. Diffuse skin disease

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Select the correct answer using the code given below:
(a) 1, 2 and 4
(b) 3 and 4 only
(c) 1, 3 and 4

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(d) 1, 2 and 3

88.
Which of the following statements regarding pegloticase are correct?

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1. It is enzyme conjugate
2. It is useful in chronic Gout management
3. The main adverse effects are infusion reactions and development of antibodies

Select the correct answer using the code given below:

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(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
89.

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The most common cause of sensorineural hearing loss in adults is:
(a) Otosclerosis
(b) Meniere?s disease
(c) Presbycusis
(d) Meningitis

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90.
A 50-year old male presents with dizziness. Which one of the following clinical findings does
NOT favour a central cause?
(a) Poor saccades
(b) Gaze evoked nystagmus

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(c) Inhibition by visual fixation
(d) Presence of diplopia, dysarthria

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91.
A young primigravida with 11 weeks pregnancy presents with sudden onset pain and
swelling of left lower limb. Homan?s sign is positive. Duplex ultrasonogram shows non-
compressibility of veins in the affected region, with absent flow. The drug of choice for

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treatment is:
(a) Enoxaparin
(b) Amoxycillin?Clavulanic acid
(c) Warfarin
(d) Limb elevation only

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92.
All of the following are clinical features of hypovolaemic shock EXCEPT:
(a) Cold clammy skin
(b) Bradycardia
(c) Hypotension

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(d) Oliguria
93.
Which one of the following is most appropriate to describe classic heat stroke?
(a) Patients core body temperature rises above 44?C with headache, nausea and loss of
consciousness

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(b) Patients core body temperature rises above 40 ?C with muscle tremors, confusion,
loss of consciousness and loss of sweating
(c) Patients core body temperature rises above 38 ?C with increased sweating,
tachypnoea, tachycardia and loss of consciousness
(d) Patients core body temperature is above 40 ?C with disorientation, increased

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sweating, peripheral vasodilation, tachycardia and loss of consciousness
94.
Which of the following is NOT a priority in the initial management of shock from venomous
snake?

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(a) Aggressive volume resuscitation
(b) Vasopressor support
(c) Anti-venom administration
(d) All of these are undertaken simultaneously

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95.
Which one of the following is NOT an appropriate criterion for diagnosis of Systemic
Inflammatory Response Syndrome (SIRS)?
(a) Respiratory rate > 20/mm
(b) Heart rate > 90/min

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(c) Total leucocyte count > 16 ? 10
9
per Litre
(d) Temperature > 38
0

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C

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96.

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All of the following predispose to Acute Respiratory Distress Syndrome EXCEPT:
(a) Acute Pancreatitis
(b) Toxic gas inhalation
(c) Aspiration of gastric contents
(d) Severe Bronchial asthma

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97.
An 8 year old child has consumed a few tablets of a drug that were being taken by his mother
on a regular basis. Following this the child develops gastric necrosis, acidosis, shock and
hepatic necrosis. Which is the most likely drug?
(a) Multivitamins

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(b) Calcium carbonate
(c) Folic acid
(d) Iron
98.
A newborn weighing 1.5 kg at birth presents at 6 hours of age with lethargy, weak and high

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pitched cry and difficulty in feeding. What is the next step in management?

(a) Estimation of blood sugar
(b) Estimation of serum calcium
(c) Supplementary oxygen

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(d) Bedside electrocardiogram

99.
In a child with acute organophosphorus poisoning, which one of the following drugs will act
as anti-sialogogue and peripheral parasympatholytic agent?

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(a) Carbamates
(b) Atropine
(c) Benzodiazepine
(d) Pralidoxime

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100.
A 6-year old child needs to undergo a central Catheter placement for total parental nutrition.
The procedure is likely to evoke pain and anxiety. Which of the following is the most
appropriate drug for sedation and analgesia in this child?

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(a) Chloral hydrate
(b) Midozolam
(c) Propofol
(d) Ketamine
101.

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Which one of the following is the drug of choice in a child presenting with supraventricular
tachycardia?

(a) Atropine
(b) Lidocaine

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(c) Adenosine
(d) Nalaxone


102.

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Which one of the following drugs is used in cardiopulmonary resuscitation for pulseless
ventricular fibrillation?

(a) Atropine
(b) Adenosine

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(c) Lidocaine
(d) Amiodarone
103.
Which one of the following is a sign of good attachment during breastfeeding?
(a) The baby?s nose is at the level of the nipple

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(b) The baby?s chin touches the breast
(c) Most of the nipple is in the mouth and the lower areola is visible
(d) The baby?s lower lip is inverted
104.
Which one of the following signs is NOT included as an indicator of a vigorous baby

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immediately after delivery of an infant born through meconium strained liquor?
(a) Pink colour
(b) Strong respiratory efforts
(c) Good muscle tone
(d) Active movements of the baby

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105.
All are true for a Cephalohematoma in a newborn EXCEPT:
(a) It is located over the parietal bones in the subcutaneous plane
(b) It may be associated with hyperbilirubinemia
(c) It increases in size in the first 12?24 hours

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(d) It can take 3?6 weeks to resolve
106.
Which of the following sick neonates can be started on ?Minimal Enteral Feeding?, if
hemodynamically stable?
(a) Septic neonate with sclerema

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(b) Neonate with necrotizing enterocolitis (NEC)
(c) Neonate on mechanical ventilation
(d) Symptomatic hypoglycaemia
107.
Which one of the following drugs is contraindicated in a mother who is breastfeeding her

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infant?
(a) Bromocriptine
(b) Chlorpromazine
(c) Acyclovir
(d) Morphine

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108.
A term neonate presents with tachypnea on day 1 after birth. The chest X-ray reveals
hyperexpanded lung fields, prominent vascular markings, and prominent interlobar fissure.
Which of the following is the most probable diagnosis?
(a) Congenital lobar emphysema

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(b) Diaphragmatic hernia
(c) Transient tachypnea of the newborn
(d) Tracheoesophageal fistula

109.

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A pre-school boy can go upstairs on alternate feet and has also started copying a circle. How
many blocks should he be able to build a tower with, without toppling over?

(a) 5
(b) 7

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(c) 9
(d) More than 10

110.
Which one of the following drugs is the antidote for benzodiazepine poisoning?

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(a) Flumazenil
(b) Atropine
(c) Naloxone
(d) Pralidoxime aldoxime methiodide

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111.
A 3-year old child develops severe respiratory distress after inhalation of fumes arising from
burning plastic. The child is started on supportive ventilation. Which one of the following
antidotes needs to be given?

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(a) Hydroxycobalamin
(b) Amylnitrate
(c) Sodium nitrite
(d) N-acetyl cysteine
112.

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A child has an incurving of the little finger. What is this condition known as?
(a) Camptodactyly
(b) Brachydactyly
(c) Partial cutaneous syndactyly
(d) Clinodactyly

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113.
A 4-week old infant presents with repeated episodes of non-bilious vomiting since 7 days.
The infant seems active and hungry after the vomiting. Examination reveals an olive-shaped
mass in the epigartrium. Which metabolic abnormality is expected in this infant?
(a) Hyperchloremia

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(b) Metabolic alkalosis
(c) Hyperkalemia
(d) Hyponatramia
114.
Which one of the following is the correct dose and route of administration of hepatitis B

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vaccine in children?

(a) 0.5 mL dose with 10 microgram of antigen subcutaneously
(b) 0.5 mL dose with 10 microgram of antigen intramuscularly
(c) 1 mL dose with 5 microgram of antigen subcutaneously

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(d) 1 mL dose with 5 microgram of antigen intramuscularly


115.
Which one of the following statements is correct for approved acellular pertussis vaccine?

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(a) It contains at least 3 IU of inactivated pertussis toxin
(b) It contains at least 3 pathogenic pertussis antigens
(c) It?s efficacy is superior to the whole cell pertussis vaccine
(d) Presence of nonfimbrial protein is a mandatory component
116.

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Which of the following is recommended in the follow up health visits of a child with Down
syndrome?
(a) Growth assessment twice a year in the first year and annually till 5 years
(b) Annual auditory screening from 1 to 5 years
(c) Screening for refractory error if visual impairment is suspected

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(d) Annual thyroid function test from birth to 2 years
117.
A 12 year old child presents with delayed puberty and delayed bone age. His growth records
reveal that he was growing normally till 1 year of age, after which both his height and weight
fell to below the third centile for age. Subsequently, he continued to grow below the third

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centile with normal height velocity. What is the most likely diagnosis?
(a) Familial short stature
(b) Constitutional growth delay
(c) Growth hormone deficiency
(d) Skeletal dysplasia

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118.
According to the ?Integrated Management of Neonatal and Childhood Illnesses? (IMNCI)
classification of young infants upto 2 months, which one of the following signs is NOT
included in ?Possible Serious Bacterial Infection?
(a) Fast breathing (50 breaths or more per minute)

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(b) Severe chest indrawing
(c) Axillary temperature less than 36.5
0
C
(d) Movement only when stimulated or no movement at all

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119.
Neonatal tetanus elimination in India is defined as less than one case per:

(a) 100 live births per year
(b) 1000 live births per year

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(c) 10000 live births per year
(d) 100000 live births per year
120.
Which one of the following facilities has been established at district hospitals in India to
strengthen the care of low birth weight babies and sick newborns?

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(a) Special Newborn Care Units (SNCU)
(b) Newborn Treatment Units (NTU)
(c) Newborn Stabilization Units (NSU)
(d) Shishu Suraksha Units (SSU)

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