GOMAL MEDICAL COLLEGE, MTI, D.I.

KHAN
MCQs Written Test 4th YEAR MBBS (Block-L) Date: 18th October, 2022
Name of Student: ____________________ Roll No.______________
Please encircle the correct answer with blue/black pen Paper ID: BLUE
TIME ALLOWED: 02-HOUR’S TOTAL MARKS: 120
Note: Attempt ALL questions from this section. Select ONE best answer. Each question carries 01 mark.
Q#1: A 30 year old female presented with weight gain,depression, constipation and fatigue. On lab investigations she is diagnosed
as a case of hypothryodisim. Which of the following drug should be given to her?
a) Carbimazole
b) Methimazole
c) Propylthiouracil
d) Levothyroxine
e) Octreotide
Q#2: Vasopressin is used to treat all of the followingconditions EXCEPT:
a) Diabetes insipidus
b) Cardiac arrest
c) To control bleeding from oesophageal varices
d) Hyponatremia
e) Both c and d
Q#3: Which of the following statement ischaracteristic of metformin?
a) It decreases insulin resistance
b) It promotes insulin secretion
c) Risk of hypoglycemia is far more than that withsulfonylureas
d) It has nothing to do with hepaticgluconeogenesis
e) Weight gain may occur with metformin
Q#4: A 50 years old female with type 2 diabetes now presented with heart failure.Which of the following anti diabetes drug should
be avoided this patient.
a) Pioglitazone
b) Acarbose
c) Miglitol
d) Metformin
e) Sitaglipin
Q#5: 30 years old female using med Roxy progesterone as an injectable contraceptive. Which of the following side effect is not of
concern if she wants to use it for long time?
a) Headache
b) Depression
c) Weight gain
d) Change in libido
e) Endometrial cancer
Q#6: All of the following are selective estrogenreceptor modulators EXCEPT:
a) Tamoxifen
b) Raloxifene
c) Mestranol
d) Clomiphene
e) Ospemifene
Q#7: A 35 years old female comes to you for post coital or emergency contraception. Which one of the following would you
prescribe to her?
a) Progestin only mini pills
b) Transdermal patch of ethinyl estadiol
c) Medroxyprogesterone IM
d) High dose of levonorgestrel
e) Low dose ethinyl estradiol
Q#8: Which one of the following is orally activetestosterone?
a) Testosterone cypionate
b) Testosterone enanthate
c) Fluoxymesterone
d) Oxandrolone
e) Both c and d
Q#9: High doses of androgens in children can lead to:
a) Decrease formation of haemoglobin
b) Retinal detachement
c) Short stature
d) Memory problems
e) Cerebellar dysfuntion
Q#10: Which one of the following is true regardingsulfonylureas?
a) Stimulation of insulin release from páncreas
b) Activation of ATP sensitive potassium channels
c) Increase hepatic gluconeogenesis
d) Decrease peripheral insulin sensitivity
e) Can lead to weight loss
Q#11: Which of the following is side effect of octreotide?
a) acromegalay
b) carcinoid síndrome
c) bleeding from oesophageal varices
d) gall bladder Stones
e) all of above
Q#12: A 30 years old lady presented with galactorrhea having high prolactin level.Which of the following medicine should not
be used in thispatient.
a) Bromocriptine
b) Cabergoline
c) Metoclopramide
d) Risperidone
e) Both c and d.
Q#13: Which of the following is long acting insulin?
a) Insulin glargine
b) Regular insulin
c) Insulin lispro
d) Insulin aspart
e) NPH insulin
Q#14: Which one of the following is selective alpha1A blocker?
a) Doxazosin
b) Tamsulosin
c) Terazosin
d) Alfuzosin
e) Finasteride
Q#15: Which one of the following drug can be usedto treat prostate cancer?
a) Fluoxymesterone
b) Oxandrolone
c) Androstenedione
d) Flutamide
e) Dehydroepiandrosterone
Q#16: In 2005, Pakistan crude birth rate was 36 births per 1000 population and the crude death rate was 9 deaths per 1000
population. What was the population growth rate of the country in that year assuming no in and out migrations?
a) 2.9 %
b) 2.8 %
c) 2.7 %
d) 2.6 %
e) 2.5 %
Q#17: The changes in the size of population are indicated by five stages of demographic transition. Pakistan is currently in the:
a) First stage
b) Third stage
c) Second stage
d) Fourth stage
e) Fifth stage
Q#18: Population size is determined by fertility, mortality and migrations. A researcher concluded that Pakistan’s population is
increasing on account of high fertility which measure did he rely upon the most to conclude this?
a) Growth rate
b) Crude birth rate
c) Natural increase rate
d) Total fertility rate
e) General fertility rate
Q#19: The number of daughters a new born girl will bear during her life time assuming fixed age specific fertility and mortality
rate, refers to which one of the following?
a) Age specific fertility rate
b) Gross reproduction rate
c) Net reproduction rate
d) Total fertility rate
e) General fertility rate
Q#20: The absolute number of population of an area at any point in time is:
a) Count
b) Rate
c) Ratio
d) Proportion
e) Average
Q#21: Many women in a country are educated, independent and they work for earning their lively hood too. When the number of
males are expressed in relation with 100 females this is:
a) Sex ratio
b) Sex rate
c) Dependency ratio
d) Literacy rate
e) Working women ratio
Q#22: When total number of live births are expressed against the midyear population at a given place and during a given period.
We are referring:
a) General fertility rate
b) Crude birth rate
c) Total fertility rate
d) Specific birth rate
e) Gross reproductive rate
Q#23: Hameed, Sara and Saima were born in the same year, they were neighbors and very close friends too. It was just a
coincidence that their parents also got married about the same time. The most likely reason for their admission in the same class
is:
a) Birth cohort
b) Marriage cohort of parents
c) Friendship
d) Neighborhood
e) School accessibility
Q#24: Keeping in mind the population pyramid of Pakistan. Which of the following features is most obvious?
a) Low fertility
b) Low mortality
c) Increased life expectancy
d) High dependency ratio
e) Low sex ratio
Q#25: General fertility rate is a more refined measure than the crude birth rate because it relates births to the age sex group at
risk of giving birth while defining general fertility rate the denominator consists of:
a) Mid-year total population of women
b) Population of women above 15 years of age
c) Population of women in child bearing age
d) Population of unmarried women
e) Total number of live births
Q#26: Fertility refers to the number of live births women have. The best picture of how many children women are currently having
is given by:
a) Total fertility rate
b) Age specific fertility rate
c) General fertility rate
d) A crude birth rate
e) Net reproduction rate
Q#27: Population doubling time is another way of expressing population growth. If we suppose that growth rate of Poland
remains constant at 0.08% population would be doubled in about.
a) 800 years
b) 870 years
c) 875 years
d) 880 years
e) 890 years
Q#28: Population study shows that it has five different stages of demographic transition. Pakistan is currently having decreased
death rate and declining but still an increased birth rate compared to death rate, so we will place Pakistan in:
a) Stage I
b) Stage II
c) Stage III
d) Stage IV
e) Stage V
Q#29: Demographic cycle has five stages and each country is allotted a different stage. For examples if birth rate of a country is
lower than death rate with decreasing population, then we call it as:
a) High stationary
b) Early expanding
c) Late expanding
d) Low stationary
e) Declining
Q#30: Which of the following depicts age and sex composition of a population?
a) Pie chart
b) Histogram
c) Population pyramid
d) Line diagram
e) Scatter diagram

Q#31: The yield of a screening program by a field test increased over a period of 3 years although the tradeoff between sensitivity
and specificity remained the same. It gives a clue to an increase in;
a) Validity
b) Accuracy
c) Prevalence
d) Incidence
e) Reliability
Q#32: A woman came with ante-partum bleeding. She was to be transfused with blood. Her blood was sent for blood grouping
and HBV screening. She was found to be HB positive This screening is;
a) Multiphasic
b) High risk
c) Research
d) Mass
e) Opportunistic
Q#33: Worker of lead foundry is tested for coproporphyrin in the urine this screening is:
a) Multiphasic
b) Targeted /high risk
c) Research
d) Mass
e) opportunistic
Q#34: For screening of tuberculosis, Mantoux, chest x-rays and sputum analysis were used on the same occasion in Rawalpindi
District. This screening is an example of:
a) Multiphasic
b) Targeted
c) Research
d) Mass
e) Opportunistic
Q#35: The extent to which a test measures what it was originally designed to measure is described as:
a) Sensitivity
b) Specificity
c) Validity
d) Reliability
e) True-positive value
Q#36: Accuracy of the screening test will depend upon:
a) Validity
b) Systemic error
c) Reliability
d) Random error
e) Precision
Q#37: A pap smear and colposcopy for the early detection of cervical cancer constitute
a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Medical treatment
e) Surgical treatment
Q#38: A screening test is positive in the majority of cases but false positive rate is much higher than true positives this indicates:
a) Low PPV
b) Low NPV
c) Low accuracy
d) High validity
e) High specificity
Q#39: A 28 years old nulliparous lady with hirsuitism, oligomennorhoea and inability to conceive. She is diagnosed as having
polycystic ovaries on transvaginal ultrasound. What is the correct option of her cancer risk in future.
a) Increased risk of breast cancer
b) increased risk of ovarian cancer
c) increased risk of endometrial hyperplasia and endometrial cancer
d) increased risk of large gut cancer
e) None of them
Q#40: Ovarian artery is a branch of which main artery:
a) Internal iliac artery
b) External iliac artery
c) Aorta
d) Femoral artery
e) Both C and D
Q#41: A 30 years old lady came to OPD for contraception advice. She is P1 and lactating a six months old baby. She gives history of
irregular vaginal spotting off and on while her urine pregnancy test is negative. Her BP is normal with BMI of 21 while there is no
personal or family history of thromboembolism. What will be the most suitable contraceptive method for her?
a) IUCD
b) Oral contraceptive pills
c) Barrier method ( condom)
d) MIRENA
e) None of the above
Q#42: A 25-year-old lady present to ER with C/O Ammenorrhoea of two weeks, abdominal pain and vaginal bleeding. She had
fainting attacks in morning. On examination BP 90/60mmHg, pulse 112/min, afebrile PA: Examination tenderness positive in left
side of abdomen. Pv: Examination Uterus A\v normal size, curvical excitation positive, fullness in left adnexa, vaginal bleeding
positive. Which of the following is most likely diagnosis?
a) Ruptured ectopic pregnancy.
b) Hydatiform Mole.
c) Incomplete miscarriage.
d) Complete miscarriage.
e) Both A and B
Q#43: A 35 Year old nulliparous present to opd with complaint of primary infertility and HMB for 2 years. On examination BP
120/70 mmHg, pulse 90\min. Abdominal examination reveales a mass of 10-12 cm in lower right abdomen mobile non tender,
firm, dull on precaution shifting dullnes –ve , P\V examination uterus size 12 wk size, adnexa are clear.
a) Fibriod uterus
b) Adenomyosis
c) Ovarion cyst
d) Endometriosis
e) Both A and B
Q#44: A 70 yrs old lady presents to OPD with complaint of involuntary loss of urine while coughing and sneezing. She also gives
history of urgency, hesitancy and frequency of urine. Her pelvic examination is normal while her Urine R/E report is negative for
pus cells. What will be the most accurate diagnostic test to plan her management?
a) Urine culture and sensitivity
b) Cystoscopy
c) Renal function tests
d) Urodynamic studies
e) None of the above
Q#45: A 30 years old lady married for five years presents to Gyn OPD with complaint of inability to conceive. She gives history of
two miscarriages followed by D and C by a local LHV .Her husband semen report is normal while lady has documented ovulation
on TVS in last two cycles. What will be the next appropriate investigation for the workup this couple?
a) Mid luteal phase serum progesterone level
b) Hysterosalpingography
c) Repeat husband semen analysis after three months
d) Hysteroscopy
e) None of the above
Q#46: A primigravida at 30 wks of gestation presented to Gyn OPD with complaints of pain lower abdomen, dysuria and nausea.
Her Urine R/E report shows numerous pus cells while urine culture report is positive for E-coli growth. What is the most likely
complication of UTI in pregnancy?
a) Miscarriage
b) HELLP Syndrome
c) Preterm labour
d) Renal failure
e) None of the above
Q#47: A 22 year old lady having one child of two years presents to Gyn OPD with complaint of new onset malodourous frothy
yellow discharge for two weaks. On spaculum examination, you visualize a cervix with punctate haemorrhage. What next step
would you take?
a) Take a high vaginal swab for microscopy and culture
b) Prescribe treatment for Candiasis because this is most common
c) Advise hospital admission for antibiotics
d) Counsel on hygiene practice
e) None of the above
Q#48: 80 years old menopausal lady is brought to gyne OPD with complaint of something coming out of vagina. She had history of
ischemic heart disease along with COPD. On examination you diagnose third degree UV prolapse. What will the best management
option for this lady?
a) Vaginal hysterectomy and AP repair
b) Ring pessary
c) Sacrohysteropexy
d) Sling operation
e) None of the above

Q#49: A 30 year old female presented with solitary thyroid nodule. She complained of hoarseness of voice. On clinical examination
cervical lymph node is also palpable. On thyroid scan it was cold solid nodule. FNAC of nodule showed intranuclear inclusions in
aspirated cells. What is the diagnosis?
a) Anaplastic Carcinoma
b) Follicular Carcinoma
c) Hurthle cell Carcinoma
d) Medullary Carcinoma
e) Papillary Carcinoma

Q#50: In conventional papillary thyroid carcinoma there are two driver gene mutations seen in pathogenesis, one is point
mutation in BRAF gene. Which other gene mutation is involved in its pathogenesis?
a) Gene fusion of RET
b) Mutation in PIK3CA
c) PTEN mutation
d) PAX8 gene mutation
e) Point mutation of beta catenin

Q#51: A 15 year old girl was diagnosed of papillary thyroid carcinoma. Her parents were worried and asked about the risk factors
causing this carcinoma. Which of the following is major risk factor predisposing to papillary thyroid cancer?
a) Betel nut chewing
b) Iodine deficiency
c) Ionizing radiation exposure
d) Tobacco
e) UV rays of sun exposure
Q#52: A 40 year old female patient complained of neck mass with dysphagia. On biopsy of the tumor, it was diagnosed as
Medullary thyroid carcinoma. Which of the following is characteristic histologic finding in Medullary thyroid carcinoma?
a) Amyloid deposits
b) Neurofibrillary tangles
c) Pseudo-rosettes
d) Russel bodies
e) Water clear cell hyperplasia

Q#53: A 50 year old woman complained of post-menopausal bleeding. On examination her cervix was eroded and ulcerative.
Biopsy was taken and diagnosis of Squamous intraepithelial neoplasm was made on the basis of nuclear changes along with
cytoplasmic halos having perinuclear vacuoles termed koilocytic atypia. Which of the following is associated with koilocytic atypia?
a) EBV
b) High Ki-67
c) High CEA level
d) HPV encoded protein E5
e) Keratin formation

Q#54: A 30 year old woman presented with the complaint of menstrual irregularities and infertility. On microscopic examination,
irregular nests of endometrial stroma and endometrial glands were seen in the myometrium. What is the diagnosis in this case?
a) Adenomyosis
b) Atypical endometriosis
c) Chocolate cyst
d) Endometrial hyperplasia
e) Endometrial carcinoma

Q#55: Which of the following is the ovarian counterpart of testicular seminoma?

a) Choriocarcinoma
b) Dysgerminoma
c) struma ovarii
d) Teratoma
e) Yolk sac tumor

Q#56: A 19 year old woman had ultrasound at 09 weeks of her pregnancy which showed snow storm appearance. On further work
up of the patient it was diagnosed complete hydatidiform mole. What is the karyotype in complete hydatidiform mole?
a) 46 XX
b) 69,XXY
c) 92,XXXY
d) Inhibition of TGF beta
e) VEGF stimulation

Q#57: A 30 years old woman comes to the OPD. She is complaining of heat intolerance, nervousness, insomnia, palpitations and
increased appetite for the last few months. On examination, she is having swelling in the neck, fine tremors, and protrusion of the
eye ball. What could be the most appropriate investigations for making the diagnosis?
a) CT scan
b) ECG
c) Ophthalmologic examination
d) Thyroid function tests
e) Ultrasound neck

Q#58: What is the most common cause of hyperthyroidism?

a) Excessive iodine intake
b) Grave’s disease
c) Medications
d) Thyroiditis
e) Thyroid nodule

Q#59: what is the most common route of transmission of treponema pallidum (syphillus)?
a) Droplet infection
b) Through intimate sexual contact
c) Mother to fetus
d) Respiratory route
e) Through blood transfusion

Q#60: In secondary syphillus, moist lesions on genitalia are known as.

a) Condylomata lata
b) Chancre
c) Erythema marginatum
d) Maculopapular rash
e) Papules
Q#61: What is the most common type of immune complex mediated glomerulonephritis?
a) Fungal
b) Parasitic
c) Post streptococcal
d) Rickettsial
e) Viral
Q#62: Treatment of post streptococcal GN usually requires to manage the urgent problem of
a) Edema
b) Fever
c) Heamaturia
d) Hypertension
e) Proteinuria

Q#63: Which is the most commonly involved age group by post streptococcal glomerulonephritis?
a) Adults
b) Children
c) Pregnant women
d) Immunocompromised
e) Men
Q#64: A 50 year old male patient presented with costovertebral pain, palpable mass & hematuria. He also complained with fever,
weight loss & malaise. On biopsy of renal mass, the diagnosis of Clear cell carcinoma was made. Which gene mutation is
responsible for clear cell carcinoma?
a) Loss of VHL
b) Mutated BHD gene
c) Mutated FH gene
d) Mutated MET gene
e) VEGF inhibition

Q#65: A 15 year old male patient having nephrotic syndrome was advised renal biopsy. On light microscopy segmental sclerosis
was seen in few glomeruli. On electron microscopy both sclerotic and non-sclerotic areas show diffuse effacement of foot
processes. On immunofluorescence IgM & C3 is present in sclerotic areas. Which glomerular disease is cause of nephrotic
syndrome in this case?
a) Berger Disease
b) Focal segmental glomerulosclerosis (FSGS)
c) Dense deposit disease
d) Membranoproliferative glomerulonephritis (MPGN)
e) Membranous Nephropathy
Q#66: An 8 year old boy presented with nephritic syndrome giving history of sore throat infection 1 month ago. His renal biopsy
was done. On light microscopy enlarged hypercellular glomeruli with leukocytic infiltration seen. On immunofluorescence granular
IgG & C3 in GBM. On electron microscopy subepithelial humps are seen. What is the diagnosis?
a) Chronic glomerulonephritis
b) Goodpasture Syndrome
c) IgA nephropathy
d) Minimal change disease
e) Postinfectious glomerulonephritis

Q#67: Which one of the following is the best marker to monitor thyroxine status in hypothyroid patient?
a) T3
b) T4
c) TSH
d) T3 and T4
e) T3,T4 and TSH levels

Q#68: Which one of the following is the most common cause of Thyrotoxicosis?
a) Diffuse goiter
b) Graves disease
c) Multi nodular goiter
d) Solitary nodule
e) Toxic nodular goiter
Q#69: Which one of the following fasting blood sugar level needs further investigations?
a) 15mmol/L
b) 10mmol/L
c) 5mmol/L
d) Less than 7mmol/L
e) More than 7mmol/L
Q#70: Patient with pituitary tumor has infertility. It is possibly due to:
a) Addison'
b) CHF
c) Conn's syndrome
d) Cushing syndrome
e) SIADH
Q#71: Which one of the following causes cervical dysplasia?
a) Chronic irritation
b) EBV
c) Herpes
d) HPV
e) IUCD
Q#72: Which one of the following is cheaper and most valuable test for diagnoses of cervical intraepithelial neoplasia?
a) Dilation and curettage
b) Evacuation and curattag
c) Laproscopy
d) Pap smear
e) Ultrasound
Q#73: Which tumor is derived from all the 3 germ layers?
a) Adenocarcinoma
b) Bronchogenic carcinoma
c) Chancroid
d) Rhabdomyosarcoma
e) Teratoma
Q#74: Which of the following is the most common site for metastasis of chorizo carcinoma?
a) Cervix
b) Fallopian tube
c) Lung
d) Ovary
e) Uterus
Q#75: A 65 year old smoker presents with gross total painless hematuria. Which one of the following is the most likely diagnosis?
a) Benign prostatic hyperplasia
b) Ca prostate
c) Ca urinary bladder
d) Cystolithiasis
e) Urinary tract infection
Q#76: Medullary cystic disease of the kidney is best diagnosed by:
a) Biopsy
b) Nuclear scan
c) Ultrasound
d) Urography
e) X-ray
Q#77: Anion gap decrease in:
a) Hypoalbuminemia
b) Ketoacidosis
c) Lactic acidosis
d) Metabolic Alkalosis
e) Salicylate poisoning
Q#78: A 24-year-old male was trying to move his wardrobe when it fell on his thigh. His leg was trapped underneath it for several
hours before someone was able to help him get out. When he was seen in ED his urine was dark and dipstick was positive for
blood. His HR=115 bpm and systolic bp=100mmhg. Lab result show creatinine of 320 μmol/L and urea of 13mmol/L. what is the
single most likely cause of renal failure?
a) Acetylcholine
b) Drug toxicity
c) Troponin
d) Acetoacetate
e) Myoglobin
Q#79: A 32-year-old man presents with painless hematuria and flank pain. His blood pressure is 155/98 mmhg. The rest of physical
examination was otherwise normal. What is the single most likely diagnosis?
a) Bladder cancer
b) Adult polycystic kidney disease
c) Thrombotic thrombocytopenic purpura
d) Prostate cancer
e) Hemolytic uremic syndrome
Q#80: A 20-year-old woman, working in a daycare, develops gross hematuria. She was diagnosed with DM type-1 a year ago and is
taking insulin injection daily. Her physical examination is unremarkable. Labs: s. creatinine=1.0mg/dl, s. albumin=4.0mg/dl,
urinalysis= numerous RBCs and few RBC casts; 1+ protein, s. complement=normal. Most likely diagnosis is?
a) Diabetic nephropathy
b) Ig A nephropathy
c) Membranous nephropathy
d) Minimal change disease
e) Poststreptococcal glomerulonephritis
Q#81: A 45-year-old hypertensive man presents with tiredness, lethargy, fluid retention and proteinuria. His albumin levels are
low. What is the single most definitive diagnostic test?
a) Mid-stream urine for culture
b) Renal biopsy
c) Renal function tests
d) Urine microscopy
e) Serum protein
Q#82: The causes of impotence in males include all except:
a) Psychological reason
b) Congenital malformation
c) Uncontrolled diabetes
d) Sterility
e) Stress
Q#83: The causes of impotence in females include all except:
a) Vaginismus
b) Extreme hatred
c) Fear
d) Hypertension
e) Stress
Q#84: False virgin is who has
a) Elastic hymen
b) No hymen
c) Imperforate hymen
d) Annular hymen
e) None of above

Q#85: Rape is defined under following section of Pakistan Penal Code:

a) 320
b) 325
c) 375
d) 376
e) 420
Q#86: The minimum age for consent for sexual intercourse for wife is:
a) 12 year
b) 14 year
c) 15 year
d) 18 year
e) 11 year
Q#87: Sex with a woman is rape except:
a) Consent has been received by fear
b) She has unsound mind
c) When she is wife
d) She is intoxicated
e) When Age is below 18

Q#88: Sin of Gomorrah is:

a) Anal intercourse
b) Buccal coitus
c) Incest
d) Lesbianism
e) None
Q#89: Pedestry of buggery is:
a) Sodomy
b) Incest
c) Buccal coitus
d) Lesbianism
e) None of above
Q#90: Sadism is when a person drives sexual pleasure by:
a) Beating the partner
b) Urinating on partner
c) Getting beaten by partner
d) Wearing clothes of opposite sex
e) Sexual Gratification.
Q#91: Masochism is when a person drives Sexual pleasure by:
a) Inflicting pain on partner
b) Getting pain from partner
c) Urinating on partner
d) Dreaming about partner.
e) None of above.

Q#92: The MOST common cause of permanent congenital hypothyroidism is

a) Dyshormonogenesis
b) Thyroid dysgenesi
c) IODINE deficiency
d) Defect of iodide transport
e) Pended syndrome

Q#93: Which of the following is accurate regarding urine studies in nephrotic syndrome?
a) A 2+ reading on urinalysis via dipstick represents 300 mg/dL of urinary protein or more, correlating with a daily loss
of 3 g or more
b) The presence of 4 or more red blood cells per high-power field in a urine sediment examination is required for a
diagnosis of microhematuria
c) A measurement of 100-150 mg of total protein present in a 24-hour urine collection suggests early nephrotic
syndrome
d) A ratio of urine protein to urine creatinine > 2 g/g indicates nephrotic-range proteinuria
e) None of the above
Q#94: In uncentrifuged sample of urine, definition of significant pyuria is:
a) >3 leukocytes per high power field
b) >10 leukocytes per high power field
c) >10 leukocytes/cu.mm
d) >5 leukocytes/cu.mm
e) None of the above
Q#95: A 36-year-old man presents to the emergency room with renal colic. His vital signs are normal and a urinalysis shows
microscopic hematuria. A radiograph reveals a 1.5-cm stone. Which of the following is the most appropriate management of this
patient?
a) Hydration and analgesics
b) α-Adrenergic blocker
c) Extracorporeal lithotripsy
d) Percutaneous nephrostomy tube
e) Open surgery to remove the stone

Q#96: A 45-year-old woman presents with a 7-cm renal cell carcinoma with radiologic evidence of abdominal lymph node
involvement with no distant metastases. Which of the following is the most appropriate management of this patient?
a) Radical nephrectomy
b) Radiation
c) Chemotherapy
d) Radiation followed by nephrectomy
e) Chemotherapy followed by nephrectomy

Q#97: A 58-year-old man is found to have high serum prostate–specific antigen (PSA) concentration with a normal prostate
examination. A biopsy of the prostate confirms low-grade carcinoma. The patient wishes to avoid therapy involving any risk for
impotence. Which of the following is the most appropriate management of this patient?
a) Observation
b) Chemotherapy
c) Prostatectomy
d) Radiation therapy
e) Hormonal therapy

Q#98: A 55-year-old man presents with fever and pain in the perineal region. Upon further questioning he also complains of
frequency, urgency, dysuria, and a decreased urinary stream. On physical examination his abdomen is soft, nondistended, and
nontender. Digital rectal examination demonstrates exquisite tenderness on the anterior aspect. Laboratory examination reveals
leukocytosis and findings on urinalysis are consistent with a bacterial infection. Which of the following is the most likely diagnosis?
a) Urinary tract infection
b) Benign prostatic hyperplasia
c) Prostatitis
d) Pyelonephritis
e) Nephrolithiasis

Q#99: Which of the following statements about kidney biopsy is true?

a) It is usually required to confirm a diagnosis of diabetic nephropathy
b) It causes bleeding in a minority of patients
c) It is essential to diagnose anti-glomerular basement membrane disease
d) It requires a general anaesthetic
e) It should only be performed if it will change patient management

Q#100: Polycystic kidney disease is thought to be primarily due to a genetic abnormality of:
a) Sodium transport
b) Cell division
c) Tubular membrane structure
d) Epithelial permeability
e) Cilial function
Q#101: How does testicular torsion typically present?
a) Sudden pain in the scrotum and an absent cremasteric reflex
b) Swelling of the scrotum and fever
c) painless testicular mass that cannot be transilluminated
d) ‘Bag of worms’ appearance of the scrotum
e) Painless testicular swelling with transillumination
Q#102: When progressive enlargement of a multinodular goiter causessymptomatic tracheal compression, the preferred
management in otherwise good-risk patients is:
a) Iodine treatment
b) Thyroid hormone treatment
c) Surgical resection of the abnormal thyroid
d) Radioactive iodine treatment
e) Partial thyroidectomy

Q#103: Hyperparathyroidism can affect which of the following organs and body systems?
a) Gastrointestinal tract.
b) Kidneys.
c) Skeleton.
d) Neuromuscular system
e) All of the above
Q#104: 15 years old diabetic patient presented to emergency department in semi unconscious state. She had severe abdominal
pain and vomiting. Her labs were as under: RBS: 401mg/dl, Urinary ketones: 3+, Serum osmolarity: 314mOsm/L. What is the likely
diagnosis?
a) Diabetic ketoacidosis
b) Lactic acidosis
c) Hyperosmolar hyperglycaemic state
d) Appendicitis
e) None of the above

Q#105: A 19 year old medical student presented with complaints of weight loss, polyuria and polydipsia. He was otherwise stable.
His labs were as under: FBS. 397mg/dL, HbA1C: >15 %. What will be the treatment strategy?
a) Metformin
b) Sulfonylureas
c) DDP4 inhibitors
d) Insulin
e) Diet and life style modification

Q#106: 35 years old female presented to emergency department with polyuria. She is diabetic for past 2 years and using
glimepiride 4mg. Now, she got pregnant with gestational amenorrhea of 4months. Her labs are as under: RBS 250mg/dL, HbA1C
7.4%. What will be the treatment strategy?
a) Continue glimepiride and add Metformin.
b) Stop glimepiride and start on GP-1 analogue
c) Continue glimepiride and add DDP 4 inhibitors
d) Stop glimepiride and switch to insulin
e) Continue glimepiride and add insulin

Q#107: 30 year old lady has obesity, infertility hirsutism and depression. What is the most likely condition she suffering from?
a) Hypothyroidism
b) Morbid obesity
c) Polycystic ovary syndrome
d) Polyglandular syndrome
e) Type I diabetes mellitus

Q#108: 15 year old female presented to emergency department in the state of coma and fever. She has air hunger and
dehydrated her GCS is 9/15, Pube 100, Bl 100/60, blood sugar level are 450 mg/dl. What is the best treatment option for this
patient?
a) Metformin
b) Gliclazide
c) Long acting insulin
d) Hydration with saline and Humulin R (DKA protocol)
e) DPP4 inhibitors
Q#109: 30 year old diabetic patient presented with polyuria, burning micturition. Her blood glucose levels are 250 mg/dl despite
on oral medications. She has this unary complaint for last few months. What are the best investigations plans for her
management?
a) Urine routine analysis/RBS
b) Fasting blood glucose daily
c) Blood culture, RBS
d) Urine culture HbAb/c, RBS
e) Ultrasound abdomen pelvis

Q#110: P7, post-menopausal for 3 years, presented in OPD with heavy P/V bleeding – on TVS, endometrial thickness is
10mm e- normal pelvic structure. What will be the next investigation to proceed for diagnosis?
a) Hysteroscopy
b) Pap smear
c) Colposcopy
d) Hysteroscopy direct Biopsy
e) Cone biopsy

Q#111: A 21 year old girl, Presented with irregular P/V bleeding and subfertility. Her BMI is 31 and ultrasound is showing
PCO2.What is the possible initial approach to plan in her further management?
a) Life style modify calves
b) Metformin
c) Weight Reduction
d) Spironolactone
e) ICSI

Q#112: A 54 year old menopausal l women presented with mass lower abdominal. Pelvic ultrasound is showing complex
mass in pelvis and her CA.125 is 180 Iv/l what do you suggest the possible management place from now as ward.
a) Chemotherapy F/B radiotherapy
b) Afitvaut Chemotherapy
c) Intra prenatal Phosphorous therapy
d) Palliative surgery
e) Cytoreduction + adjuvant chemotherapy
Q#113: Most common cause of Hyperthyroidism in pregnancy
a) Thyroid solitary adenoma
b) Graves disease
c) Multi nodular Goiter
d) Thyroiditis
e) Both C and D
Q#114: 35yrs old female presented to hospital with anterior Neck pain, Palpitations, Tremors. She had a common cold 1 week
back. Her ESR is 80. T4, T3 elevated and TSH are low. What is the most likely diagnosis?
a) Pharyngitis
b) Neck abscess
c) Thyroiditis
d) Graves disease
e) Multi nodular Goiter
Q#115: Which one is not an appropriate treatment for Graves’ disease?
a) Beta blockers
b) Surgical removal of thyroid gland
c) Radio-active iodine
d) Antithyroid drugs
e) Thyroxine
Q#116: All are the symptoms of hypothyroidism except
a) Fatigue
b) Weight gain
c) Raised urea / creatinine
d) Mental retardation
e) None of the above
Q#117: Iodine deficiency can cause
a) Goiter
b) Thyroid cancer
c) Solitary Nodules
d) Thyroiditis
e) Both B and C
Q#118: Hyperparathyroidism causes:
a) Heat intolerance
b) High blood sugar
c) Increased urination
d) Headache
e) All of the above
Q#119: Most common cause of Cushing syndrome:
a) ACTH Secreting tumor
b) Adrenal adenoma
c) Exogenous steroids
d) Adrenal Carcinoma
e) All of the above
Q#120: A young Asthmatic previously taking Exogenous steroids came to emergency with vomiting, abdominal pain, low BP, dry
mucous Membranes blood sugar 120mg/dl mostlikely Dx is:
a) Cushing syndrome
b) Diabetes mellitus
c) Diabetes insipidus
d) Addisonian crisis
e) None of the above