1.

30-year-old patient presents with bilateral leg

weakness and paresthesias in feet. O/E: distal areflexia
is noted with extensor plantars. Which of the following
should be done next?

a. Lumbar puncture and NCV

b. Serum Vitamin B12 and NCV
c. MRI spine and CSF oligoclonal bands
d. Start empirical IVIG
2. A marathon runner is having severe muscle cramps
and collapses before the finish line. He is rushed in an
ambulance to your hospital. O/E PR = 110/ min, BP =
100/80 mm Hg, normothermic to touch with dry oral
mucosa, lips. Blood work was done and shows sodium=
130 meq/L, potassium = 3.5 meq/L and Chloride -100
meq/L. Which of the following is best for management
of this patient?
a.Start 3% hypertonic saline
b.Start N/2 in 5% dextrose
c.Start Normal saline
d.Start Ringer lactate
3. 85-year-old man presents with a sudden onset of severe
occipital headache and has vomited on two occasions since the
headache began. He also complains of double vision.
His examination findings are as follows:
Glasgow Coma Scale 15/15
Neck stiffness +++
Comment on where is the likely site of pathology?

a. Anterior communicating artery

b. Posterior communicating artery
c. Lenticulostriate artery
d. Posterior cerebral artery
4. An Elderly gentleman collapses at Delhi Metro
gate and you are first responder on the scene.
Which is the first step you shall perform?
a.Check for Breathing efforts
b.Check for Carotid pulse
c.Apply AED and do rhythm check
d.Start Chest compressions
5. A 40-year-old man with 15-year history of smoking 20
cigarettes per day presents with an episode of mild
hemoptysis. Chest X ray shows a 2 cm mass near the
mediastinum. Which is the next best step for management
of this patient?

a. CT guided Biopsy
b. Bronchoscopy with Biopsy
c. Sputum Cytology
d. Sputum for AFB
6. Which of the following leads to pulseless
electrical activity?
a. LV pseudo-aneurysm
b. Ventricular fibrillation
c. Pulmonary embolism
d. Complete heart block
7. Which of the following steps is not useful in
management of pulseless Ventricular tachycardia?
a. Advanced airway
b. Amiodarone
c. Cardioversion
d. Epinephrine
8. A 30-year-old alcoholic male has come with
complaints of multiple episodes of right upper
quadrant pain. LFT shows Serum Bilirubin= 0.8mg%,
SGOT= 150 U/L and SGPT= 40 U/L and PT = 20/15
seconds. USG shows mild hepatomegaly with
preserved echogenicity. Which of the following
drugs will be useful for management of RUQ pain of
this patient?
a.Reduce alcohol intake gradually
b.Disulfiram
c.Steroids
d.Ursodeoxycholic acid
9. 60-year-old man is having multiple episodes of
maroon color stool for last one year. Work up involved
colonoscopy twice which was normal. However FOBT
in 2023 is consistently positive. His bowel habits are
normal and weight is same as last year. He
occasionally consumes chicken and meat and rest of
his meals are vegetarian. Which of the following is the
possible etiology of his presentation?

a.Inflammatory bowel syndrome

b.Irritable bowel syndrome
c.Cancer Rectum
d. AV malformation colon
10. 50-year-old rickshaw puller presents with
complaints of early satiety, recurrent vomiting
episodes and significant weight loss. On
examination a lump in epigastrium is felt which is
hard in consistency. Which of the following should
be the first differential diagnosis of this patient?
a.Peptic ulcer disease
b.Carcinoma stomach
c.Carcinoma pancreas
d.Abdominal tuberculosis
11. 50-year-old alcoholic patient is having repeated
episodes of epigastric pain. He has vomited thrice
in last one hour in the ER. GPE shows pulse rate of
110/min, BP= 130/80 mm Hg, circumoral pallor and
dry tongue. Per abdomen reveals extreme
tenderness in epigastric area, rebound tenderness
is absent and reduced bowel sounds. There is no
evidence of free fluid in abdomen and spleen is not
palpable. What is the clinical diagnosis?
a.Acute cholecystitis
b.Portal Hypertension
c.Acute pancreatitis
d.Mallory Wiess Syndrome
12. 65-year-old has developed sudden onset right arm
weakness with aphasia for last 6 hours. NCCT head was
normal. CTA shows occlusion of M1 segment of MCA.
Which of the following is the best management of this
patient?

a. Start Enoxaparin, loading dose of aspirin and high intensity statins

b. Admit the patient and start thrombolysis
c. Admit the patient and schedule thrombectomy
d. Admit the patient and start mannitol
13. 20-year-old patient went to a camping trip and
developed acute gastroenteritis. He has had 15
episodes of loose motions in last 3 hours and is
having prostration and extreme fatigue with cramps
in legs. Which is correct about the electrolyte
imbalances expected in this patient?

a.Hypovolvemic hyponatremia with hypokalemia

b.Euvolvemic hyponatremia with hypokalemia
c.Hypervolemic hyponatremia with hypokalemia
d.Pseudo hyponatremia
14. 90-year-old patient is having complaints of
recurrent episodes of dizziness and syncopal
episodes. His ECG and CXR is shown below. Which
of the following devices is visible in Chest X Ray?

a. Implantable cardioverter
defibrillator
b. Pacing Device
c. Vagal nerve stimulator
d. Chemo-port
15. A smoker had developed blood-tinged sputum
during cough. On work up Chest X-ray was normal.
Which of the following is the next procedure done?

a. Bronchoscopy
b. Repeat CXR
c. CT chest
d. Sputum test
16. Cause of Cushing syndrome in 68yr old
smoker male with episodes of non life
threatening hemoptysis?

a. Ectopic ACTH production

b. Ectopic CRH production
c. Adrenal Carcinoma
d. Pituitary Micro-adenoma
17. 20-year-old patient went to a camping trip and
developed acute gastroenteritis. He has had 15
episodes of loose motions in last 3 hours and is
having prostration and extreme fatigue with cramps
in legs. Which is correct about this patient?

a.Increased anion gap metabolic acidosis

b.Decreased anion gap metabolic acidosis
c.Mixed metabolic and respiratory acidosis
d.Normal anion gap metabolic acidosis
18. 35-year-old banker was recently diagnosed with
hypertension and was started on ACEI. He is
currently having severe flank pain. USG done in ER
shows enlarged kidneys with multiple cysts. Which
of the following finding is next expected in this
patient?
a.Lung cysts
b.Liver cysts
c.Renal vein thrombosis
d.Renal artery stenosis
19. A 15-year-old child has developed dystonia and
poor school grades. Slit examination is shown below.
Which is the initial investigation recommended for the
patient?
a. Serum ceruloplasmin
b. Serum copper
c. 24 hr urinary copper
d. Liver biopsy
20. 40-year-old man was having weight loss and
recurrent episodes of colicky pain for last one year
and had shown many doctors and was not getting
relief. Your work shows positive A.S.C.A and CT
abdomen with contrast shows multiple strictures in
small and large bowel. A diagnosis of Crohn disease
is made. The Initial treatment for management of
mild to moderate Crohn’s disease is?
a.Mesalamine
b.Infliximab
c.Budesonide
d.Sulfasalazine
21. A 40-year-old alcoholic is admitted with
symptoms of confusion and repeated falls with gait
ataxia. Cranial nerve examination shows nystagmus
with bilateral lateral rectus palsy. Rest of CNS
examination could not be completed due to non-
cooperation of patient. Which of the following is the
best management of this patient?
a.IV thiamine plus 10 percent dextrose
b.IV 25 percent dextrose plus thiamine
c.CT scan to rule out CNS bleed due to falls
d.IV diazepam
22. Which of the following is not complication of
recurrent packed RBC transfusion is?
a.Circulatory overload
b.Acute lung injury
c.Jaundice
d.Diarrhea
23. A 40-year-old patient of chronic hepatitis B was
non-compliant to medication. He has now developed
features of hepatic encephalopathy due to
decompensated cirrhosis. Which of the following
shall be noted in this patient?
a.Motor aphasia
b.Sensory aphasia
c.Conduction aphasia
d.Anomic aphasia
24. Anion gap is increased in all except?

a.Renal tubular acidosis

b.Diabetic ketoacidosis
c.Acute tubular necrosis
d.Ethylene glycol poisoning
25. A 40-year-old smoker has presented with
complaints of respiratory distress on climbing
stairs. The AP diameter of chest is more than
transverse diameter of chest in the patient. CXR was
performed. Which is the best management of this
patient?
a. Insert wide bore needle in second
intercostal space mid clavicular line
b. Insert wide bore intercostal drainage
tube in 5th intercostal space anterior
axillary line
c. Low flow supplemental oxygen
d. High flow oxygen with nasal cannula
26. On Post-operative day 2, patient is complaining of
respiratory distress. Sp02 is 80% in room air. On
auscultation air entry is reduced in left infra-mammary
and infra-axillary area. What is the next step in
management of patient?
a.Supplemental oxygen and tube
thoracostomy if required
b.Perform urgent needle thoracotomy in
triangle of safety
c.Perform elective intubation and positive
pressure ventilation
d. Perform intubation and Low volume
ventilation
27. Which of the following is the most common
cause of transfusion associated hepatitis?
a.Hepatitis A
b.Hepatitis B
c.Hepatitis C
d.Hepatitis D
28. M.E.L.D score includes all except?

a.Serum albumin
b.Serum creatinine
c.Serum bilirubin
d.INR
29. Fatty liver with hepatomegaly is seen in?

a.Marasumus
b.Metabolic Syndrome
c.Wilson disease
d.Nutmeg liver
30. 20-year-old patient has developed flaccid
paraplegia with ascending symmetrical paralysis. LP
shows albumin cytological dissociation and Nerve
Conduction velocity shows evidence of
demyelination. The ABG shows pH= 7.30, pC02= 50
mm Hg, HC03= 26 meq and p02= 70 mm Hg. Which
of the following shall not be useful for this patient?
a.Intravenous immunoglobulins
b.Intravenous methylprednisolone
c.Plasmapheresis
d.Elective intubation and mechanical ventilation
31. A 20-year-old student is having complaints of
daily episodes of loose motions leading to disturbed
academics. On follow up significant weight loss is
noted with features of vitamin deficiencies. Which of
the following test is not useful for diagnosis of this
patient?
a.D- Xylose absorbtion test
b.Fecal fat estimation
c.Urine aminoaciduria
d.Breath Hydrogen test
32. Which of the following virus is the leading cause
of post Kidney transplantation lymphoma?
a.EBV
b.CMV
c.Herpes
d.Aspergillus
33. Which of the following is not an autoimmune
disease?
a.Rheumatoid arthritis
b.Graves’ disease
c.S.L.E
d.I.B.D
34. Flapping tremor occurs due to all except?

a.C02 narcosis
b.Hepatic encephalopathy
c.Uremic encephalopathy
d.Paralysis Agitans
35. Which of the following conditions leads to
development of Hypokalemia, hypovolemia and
diarrhea non responsive to fasting?
a.Simmond’s disease
b.Verner Morrison syndrome
c.Werner Syndrome
d.Turcot syndrome
36. A previously healthy 45-year-old woman has
been unable to open her left eye since awakening
that morning. Which of the following cranial nerves
is most likely to be affected?
a. 3
b. 4
c. 6
d. 7
37. Which of the following is not a feature of
Zollinger Ellison Syndrome?
a.Diarrhea non-responsive to fasting
b.Epigastric pain
c.Large gastric ulcer
d.Secretin study is the investigation of choice
38. Carbohydrate related to blood grouping?

a.Arabinose
b.Xylulose
c.Xylose
d.Fucose
39. Discriminant score is used for management of?

a.Viral hepatitis
b.Alcoholic hepatitis
c.Variceal bleeding
d.Weight loss
40. Which is not a cause of upper GIT bleeding is

a.Meckel’s diverticulum
b.Mallory Weiss syndrome
c.Gastric antral vascular ectasia
d.Portal hypertension