Visual Test 5 PDF

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.
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Test Information
Test Name
Visual QBank Set-5
Total Questions
100
Test Type
Examination
Difficulty Level
Difficult
Total Marks
300
Duration
90minutes
Test Question Language:- ENGLISH

(1).
A 38-year-old man with a chronic illness presents with skin changes of the shins, as shown here. One of the plaques has ulcerated. What
is the most likely chronic underlying disease?
a. T-cell lymphoma
b. Diabetes mellitus
c. Sarcoidosis
d. Psoriasis
Solution. 1. B - The skin lesion depicted here is Necrobiosis Lipoidica Diabeticorum, which are yellowish brown, atrophic, telengiectatic
lesions commonly occurring on shins
Your Answer. b
Correct Answer. b
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(2).
A 45-year-old laborer presents with vesicles and bullae in light-exposed areas. These lesions leave scars. He is an alcoholic. He reports no
abdominal pain or loose stools. His mental status is normal. What is the diagnosis
a. Porphyria variegata
b. Acute intermittent porphyria
c. Porphyria cutanea tarda
d. Coproporphyria
Solution. 2. C - Porphyria cutanea tarda (PCT) is the most common porphyria
- Patients have reduced activity of hepatic uroporphyrinogen decarboxylase
- Associated with alcohol, hepatitis C, estrogens
- Patients with PCT do not experience gastrointestinal or neurologic symptoms
Your Answer. c
Correct Answer. c
(3).
The condition shown here is more commonly associated with which of the following?
a. Weight loss
b. Truncal ataxia
c. Polyuria
d. Syndrome of inappropriate secretion of antidiuretic hormone
Solution. 3. C - CT shows enlarged sella turcica with supracellar calcification suggestive of craniopharyngioma
- Craniopharyngioma is the most common tumor in the pituitary region in childhood
- Polyuria occurs due to the Diabetes insipidus caused by the tumor; though SIADH can occur, it is much less common than DI
Your Answer. d
Correct Answer. c
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(4).
A 40 year old patient presents with arthralgia, weakness and skin changes as shown in the figure. Which is the most common condition
that may be associated with this condition?
a. Scleroderma
b. Primary Sclerosing Cholangitis
c. Hemochromatosis
d. Hepatitis C infection
Solution. 4. D - The figure shows the patient with multiple purpuric patches and digital infarction of his toes
- The condition the patient is suffering from is Cryoglobulinemia. It presents with a classical triad of arthralgia, purpura and
weakness.(Meltzer triad)
- The most common secondary cause for cryoglobulinemia is hepatitis C infection
Your Answer. a
Correct Answer. d
(5).
All of the following are associated with this nail change except:
a. Cirrhosis
b. Adult-onset diabetes mellitus
c. Congestive heart failure
d. Ulcerative colitis
Solution. 5. D - Terrys nail is a condition characterized by whitening, ground-glass appearance of the proximal or entire nail
- Results from changes in the nail bed, not in the nail itself
- The condition is associated with cirrhosis, chronic congestive heart failure, adult-onset diabetes and increasing age
Your Answer. c
Correct Answer. d
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(6).
. A 62-year-old ex-smoker presents with complaints of a 10-kg weight loss and occasional hemoptysis. One of the general examination
findings is shown in the figure. Physical findings associated with this syndrome include all of the following except:
a. Facial flushing
b. Periorbital edema
c. Hepatomegaly
d. Increased jugular venous pressure
Solution. 6. C - The patient is suffering from superior mediastinal syndrome probably due to carcinoma lung
- Other causes include mediastinal lymphoma, multinodular goitre, aortic aneurysm etc
Your Answer. c
Correct Answer. c
(7).
A 65-year-old woman presents with fatigue and a sore tongue. She has a history of diabetes mellitus and hypothyroidism. She is anemic.
What is the most likely diagnosis
a. Vitamin B 12 deficiency
b. Folic acid deficiency
c. Iron deficiency
d. Primary systemic amyloidosis
Solution. 7. A - Patient is suffering from B12 deficiency caused by Pernicious anemia
- It causes beefy red tongue
- It is associated with various auto immune conditions like thyroiditis, Type I DM
Your Answer. d
Correct Answer. a
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(8).
Five days previously, ramipril was prescribed for a 60-year-old hypertensive man with type 2 diabetes mellitus. He now presents with
the condition shown here. What is the diagnosis?
a. Renal dysfunction
b. Superior vena cava syndrome
c. Ramipril allergy
d. Angioedema
Solution. 8. D - Angioedema due to ACE inhibitors use caused by accumulation of Bradykinin and substance P- Usually occurs within
first week of onset of therapy
Your Answer. c
Correct Answer. d
(9).
A 26-year-old woman gives history of changes in her leg as shown in the figure. If the predisposing condition is primary rather than
secondary, all of the following are true except:
a. Women are more often affected than men

b. Digital ulceration is a rare complication
c. Livedo reticularis frequently is present
d. This condition is often associated with future connective tissue disease
Solution. 9. D - Primary Raynauds disease begins at the time of menarche and are precipitated by emotional attacks and cold exposure
Your Answer. b
Correct Answer. d
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(10).
A 35-year-old man with ankylosing spondylitis who is recovering from a diarrheal illness complains of blurred vision, arthritis, and the
lesions shown here. What is the diagnosis?
a. Circinate balanitis
b. Erythroplasia of Queyrat
c. Syphilis
d. Zoons balanitis
Solution. 10. D- Patient is suffering from Reiters syndrome (arthritis, conjunctivitis and non gonococcal urethritis)
Your Answer. a
Correct Answer. d
(11).
The skin lesions shown here developed 1 week into an upper respiratory tract infection in a 55-year-old woman. What are these lesions
called?
a. Erythema nodosum
b. Erythema multiforme
c. Erythema ab igne
d. Necrolytic migratory erythema
Solution. 11. B - Erythema multiforme is part of the spectrum of conditions, including Stevens-Johnson syndrome (SJS) and, most
severely, toxic epidermal necrolysis (TEN)
- It may be associated with drugs and infections, including Mycoplasma pneumoniae, Yersinia enterocolitica, and viral infections,
especially herpes simplex
- characterised by iris or target shaped lesions
Your Answer. c
Correct Answer. b
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(12).
A 47-year-old man presents with fever, fatigue, swollen cervical nodes, and the oral lesions shown here. All of the following may
predispose a patient to this condition except
a. Diabetes mellitusAcute pancreatitis

b. Acute pancreatitis
c. Human immunodeficiency virus infection
d. Xerostomia
Solution. 12. B - The patient is suffering from oral thrush caused by Candida albicans
- Xerostomia, smoking and recent antibiotic use can predispose to the disease in addition to other immunosuppressive conditions
Your Answer. b
Correct Answer. b
(13).
A 26-year-old man with a history of seasonal allergies, frequent bouts of sinusitis, cough, with following findings shown in the picture.
Which of the following tests would be the most helpful for making the diagnosis?
a. Perinuclear-staining antineutrophil cytoplasmic antibody

b. Cytoplasmic-staining antineutrophil cytoplasmic antibody
c. Erythrocyte sedimentation rate
d. Antibody to double-stranded DNA
Solution. 13. B - The person is suffering from Wegners granilomatosis
- Saddle nose deformity and ear ulcerations are shown in the figure
Your Answer. a
Correct Answer. b
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(14).
The lesion shown here developed in a neutropenic patient after hematogenous spread from a nasal source. Biopsy result of the lesion is
also shown. What is the most likely diagnosis
a. Aspergillosis
b. Blastomycosis
c. Histoplasmosis
d. Mucormycosis
Solution. 14. D - The causative agent is Rhizopus species, Zygomycetes, resulting in invasive fungal disease
- Treatment is by surgical debridement and Amphotericin B
Your Answer. c
Correct Answer. d
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(15).
A 69-year-old man with a history of chronic loose stools presents with intense burning and itching due to symmetrically distributed
groups of vesicles and papules. How should this skin condition be treated?
a. Gluten-free diet
b. Acyclovir
c. Topical corticosteroids
d. Psoralen with ultraviolet-A (PUVA) light
Solution. 15. A - Dermatitis herpetiformis is an immune mediated bullous disease
- IgA deposits in skin on immunofluorescene is critical for diagnosis
- 70% have IgA anti endomysial antibodies
Your Answer. a
Correct Answer. a
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(16).
A homeless person had a toothache for several months before development of a foul-smelling cough and dyspnea. This disorder is most
commonly associated with septic thrombosis of which one of the following?
a. Internal jugular vein

b. External jugular vein
c. Internal carotid artery
d. Cavernous sinus
Solution. 16. A - Lemierres syndrome, or jugular vein suppurative thrombophlebitis, is an unusual illness that may occur as a
complication after an episode of pharyngotonsillitis
- It is characterized by the sequence of septic thrombosis of the internal jugular vein, bacteremia, septic pulmonary emboli, and
metastatic abscess formation
Your Answer. d
Correct Answer. a
(17).
A child was born 1 year after his mother was infected with a sexually transmitted disease. Shown here are the abnormal teeth of the
child. Which one of the following actions might have prevented this abnormality?
a. Maternal avoidance of tetracycline treatment for the sexually transmitted disease

b. Maternal avoidance of alcohol ingestion
c. Maternal treatment with penicillin
d. Maternal avoidance of tobacco use
Solution. 17. C - Hutchinsons teeth are characterized by notching of the incisors due to defects in early tooth development
- Fetal infection with Treponema pallidum most likely occurs after the fifth gestational month in women who have been infected for less
than 2 years- Both mother and fetus may be cured with penicillin treatment of the mother before birth of the child, although some
abnormalities may persist depending on the stage of development of the fetus when treatment was begun
Your Answer. c
Correct Answer. c
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(18).
The skin lesions shown here and lymphadenopathy developed in a 41-year-old man. Biopsy of the lesions showed lymphocytes with
hyperchromic and convoluted nuclei. Which of the following treatment options is appropriate?
a. Oral doxycycline
b. Intravenous third-generation cephalosporin
c. Highly active antiretroviral therapy
d. Psoralen with ultraviolet A light
Solution. 18. D - The patient has Mycosis Fungoides or Cutaneous T-CellLymphoma
- Szary syndrome accounts for about 5% of presentations of cutaneous T-cell lymphoma (CTCL).
- Szary cells are atypical T cells with characteristic hyperconvoluted nuclei and periodic acid-Schiffpositive vacuoles. These cells
involve the epidermis, dermis, and, later, peripheral blood
Your Answer. d
Correct Answer. d
(19).
The lesions shown here were tender and occurred on the palms and feet and in the mouth of a 4-year-old child and his father. What is the
causative agent?
a. Herpesvirus
b. Epstein-Barr virus
c. Coxsackievirus
d. Varicella-zoster virus
Solution. 19. C - Coxsackievirus A16, an enterovirus, is the most common cause of hand, foot, and mouth disease
Your Answer. d
Correct Answer. c
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(20).
A 42-year-old woman has the rash shown here, pleuritis, and lymphopenia. Drug-induced forms of this disease have a 95% association
with which of the following?
a. Increased frequency of central nervous system and renal involvement

b. Antihistone antibody
c. Anticentromere antibody
d. Positive extractable nuclear ribonucleoprotein antigen
Solution. 20. B - Anti histone antibodies are associated with drug induced lupus
- Hydralazine and Procainamide are the commonest associations
Your Answer. b
Correct Answer. b
(21).
A 51-year-old man presents with a 3-month history of loose, watery stools and dyspnea on exertion. Laboratory studies show renal
insufficiency. Chest radiograph and oral cavity examination finding is given. What is the diagnosis?
a. Whipples disease
b. Primary systemic amyloidosis
c. Gauchers disease
d. Hemochromatosis
Solution. 21. B - Macroglossia, cardiomegaly, GI involvement and renal dysfunction are the complaints which are well documented
manifestations of systemic amylodosis
- Renal insufficiency is the most common manifestation while congestive heart failure is the second most common feature
Your Answer. b
Correct Answer. b
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(22).
A 33-year-old woman has the skin lesions shown here. All of the following statements are true with regard to this condition except:
a. "Sausage appearance to fingers is characteristic

b. The incidence of uveitis is high
c. Treatment includes nonsteroidal anti-inflammatory drugs, methotrexate, and azathioprine
d. Involvement of distal interphalangeal joints is common
Solution. 22. B - There are 5 clinical groups of psoriatic arthritis (Wright and Moll classification)
- Asymmetric oligoarthritis (70% of patients with psoriatic arthritis)
Symmetric polyarthritis (rheumatoid factornegative) (15%)
Arthritis mutilans (5%)
Distal interphalangeal jointpredominant (5%)
Psoriatic spondylitis (often HLA-B27positive) (5%)
Your Answer. b
Correct Answer. b
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(23).
A 62-year-old man presents to your office with blurry vision, dyspnea, and occasional oral mucosal bleeding. Funduscopic picture is
shown below. Which one of the following should most likely be in your differential diagnosis?
a. Diabetes mellitus
b. Non-Hodgkins lymphoma
c. Acute pancreatitis
d. Waldenstrms macroglobulinemia
Solution. 23. D - Hyperviscosity syndrome is characterized by fatigue, blurry vision, confusion, and mucosal membrane bleeding
- Funduscopic findings include characteristic sausage-shaped retinal veins (dilatation and segmentation of retinal veins) and
papilledema
- Causes for hyperviscosity: Waldenstrms macroglobulinemia (IgM), Multiple myeloma (IgA), Hyperleukocytosis (as in acute
lymphoblastic leukemia), Polycythemia
Your Answer. d
Correct Answer. d
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(24).
A 60-year-old man has an acutely painful third toe and the chronic hand findings shown here. All of the following treatments would be
appropriate in this setting except:
a. Allopurinol
b. Colchicine
c. Indomethacin
d. Intra-articular corticosteroid injection
Solution. 24. A - Gout characteristically causes extreme pain with inflammation of a single joint in the lower extremity, but other joints
can be involved
- Diagnosis: joint fluid aspiration shows negatively birefringent needle-shaped uric acid crystals under polarized light
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for initial treatment. Colchicine is another option. Intra-articular
corticosteroids, intramuscular adrenocorticotropic hormone, and systemic corticosteroids can be used for patients unable to take NSAIDs
- Although allopurinol is effective for tophaceous gout in the intercritical period, it should not be used during an acute flare because the
disease may worsen
Your Answer. a
Correct Answer. a
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(25).
A 58-year-old man presents with dyspnea, cough, and the new onset of the oral lesions shown here. Which one of the following viruses is
most likely present in this tissue
a. Epstein-Barr virus
b. Human papillomavirus, types 16, 18
c. Varicella zoster virus
d. Human herpesvirus 8
Solution. 25. D - Kaposi sarcoma occurs in two main subtypes: endemic and classical
- Present as angioprolifertive patch or plaque in trunk, face or oral mucosa
- Pulmonary KS presents as dyspnea and cough
Your Answer. d
Correct Answer. d
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(26).
An 18-year-old woman reports a 6-week history of fatigue, nausea, involuntary weight loss, and darkening of the skin. Which one of the
following tests is the most helpful for establishing the diagnosis
a. ACTH stimulation test

b. Serum prolactin test
c. Serum potassium test
d. Dexamethasone suppression test
Solution. 26. A - ACTH prohormone production is increased (propiomelanocortin), which results in increased melanocytestimulating
hormone level and hyperpigmentation
- Hyperpigmentation may be most notable on the elbows, knees, and buccal mucosa and at surgical scars
- Addisons disease is diagnosed most reliably with the ACTH stimulation test
Your Answer. c
Correct Answer. a
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(27).
Painful ulcers developed on the thighs, abdomen, and legs (shown here) of a 47-year-old obese woman with end-stage renal disease who
was receiving dialysis. What is the diagnosis?
a. Calciphylaxis
b. Venous stasis ulcers
c. Atheroemboli syndrome
d. Mixed cryoglobulinemia
Solution. 27. A - Calciphylaxis is the calcification of the media of small arteries and arterioles leading to ischemic necrosis and
ulceration
- Initially the lesions appear violaceous. These often become hard, indurated, and ulcerated with overlying eschar as the subcutaneous fat
becomes necrotic
- Obese women with chronic renal failure and hypertension are the prototypic patients
Your Answer. a
Correct Answer. a
(28).
Abnormal laboratory values in this patient might include which one of the following?
a. Increased calcium
b. Decreased calcium
c. Decreased phosphate
d. Decreased parathyroid hormone
Solution. 28. B - Pseudohypoparathyroidism is characterized by end-organ resistance to parathyroid hormone (PTH) at the receptor or
postreceptor level
- Physical findings include short stature, obesity, round face, short metacarpals and metatarsals, mild mental retardation, and
subcutaneous calcification
- Laboratory findings include the following Increased PTH, Decreased calcium, Increased phosphate
- Patients with pseudopseudohypoparathyroidism have similar physical findings without the biochemical abnormalities
Your Answer. b
Correct Answer. b
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(29).
41-year-old man presents with hematochezia that has been present for 2 weeks. His past medical history is notable for recurrent
epistaxis. His father died of stroke at a young age. Which one of the following is a common pulmonary manifestation of his disease?
a. Pulmonary fibrosis
b. Arteriovenous malformation
c. Obstructive lung disease
d. Pleural effusion
Solution. 29. B - Hereditary hemorrhagic telangiectasia (HHT) is also known as Osler-Weber-Rendu disease
- HHT is an inherited autosomal dominant disorder characterized by telangiectasia of the skin and mucous membranes
- In 20% of patients with HHT, pulmonary arteriovenous malformations (AVMs) develop
- AVMs cause shunting of blood, which in turn causes dyspnea, cyanosis, and clubbing
- AVMs also can lead to paradoxic embolism and stroke
Your Answer. b
Correct Answer. b
(30).
The complaints shown in the picture, hypertension, arthralgias, abdominal pain, and mononeuritis multiplex developed in a 30-year-old
woman. Biopsy showed acute necrotizing vasculitis. If this condition were due to an infectious disease, which of the following conditions
would be most likely?
a. Mycoplasma pneumonia
b. Mycobacterium leprae
c. Syphilis
d. Viral hepatitis
Solution. 30. D - Polyarteritis nodosa (PAN) is an acute necrotizing vasculitis that affects medium-sized and small arteries
- PAN is a systemic disease that commonly involves the kidneys, peripheral nerves, skin, and gastrointestinal tract
- Perinuclear-staining antineutrophil cytoplasmic antibody (p-ANCA) test may be positive but it is not specific for the disease
- Hepatitis B and C virus infections have been associated with some cases of ANCA-negative PAN. Treatment for these cases does not
include immunosuppressive agents but rather antiviral medications and interferon alfa
- Angiography typically shows focal stenoses and microaneurysms of visceral arteries, especially the renal and mesenteric arteries
Your Answer. b
Correct Answer. d
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(31).
An 18-year-old man presents to your office for medical clearance before participating in fall sports. The baseline electrocardiogram is
shown here. This pattern is most commonly associated with which one of the following congenital abnormalities?
a. Atrial septal defect

b. Ebsteins anomaly
c. Tetralogy of Fallot
d. Dextrocardia
Solution. 31. B - Electrocardiographic (ECG) features of Wolff-ParkinsonWhite (WPW) patternwhich are indicative of preexcitation
include the following:
Short PR interval (<0.12 second)
Wide QRS complex (>0.12 second)
Gradual slurred upstroke of the QRS complex (delta wave)
Your Answer. b
Correct Answer. b
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(32).
A 13-year-old Sephardic Jewish boy had recurrent fever, abdominal pain, pleuritic chest pain, and the skin lesions shown here. What is
the treatment of choice?
a. Nafcillin
b. Acetaminophen
c. Colchicine
d. Prednisone
Solution. 32. C - The boy is suffering from Familial Meditteranean fever / Familial Paroxysmal Polyserositis
- Patients present with fever, abdominal pain, arthralgia, pleuritis and erysipelas like skin rashes and amylodosis (AA) with raised ESR
- It occurs due to mutation in MEFV gene of chromosome 16 that codes for pyrin / marenostrin
Your Answer. d
Correct Answer. c
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(33).
A pair of siblings (brother and sister) have multiple brown macules and nodular lesions on their skin. Their father has similar lesions. All
of the following are part of the diagnostic criteria for this disease except:
a. Axillary or inguinal freckling

b. Two or more Lisch nodules of the iris
c. Positive family history
d. Adenoma sebaceum
Solution. 33. D - Neurofibromatosis type 1 is autosomal dominant
- Diagnosis is based on 2 or more of the following:
Six or more caf au lait macules
Axillary or inguinal freckling
Two or more Lisch nodules of the iris
Two or more neurofibromas
One plexiform neurofibroma
A positive family history
Your Answer. d
Correct Answer. d
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(34).
A 58-year-old man was treated with tissue plasminogen activator after an anterior myocardial infarction and then admitted to the
hospital. He was given intravenous unfractionated heparin. Four days later, discoloration of his feet and hands is noted. Which one of the
following is true of this condition?
a. It is associated with concurrent use of acetylsalicylic acid

b. Cessation of smoking prevents progression of this illness
c. Optimal treatment includes continuation of heparin therapy
d. Antigen-antibody interactions may be causative
Solution. 34. D - The prevalence of heparin-induced thrombocytopenia (HIT) during heparin therapy has been reported to be 5%-10%
- The diagnosis may be supported by the presence in serum of heparin-associated antibodies found by enzyme-linked immunosorbent
assay or heparin-dependent plateletstimulating activity with a 3H-serotonin-release assay
- Onset is usually 4 to 10 days after initiation of therapy
- Complications can include either thrombosis or hemorrhage
- Treatment includes discontinued use of all heparin products, including intravenous flushes. If anticoagulation is critical to prevent
further progression of thrombus, alternative therapies such as danaparoid or lepirudan may be initiated
Your Answer. a
Correct Answer. d
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(35).
A 25-year-old man presents with a 3-month history of crampy abdominal pain and bloody diarrhea and a 3-week history of multiple red
and tender lesions of the forearms. His past medical history is notable for low back pain, worse in the morning. What is the most likely
underlying cause for his skin condition?
a. Sarcoidosis
b. Inflammatory bowel disease
c. Yersinia enterocolitica infection
d. Medication
Solution. 35. B - Erythema nodosum (EN) presents as tender, red, quartersized subcutaneous nodules usually localized to the pretibial
areas
- The most common cause of EN is streptococcal pharyngitis
- The drugs most commonly associated with EN are Sulfonamides and OCPS
- EN also is associated with the Sarcoidosis, IBD, Behets syndrome
Your Answer. b
Correct Answer. b
(36).
The skin lesions shown here developed in a 45-year-old man with hypertension after percutaneous renal angiography. Complete blood
count shows eosinophilia. What is this syndrome?
a. Antiphospholipid antibody syndrome

b. Warfarin necrosis syndrome
c. Scleroderma renal crisis
d. Blue toe syndrome
Solution. 36. D - The patient is suffering from cholesterol embolism / blue toe syndrome
- Eosinophilia, eosinophiluria, hypocomplementemia, and increased erythrocyte sedimentation rate have been noted on laboratory
investigations
- Definitive diagnosis is made by finding cholesterol clefts on biopsy of affected tissue
Your Answer. a
Correct Answer. d
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(37).
The blistering rash shown here and erosions of mucous membranes developed in a 54-year-old man 1 day after he started therapy with
trimethoprim-sulfamethoxazole for an upper respiratory infection. What is this condition called?
a. Jarisch-Herxheimer reaction
b. Stevens-Johnson syndrome
c. Red man syndrome
d. Scalded skin syndrome
Solution. 37. B - This scenario may come under Steven Johnsons syndrome or Toxi Epidermal Necrolysis
- In SJS, less than 10% of total body surface area is affected
- In overlap, or transitional, SJS-TEN, 10% to 30% of total body surface area is affected
- In TEN, more than 30% of total body surface area is affected
Your Answer. a
Correct Answer. b
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(38).
This pleural fluid was drained from a patient after a motor vehicle accident. Similar pleural fluid may be associated with all of the
following except:
a. Pleural fluid triglyceride level of more than 100 mg/dL

b. Moderate congestive heart failure
c. Lymphangiomyomatosis
d. Thoracic duct obstruction
Solution. 38. B - Chyle can be differentiated from other fluids by its high pleural triglyceride level (more than 100 mg/dL) in the setting
of normal serum triglyceride levels
- Numerous causes for chylous effusions may be broadly categorized as:
Congenital (e.g., thoracic duct atresia)
Traumatic (e.g., central line placement associated with subclavian vein thrombosis, after thoracic or esophageal surgery, penetrating
injury)
Intrinsic (e.g., neoplasm, pulmonary lymphangiomatosis)
Extrinsic (e.g., infections, such as tuberculosis)
Your Answer. b
Correct Answer. b
(39).
A 69-year-old man presents with an acute severe headache. Physical examination reveals an isolated left third cranial nerve palsy.
Laboratory studies show hyponatremia and abnormally low levels of LH, FSH, TSH, ACTH, testosterone and cortisol. What is the
diagnosis?
a. Hypothalamic hemorrhage
b. Neurosarcoidosis
c. Pituitary apoplexy
d. Lymphocytic hypophysitis
Solution. 39. C - Pituitary apoplexy refers to hemorrhagic infarction of the pituitary gland
- Predisposing conditions include Pituitary tumor, Pregnancy, Anticoagulation therapy, Increased intracranial pressure, Vascular disease
- Patients may present with the Headache, Ocular palsies, Visual field defects, Altered mental state, Acute adrenocortical crisis
Your Answer. c
Correct Answer. c
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(40).
A rash developed in a 14-year-old boy, first around his eyes and then on his trunk and extremities. The involved skin is tender. Which
physical sign is shown on the patients back?
a. Asboe Hansen sign

b. Nikolskys sign
c. Oslers sign
d. Schultzes sign
Solution. 40. B - Staphylococcal scalded skin syndrome is caused by exfoliative toxins produced by strains of Staphylococcus aureus
- The syndrome is characterized by sudden onset of reddened skin that later loosens in large areas The syndrome that begins
periorbitally and spreads to the trunk and centrifugally to the limbs
- Nikolskys sign is bullae formation or sloughing caused by gentle lateral stroking
Your Answer. b
Correct Answer. b
(41).
A 22-year-old woman with hypothyroidism has the patch of hair loss shown here. Biopsy of the affected area shows a Tcellpredominant
infiltrate. What is the most likely cause?
a. Androgenic alopecia
b. Telogen effluvium
c. Tinea capitis
d. Alopecia areata
Solution. 41. D - Alopecia aerate is characterized by well-circumscribed, circular areas of patchy hair loss
- Associated with hypothyroidism, pernicious anemia, hyperthyroidism, vitiligo, atopy and Down syndrome
Your Answer. b
Correct Answer. d
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(42).
A 45-year-old man presents with an acutely swollen knee. He reports no pain. His past medical history is notable for type 1 diabetes
mellitus, which has been poorly controlled. What is the diagnosis?
a. Septic arthritis
b. Osteomyelitis
c. Torn anterior cruciate ligament
d. Charcots arthropathy
Solution. 42. D - Charcots arthropathy is also known as neuropathic arthropathy
- Patients with Charcots arthropathy have impaired pain and position sense; neuropathy and repeated injury lead to the arthropathy
- The causes of are diabetes mellitus, Tabes dorsalis (classically involving the spine and hip), Leprosy (hand and feet joints), Amyloidosis,
Syringomyelia (affects the shoulder)
- Radiographs reveal disorganized joint architecture
Your Answer. d
Correct Answer. d
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(43).
A 16-year-old high school boy has a sore throat and the rash shown here, which started on the trunk and spread to the arms and legs but
not the palms and soles. The appearance of his tongue is also shown. What is the most likely diagnosis?
a. Scarlet fever
b. Kawasaki disease
c. Toxic shock syndrome
d. Measles
Solution. 43. A -T he causative agent is group A streptococcus (Streptococcus pyogenes)
- Strawberry tongue is caused by enlarged papillae
- The characteristic sandpaper rash spreads from trunk to extremities, beginning 1 to 2 days after initial fever, sore throat, and
vomiting. Circumoral pallor also is thought to be characteristic
- Hyperpigmentation in the bend of the elbow (Pastias sign)
- Penicillin remains the treatment of choice
Your Answer. a
Correct Answer. a
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(44).
On physical examination, a 56-year-old obese woman with Type 2 diabetes mellitus has skin lesions as shown in the figure. A previous
physician correctly told her this skin finding was related to her obesity and diabetes. What disease, other than diabetes, also is
associated with this skin finding?
a. Adenocarcinoma of the gastrointestinal tract

b. Thyroid disease
c. Polycystic ovaries
d. All of the above
Solution. 44. D - Acanthosis nigricans involves the intertriginous regions, especially the axillae and groin
- Acanthosis nigricans is associated with Obesity, Type 2 diabetes mellitus, Cushings disease, Polycystic ovaries, Thyroid disease,
Adenocarcinoma of the gastrointestinal tract, Acromegaly, Medications (e.g., prednisone, nicotinic acid)
- Acanthosis nigricans can be familial (usually autosomal dominant)
Your Answer. d
Correct Answer. d
(45).
A 36-year-old woman with a history of multiple miscarriages has the lesions shown here. Her activated partial thromboplastin time is
prolonged. Treatment should include which one of the following
a. High-dose oral corticosteroids

b. Warfarin with a goal international normalized ratio of 3 to 4
c. Fresh frozen plasma
d. Plasma exchange and high-dose cyclophosphamide
Solution. 45. B - Antiphospholipid antibody syndrome include recurrent arterial or venous thromboembolic disease, recurrent fetal loss,
sterile endocarditis, livedo reticularis, and thrombocytopenia
- In patients who have had thrombosis, treatment is with warfarin anticoagulation (INR 2.5-3.5 or higher)
Your Answer. d
Correct Answer. b
31/65
(46).
A 33-year-old sexually active man presents with this painless ulcer. Approximately how long ago did the inoculation occur?
a. 12 to 48 hours
b. 3 to 90 days
c. 3 to 6 months
d. >1 year
Solution. 46. B - In primary syphilis, a painless ulcer (chancre) appears at the site of inoculation within 3 to 90 days after infection
- Differential diagnosis includes herpes simplex and Haemophilus ducreyi(chancroid), but these ulcers are usually painful
Your Answer. b
Correct Answer. b
(47).
A 52-year-old woman has diarrhea, wheezing, and the skin reactions shown here, which seemed to be associated with emotion and
alcohol ingestion. What is the best screening test?
a. Urinary 5-hydroxyindoleacetic acid (5-HIAA)

b. Antimitochondrial antibodies
c. Antinuclear antibodies
d. Skin biopsy
Solution. 47. A - Carcinoid tumors metastatic to the liver cause flushing, wheezing, and diarrhea
- Most common sites of origin are Terminal ileum (90%), Lungs and bronchi, Appendix, Rectum, Stomach
- Cardiac involvement usually includes the right-sided valves (tricuspid and pulmonary regurgitation or stenosis)
- Serotonin-like substances are responsible for the symptoms
Your Answer. d
Correct Answer. a
32/65
(48).
A 75-year-old man presents with weight loss, painful plaques on his hands, and a low-grade fever. This syndrome is most often associated
with patients who have which one of the following?
a. Celiac sprue
b. Acquired immunodeficiency syndrome (AIDS)
c. Acute leukemia
d. Multiple myeloma
Solution. 48. C - Sweets syndrome is also known as acute febrile neutrophilic dermatosis
- The components of this disease include Fever, blood neutrophilic leukocytosis, raised painful plaques on the limbs, face, and neck,
histologic findings of dense infiltration of the dermis by mature neutrophils
- The syndrome may be idiopathic, drug-related, or associated with malignancy
Your Answer. d
Correct Answer. c
33/65
(49).
A 42-year-old woman with a past history of multiple sexually transmitted diseases and progressive dementia has the skin lesions shown
here and shortness of breath. Of the procedures listed below, which one is most important for directing definitive therapy for the
unifying diagnosis?
a. Lumbar puncture
b. Echocardiography
c. Magnetic resonance imaging
d. Triple-phase bone scanning
Solution. 49. A - Tertiary syphilis: manifestations include Gummatous osteomyelitis, Aortitis (with ascending aortic aneurysm and aortic
regurgitation), Neurosyphilis, Tabes dorsalis
- Seropositivity mandates cerebrospinal fluid examination because neurosyphilis is often asymptomatic
Your Answer. a
Correct Answer. a
34/65
(50).
A 60-year-old woman presents with arthritis and a long history of recurrent painful ulcers of the mouth and genitalia. Past medical
history is notable for venous thromboembolism and uveitis. What is the diagnosis?
a. Primary syphilis
b. Herpes simplex
c. Sarcoidosis
d. Behets syndrome
Solution. 50. D - Behets syndrome is a chronic, relapsing, multisystem, inflammatory disorder characterized by recurrent oral
aphthous ulcers and any 2 of the following:
Genital aphthous ulcers, Uveitis, Cutaneous nodules or pustules, Phlebitis, Arteritis, Arthritis, Meningoencephalitis
Your Answer. d
Correct Answer. d
35/65
(51).
This patient presents with the skin lesions shown and with persistent hyperglycemia. What is the diagnosis?
a. Nesidioblastoma
b. Glucagonoma
c. Acute pancreatitis
d. Somatostatinoma
Solution. 51. B - Glucagonoma Syndrome With Necrolytic Migratory Erythema
- Other features include Normochromic normocytic anemia, Diarrhea, Weight loss, Glossitis, stomatitis, and angular cheilitis, Diabetes
mellitus, Hypoaminoacidemia
Your Answer. b
Correct Answer. b
36/65
(52).
A 17-year-old boy with these lesions complains of abdominal pain and back pain. All of the following are true of this disease except:
a. Pathologic findings are marked by segmental bowel inflammation and skip lesions
b. It may be associated with ankylosing spondylitis
c. Renal oxalate stones occur in 5% to 10% of patients
d. Smoking has been associated with a preventive effect
Solution. 52. D -Crohns disease: Lesions can involve anywhere from mouth to anus and cause ulcers, stricutres and perianal disease
- It can be associated with Ankylosing spondylitis and renal oxalate stones
- Smoking has a protective effect on ulcerative colitis while it worsens Crohns disease
Your Answer. b
Correct Answer. d
37/65
(53).
In this 15-year-old girl, these lesions developed in sun-exposed areas. She is exquisitely sensitive to sunburn. What is the cause of this
rare disorder?
a. Systemic lupus erythematosus

b. Defective porphyrin metabolism
c. Autoimmune reaction to self-antigens in the skin
d. Autosomal recessive defect in DNA excision repair mechanism
Solution. 53. D - Xeroderma Pigmentosa
- Skin findings include Actinic keratoses, cutaneous melanoma, progressive atrophy, irregular pigmentation, telangiectases, basal cell
carcinoma, squamous cell carcinoma
Your Answer. b
Correct Answer. d
(54).
The ankle and nails shown here are those of a 56-year-old ill-appearing woman. Which one of the following organ systems has the highest
likelihood of being diseased?
a. Liver
b. Kidneys
c. Lungs
d. Heart
Solution. 54. C - The person is suffering from Yellow Nail syndrome
- It is characterised by triad of yellow nails, ankle
Your Answer. b
Correct Answer. c
38/65
(55).
A 31-year-old man with Streptococcus viridians endocarditis has acute right hemiparesis and dysarthria. Which one of the following is
the most likely cause?
a. Atypical migraine
b. Left brain abscess
c. Seizure with Todd paralysis
d. Left middle cerebral artery occlusion
Solution. 55. D - Left middle cerebral artery occlusion has occurred due to the septic emboli from infective endocarditis focus
Your Answer. d
Correct Answer. d
(56).
In this case, in addition to diagnostic testing, which empiric therapy is most appropriate?
a. Amphotericin B
b. Oxacillin and gentamicin
c. Vancomycin and gentamicin
d. Ceftriaxone and doxycycline
Solution. 56. D - Ceftriaxone for gonococal urethritis and Doxycycline for non gonococcal urethritis (eg: Chlamydia)
Your Answer. d
Correct Answer. d
39/65
(57).
A 37-year-old man with acquired immunodeficiency syndrome (AIDS) presents with fever, seizures, and altered mental status. His last
known CD4 cell count was less than 50 cells/mm3. Which one of the following is the best prophylactic agent for this condition?
a. Rifabutin
b. Trimethoprim-sulfamethoxazole
c. Pyrimethamine
d. Fluconazole
Solution. 57. B - Central Nervous System Toxoplasmosis
- Typical appearance is of multiple ring-enhancing lesions within the brain parenchyma
- Central nervous system lymphoma can mimic toxoplasma encephalitis
Your Answer. b
Correct Answer. b
40/65
(58).
These are the hand and skin findings of a 26-year-old woman who complains of early satiety. Her past medical history is notable for
upper gastrointestinal bleeding and rectal prolapse. What is the diagnosis?
a. Ehlers-Danlos syndrome
b. Cutis laxa
c. Marfan syndrome
d. Congenital contractural arachnodactyly
Solution. 58. A - Ehlers-Danlos syndrome is characterized by highly elastic connective tissue
- Patients with skin manifestations have hyperextensible, fragile skin that heals poorly, characteristically forming wide, thin, fish-mouth
scars.
- Patients are predisposed to gastrointestinal motility disorders, visceral diverticulosis, mitral valve prolapse, dilatation of the aortic root,
pes planus, scoliosis, degenerative arthritis, pneumothorax, dilatation of the pulmonary artery
Your Answer. a
Correct Answer. a
41/65
(59).
An 82-year-old man presents with 8 weeks of periorbital edema, 6 weeks of rash, and 2 weeks of bilateral shoulder and arm aches and
weakness. What is the diagnosis?
a. Polymyalgia rheumatica
b. Dermatomyositis
c. Hypothyroidism
d. Polymyositis
Solution. 59. B - Skin findings associated with DM: Heliotrope rash of the eyelids, Rash of the metacarpophalangeal and proximal
interphalangeal joints (Gottrons papules), Photosensitivity dermatitis of the face
- Proximal myositis with associated pain and weakness is characteristic of DM
- The anti-Jo1 antibody is present in 25% of patients with DM
Your Answer. a
Correct Answer. b
42/65
(60).
A 30-year-old man presents with personality changes, jaundice, joint pain, and this eye finding. The disease associated with these
findings is caused by defects in metabolism of which element?
a. Zinc
b. Magnesium
c. Copper
d. Selenium
Solution. 60. C - Wilsons disease is an autosomal recessive defect in biliary excretion of copper results in deposition in the liver, brain,
and cornea, among other tissues due to mutation in ATP 7B gene of chromosome 13
- Kayser-Fleischer rings are more frequent in patients with neurologic complications
Your Answer. c
Correct Answer. c
(61).
The picture given below is that of a person renowned as the Father of Gynaecology. Identify the personality
a. Marion Sims
b. Virginia Apgar
c. Howard Kelly
d. Priscilla white
Solution. 1. A - Marion Sims (devised the repair for vesico vaginal fistula)
Your Answer. a
Correct Answer. a
43/65
(62).
Identify the type of pelvis shown in the figure:
a. Robert pelvis
b. Rachitic pelvis
c. Naegele pelvis
d. Platypelloid pelvis
Solution. 2. C - Naegele pelvis (one ala of sacrum absent; In Robert pelvis, both ala absent)
Your Answer. b
Correct Answer. c
(63).
What is the length of the fetal skull diameter marked in the figure as A?
a. 9.4 cm
b. 8.5 cm
c. 8 cm
d. 7.7 cm
Solution. 3. C - 8 cm (Bitemporal diameter: shortest diameter of fetal skull)
Your Answer. d
Correct Answer. c
44/65
(64).
What is the cause for the CTG picture shown below:
a. Normal variation
b. Cord prolape
c. Fetal hypoxia
d. Rh isoimmunisation
Solution. 4. C - Fetal hypoxia (Late decelerations due to hypoxia or uteroplacental insufficiency; Variable decelerations are produced by
cord prolapse; Sinusoidal fetal heart tracing is seen in Rh iso immunisation)
Your Answer. c
Correct Answer. c
45/65
(65).
What is the name of the uterine anomaly shown in the figure?
a. Uterus didelphys
b. Bicornuate uterus
c. Biarcuate uterus
d. Septate uterus
Solution. 5. A - Uterus didelphys
Your Answer. b
Correct Answer. a
(66).
What is the variant of placenta shown in the picture?
a. Battledore placenta
b. Furcate placenta
c. Succenturiate placenta
d. Velamentous insertion
Solution. 6. C - Succenturiate placenta (a small accessory lobe of placenta with separate blood supply)
Your Answer. c
Correct Answer. c
46/65
(67).
What is the diagnosis from the antenatal ultrasound Doppler given below in a women with amenorrhea?
a. Ectopic pregnancy
b. Blighted ovum
c. Vesicular mole
d. Ovarian tumor
Solution. 7. A - Ectopic pregnancy (Ring of fire sign shown in the picture; Bagel sign / Tubal ring sign in ultrasound)
Your Answer. a
Correct Answer. a
(68).
Identify the manoeuvre depicted in the figure below:
a. Burns Marshall manoeuvre

b. Pinards manoeuvre
c. Ritgen manoeuvre
d. Mauriceau Smellie Veit manoeuvre
Solution. 8. D - Mauriceau Smellie Veit manoeuvre
Your Answer. b
Correct Answer. d
47/65
(69).
The antenatal ultrasound picture given below is suggestive of:
a. Dichorionic pregnancy
b. Monochorionic pregnancy
c. Conjoint twins
d. Snow storm sign of vesicular mole
Solution. 9. A - Dichorionic pregnancy (Lambda / Twin peak sign is visualised; T sign is seen in monochorionic pregnancy)
Your Answer. c
Correct Answer. a
(70).
What is the grade of placenta previa shown in the figure below?
a. I
b. II
c. III
d. IV
Solution. 10. B - Grade II (Marginal placenta previa: reaches up to internal os)
Your Answer. b
Correct Answer. b
48/65
(71).
Identify the syndrome from its components shown in the figure:
a. Dandy walker malformation

b. Wolf Hirschhorn syndrome
c. Meckel Gruber syndrome
d. Patau syndrome
Solution. 11. C - Meckel Gruber syndrome(Posterior encephalocele, polycystic kidneys, polydactyly)
Your Answer. b
Correct Answer. c
(72).
The ultrasound of the fetus shown below is diagnostic of:
a. Down syndrome
b. Anencephaly
c. Spina bifida
d. Encephalocele
Solution. 12. B - Anencephaly
Your Answer. c
Correct Answer. b
49/65
(73).
Identify the manoeuvre shown in the figure:
a. McRoberts manoeuvre
b. Burns Marshall manoeuvre
c. Woodscrew manoeuvre
d. Zavanelli manoeuvre
Solution. 13. B - Burns Marshall manoeuvre
Your Answer. a
Correct Answer. b
(74).
The instrument shown in the picture is used in which surgery in gynecology?
a. Hysterectomy
b. Ovarian cystectomy
c. Myomectomy
d. Salpingectomy
Solution. 14. C - Myomectomy (Bonneys clamp to reduce blood loss during surgery)
Your Answer. c
Correct Answer. c
50/65
(75).
A 40 year old woman presented with complaints of profuse vaginal discharge. There was no discharge from the cervix on speculum
examination. Microscopic examination done on the wet mount of discharge is given below. What is the probable diagnosis?
a. Candidal vaginitis
b. Bacterial vaginosis
c. Trichomonas vaginitis
d. Chlamydial vaginitis
Solution. 15. B - Bacterial vaginosis (Clue cells shown in the picture; Amsel criteria used for diagnosis; Whiff test positive)
Your Answer. b
Correct Answer. b
(76).
A 45 year old woman noticed mass in her left breast with bloody discharge. Histopathologic picture of the lesion is given below. The
treatment is:
a. Modified radical mastectomy

b. Breast conservation therapy
c. Microdochotomy
d. Hadfield operation
Solution. 1. D - The picture shows dilated ducts with secretions and lipid laden histiocytes indicative of Duct ectasia
- Hadfields operation (excision of all major ducts) is the treatment of choice
- The disease is more common in smokers and cause slit like nipple retraction
Your Answer. c
Correct Answer. d
51/65
(77).
Which of the following is false about the condition shown in the picture below:
a. Thrombophlebitis of superficial veins of breast

b. Lymphatic infiltration of tumor cell
c. Cord like appearance of subcutaneous veins
d. NSAIDs and warm compresses can produce resolution
Solution. 2. B - The condition depicted is Mondors disease or String phlebitis
- Lateral thoracic, thoracoepigastric and superficial epigastric veins are commonly involved
Your Answer. a
Correct Answer. b
(78).
A child presents with a swelling as shown in the picture below. What is the probable diagnosis?
a. Dermoid cyst
b. Meningoencephalocele
c. Lipoma
d. Mucocele of maxillary and ethmoid sinus
Solution. 3. B - Meningoencephalocele is the herniation of meninges and brain which presents as a cystic swelling which is expansile,
translucent, compressible and brilliantly transilluminant
Your Answer. b
Correct Answer. b
52/65
(79).
The following appearance of esophagus in barium swallow is seen in which of the following conditions?
a. Diffuse esophageal spasm

b. Scleroderma
c. Achalasia cardia
d. Carcinoma esophagus
Solution. 4. A - The normal sequential paralysis is replaced by uncoordinated simultaneous contractions the produce curling in the wall,
pseudodiverticula and sacculations called the cork screw esophagus
Your Answer. a
Correct Answer. a
53/65
(80).
Which of the following is a true statement regarding the condition in a 40 year old male shown in the picture below:
a. It is inherited in autosomal recessive fashion

b. It is a risk factor for Renal cell carcinoma
c. It is usually caused by a single gene mutation on chromosome 16
d. It presents with abdominal pain
Solution. 5. C - Adult polycystic kidney disease is inherited in autosomal dominant fashion
- It occurs due to mutations in Polycystin 1 and 2 genes in chromosomes 16 and 4 respecively
Your Answer. c
Correct Answer. c
54/65
(81).
What is the most likely underlying diagnosis?
a. Acute Renal Failure

b. Acute cholecystitis
c. Immune thrombocytopenia
d. Acute pancreatitis
Solution. 6. D - The clinical signs shown are Cullen sign (periumbilical bluish hue) and Grey turners sign (discolouration of flanks), both
of which signify an intraperitoneal bleed as in acute pancreatitis
Your Answer. d
Correct Answer. d
(82).
A 46-year-old man presented with left lower quadrant pain, tenderness, and rebound tenderness on examination. He was afebrile and the
blood tests were normal. The abdominal CT is given below. What is the most probable diagnosis?
a. Appendicitis
b. Epiploic appendagitis
c. Diverticulitis
d. Typhilitis
Solution. 7. B - The abdominal CT showed a hypodense pericolonic oval mass of 25 cm with adjacent fat stranding: a classic picture of
epiploic appendagitis
- Epiploic appendages are roughly 50100 pedunculated adipose structures protruding from the serosal surface of the colon from the
caecum to the rectosigmoid junction.
- Torsion of the pedicle or central venous thrombosis could cause epiploic appendagitis, which can simulate diverticulitis, appendicitis,
and cholecystitis.
Your Answer. d
Correct Answer. b
55/65
(83).
What is the most likely diagnosis?
a. Ruptured bowel
b. Subdiaphragmatic abscess
c. Recent laproscopic surgery
d. Chilaiditi syndrome
Solution. 8. D - The radiograph shows a haustral pattern of subdiaphragmatic lucency, overlapping the upper border of the liver
shadow.
- The visualisation of a gas filled transverse colon lumen interpositioned between the right hemidiaphragm and the liver on a chest film is
called Chilaiditi's sign.
Your Answer. d
Correct Answer. d
56/65
(84).
The appearance shown in the radiograph is most probably due to:
a. Enterobacter cloace infection

b. Uterine fibroid disease
c. Crohns disease
d. 2-Naphthylamine exposure
Solution. . - The radiograph shown a thin layer of air within the bladder wall
- It is most probably due to emphysematous cystitis caused by gas producing organisms like Enterobacter cloacae
- It usually presents with non specific symptoms like lower abdominal pain, hematuria, pyuria etc
Your Answer. b
Correct Answer. a
(85).
What is the name of the characteristic appearance marked by an arrow in the picture below?
a. Golf hole ureter

b. Adder head deformity
c. Thimble bladder
d. Sandy patch
Solution. 10. B - The arrow points towards a ureterocele which is the cystic swelling of the terminal portion of ureter
- produces the characteristic cobra-head or adder-head deformity
Your Answer. d
Correct Answer. b
57/65
(86).
The picture shown below depicts a renal anomaly. Which of the following is not true of this condition:
a. Flower vase appearance in IVP

b. Ureteral obstruction common
c. Heminephrectomy improves function
d. Lower calyx is reversed
Solution. 11. C - Heminephrectomy does not improve renal fuction
Your Answer. a
Correct Answer. c
(87).
The given radiograph in a neonate is diagnostic of:
a. Ileal perforation
b. Necrotising enterocolitis
c. Meconium ileus
d. Colonic aganglionosis
Solution. 12. B - The radiograph shown is a classical depiction of Pneumatosis intestinalis (gas in the bowel wall) that occurs in
necrotising enterocolitis
- Modified Bells staging is used in grading the condition
Your Answer. d
Correct Answer. b
58/65
(88).
The characteristic endoscopic appearance of the stomach shown below is produced by:
a. Prolapse gastropathy
b. Gastric antral vascular ectasia
c. Gastric hemorrhagic telengiectasia
d. Dieulafoy lesions
Solution. 13. B - The picture shows the characteristic watermelon stomach seen in Gastric antral vascular ectasia (GAVE)
- Argon laser coagulation is used as treatment
Your Answer. d
Correct Answer. b
(89).
The primary in which of the following sites most commonly accounts for the condition of the liver shown in the figure
a. Head of pancreas
b. Stomach
c. Gall bladder
d. Periampullary
Solution. 14. C - Among the options, Gall bladder is the most common site of primary in multiple liver metastasis
Your Answer. c
Correct Answer. c
59/65
(90).
The most common cause for the appearance shown in the chest xray is:
a. Hepatocellular carcinoma
b. Renal cell carcinoma
c. Testicular tumor
d. Carcinoma stomach
Solution. 15. B - The chest radiograph depicts multiple rounded metastatic lesions in lung described as cannon ball lesions
- Renal cell carcinoma is the most common source of cannon ball metastasis followed by testicular cancer
Your Answer. b
Correct Answer. b
(91).
The radiograph shown below is indicative of:
a. Ileal atresia
b. Annular pancreas
c. Jejunal atresia
d. Duodenal atresia
Solution. 16. C - The radiograph shows the Triple bubble sign seen in jejuna atresia
- Double bubble sign is seen in duodenal atresia and annular pancreas while multiple bubbles appear in ileal atresia
Your Answer. c
Correct Answer. c
60/65
(92).
What is the name of the instrument?
a. Morris retractor
b. Doyens retractor
c. Carneys retractor
d. Deavers retractor
Solution. 17. A - The instrument shown is Morris retractor used for tissue retraction in appendectomy, thyroidectomy, mastectomy etc
Your Answer. c
Correct Answer. a
(93).
Identify the instrument
a. Listers sinus forceps

b. Kochers hemostatic forceps
c. Babcocks tissue forceps
d. Lanes tissue forceps
Solution. 18. C - Babcocks tissue forceps
Your Answer. c
Correct Answer. c
61/65
(94).
The instrument shown below is used in which of the following surgeries?
a. Parotidectomy
b. Thyroidectomy
c. Cystolithotomy
d. Cholecystectomy
Solution. 19. B - Kochers thyroid dissector: used during thyroid surgeries to dissect superior thyroid pedicle
Your Answer. a
Correct Answer. b
(95).
The painless ulcers shown here developed in a 55-year-old man with diabetes who did not recall any antecedent trauma. What type of
ulcer is this?
a. Venous
b. Arterial
c. Neurotrophic
d. Embolic
Solution. 20. D - The ulcer developed is probably a neurotrophic one since it is painless
- Ulcers of vascular origin are generally painful in nature
Your Answer. c
Correct Answer. d
62/65
(96).
A 34-year-old male smoker reports having rest pain and lower extremity digital ulcers for 2 months. He also reports a 1-year history of
claudication. Which one of the following is the best means of preventing amputation?
a. Smoking cessation
b. Calcium channel blockers
c. Peripheral artery bypass
d. Pentoxifylline
Solution. 21. A - The history and physical examination is consistent with Buergers disease (TAO)
- The cornerstone of TAO management is smoking cessation
Your Answer. c
Correct Answer. a
(97).
A 55-year-old man had the painless lesions shown here. Biopsy reveals carcinoma in situ. What is this condition?
a. Primary syphilis
b. Erythroplasia of Queyrat
c. Plasma cell balanitis of Zoon
d. Circinate balanitis of Reiters syndrome
Solution. - t22. B - Lesions are slightly raised, velvety, shiny, erythematous to violaceous plaques that are dry, may be scaling, and are
usually painless
- Lesions occur on the glans penis, prepuce, or urethral meatus
- Surgical removal of the involved areas with 5-mm margins virtually eliminates the risk of invasive squamous cell carcinoma- Topical
laser treatments and 5-fluorouracil have been used for extensive involvemen.
Your Answer. b
Correct Answer. b
63/65
(98).
A 40 year old male patient presented with mild abdominal pain, mild constipation with a feeling of incomplete evacuation and mucus in
stools for the past 4 years. On examination, tenderness present on left iliac fossa. Barium enema picture is given below. The most likely
diagnosis is:
a. Ulcerative colitis
b. Diverticular disease of colon
c. Irritable bowel syndrome
d. Carcinoma colon
Solution. 23. B - Diverticula is the most common cause of significant lower GI bleeding
- Most common site: Colon (Sigmoid colon)
- Investigation of choice for diverticulosis: Barium enema
- Best method of diagnosis and treatment: Colonoscopy
Your Answer. b
Correct Answer. b
(99).
A 65-year-old woman presents with fatigue, right flank pain, and ankle edema. Laboratory studies show increased liver enzyme values
and microscopic hematuria. The picture CT scan abdomen is given below. What is the diagnosis?
a. Choledocholithiasis
b. Nephrolithiasis
c. Hepatocellular carcinoma
d. Renal cell carcinoma
Solution. 24. D - Triad of clinical features of RCC are hematuria, abdominal pain and palapable mass
- Stauffer syndrome is abnormal LFT in the setting of RCC, which is not due to metastasis rather by cholestasis
Your Answer. d
Correct Answer. d
64/65
(100).
Identify the investigation used:
a. DMSA scan
b. DTPA scan
c. HIDA scan
d. MAG 3 scan
Solution. 25. C - HIDA (Hydroxy Imino DiAcetic acid) scan helps to track the production and flow of bile from the liver into small
intestine
Your Answer. d
Correct Answer. c
Test Answer
1.(b)
2.(c)
3.(c)
4.(d)
5.(d)
6.(c)
7.(a)
8.(d)
9.(d)
10.(d)
11.(b)
12.(b)
13.(b)
14.(d)
15.(a)
16.(a)
17.(c)
18.(d)
19.(c)
20.(b)
21.(b)
22.(b)
23.(d)
24.(a)
25.(d)
26.(a)
27.(a)
28.(b)
29.(b)
30.(d)
31.(b)
32.(c)
33.(d)
34.(d)
35.(b)
36.(d)
37.(b)
38.(b)
39.(c)
40.(b)
41.(d)
42.(d)
43.(a)
44.(d)
45.(b)
46.(b)
47.(a)
48.(c)
49.(a)
50.(d)
51.(b)
52.(d)
53.(d)
54.(c)
55.(d)
56.(d)
57.(b)
58.(a)
59.(b)
60.(c)
61.(a)
62.(c)
63.(c)
64.(c)
65.(a)
66.(c)
67.(a)
68.(d)
69.(a)
70.(b)
71.(c)
72.(b)
73.(b)
74.(c)
75.(b)
76.(d)
77.(b)
78.(b)
79.(a)
80.(c)
81.(d)
82.(b)
83.(d)
84.(a)
85.(b)
86.(c)
87.(b)
88.(b)
89.(c)
90.(b)
91.(c)
92.(a)
93.(c)
94.(b)
95.(d)
96.(a)
97.(b)
98.(b)
99.(d)
100.(c)
65/65

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Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Visual QBank Set-5

Test Question Language:- ENGLISH

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Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

a. Women are more often affected than men

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a. Diabetes mellitusAcute pancreatitis

a. Perinuclear-staining antineutrophil cytoplasmic antibody

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Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

a. Internal jugular vein

a. Maternal avoidance of tetracycline treatment for the sexually transmitted disease

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a. Increased frequency of central nervous system and renal involvement

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a. "Sausage appearance to fingers is characteristic

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a. ACTH stimulation test

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Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

a. Atrial septal defect

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a. Axillary or inguinal freckling

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a. It is associated with concurrent use of acetylsalicylic acid

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a. Antiphospholipid antibody syndrome

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a. Pleural fluid triglyceride level of more than 100 mg/dL

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a. Asboe Hansen sign

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Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

a. Adenocarcinoma of the gastrointestinal tract

a. High-dose oral corticosteroids

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a. Urinary 5-hydroxyindoleacetic acid (5-HIAA)

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Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

a. Systemic lupus erythematosus

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Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.