Combined Medical Services Exam Papers

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1. A 40-year old male is admitted with acute inferior wall myocardial infarction. Half
an hour later his B.P. is 80/50 mm Hg and heart rate is 40/minute with sinus rhythm. The most appropriate step in the management of this patient would be:
(a) Administration of normal saline 300 ml over 15 minutes
(b) Immediate insertion of temporary pacemaker
(c) Intravenous administration of atropine sulfate
(d) Intravenous administration of iso-prenaline 50ug/minute


2. The characteristic feature of tricuspid insufficiency in the jugular venous pulse is: (a) Prominent a wave
(b) Exaggerated x and y descents
(c) Cannon waves
(d) Obliteration of the x descent and prominent CV wave


3. Match List I with List II and select the correct answer using the code given below
the lists:
List I (Clinical Features) List II (Diagnosis)
A. Osler s node 1. Patent ductus arteriosus with reversal of shunt
B. Differential cyanosis 2. Aortic stenosis with aortic regurgitation
C. Bisferiens pulse 3. Pulmonary hypertension
D. Graham Steell murmur 4. Subacute bacterial endocarditis
Code:
A B C D
(a) 4 1 2 3
(b) 4 1 3 2
(c) 1 4 2 3
(d) 1 4 3 2

4. Acute aortic regurgitation occurs in:
(a) Infective endocarditis
(b) Ankylosing spondylitis
(c) Marfan’s syndrome
(d) Rheumatoid arthritis


5. The following are early complications of acute myocardial infarction except:
(a) Papillary muscle dysfunction
(b) Ventricular septal defect
c) Ventricular free wall rupture
(d) Dressler’s syndrome

6.
For which one of the following serum proteins, the levels of protein do not
decrease in nephrotic syndrome?
(a) Albumin
(b) Transferrin
(c) Fibrinogen
(d) Ceruloplasmin

7. Following are the causes of high anion-gap acidosis except:
(a) Renal tubular acidosis
(b) Acute renal failure
(c) Chronic renal failure
(d) Diabetic ketoacidosis

8. A patient of cirrhosis develops oliguria and worsening azotemia. Urinary sediment
is normal. Urinary sodium concentration is 5 mEq/L. The most likely cause could
be:
(a) Interstitial nephritis
(b) Acute tubular necrosis
(c) Acute glomerulonephritis
(d) Hepato-renal syndrome

9. Which one of the following infections is related to subacute sclerosing
panencephalitis (SSPE)?
(a) HIV
(b) Measles virus
(c) Japanese B encephalitis virus
(d) JC virus

10. Consider the following:
1. Failure to swing the arms while walking
2. Nystagmus
3. Cogwheel rigidity
4. Festinant gait

Typical features of Parkinsonism include which of the above?
(a) 2, 3 and 4
(b) 1, 2 and 4
(c) 1 and 3 only
(d) 1, 3 and 4

11. Consider the following sites of lesion:
1. Left optic tract
2. Left optic radiation
3. Optic chiasma
4. Left lateral geniculate body
Right homonymous hemianopia will result from lesions at which of the above?
(a) 1 and 3 only
(b) 1, 2 and 4
(c) 2, 3 and 4
(d) 1, 2 and 3

12. Raised alkaline phosphatase is seen in the following except:
(a) Hyperparathyroidism
(b) Obstructive jaundice
(c) Osteomalacia
(d) Multiple myeloma

13. Consider the following statements about acromegaly:
1. Fibroma molluscum and acanthosis nigricans are common findings.
2 Growth hormone secretion is increased by TRH in 50 to 80% of
acromegalics.
3 Acroosteolysis is a common radiological finding

4. Diabetes mellitus may be associated in nearly 25% of acromegalics
Which of the statements given above are correct?
(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4
(d) 2, 3 and 4

14. Causes of hypomagnesemia include all of the following except:
(a) Betablocker
(b) Chronic pancreatic insufficiency
(c) Poorly controlled diabetes mellitus
(d) Alcoholism

15. Which of the following conditions are associated with secondary diabetes
mellitus?
1. Thyrotoxicosis, pheochromocytoma and acromegaly
2. Haemochromatosis
3. Pancreatic carcinoma
Select the correct answer using the code given below:
(a) 2 and 3 only
(b) 1, 2 and 3
(c) 1 and 3 only
(d) 1 and 2 only

16. Consider the following statements:
1. Boils/suppurative lesions around the nose must be promptly treated with
antibiotics.
2. Suppurative lesions around the nose lead to cavernous sinus thrombosis.
Which of the statements given above is/are correct?
(a) 1 only
(b) 2 only
(c) Both 1 and 2
(d) Neither 1 nor 2

17. Which one of the following is not the ECG change of hyperkalemia?
(a) Tall T-wave
(b) Tall P-wave
(c) Prolonged PR interval
(d) QRS- widening

18. Which one of the following tests has the highest chance of detecting HIV infection
in a blood donor during the window period?
(a) Demonstration of antibody to HIV by ELISA
(b) CD4 count
(c) p24 antigen detection
(d) Western blot test

19. Which of the following features are characteristic of tuberculoid leprosy?
1 Type 2 lepra reaction
2. A few lesions with well demarcated edges
3. Early and marked nerve damage
4. Tendency to heal spontaneously
Select the correct answer using the code given below:
(a) 1, 2 and 3
(b) 2, 3 and 4
(c) 1 and 4
(d) 2 and 3 only

20. Which one of the following immunological reactions occurs in Goodpasture s
syndrome?
(a) Type I Atopy
(b) Type II cytotoxicity
(c) Type III immune complex
(d) Type IV cell mediation



Combined Medical Service Exam Question Paper