Q.1 Long scenario ,patient had Dm Creatinine level ws 1.5.

he was given ACEI , his cratinine

level becomes 3.5. Reason ?

A. efferent arteriolar dilation gfr drops and so Creatinine goes up.

Q.2 Female patient pregnant comes at 38 wk with watery discharge. Her uterine contractions
are 3/mins. They asked she is at risk of what ? Options : placenta previa , placental abruption ,
vasa previa and chorioamnionitis.

Q.3 A Pt comes with dizziness and some other vague symtptoms. Ecg given showing A.fib. what
will be the effect over SV, CO and HR (arrows)? All dec

Q.4 Patient with WPW syndrome , in scenario delta wave ws mentioned . Impulse takes
shortcut from ? Atria to ventricles , AVN to ventricles , AVN to perkinji , Ventricles to perkinji?

Q.5 Two patients one is young athelete and other is old hypertensive. What cardiac finding will
be common between them ? A. concentric hypertrophy B. S4 , C. S3 other dun remember.

Q.6 PP increases in which condition ? Aging . maximum exercise , cardiac failure . other options
I dun remember.

Q.7 Patient coming with JVP distension , pedal edema , crackles over lung S3 present. They
asked to identify murmur via steth position. Murmur ws loudest over Mitral area. MR, TR , MS ,
functional murmur, I did MR.

Q.8 patient with alcholol withdrawl symptoms , Bugs crawling. Rx? Diazepam(long acting),
Oxazepam ws in option But nt given.

Q.9 Long scenario , Pt has lung cancer. Biopsy of lymph node is done. CT showing needle is
being passed till lymph node in centre. How many layers of pleura this needle has pierced?

One , two , three , four , five? I had no clue abt that cuz that ws a vague CT scan. I did 2

Q.10 Pt with vomiting for 3 days , Labs showing alkalosis. What solute will inc in urine ?

Na, Mg , Ca , Cl , K

Q.11 Long scenario of CD , Pt underwent terminal iliectomy. Now he has developed foul
smelling stools. Reason ? Bile acids are lost in stool

Note : there were 8-9 ques on colectomy and ileostomy and they were asking electrolyte
disturbances after them, I don’t remember them so must cover this topic.
Q.12 A person got concusion over his head from bomb blast and after then he has developed
polyuria. What you ll find on urine DR?

Urine osmolarity <50

Q.13 Patient with shock (long scenario) , his serum rennin level are increased. Inc in rennin is
due to which receptors?

B1 adrenoceptors.

Q.14. A 12 year old boy having muscle pain on exercise. His venous lactate levels are 12( nt
sure abt exact value) and after exercise venous lactate level increases( given in values) what
defect is he having ?

A.Myophosphorylase deficiency , B. Fatty acid oxidation defect.

Q.15. a 15 yr old boy with muscle pain over exercise. After exercise venous lactate levels remain
same. Defect ?

Myophosphorylase deficiency

Note : Two questions over Congental diaphragmatic hernia. One ws failure to form
pleuroperitoneal fold, Options of other ques I don’t remember.

Q.18 A female patient is having dyspareunia for 5 yrs, she also feels pain at the start of
menstruation and pain resolves at the end of menses. Her menstrual cycles are regular 26-34
days. She feels pain on hegar dilator insertion. On examination there are small red nodules over
mucosa. Dx? A. endomteriosis B. vaginismus C. adenomyosis

Q.19. Long scenario , pt having gastric CA , and he is taking 5-FU for it. What cells will dec the
most due to side effect of his chemotherapy?

A. neutrophills B. lymphocytes C. monocytes . D. Eosino

Note : 3-4 ques over throid hormones ( arrows) like exogenous T3 will have what effect over
over T4,T3 and TSH levels.

Q.24. Patient having osteomlacia effect over PTH , CA , Phosphate? Inc , dec , dec

Q.25 Clitorus sensory supply? Pudendal , ilioinguinal , genitofemoral

Q. 26 pt is nt able to abduct arm till 30* But can abduct it after 30*. Muscle involved ?
Supraspinatus

Q. 27 Trendelenburg gate scenario. Muscle affected ? G, medius

Q. 29. Psychatrist pt with suicidal attempt is admitted to hospital , she says the physician that
my previous physician was so rude with me , he did not agreed to anything what I said. You are
so good bla bla bla. At the time of discharge she asked the physician to join ger at dinner. What
will be the response by physician?

A. I can’t come on dinner but thanks a lot for your appreciation

B. Go for the dinner cuz she may go for another suicidal attempt.

I did A. duno the answer !

Q.30 Long scenario , Pt unable to form new memories. MRI given identify the structure
damaged. Hippocampus

Q.31 post stroke pain syndrome scenario. MRI given identify the structure damaged. Thalamus

Q.32 Patient with Left lower foot paralysis and bebniske positive over left.. Angiogram given
identify the artery damaged. Right ACA

Q.33 Pt with severe pain over left eye , the structure damaged is at which area ? Gross brain
section ws given u have to identify superior orbital fissure ( Opthalmic nerve damaged)

Q.34 Long scenario patient developed neutropenia, agent given to Rx his condition? Filgrastim

Note : 2 cases over DKA. In one ques they asked changes in ABGS. And in other they aksed
which of the following will occur? Ans ws beta oxidation of FAs will inc

Q. 37 Patient with dermatitis and ataxia , broad based gait. No symptoms of dementia were
given. Which of the following Amino acid will be defienct ?

Tryptophan , Glycine , serine , threonine

Q.38 Arrow pointed over Amgygdala on MRI. What will happened if this structure gets
damaged?

Hyperexuality , Hyperorality

Note : two cases over herpes simplex virus and one over Zoster

Q.41. Young female with severe right ankle pain . synovial analysis is done. Gram staining
Picture is given . dx? Gonococcal arthritis

Q. 42 A patient is undergoing AAA repair. Surgeon accidently injured artery at T8 level. What
findings u ll find in this patient afterward? Paraplagia
Note : 2 direct ques from NBME 18 must do that

Q. 45. Young male with uretheral discharge. Analysis shows neutrophills but no organisms. Rx
given ? Azithromycin

Note 8-10 experimental ques over mice .. don’t remember them 2-3 were tough , rest doable.

Q.56 A child comes with pain over distal femur , some ither history ws given . Biospy picture
given . dx ? Ewings TUMOR

Q. 57. An African female coming with signs of anemia , her Hb electrophoresis hows Inc Hb A2
levels >4. What of the following is true?

SHe has inherited a defective gene from one parent only

Q58. ques over pneumothorax. Big scenario: dec vocal fermitis over affected side

Q. 59 A mice is genetically programmed to form a protein . Protein consists of 6

transmembrane units and 1 unit has ATPase activity. Which of the following will be the function
of protein?

A. Its function is to transport solutes into the cell

B. it helps in paracrine signaling

C. its function is to move into nucleus and inc transcription activity

Two other weird option. No G protein ws in option

Q.60 HOCM case asking for mutation. Mutation in sarcomere protein

Q. 61. Patient with liver failure, ascetic picture Given . Patient has guarding and rebound
tenderness. MCC of this condition ? E.coli (Spontaneous bacterial peritonitis)

Q.62 Heroin Iv drug abuser has developed high grade fever and Holosystolic murmur over left
lower sterna border. Rx for this ?

Liposomal amphotericin

Q.63 There ws a scenario in which they said protein activity low before and high after doing
something with DNA . don’t remember exactly. What ws the condition before and after ?

Deacetylation and acetylation

Two cases over trauma

Two cases over burns

Q.67. Long scenario , Infection resolved . which of the following enzyme of neutrophill helped
killing organism . Catalase , SOD , NADPH OXIDASE , GLUTATHIONE REDUCTASE.

Q. 68. Pregnant female at 27 week of gestation eating ice and other weird stuffs. What will u
get on cbc ?

Microcytosis

Q. 69 Patient with Hypertryglycerdemia is given a drug that is Cationic , inc LDL receptors over
hepatocytes and excreted in stool. Name the drug ?

Ezetimibe , Cholystyramine? No statins in options

(NOTE: statins , Ezetimibe , cholystyramines all inc LDL receptors over hepatocytes)

Q.70Long scenario, Patient is given an agent that inc Erythroblasts counts In marrow.
Erythropoitin

Q.71 Patient has developed mass over forearm , he has severe pain . sensation of pain is carried
via ?

Musculocutaneous Nerve

Q.72 WDHA syndrome case

Q. 73. Pedigree shown several member have developed hemangioblastomas , some have in eye
, few have in cerebellum and retina , In which of the following the patient has developed
mutation?

Tumor suppressor gene , Oncogene , protooncogenes, transcription factors. Ans is Tumor

suppression gene(VHL)

Q. 73. A 13 yr old has short height and coarse facial features. She and her family live in an area
with Low population. Which of the following explains her defects?

A. pleuotrophy , B. founder effect. C. Loss of heterozygosity. Ans Pleotrophy

Q.74 A case over Pheochromocytoma. Inc in metanephrines

Q. 75 cardiac tamponade case. Effect over BP , HR and CO arrows. ? (Dec , inc , dec)

Q. 76 Chrons disease case, PPD test is done before giving the medication. Drug ?
Certolizumab

Q.77 IBS scenario , female having constipation. Drug given for that has MoA ?

5HT4 agonist(Tegaserod)

Note: There were 7-8 experimental questions which were weird and Immuno ws bit tricky so do
that well wish me luck my results on 27th feb