MCQs

1. Tears contain which one of the following antibodies

(A) IgA
(B) IgG
(C) IgD
(D) IgE
(E) IgM

2. The activation of a CD8-positive T lymphocyte requires presentation of antigen in association

with:

(A) Class I MHC protein and synthesis of interleukin-2 by CD4 T lymphocytes

(B) Class I MHC protein and synthesis of gamma-interferon by macrophages

(C) Class II MHC protein and synthesis of interleukin-1 by macrophages

(D) Class II MHC protein and synthesis of interleukin-4 by CD4 T lymphocytes

( E) Class II MHC protein and synthesis of both interleukin-4 and 1by CD4 T lymphocytes

3.Which one of the following sets of cells can present antigen to helper T cells?

(A) B cells and dendritic cells

(B) B cells and cytotoxic T cells

(C) Macrophages and eosinophils

(D) Neutrophils and cytotoxic T cells

(E) Neutrophils and plasma cells

4. Regarding the structure and reproduction of fungi , which statement is true

(A) The fungal cell membrane contains ergosterol, whereas the human cell membrane
contains cholesterol.
(B) The fungal cell membrane contains cholesterol, whereas the human cell membrane
contains ergosterol.
(C) Both fungal cell membrane and human cell membrane contains ergosterol
(D) Fungi are prokaryotes
(E) Human cell forms hyphae and spores

5. Botulism is a disease which is acquired by eating Improperly canned vegetables

It is caused by Clostridium botulinum. How does this organism appears on gram stain?

(A) Gram negative rod

(B) Gram negative cocci
(C) Gram positive rod
(D) Gram positive cocci
(E) Gram variable

6. Which one of the following bacteria is acquired through vertical transmission.

(A) Chlamydia trachomatis
(B) Clostridium tetani
(C) Haemophilus influenzae
(D) Shigella dysenteriae
(E) Streptococcus pneumoniae

7. In which one of the following bacterial growth phases, an antibiotics such as penicillin most
likely to kill bacteria?
(A) Lag phase
(B) Log Phase
(C) Stationary Phase
(D) Death Phase
(E) Both lag and log phase

8. Regarding endotoxin, which one of the following is the MOST accurate?

(A) Endotoxin is a polypeptide, the toxic portion of which consists of two D-alanines.
(B) Endotoxin is produced by both gram-positive cocci as well as gram-negative cocci.
(C) Endotoxin acts by binding to class II MHC proteins and the variable portion of the beta
chain of the T-cell receptor.
(D) Endotoxin causes fever and hypotension by inducing the release of interleukins such
as interleukin-1 and tumor necrosis factor.
(E) The antigenicity of endotoxin resides in its fatty acid side chains.

9. The following statement regarding antibiotics action is correct

(A) Bacteriostatic are those drugs that kill bacteria.
 (B) Bactericidal are those drugs that slow or interfere with growth of bacteria without killing
them.
(C) Selective toxicity is selective inhibition of the growth of the microorganism without
damage to the host.
(D) Broad-spectrum antibiotics are those drugs that drugs which are active against both
bacteria and viruses.
(E) Narrow spectrum antibiotics are those drugs that slow the growth of bacteria

10. UV irradiation kills microorganisms

(A) By causing lethal mutations in their DNA
(B) By causing lethal mutations in their Mitochondria
(C) By causing lethal mutations in their Endoplasmic reticulum
(D) By causing lethal mutations in their RNA
(E) By causing lethal mutations in their cytoplasm

11. All autoclaves are pressure vessels, they work at

(A) 121ο C, for 15min at 50 lb/in2
(B) 121ο C, for 15 seconds at 15 lb/in2
(C) 12ο C, for 15min at 15 lb/in
(D) 21ο C, for 15min at 15 lb/in2
(E) 121ο C, for 15min at 15 lb/in2

12. What is the single most important reason for healthcare workers to practice good hand hygiene?
(A) To remove visible soiling from hands
(B) To prevent transfer of bacteria from the home to the hospital
(C) To prevent transfer of bacteria from the hospital to the home
(D) To prevent infections that patients acquire in the hospital
(E) To prevent the staff from getting sick.
13. Which one of the following is always needed while dealing with a case of active pulmonary
Tuberculosis?
(A) Gloves
(B) Surgical mask
(C) Gown
(D) N95 respirator
(E) Face shield
14. 10. Which one of the following is a type of passive immunization

(A) Diphtheriae toxoid

(B) BCG

(C) Botulinum antitoxin

(D)Anthrax purified protein

(E) Tetanus toxoid

15.A deficiency of which one of the following complement components predisposes to

bacteremia caused by members of the genus Neisseria?

(A) C1

(B) C3b

(C) C5a

(D) C5b

(E) C5b, 6 ,7, 8, 9

1. A 68-year-old woman suddenly lost consciousness; on awakening 1 hour later, she could
not speak or move her right arm and leg. Two months later, a head CT scan showed a
large cystic area in the left parietal lobe. Which of the following pathologic processes
has most likely occurred in the brain?
(A) Fat necrosis
(B) Coagulative necrosis
(C) Apoptosis
(D) Liquefactive necrosis
(E) Karyolysis

2. A 32-year-old man experiences “heartburn” and gastric reflux after eating a large meal.
After many months of symptoms, he undergoes upper gastrointestinal endoscopy, and a
biopsy specimen of the esophageal epithelium is obtained. Which of the following
pathologic changes, has most likely occurred?
(A) Squamous dysplasia
(B) Mucosal hypertrophy
(C) Columnar metaplasia
(D) Atrophy of lamina propria
(E) Goblet cell hyperplasia

3. A 45 years old coal worker man has had a chronic cough for the past year. A chest
radiograph shows enlargement of hilar lymph nodes. Examination of the biopsied hilar
lymph nodes reveals a uniform, dark black cut surface. Which of the following pigment
most likely accounts for the appearance of the lymph nodes?
(A) Melanin
(B) Carbon
(C) Hemosiderin
(D) Lipofuscin
(E) Amyloid

4. Which of the following is the hallmark of reversible injury:

(A) Defects in plasma membrane
(B) Cellular swelling
(C) Nuclear fragmentation
(D) Chromatin clumping
(E) e) Influx of calcium ions
5. What roles in regulating the intrinsic pathway of apoptosis are played by the Bcl-2
protein family members Bax and Bcl-2?
(A) Bax inhibits apoptosis while Bcl-2 stimulates apoptosis.
(B) Bax stimulates apoptosis while Bcl-2 inhibits apoptosis.
(C) Both Bax and Bcl-2 inhibit apoptosis.
(D) Both Bax and Bcl-2 stimulate apoptosis.
(E) Bax and Bcl2 have no role in apoptosis.
6. Healing by first intention involves
(A) An initial infiltration of macrophages
(B) The growth of abundant granulation tissue from the edge of the wound
(C) The infiltrate of neutrophils into the clot within 24 hours
(D) The formation of scar within one week
(E) The appearance of granulation tissue within 48 hours

7. Which of the following is the hallmark of acute inflammation:

(A) Neutrophils
(B) Connective tissue
(C) Macrophages
(D) Granulation tissue
(E) Granuloma formation
8. During acute inflammation, histamine-induced increased vascular permeability causes
the formation of exudates (inflammatory edema). Which of the following cell types is
most likely to secrete histamine and cause this increased vascular permeability?
(A) Endothelial cells
(B) Fibroblasts
(C) Lymphocytes
(D) Mast cells
(E) Neutrophils
9. Which factor ties together activation of the clotting cascade, kinins and the fibrinolytic
system?
(A) Stuart Factor
(B) Prothrombin
(C) Plasminogen
(D) Factor XII -Hageman factor
(E) Kallikrein
 RESPIRATORY SYSTEM
1. A 34-year-old man developed severe
dyspnea with wheezing. Sputum
cytologic specimen showed Curschmann
spirals and acute inflammatory cells
mostly eosinophils in a background of
abundant mucus. What is the most
likely diagnosis?
A. Bronchiectasis
B. Pneumonia
C. Bronchial asthma
D. Centrilobular emphysema
E. Chronic bronchitis
2. A pathologist performing an autopsy
notices the grayish brown and firmer
appearance of lower lobe of the lung.
Histological sections from same area
show progressive disintegration of RBCs
and presence of a fibrinosuppurative
exudate. Such features are consistent
with which of the following?
A. Lung abscess
B. Congestion
C. Gray hepatization
D. Red hepatization
E. Resolution
3. A 50 year old heavy smoker
complained of persistent
nonproductive cough. Cytological
examination of the bronchial
washings revealed small uniform
looking neoplastic round to oval
cells with little cytoplasm and
increased mitotic figures. Which of
the following is the most likely
diagnosis?
A. Adenocarcinoma
B. Large cell carcinoma
C. Squamous cell carcinoma
D. Small cell carcinoma
E. Combined carcinoma
4. A 38-year-old woman
presented with prolonged
history of shortness of breath
and production of abundant
foul-smelling sputum. CT scan
of chest reveals markedly
distended peripheral bronchi.
Which of the following is most
likely diagnosis?
A. Bronchiectasis
B. Pulmonary tuberculosis
C. Chronic Bronchitis
D. Emphysema
E. Bronchial asthma
5. Which of the following
statement is correct regarding
atelectasis of lung?
A. It is loss of lung volume
caused by inadequate
expansion of airspaces
B. It results in shunting of
inadequately oxygenated
blood from arteries into veins
C. Resorption atelectasis is
associated with accumulation
of air within pleural cavity
D. Contraction atelactasis is
potentially reversible
E.Compression atelactasis is
associated with fibrotic
changes in lung or pleura
6. On the 11th postoperative day, a
patient ambulates to the bathroom,
but upon returning to bed becomes
 extremely dyspneic and diaphoretic. A. Bordetella pertussis
You should strongly suspect: B. Haemophilus influenzae
C. Klebsiella pneumoniae
A.  Pulmonary edema D. Legionella pneumophila
E. Pseudomonas aeruginosa
B.  Pleural effusion
10. A 60 year old patient resident of a
C.  Post-operative atelectasis
nursing home presents to the emergency
D.  Pulmonary embolus department with a fever of 104f ,shaking
chills, severe pain to the right side of the
E.  Diffuse alveolar damage chest that worsens with breathing and a
productive cough with blood tinged sputum
7. In Tuberculosis, the secondary lesion
.Gram stain revealed gram positive
appear mostly in the apices of lung due to diplococci. What is the most likely
A. Increase concentration of oxygen diagnosis
B. decrease concentration of oxygen A. Meningitis
C. anaerobic conditions B. Mumps
D. microaerophilic condition C. Pneumonia
E. increase CO2 concentration D. Chicken pox
E. Rabies
8. In a case of reactivation of tuberculosis,
which one of the following reasons of 11. Which of the following pathologic
reactivation is correct processes has most likely occurred in a
A. Decrease cell mediated immunity pulmonary nodule due to infection by
B. Decrease humoral immunity Mycobacterial tubeculosis?
C. Deficiency of complement proteins
A. Caseous necrosis
D. Increase humoral immunity
B. Coagulative necrosis
E. Increased cell mediated immunity
C. Fat necrosis
D. Fatty change
9. A 75 yrs old patient presented with a
E. Gangrenous necrosis
fever of 39°C and a cough productive of
yellowish sputum. Gram stain of the 12. A patient presented with the history
sputum shows small gram-negative rods. sore throat and fever. On examination,
There is no growth on blood agar, but throat and tonsils were inflamed with
colonies do grow on chocolate agar yellowish exudate. Cervical lymph nodes
supplemented with hemin(factor X and NAD were enlarged and tender. What is the most
(factor V).Which one of the following likely pathogen involved?
bacteria is the most likely cause of her
A. Streptococcus agalactie
pneumonia?
 B. Streptococcus pyogenes
C. Streptococcus pneumoniae
D. Streptococcus mutans
E. Streptococcus viridans
13. A 14 yr old male patient presented with
a history of fever, painful swelling in his
feet, knees and right wrist 14 days after a
throat infection. Patient also complained of
palpitation, chest pain and shortness of
breath occasionally. What is the most likely
diagnosis
A. Meningitis
B. Post streptococcal
glomerulonephritis
C. Pneumonia
D. Post streptococcal rheumatic fever
E. Tuberculosis
14. Which one of the following best
describes the pathogenesis of rheumatic
fever?
A. An exotoxin produced by
Streptococcus pyogenes that acts as
a superantigen damages cardiac
muscle.
B. An exotoxin produced by
Streptococcus pyogenes that
ADPribosylates G protein damages
joint tissue.
C. Antibody to the capsular
polysaccharide of Streptococcus
pyogenes cross-reacts with joint
tissue and damages it.
D. Antibody to the M protein of
Streptococcus pyogenes cross
reacts with antigens of joint, brain
and cardiac muscle and damages it.
E. Endotoxin produced by
Streptococcus pyogenes activates
macrophages
15. Regarding influenza virus and the
disease influenza, which one of the
following statements is TRUE?
A. Both the killed and the live,
attenuated vaccines induce lifelong
immunity.
B. Influenza B virus causes more severe
disease and epidemics than does
influenza A virus.
C. Antigenic drift involves major
changes in antigenicity that result
from reassortment of the segments
of its RNA genome.
D. The classification of influenza viruses
into A, B, and C viruses is based on
antigenic differences in their
hemagglutinin.
E. Its surface proteins, hemagglutinin
and neuraminidase, have multiple
serological types.
16. Which of the following parasites passes
through the lung during human infection ?
A. Ascaris lumbricoides
B. Plasmodium falciparum
C. Teania solium
D. Giardia lamblia
E. Trichomonas vaginalis
 17. Which of the following fungi is findings is most likely to be present in this man?
responsible for cavitatory lung lesions after
inhalation of its spores A. Urea nitrogen of 110 mg/dL
A. Coccidioides immites
B. Candida albicans B. Troponin I of 32 ng/mL
C. Cryptococcus neoformans C. ALT of 876 U/L
D. Paracoccidioides brasiliensis D. HDL cholesterol of 55 mg/dL
E. Histoplasma capsulatum E. Sodium of 115 mmol/L
4. 21. Friable vegetations on the valves of heart
Ar characteristic of
18. A 51-year-old woman presents with a long A. Infective endocarditis
history of poorly controlled hypertension, B. Calcific aortic stenosis
diabetes mellitus, and signs of renal failure. C. Atherosclerotic aortic aneurysm
Renal biopsy reveals the lumens of the D. Atherosclerosis
small blood vessels to be narrowed E. Malignant hypertension
by uniform, homogenous, pink deposits
within the walls of the vessels. 22. A man presented with high grade fever
No “onion skinning” or necrosis of blood vessels .O/E he had bad congested tonsils .His CBC
is seen. What is the best diagnosis? showed high TLC with 90% neutrophils.
A. Medial calcific sclerosis This is known as
B. Arteriosclerosis obliterans A. Eosinophilic leukocytosis
C. Hyperplastic arteriolosclerosis B. Monocytosis
D. Hyaline arteriolosclerosis C. Neutrophilic leukocytosis
E. Thromboangiitis obliterans D. Lymphocytosis
E.
19. A 50-year-old woman has suffered throbbing 23-Reedsternberg cells are pathognomonic
headaches with extreme tenderness over the of 
right temple. Her sedimentation rate is 104 mm/hr. A. Non Hodgkin lymphoma
Biopsy of the temporal arartery is likely to show: B. Hodgkin lymphoma
A. Giant cell arteritis C. LPDs
B. Atherosclerotic plaques with narrowing D. Mantle cell lymphoma
C. Arterial dissection E. Follicular lymphoma
D. Acute necrotizing granulomas
E. Polyarteritis nodosa 24. CLL (Chronic lymphocytic leukemia)
20. A 50-year-old man has the sudden onset of substernal is 
chest pain. The pain persists for the next three hours. A. Chronic Lymphoproliferative disorder
He then becomes short of breath and diaphoretic. B. Chronic myeloproliferative disorder
An ECG shows ST segment elevation in anterior C. Acute leukemia
leads V1 - 6. Which of the following serum laboratory test D. Chronic leukemia
 E. Myelodysplastic syndrome
25. Which one of the following parasites
causes myocardial cell damage resulting in
A. Ascaris lumbricoides
B. Plasmodium falciparum
C. Teania solium
D. Trypanosoma cruzi
E. Trichomonas vaginalis
26. Which one of the following viruses is
responsible for causing both pericarditis
and myocarditis (1mcq)
A. Coxsackie virus
B. Mumps virus
C. HIV
D. Varicella zoster
E. Rabies virus
27. A young woman develops a 102°F fever
2 days after menses. She reports using
tampons. After several days, the fever is
accompanied by hypotension, myalgias, and
a diffuse rash on the chest. Diagnosis of
toxic shock syndrome was made. Which one
of the following bacteria is the causative
organism
A. Streptococcus agalactie
B. Streptococcus pyogenes
C. Staphylococcus aureus
D. Staphylococcus epidermidis
E. Staphylococcus saprophyticus
28. Which one of the following bacteria is
the most likely causative organism of
infective endocarditis
A. Streptococcus agalactie
B. Streptococcus pyogenes
C. Streptococcus pneumoniae
D. Enterococci
E. Streptococcus viridans
T 29.The most common cause of endocarditis
in in drug abusers is
A. Staph aureus
B. Staph epidermidis
C. Staph bovis
D. Streptococcus viridians
E. Enterococci
30. A patient presented with a history of high grade
fever with chills and rigors, severe headache and
mayalgias after mosquito bite. After a few days patient
also developed black coloured urine. Complete blood
count showed severe anemia and renel function test
were deranged indicating acute renal failure. Diagnosis
of black water fever was made. Which one of the
following parasite is the most likely causative organism
A. Plasmodium falciparum
B. Trypansoma cruzii
C. Ascaris lumbricoides
D. Entamoeba histolytica
E. Leishmanial Donovanii
31. Histology of a testicular tumor in a 24
years old man revealed syncitial sheet of
polymorphic cells with vesicular nuclei,
prominent nucleoli and prominent
lymphocytic infiltrate in the stroma. The
most likely diagnosis is:
A. Yolk sac tumor
B. Seminoma
C. Teratoma
 D. Choriocarcinoma. and cheesy material. Which of the
E. Embryonal carcinoma. following is the most likely
32. A 40-year-old man has noted diagnosis?
painless gradual enlargement of his A. Dysgerminoma
scrotum. Physical examination B. Embryonal carcinoma
reveals positive transillumination C. Granulosa cell tumor
test. An ultrasound reveals a 5 cm D. Teratoma
thin-walled cystic fluid-filled area in E. Yolk sac tumor
the region of the right testis.Which
35. Histological examination of
of the following is the most likely
uterus reveals presence of
diagnosis? 
endometrial glands and stroma with
A. Seminoma  in the myometrium. What is the
B. Torsion  most likely diagnosis?
C. Hydrocele 
A. Endometrial hyperplasia
D. Varicocele 
B. Adenomyosis
E. Syphilitic orchitis 
C. Endometriosis
33. A 21-year-old sexually active man D. Endometrial polyp
is notified by the health department E. Leiomyoma
that his last sexual contact 3 weeks
36. Which of the following describes
prior has a positive serologic test for
presence and growth of tissue similar
syphilis. Which of the following
to endometrium outside the uterus?
findings in this man is most likely to
be indicative of his acquisition of this A. Adenomyosis
infection?  B. Endometrial hyperplasia
C. Endometriosis
A. Positive VDRL in the CSF  D. Endometrial polyps
B. Testicular gumma on biopsy  E. Invasive mole
C. Mucocutaneous rash  37. A 45 year old man presented with the
D. Penile chancre  complaints of yellowish colored discharge
E. Genital condyloma lata  from urethra, dysuria and urethral
discomfort. Past history revealed sexual
34. During pelvic examination of a
interaction with multiple partners.
25-year-old female, a cystic mass is
On gram stain of urethral discharge gram
found in the left ovary. The mass is
negative diplococci were seen.The organism
removed and the specimen shows
involved is:
unilocular cyst containing hair, tooth
A. Chlamydia trachomatis
 B. Neisseria gonorrhoeae
C. Staphylococcus aureus
D. Streptococcus pneumoniae
E. Treponema pallidum
38. In a case of genital herpes, the chief
complaint would be
A. Pain less genital ulcers
B. Painful genital ulcers
C. Maculopapular rash on the body
D. Warts
E. Carcinoma of cervix
39. A 29-year-old woman presents with
nervousness, heat intolerance, and weight
loss. Examination reveals exophthalmos and
pretibial myxedema. Investigations reveals
elevated serum thyroxine (T4) and
Pharmacology Section
triiodothyronine (T3) levels and serum
thyroid-stimulating hormone (TSH) is
decreased. Which of the following types of
autoantibodies is most specific for this
individual disease?
A. Antimicrosomal antibodies
B. Antithyroglobulin antibodies
C. Antithyroid peroxidase antibodies
D. TSH-receptor-blocking antibodies
E. TSH-receptor-stimulating antibodie
40 The most common cause of
Chronic Adrenal Insufficiency
Worldwide is:
A. Autoimmune disease
B. Drugs
C. Fungal Infection
D. Malignant Metastasis
E.Tuberculosis
41. A patient with status asthmaticus presents to the emergency department. He has severe
respiratory acidosis and hypoxia. Beta 2 agonists have failed to improve his condition. Which one
of the following drugs is most likely added to provide relief from acute symptoms?
A. Inhaled cromolyn sodium
B. Parenteral antihistamine
C. Parenteral corticosteroid
D. I / V Aminophylline
E. Switch to isoprenaline
42. A 55-year-old female who is taking Propranolol for the management of cardiovascular disease
experiences an acute asthmatic attack. Which of the following would you prescribe to attenuate
this asthmatic attack?
A. Cromolyn Na
B. Salbutamol
C. Beclomethasone
D. Ipratropium Bromide
E. A leukotriene receptor agonist
43. A diabetic patient presents with cough, haemoptysis, and a single shaking chill. His temperature is
101F, and a chest x-ray demonstrates lobar pneumonia. Gram staining reveals gram positive
diplococci. Correct therapy would be to administer which of the following?
A. Gentamicin
B. Penicillin G
C. Ampicillin
D. Ciprofloxacin
E. Carbenicillin
44. Mr. Naseer 70 years old man complains of cough for the last 2 days. His temperature was 103 O F.
physical examination reveals rales in his right lungs and X-ray examination shows increased
density in the right middle lobe. A sputum smear show gram positive cocci. Sputum culture shows
penicillinase producing staphylococcus. Which of the following Penicillins would be best to
administer?
A. Ampicillin
B. Carbencillin
C. Mezlocillin
D. Oxacillin
E. Ticarcillin
45. A six months old child was brought to emergency department with history of ingestion of some
drug. That drug was prescribed to his father for treatment of certain infection. The child
presented with vomiting and diarrhea with green stools. He was lethargic with an ashen color.
 Other signs and symptoms include hypothermia, hypotension and abdominal distension. The
drug most likely to be the cause of this problem is:
A. Doxycycline
B. Ampicillin
C. Clindamycin
D. Chloramphenicol
E. Erythromycin
46. A man developed bleeding that required a reduction in her warfarin dose while being treated for
a gallbladder infection. Which antibiotic was most likely responsible for this drug interaction?
A. Aztreonam
B. Ertapenem
C. Cefotetan
D. Cefotaxime
E. Piperacillin
47. A woman being treated for a mycobacterial infection develops optic neuritis. Which anti- TB drug
it could be?
A. Isoniazid
B. Rifampicin
C. Ethambutol
D. Pyrazinamide
E. Streptomycin
48. A patient suffering from pulmonary tuberculosis is being treated by combination therapy of 1 st
line Anti-TB drugs. One of these drugs induces symptoms of a vitamin deficiency. Which is the
drug and produces deficiency of which vitamin?
A. Isoniazid and Vitamin B1
B. Rifampin and Vitamin B1
C. Rifampin and Vitamin B2
D. Isoniazid and Vitamin B6
E. Rifampin and Vitamin B6
49. There has been a severe outbreak of epidemic of influenza virus in your city. A drug is
administered prophylactically to most of the population that inhibits viral penetration and
uncoating. Which one of the following drugs was administered?
A. Acylovir
B. Ganciclovir
C. Amantadine
D. Saquinavir
E. Zidovudine
50. A woman has been on systemic antibiotic for life threatening pneumonia .During her treatment,
she develops severe oral thrush (Candidiasis by candida albicans).Which one of the following
antifungal drugs will be prescribed orally (as drops) by the doctor?
A. Amphotericin B
B. Fluconazole.
C. Nystatin
D. Terbinafine
E. Griseofulvin
51. A 34 year old man receiving medication for hyperthyroidism and CCF, developes skin rash puritis,
fever, diarrhea, bitter taste in his mouth and feeling of anxiety. Which of the following drugs is
most likely to cause these symptom?
A. Chlordiazepoxide
B. Hydrochlorothiazide
C. Captopril
D. Propylthiouracil
E. Nifedipine
52. A 51 year old male patient with type 2 diabetes mellitus and chronic renal disease undergoes
intense physical exercise and later ends up in the emergency ward with hyperventilation and a
picture of respiratory alkalosis due to metabolic acidosis. Which medication he was receiving,
caused these symptoms?
A. Chlorpropramide
B. Metformin
C. Rosiglitazone
D. Nateglinide
E. Glimepride
53. A patient is receiving an oral hypoglycemic agent that increases the secretion of insulin and has
the longest duration of action. Which of the following drugs could
it be?

A. Repaglinide
B. Metformin
C. Tolbutamide
D. Chlorpropamide
E. Rosiglitazone
54. Which of the following drugs is useful in type-2 diabetes, it increases the effect of incretins and acts as a
Dipeptidyl Peptidase- 4 (DPP- 4) Inhibitor?
A. Exenatide
B. Liraglutide
C. Vildagliptin
 D. Canagliflozin
E. Pioglitazone
55. A patient is given an antihypertensive drug that causes orthostatic hypotension. Which of the
following is it most likely to be?
A. Propranolol
B. Prazosin
C. Captopril
D. Atenolol
E. Losartan
56. A 65 year old man has cardiac risk factors of hypertension and is on aspirin. Echocardiography
shows reduced ejection fraction at 50%. Which of the following medications may reduce the
risk of future cardiovascular events?
A. Isosorbide
B. Frusemide
C. Ramipril
D. Clopidogrel
E. Verapamil
57. Mr. G W Bush, a 65years old Ex. politician is taking sildenafil for erectile dysfunction.He is a
known patient of asthma and hypertension.His Asthma and hypertension are well controlled
with medication. Now he is also having episodes of angina.Which of the following anti-anginal
drug is contraindicated for Mr G W Bush?
A. Atenolol
B. Verapamil
C. Nicorandil
D. Nitroglycerine
E. Ranolazine
58. A patient is having resistant ventricular arrhythmia that has failed to respond to treatment.
Finally he is treated with a drug that causes corneal micro-deposits and a half-life of months.
Most likely the drug is:
A. Bretylium
B. Quinidine
C. Flecainide
D. Amiodarone
E. Procainamide
59. A 55-year old patient has variant angina and moderate hypertension. Which one of the following agents
would be best suited to treat both conditions?
A. Nifedipine
B. Captopril
 C. Atenolol
D. Nitroglycerine
E. Propranolol
60. A sixty year-old woman, who has smoked since she was 16 years old, complains of shortness of
breath, flutter in her chest, and a heart rate of 160 with an irregularly irregular heart rhythm. You
conclude that she has atrial fibrillation - induced congestive heart failure. You decide to initiate
monotherapy using:
A. Propranolol
B. Verapamil
C. Quinidine
D. Digoxin
E. Adenosine
61. A patient who has a history of getting sick at high altitudes is planning a trip with his friends to
Murree. Which drug should he take for prophylaxis?
A. Ethacrynic acid
B. Spironolactone
C. Indapamide
D. Acetazolamide
E. Chlorthalidone
62. A 58-year man with CCF requires therapy with hydrochlorothiazide. His monthly serum chemistry
profile shows persistent hypokalemia. The most appropriate next step is to add which of the
following diuretics to his regimen?
A. Acetazolamide
B. Amiloride
C. Frusemide
D. Mannitol
E.Metolazone
63. A patient of congestive heart failure was being treated with furosemide and digoxin. He developed
urinary tract infection. Which of the following antimicrobials should be avoided:
A. Ampicillin
B. Norfloxacin
C. Co-trimoxazole
D. Gentamicin
E. Ciprofloxacin
64. A young boy of 20 year met a road traffic accident and suffered head injury as a result of which
developed cerebral edema, the most useful diuretic in the above condition is:
A. Acetazolamide
B. Amiloride
 C. Ethaerymic acid
D. Mannitol
E. Furosemide
65. A patient has taken a massive overdose of digoxin. Which of the following treatments would
effectively lower free drug concentrations in the plasma?
A. FAB fragments
B. Cholestyramine
C. Activated charcoal
D. Phenytoin Sodium
E.Potassium chloride

66. A patient of fungal infection is being treated with a fungicidal agent .its mechanism of action
involves inhibition of squalene epoxidase.Which of the following drugs it could be?

A. Amphotericin B
B. Ketoconazole
C. Miconazole
D. Nystatin
E. Terbinafine
67. To treat an upper respiratory infection due to Streptococcus pneumoniae in a pregnant woman
with a known history of penicillin allergy, most of the following drugs are contraindicated. Which
one can be used?
A. Chloramphenocol
B. Azithromycin
C. Tetracycline
D. Metronidazole
E. Ciprofloxacin
68. This antibiotic causes misreading of the messenger RNA and consequently causes miscoding
leading to insertion of wrong amino acid in to the peptide chain leading to formation of wrong
protein.The drug is:
A. Streptomycin
B. Erythromycin
C. Clindamycin
D. Azithromycin
E. Minocycline
69. A 48-year-old white female complains of progressive weakness, lethargy, and cold intolerance.
She also complains of weight gain, coarsening of her facial features, hair loss, and increasing
 hoarseness in her voice. T3 and T4 are low, and thyroid-stimulating hormone (TSH) is high. What
drug treatment is most appropriate?
A. Potassium Iodide
B. Liotrix
C. Levothyroxine
D. Tri-iodotyrosine
E. Methimazole
70. A 50 year old female is diagnosed with type II diabetes mellitus. She is put on antidiabetic
therapy. The drugs prescribed is to be given to the patient 15 minutes before a meal? but no
more than 30 minutes. Which one it could be?
A. Glipizide
B. Miglitol
C. Pioglitazone
D. Metformin
E. Acarbose
71. Which of the following drugs increase uptake of glucose in muscle and decrease glucose
production in the liver?
A. Meglitinides
B. Thiazolodinediones
C. Sulphonylureas
D. Incretin analogues
E. Biguanides
72. Insulin is used for the control of glucose metabolism in the body and regulation of blood glucose
levels. Which of these is not an insulin target tissue?
A. Fat
B. Liver
C. Brain
D. Muscle
E. Blood
73. A woman is at risk of pre-term labor. Which of the following will you administer to accelerate
fetal lung maturation?
A. Betamethasone
B. Mifepristone
C. Temoxifen
D. Prednisolone
E. Sprinolacton
1. Which of the following chromosomal abnormalities is most likely to be present in the somatic
cells of a child having Down’s syndrome?
a) Haploidy
b) Monosomy
c) Mosaicism
d) Tetraploidy
e) Triploidy

2. A 13-year-old boy with fasting serum glucose of 175 mg/dL is having the following probable
inheritance pattern of this disease?
a) Autosomal dominant
b) Multifactorial
c) X-linked recessive
d) Mitochondrial DNA
e) Autosomal recessive
3. A genetic defect involving which of the following substances is most likely to be present in
Marfan’s syndrome?
a) Dystrophin
b) Collagen
c) Fibrillin-1
d) NF1 protein
e) Spectrin
4. The inheritance pattern of Hemophilia A is which one of the following?
a) Autosomal dominant mutation
b) Autosomal recessive mutation
c) X-linked mutation
d) Mosaicism
e) Random X inactivation

5. A child having hepatosplenomegaly and accumulation of foamy macrophages is most likely to

have following disease?
a) Down’s syndrome
b) Klinefelter syndrome
c) Lysosomal storage disorder
d) Diabetes
e) Hemophilia

6. The toxin released by Shigella dysenteriae in the case of dysentery is

A. Botulinum toxin
B. Neurotoxin
C. Super antigen
D. Shiga toxin
E. Cholera toxin
 7. Regarding Entamoeba histolytica, which one of the following is most accurate?
A. E. histolytica causes “flask-shaped” ulcerations in the colon mucosa.
B. Domestic animals such as dogs and cats are the main reservoir of E. histolytica.
C. In the microscope, E. histolytica is recognized by having two sets of paired flagella.
D. E. histolytica infections are limited to the intestinal mucosa and do not spread to other organs.
E. The infection is typically acquired by the ingestion of the trophozoite in contaminated food and
water.

8. A pregnant woman was diagnosed to have hepatitis B infection. Which serological marker
should be done to know the transmissibility of virus to the baby
A. HBsAg
B. HBsAb
C. HBeAg
D. HBeAb
E. HBcIgM

9. Your patient is a 30-year-old man with persistent watery diarrhea for 2 weeks. He is HIV
antibody positive with a CD4 count of 10. Routine stool culture revealed no bacterial pathogen.
Ova and parasite analysis revealed cysts that stained red in an acid-fast stain. Of the following,
which one is the most likely cause of this infection?
A. Cryptosporidium parvum
B. Entamoeba histolytica
C. Giardia lamblia
D. Trichomonas vaginalis
E. Balantidium coli
10. A patient is diagnosed with H.pylori gastritis. He is now at a risk of developing
A. Eosophageal Carcinoma
B. Colorectal Carcinoma
C. Gastric Carcinoma
D. Bladder carcinoma
E. Cervical carcinoma
11. All nursing staff working in a liver clinic were advised to have vaccination against hepatitis B.
Some of the staff members have already had the vaccine some time back. Which serological
markers should be done to know whether the vaccinated members still have the immunity
coverage due to the previous vaccination
A. HBsAg
B. HBsAb
C. HBeAg
D. HBeAb
E. HBcAb
12. A 24 year old female patient presented with the history of burning while passing urine, urgency
and supra pubic pain. In urine analysis, Pus cells were numerous. E.coli was isolated on culture.
What is the route of transmission of E.coli in urinary tract
A. By ascending spread of patients own fecal flora
B. By ascending spread of patients own skin flora
C. By descending spread of patients own fecal flora
D. By descending spread of patients own skin flora
E. By descending spread of patients own mouth flora

13. Regarding the above mentioned case of UTI(E.coli isolated) , urine routine examination will
show
A. Urobilinogen positive
B. protein positive
C. Nitrite positive
D. Glucose positive
E. Alkaline pH

14. Listeria monocytogenes is a

A. Gram negative rod
B. Gram positive rod
C. Gram negative coccus
D. Gram positive coccus
E. Gram variable rod
15. In the case of H.pylori gastritis, which test should be done to confirm the effectiveness of
treatment
A. H.pylori antibody test in serum
B. H.pylori antigen test in stool
C. Urea breath test
D. Culture/sensitivity
E. Stool routine examination
16. Pathogenic mechanism of listeria monocytogenes
A. Intracellular movement of organism with the help of filopods
B. Intracellular movement of organism with the help of pili
C. Extracelular movement of organism with the help of filopods
D. Extracelular movement of organism with the help of pili
E. Extracellular movement of organism with the help of flagella
17. A 23 year old patient presented with complaints of fever, photophobia, nausea, vomiting and
neck stiffness
Provisional diagnosis could be
A. Meningitis
B. Pharyngitis
C. Pneumonia
D. Sinusitis
E. Tonsillitis
18. A patient presented with the history of high grade fever, nausea vomiting, photophobia and
neck stiffness. There was also a history of untreated pneumonia for 5 days. Regarding route of
transmission
A. Hematogenous spread secondary to pneumonia
B. lymphatogenous spread secondary to pneumonia
C. Hematogenous spread secondary to osteomylitis
D. lymphatogenous spread secondary to osteomylitis
E. lymphatogenous spread secondary to gastroenteritis
 19. A patient was diagnosed with meningitis and the causative organism was Heamophilus
influenzae
What is the route of infection of this organism
A. Hematogenous spread secondary to upper respiratory tract infection
B. Lymphatogenous spread secondary to upper respiratory tract infection
C. Hematogenous spread secondary to urinary tract infection
D. Lymphatogenous spread secondary to urinary tract infection
E. Hematogenous spread secondary to gastrointestinal tract infection
20. The route of infection of listeria monocytogenes in neonatal meningitis is
A. Acquired during delivery through birth canal of mother colonized with listeria
B. Through mother’s milk
C. Through ingestion of contaminated honey
D. Through inhalation
E. Through lymphatogenous spread
21. Which virulence factor is involved that helps Heamophilus influenzae
in escaping phagocytosis
A. Pilli
B. Fimbriae
C. Exotoxin
D. Endotoxin
E. Capsular polysaccharide type B
22. A patient is diagnosed with meningitis secondary to the skull fracture in a road traffic accident.
Gram stain of CSF revealed gram positive diplococci
Most likely micro-organism involved is
A. Niesseria meningitides
B. Enterococcus feacalis
C. Enterobacter cloacae
D. E.coli
E. Streptococcus pneumoniae
23. Regarding rabies virus and the disease rabies, which one of the following statements is most
accurate?
A. Finding Negri bodies within macrophages is presumptive evidence of rabies virus infection.
B. It can also be transmitted by droplet infection of the rabid animal
C. Bats are also one of reservoirs of rabies virus along with dogs and cats
D. The incubation period of the disease is usually 2 to 4 days, leading to the rapid progression of the
encephalitis and death.
E. After the animal bite, rabies virus enters the bloodstream and causes infection of internal organs
24. A 30 year old female presents with a short h/o vulvovaginitis and with a curdy, whitish discharge.
She gives h/o having received a 7 day course of an antibiotic for some urinary problem. What is the
likely pathogen causing her symptoms
A. Trichomonas vaginalis
B. Chlamydia trachomatis.
C. Haemophilus ducreyei.
D. Candida albicans
E. Neisseria gonorrheae
25. Which of the following is an appropriate definition of a neoplasm?
A. the term neoplasm refers to a new growth of tissue in which the growth rate is simular and is
coordinated with that of normal tissue; it serves no useful function, and persists in the same
excessive manner after cessation of the stimuli which evoked the change
B. the term neoplasm refers to a new growth of tissue in which the growth rate exceeds and is
uncoordinated with that of normal tissue; it serves no useful function, and regulatory
mechanisms of cell contact inhibition, differentiation, and mitosis are defective; it persists in the
same excessive manner after cessation of the stimuli which evoked the change.
C. the term neoplasm refers to a controlled new growth of cells in which regulatory mechanisms of
differentiation and mitosis are defective, but cell contact inhibition is normal; such a growth abates
when the inciting stimulus is removed and/or destroyed
D. the term neoplasm refers simply to a swelling of tissue; however, the term is often used
synonymously with cancer.
E. the term neoplasia refers to a new growth of cells that is well differentiated, is not
lifethreatening, grows rather slowly, will not metastasize, and is amendable to treatment.

26. liver nodules that consist of congenital localized overgrowth of mature hepatocytes are referred to
as:
A. hepatomas
B. hamartomas
C. benign sarcomas
D. nodular hyperplasia
E. bile duct anaplasia
27.  which of the following is least likely to be used as a means of distinguishing a benign from a
malignant neoplasm?
A. degree of cellular differentiation
B. rate of growth
C. type and amount of necrosis
D. evidence of metastasis
E. mode of spread
28. which one of the following neoplasms is highly invasive but seldom spread by metastisis?
1: Which of the following feature is 4: A person had history of scalp laceration
due to fall. After few days he developed
meningitis. In this case intracranial infection
suggestive of post mortem abrasion: could be transmitted through scalp via:
a. Cavernous sinus
b. Diploic vein
c. Orbital vein
a. Bright reddish brown in color
d. Ophthalmic vein
b. Scab is slightly depressed
e. Meningeal vein
c. Blurred margins
d. Usually seen over bony prominences
e. Yellowish and translucent

5:18 years old boy presented to emergency

2: During postmortem of a putrefied body department with complain of pain on right
the hyoid bone was found to be fractured. shoulder and discoloration of skin. On
examination doctor noticed a bruise of
Fracture was on greater cornuea horn with
blackish brown discoloration. What is the
outward displacement of distal fragment. age of bruise?
These findings are suggestive of:
a. Less than 24 hours
a. Choking b. 1- 2 days
b. Gagging
c. 2-4 days
c. Hanging
d. Throttling d. 5-7 days
e. Positional asphyxia e. 8-10 days

3 : When injury extends to body cavities of 6: During a scuffle, a person fell upon the
the trunk, the nature of hurt according to lateral side of his head and had swelling on
Pakistan Penal code is: the scalp above his left ear. Most common
a. ITLAF-E-UDW site for contre-coup lesions of the brain
b. ITLAF-E-SALAHIAT-E-UDW could be
c. JURH JAIFAH a. Orbital surface of frontal lobe
d. SHAJJAH b. Parietal lobe of contralateral
e. JURH GHAR JAIFA hemisphere
c. Parietal lobe of ipsilateral hemisphere
d. Temporal lobe of contralateral
hemisphere
e. Temporal lobe of ipsilateral
hemisphere
7: According to Pakistan Penal Code fracture 10: Fish tailing of margins in stab wound
and dislocation of skull bone is: is seen with:
a. SHAJJAH-I-AMMAH
b. SHAJJAH-I-DAMIGHAH a. Single edged knife with stout back
c. SHAJJAH-I-HASHIMA edge
d. SHAJJAH –I- MUNAQQILAH b. Bayonet with ridges and grooves
e. SHAJJAH-I-MAUDIHA c. Cross head Screw driver
d. Double edged knife with thin blades
e. Double edge Knife with serrated back
edge

8: A dead body of 20 years old man brought 11: When several persons act jointly and
for an autopsy with history of skull fracture. illegally overpower an individual and hang
On examination rupture of middle him by means of rope, it is called as:
meningeal artery was present. Hemorrhage
present in meningeal space would be? a. Bansdola
b. Burking
c. Garroting
a. Acute epidural hemorrhage d. Lynching
b. Chronic subdural hemorrhage e. Mugging
c. Chronic epidural hemorrhage
d. Sub-acute epidural hemorrhage
e. Sub-acute subdural hemorrhage

9: A 25 years old man sustained injuries by 12: Separation of skull sutures in young
shot gun. On examination main wound persons by blunt trauma is classified as:
along with some peripheral wound were
present. Most probably he was targeted a. Comminuted fracture
from distance of: b. Diastatic fracture
c. Hinge fracture
 d. Ring fracture
e. Signature fracture
a. One yard
b. Two yards
c. Three yards
d. Five yards
e. Six yards

13: In road traffic accidents Sparrow foot 16: Immediate emergency treatment in
marks are produced due to impact of: carbon monoxide poisoning is:

a. 5% carbon dioxide with oxygen

a. Fragments of Wind screen b. 10% carbon dioxide with oxygen
b. Penetration of steering wheel c. 100% oxygen therapy
c. Projecting parts of car d. Sodium nitrite
d. Pedestrian with road e. Hyperbaric oxygen
e. Run over injures by vehicle

14: “Ladder tears” in traffic accidents are 17: Sodden appearance of epidermis in case
seen in which of the following organ: of drowning occurs within:

a. 0-6 hours
b. 7-12 hours
a. Aorta c. 13-17 hours
b. Heart d. 18-24 hours
c. Liver e. 25-30 hours
d. Lung
e. Pancreas

15: A dead body of young female with two

months pregnancy was brought for
postmortem examination. She was
suspected to die during abortion conducted
at home by a midwife. Which one of the
following is most immediate cause of death
during procedure?

a. Fat embolism
b. Sepsis
c. Hemorrhage
d. cervical shock
e. Air embolism