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Surgery FCPS-I

November 7, 2018
Evening Shift
Paper I

1. Motor unit consists of


a. Axon with its muscle fibers
b. Muscle spindle and its nerve supply
c. Sympathetic fibers

2. Which structure modifies its lining cells?


a. Bowman’s capsule
b. Glomerulus
c. Collecting duct
d. Distal convoluted tubule
e. Loop of Henle

3. A full-term baby develops jaundice on second day of birth. He is being


breast fed. His mother has blood group B+ve. His total bilirubin is 10mg/dl
and indirect bilirubin is 9mg/dl. What is the cause?

a. Physiological jaundice
b. Breast milk jaundice
c. ABO incompatibility
d. Rh incompatibility

4. Gene microchip array


I don’t remember the options but here is what I found on Wikipedia which
describes the correct answer: DNA microarrays can be used to detect DNA
(as in comparative genomic hybridization), or detect RNA (most commonly
as cDNA after reverse transcription) that may or may not be translated into
proteins. The process of measuring gene expression via cDNA is
called expression analysis or expression profiling.

5. A young woman has signs of viral hepatitis. She has nausea for last few
days and mild scleral icterus. On laboratory investigations, her ALT and
AST are elevated. What cellular change leads to their elevation?

a. Plasma membrane damage


b. Mitochondrial damage
c. Lysosomal mediated cell destruction
d. Clumping of chromatin

6. A 30 year old female complains of continuous chest pain that is radiating


to the back. She has had fever for last ten days. On auscultation, there is a
rustling sound at the left sternal border. Where does the damage lie?

a. Pericardium
b. Myocardium
c. Pleura
d. Intercostal muscles

7. Which muscle increases transverse diameter of chest?

a. Diaphragm
b. External Oblique
c. Serratus Anterior
d. External intercostal muscle

8. Fat metabolism syndrome


a. Symptoms after 12 hours
b. Fatal in 80% cases
c. Can be accurately diagnosed using paraffin sections
d. Requires multiple skeletal fractures to occur

9. Inhibition of drug metabolizing enzymes in the liver


a. Orange juice
b. Grapefruit juice
c. Lemon juice
d. Mango juice
e. Strawberry juice

10.Which hypophyseal structure receives signal from hypothalamus via the


hypophyseal portal system?
a. Mamillary body
b. Suprachiasmatic nucleus
c. Adenohypophysis
d. Neurohypophysis

11.Sympathetic neurons are present in spinal cord


a. White matter
b. Grey Matter
c. Lateral horn
d. Posterior horn
e. Anterior horn

12.Toll-like receptors
a. Are Important in adaptive immunity
b. Present on B-cells
c. Present on platelets and play a role in immune response
13. A patient has emphysema. What would be the acid-base imbalance present
in him?
a. Rise in H+ion concentration in plasma
b. Rise in plasma PCO2
c. Decrease in plasma HCO3- concentration
d. Positive base excess
e. Rise in plasma pH

14. Cardiac output in heavy exercise is augmented by


a. Sympathetic stimulation of resistance vessels
b. Dilatation of venous vessels
c. Constriction of venous vessels
d. Increase in ventricular contractility

15. Pulse pressure increases in


a. Thyrotoxicosis
b. Tacycardia
c. Heart failure
d. Hemorrhage
e. Aortic stenosis

16. Superficial fascia is made up of


a. Loose areolar tissue and adipose tissue
b. Only loose areolar tissue
c. Dense organized connective tissue
d. Disorganized connective tissue
e. Adipose tissue only
17. A factor which is precursor to the carrier of 1-carbon fragments at various
levels of oxidation
a. Folic acid
b. Thiamine
c. Pyridoxine
d. Biotin
e. Methionine

18. Immunological filtering occurs in spleen in


a. Marginal zone of sinusoid vessels

19. Oxidases are present in


a. Peroxisomes
b. Lysosomes
c. Golgi apparatus
d. Endoplasmic reticulum

20. Lymph
a. Production increases during exercise
b. Flow decreases during bacterial infection
c. Usually has no cells
d. Contains large amount of fibrinogen
e. Absorbs amino acids from small intestine

21. Connects cerebellum to midbrain


a. Superior cerebellar peduncle
b. Middle cerebellar peduncle
c. Inferior cerebellar peduncle
d. Cerebral peduncle
22.Cranial nerves that arise from Pons
a. Motor nerves of CN V, VI and VII
b. Cranial nerves III and IV
c. Motor nerves VII and IX

23. Lower 1/3rd of Pons contains


a. Dorsal nucleus of vagus
b. Nucleus Ambiguus
c. Nucleus Solitarius

24. Staging of cancer

25. A 20 year old female has fever and pain in lumbar region for the last 5
days. What investigation would you conduct for accurate diagnosis of the
disease?

a. Urine culture
b. Blood Widal test
c. Urine and blood culture
d. Stool culture

26. A patient has fever, malaise, anemia and weight loss for several weeks. On
examination, there is splenomgelay and splinter hemorrhages under his
nails. He also has microscopic hematuria. Which investigation will help
you diagnose the illness?
a. Blood culture
b. Serology
c. Blood for cold agglutinins
d. Ultrasound of abdomen
27. Head of pancreas lies in front of
a. IVC
b. Superior mesenteric artery

28. A patient has severe pain in his abdomen


a. Fat necrosis
b. Caseous necrosis
c. Non-caseous necrosis

29.Cortisol
a. Gluconeogenesis
b. Increases glucose utilization by cells
c. Decreases lipolysis
d. Causes protein anabolism

30. 2nd pharyngeal arch derivative


a. Stylomandibular ligament
b. Stylohyoid ligament
c. Thyroid cartilage
d. Greater horn of hyoid

31. An elderly patient comes to your clinic and complains about the staff
being rude to him. He also feels the receptionist is rude. How will you
handle the situation?
a. Refer the patient for psychiatric evaluation
b. Apologize to the patient and ask the receptionist to change her behavior
c. Fire the receptionist
d. Tell the patient no one else has complained about the staff
32. The side effect of chlorpromazine is
a. Dystonic features
b. Polyuria
c. Weight loss
d. Hallucinations

33. The size of drug is more than 1000, so the drug will move into the cell via
a. Simple diffusion
b. Osmotic pressure
c. Carrier protein
d. Phagocytosis

34. Inspiratory capacity is calculated as


a. Tidal volume and inspiratory reserve volume

35.Enlargement of submandibular and submental lymph nodes suggests


metastasis from which area?
a. Carcinoma of tongue
b. Carcinoma of lower lip
c. Carcinoma of cheek

36. Most important buffer in blood


a. Hemoglobin
b. Bicarbonate
c. H+ ion

37. A patient with pheochromocytoma needs preoperative control of blood


pressure. Which drug will you use?
a. Alpha 1 and β blocker
b. Β blocker
c. Methyl dopa

38.Transmission via mosquito


a. Filariasis

39.Blood transfusion reaction would occur if


a. O to O
b. O to AB
c. A to AB
d. AB to A

40. Patient after a few days of severe burns, developed high grade fever.
Blood culture yielded of gram negative rods in chains. He has suddenly
developed a bleeding daithesis. What is the cause?
a. DIC

41. A homosexual male has developed reddish lesions on his skin. One of his
partners has similar lesions too.
a. Kaposi’s sarcoma

42. What kind of bond is present between proteins and lipids in a membrane?
a. Hydrophobic bond
b. Covalent and hydrophobic bonds
c. Hydrogen bonds
43. A patient with end stage renal failure has had multiple blood tranfusions
for anemia. What can be given to reduce the number of transfusions?
a. G-CSF subcutaneous
b. Subcutaneous erythropoietin

44. Tricyclic antidepressants show analgesic response in


a. 3-4 weeks
b. 7 to 10 days
c. 2 months
d. 1 week

45. A patient visits a psychiatrists. His mother calls the doctor to ask about his
illness but the psychiatrist refuses to divulge anything. What is this called?
a. Confidentiality
b. Non- Maleficence
c. Benevolence

46. A portal anastomosis is a capillary network in between


a. Two veins
b. An artery and a vein
c. Two venules

47. A patient, while his stay in a hospital, develops MRSA infection. What
about the treatment would you keep in mind?
a. MRSA is sensitive to vancomycin
b. MRSA is resistant to vancomycin
c. MRSA has more virulence than staphylococcus aureus
d. MRSA is sensitive to third generation cephalosporins
48.The rate of regeneration of peripheral nerve fiber is
a. 0.3 mm/day

49. A patient has polyuria and polydipsia. Her laboratory investigations show
hypercalcemia, hyperphosphatemia, normal alkaline phosphatase levels.
What is the cause?
a. Hypervitaminosis D
b. Thiazide diuretics
c. Primary hyperparathyroidism

50. Thalassemia trait characteristic feature


a. Basophilic stippling
b. Microcytosis
c. Hypochromia

51.Vitamin B12 is dependent on for its absorption


a. Intrinsic factor
b. Gastrin
c. Vitamin D

52. A primigravida goes to her village where she develops fever and jaundice.
The disease can be fatal in her. What is the cause?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
53. A patient is brought to the emergency in a state of shock and is promptly
resuscitated. Which signs will show successful resuscitation?
a. Increase in heart rate
b. Increase in urine output
c. Decrease in blood pressure

54.What is the immediate effect of the body to lose heat?


a. Cutaneous vasodilation
b. Sweating
c. Shivering

55. Myelination in fetus starts at


a. 3 months
b. 4 months
c. 6 months
d. Just before term

56. Parasympathetic stimulation causes


a. Sweating
b. Salivation

57.An alcoholic patient has liver fibrosis. What is the cause?


a. Chronic alcoholism
b. Right heart failure

58. Which of the following has predominantly mucous acini


a. Sublingual gland
b. Submandibular gland
c. Parotid gland
59.Cells that cannot regenerate after injury
a. Stable cells
b. Labile cells
c. Permanent cells

60. A chronic smoker is working at a tire factory. He develops painless


hematuria. What is the cause of bladder carcinoma in him?
a. Smoking
b. Aryl amines
c. Nitrates

61. Fibrin is stablilized by


a. Von wiliband factor
b. Plasmin
c. Factor 9
d. Factor 13
e. Factor 12

62. Bone fibers and matrix are formed by


a. Fibroblasts
b. Osteoblasts
c. Ocsteoclasts
d. Osteocytes

63. Which of the following is a pivot joint?


a. Atlantoaxial joint
b. Atlanto occipital joint
64. Unconjugated bilirubin will bind in blood to
a. Albumin
b. Globulin

65. A patient had a bee sting. The inflammatory response will be due to
a. Histamine
b. Acetylcholine
c. Norepinephrine
d. Dopamine

66. A patient presents with ST elevation in lead IV on ECG. Which coronary


vessel is involved?
a. LAD
b. LCX
c. RCA

67. Which of the following is a disequilibrium homeostatic response of


autonomic nervous system?
a. Cushing Reflex
b. Meinere’s

68. A patient has received multiple blood transfusions. Now, his ECG shows
tall T waves. What is the cause
a. Hyperkalemia
b. Hypercalcemia
c. Hyponatremia

69. Pharyngeal phase of swallowing shows


a. Adduction of vocal cords
70. A patient’s blood shows PO2 70 mmHg. What kind of hypoxia is this?
a. Anemic hypoxia
b. Stagnant hypoxia
c. Hypoxic hypoxia

71. Chi-square test represents


a. Categorical data

72.A farmer working in the field suddenly collapses. He has pin-point pupils
and is irritable. What is the specific antidote
a. Pralidoxime
b. Atropine

73. The most immediate effect of Angiotension II is


a. Aldosterone production
b. Constriction of arterioles

74. CSF enters subarachnoid space through


a. Foramen of lushka
b. Foramen magnum
c. Arachnoid villi

75. Reabsorption of CSF occurs via


a. External jugular vein
b. Arachnoid villi

76. The purpose of AV nodal delay is to allow


a. Adequate ventricular filling

77. Central chemoreceptors respond to


a. Increase in PCO2 in blood
b. Increase pH of blood
c. Increase in H+ ion concentration in blood

78. A patient has developed multinodular goiter. This is due to


a. Fluctuating TSH
b. Increase T3 and T4
c. Decrease T3 and T4

79. Which of following contain abundant cholesterol ?


a. LDL
b. HDL
c. VLDL
d. IDL
e. Chylomicrons

80. Which test is used to determine subspecies of Staphylococcus aureus

a. Coagulase test

81. Adhesion molecule present on leukocyte after margination


a. LFA-1
b. ECAM
c. C5a
82.A patient involved in an RTA after severe bleeding will develop
a. Hypotension, tachycardia and low CVP
b. Hypotension, tachycardia and raised CVP

83. A person develops severe temporal headache. On examination, there are


vesicles on medial side of eye, ala of nose. Which nerve is involved>
a. Infratrochlear
b. Maxillary
c. Ophthalmic

84. In X-linked recessive disease


a. Full manifestation of disease in a heterozygous female is rare

85. In a patient of ischemic heart disease, peripheral edema is due to


a. Increase in capillary hydrostatic pressure
b. Decrease in plasma oncotic pressure

86. A patient has been on supplemental O2 therapy for more than 24 hours and
later develops difficulty in breathing
a. Spontaneous Pneumothorax

87. A child is brought to your clinic, she has an elongated clitoris


a. Androgenital syndrome

88. Dye injected to visual urinary system, normal appearance of dye in right
lumbar region while there is no dye in left lumbar region and a small
amount of dye in pelvic region
a. Pelvic kidney
b. Renal agenesis
c. Horseshoe kidney

89. A patient has Hashimoto’s thyroiditis. How will you confirm the
diagnosis?
a. Antimicrosomal and Anti-thyroglobulin antibodies

90. GFR
a. 10% deccrease with 10mmHg decrease in blood pressure
b. Increases with decrease in colloidal pressure

91. In primary dehydration, ECF becomes


a. Hypertonic
b. Hypotonic
c. Hyponatremia

92. PTH level is normal in


a. Pseudohypoparathyroidism
b. Osteoporosis

93. During inspiration


a. Aortic valve closes before pulmonic valve
b. Delayed closure of pulmonic valve

94. In papillary carcinoma, psamomma bodies develop due to


a. Dystrophic calcification
b. Metastatic calcification
95. Testosterone is produced by
a. Sertoli cells
b. Leydig cells
c. Seminiferous tubules
d. Seminal vesicles
e. Epididymus

96. A patient gets burn injury which heals into an irregular fibrous scar that
extends beyond the wound margins and does not contract
a. Keloid

97. Local anesthesia acts by


a. Blocking Na+ channels by binding to specific receptors on the channel

98. Maximum number of Na+ channel are present in


a. Nodes of Ranvier

99. Mechanism of action of acetazolamide


a. Excretion of H+ ions and prevents reabsorption of Na+ and K+ ions

100. Pulmonary embolism


a. Ventilation perfusion mismatch
Paper II

1. A patient has received epidural anesthesia and feels tingling in her thumb.
What dermatome is involved?
a. C5
b. C6
c. C7
d. C8
e. T1
2. Trephine bone marrow biopsy is done to examine bone marrow aspirate for
a. Aplastic anemia
b. Chronic myelogenous leukemia
c. Iron deficieny anemia

3. A patient complains of swelling in the parotid region. There is pain and


redness. Which nerve involvement is causing pain?
a. Facial nerve
b. Auriculotemporal nerve
c. Maxillary nerve

4. A 65 year old man complains of multiple swelling in posterior region of


neck for the last five months. His lab investigations are Hb 11.3, Hct 40%
MCV 88 fL, platelets 256,000/µL and WBC 7230/µL. On examination, the
swellings are firm, mobile, non-tender and discrete, located in posterior
triangle of neck. Biopsy reveals follicles of numerous crowded small
lymphocytes. What is the diagnosis?
a. Hodgkin’s lymphoma, lymphocyte predominant
b. Chronic lymphocytic leukemia
c. Acute leukemia

5. A 30 year old female has come to you with a neck mass. She is diagnosed as
a case of high-grade B-cell lymphoma with c-myc translocation. Virus
involved
a. EBV
b. CMV
c. HIV
6. Left gastric vein drains directly into
a. IVC
b. Splenic vein
c. Superior mesenteric vein
d. Inferior mesenteric vein
e. Portal vein

7. A 60 year old patient presents with progressive generalized


lymphadenopathy for last 8 months. His laboratory investigations show Hb
9.8 g/dl TLC 59×109/L and platelets 94×109/L. His biopsy shows mature
looking lymphocytes. What is the diagnosis?
a. Chronic lymphocytic leukemia
b. Hodgkin’s lymphoma

8. Patient has a deep cut on the posterolateral surface of forearm, distal to the
neck of radius. He has loss of extension and abduction of thumb. There is no
loss of sensations. Which nerve is involved?
a. Superficial branch of radial nerve
b. Deep branch of radial nerve
c. Ulnar nerve
d. Median nerve

9. Strong expiratory muscle


a. Abdominal recti
b. Scaleni
c. Trapezius muscle
d. Sternocleidomastoid

10. Final common motor pathway is


a. Corticospinal tract
b. α efferents of spinal motor neurons
c. Motor cortex

11. Center of REM is present in


a. Hypothalamus
b. Medulla oblongata
c. Cerebellum
d. Pons

12. A boy falls on his outstretched hand and fractures his clavicle at the
junction of medial 1/3rd and lateral 2/3rd. Medial fragment is displaced
upwards and lateral downwards. Which muscle is responsible for upwards
displacement?
a. Sternocleidomastoid
b. Subclavius
c. Deltoid

13. Medial longitudinal arch is supported by


a. Deltoid ligament
b. Lateral calcaneonavicular ligament

14. A 30 year old male has been operated for enlarged goiter and now
complains of hoarseness of voice and difficulty in swallowing. The nucleus
of the nerve involved in
a. Upper part of Nucleus Ambiguus
b. Lower part of Nucleus Ambiguus
c. Middle part of Nucleus Ambiguus
d. Spinal nucleus of trigeminal nerve
e. Dorsal motor nucleus of vagus
15. Left gastroepiploic artery arises from
a. Splenic artery
b. Gastroduodenal artery
c. Right hepatic artery

16. Cystic artery is a branch of


a. Right hepatic artery
b. Common hepatic artery
c. Left gastric artery
d. Gastroduodenal artery

17. A 20 year old male complains of abdominal bloating after meals and foul
smelling, frothy stools per day. Useful investigation would be
a. Stool culture and sensitivity
b. Complete stool examination
c. Blood culture
d. Ultrasound of abdomen

18.A 40 year old smoker has splenomegaly and congested face. What would be
the feature of polycythemia?
a. Increase red blood cell mass
b. Hematocrit above 50%

19.G6PD deficieny after developing hemolysis. What is the characteristic


feature of disease?
a. Chronic hemolysis
b. Self-limiting hemolysis
c. G6PD deficiency occurs only after hemolysis

20. Mechanism of action of cyclosporin after transplantation


a. Inhibits differentiation of lymphocytes
b. Prevents inflammatory response to cellular mediators
c. Prevents recognition of antigen

21. A 35 year old tall male has hypertension for the first time and dies. His
autopsy reveals a ruptured aneurysm. There is deficiency of media at the site
of rupture. What kind of aneurysm is this?

a. Dissecting aneurysm
b. Marfan aneurysm
c. Mycotic aneurysm
d. Leutic aneurysm
e. Berry aneurysm

22. Chronic intravascular hemolysis is best characterized by


a. Hemoglobinuria
b. Hemoglobinemia
c. Low haptoglobin
d. Hemosiderinuria
e. Unconjugated bilirubin

23. Loss of supination and flexion of forearm. Which nerve is involved?


a. Musculocutaneous nerve
b. Axillary nerve
c. Median nerve

24. Injury to shoulder joint in a patient leads to axillary nerve damage. Which
muscle is affected?
a. Deltoid
b. Serratus anterior
c. Supraspinatus

25. Irritation of peritoneum below diaphragm, the pain will be referred to


a. Neck and shoulder

26. A patient complains of continuous pain in chest that is not related to


respiration. Where is the cause of pain?
a. Pericardium
b. Myocardium
c. Pleura
d. Intercostal muscles

27.What is the most common tumor of pituitary gland?


a. Cranopharyngioma
b. Acidophilic adenoma
c. Basophilic adenoma

28. A patient has right homonymous hemianopia. Lesion is in


a. Left optic tract
b. Optic chiasm
c. Optic nerve

29. A patient has tumor in upper outer quadrant of right breast. The lymph from
this area will drain into
a. Anterior axillary lymph nodes
b. Apical axillary lymph nodes
c. Posterior axillary lymph nodes
d. Central axillary lymph nodes
30. During dissection of posterior triangle, which nerve might get damaged?
a. Spinal part of accessory nerve

31.Blood supply of upper 1/3rd of esophagus is


a. Abdominal aorta
b. Superior thyroid artery
c. Inferior thyroid artery

32. Lacunar ligament is medial, rolled-up part of


a. Reflected inguinal ligament
b. Inguinal ligament
c. Inferior oblique
d. Fascia transversalis

33. Superficial inguinal ring is crossed by which nerve


a. Iliohypogastric nerve
b. Ilioinguinal nerve

34. A plastic surgeon is grafting midline forehead flap to a patient. The artery
supplying this area is
a. Supratrochlear arteries
b. Facial artery
c. Infratrochlear artery

35. A patient has developed an ulcer on scrotum. The lymph goes to


a. Superficial inguinal lymph nodes

36. A female has ulcer on lower 1/3rd of labia majora and labia minora. Which
glands are involved?
a. Paraurethral glands of skene
b. Greater vestibular glands

37. A patient undergoes endoscopy which reveals hyperemic area in lower third
of esophagus. There is no ulceration, growth or bleeding. This region shows
a. Metaplasia
b. Dysplasia
c. Hypertrophy
d. Hyperplasia

38. A gardener develops cough, his chest X-ray reveals a rounded opacity in
right lobe of lung
a. Aspergillosis

39. An elderly patient complains of decreased coordination and strength in his


right thumb. There is decreased sensation on skin of thumb, index and
middle finger. Sensation on thenar eminence is intact. There is also reduced
pincer grip of thumb and index finger on examination. Which muscle is
involved?
a. Abductor pollicis
b. Opponens pollicis
c. Flexor pollicis

40. A boy falls down and fractures his medial epicondyle of humerus, damaging
the ulnar nerve. Sensations in which area would be affected?
a. Distal and palmar aspect of medial 1/3rd of hand

41.Carcinoma of prostate spreads to


a. Vertebrae
b. Ribs
c. Pelvic bones
d. Skull

42. Rupture of anterior duodenal wall will lead to collection of duodenal


contects in
a. Right anterior subphrenic space
b. Right posterior subphrenic space

43. Patient has pancreatitis. Fluid will collect into


a. Right paracolic gutter
b. Lesser sac